Tertiary Care Orthopedic Hospital Experience to Find Effect of Dynamisation in Delayed Union Tibia Shaft Fracture

Objective: Our study was designed to evaluate the effect of dynamisation in delayed union tibia shaft fractures. Methodology: This prospective study was conducted at the Orthopedic Department, Shaheed Mohtarma Benazir Bhutto Medical College, from March 2020 to March 2021. During this timeframe total of 20 patients who underwent dynamisation for reamed intramedullary nailing were recruited. After two successive visits, those patients whose fracture failed to show progressive signs of callus formation underwent dynamisation. We removed the single static screw from the longer fracture segment to perform the dynamisation procedure. We inserted a poller screw slightly medial to the nail from anterior to posterior to provide additional stability to the proximal fragment. Statistical analysis was performed by using SPSS 23.0. For evaluating the success of dynamisation Chi-square test was used. Results: The mean age of recruited patients was reported as 35.92 years ranging from 16 years to 63 years old. Out of these twenty cases, 17 were male (85%). The mean time duration of nailing was reported as 35.4 hours. Total fourteen patients were immediately treated with nailing within 20 hours of injury, while the rest six underwent delayed nailing. Total four cases of tibial fracture were turned out as failure because the patient failed to achieve union after dynamisation and underwent augmentation plating with bone grafting for the complete union. Conclusion: Delayed dynamisation is a convenient and cost-effective technique to achieve union in femoral shaft fractures. Overall, our study reported an 80% success rate but failed to achieve early dynamisation in comminuted fractures.

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An Occult Ipsilateral Femoral Neck Fracture Associated With Mid-Shaft Femur Fracture

Journal of Research in Orthopedic Science ◽

10.32598/jrosj.7.4.703.1 ◽

2020 ◽

Vol 7 (4) ◽

pp. 185-188

Author(s):

Shahin Talebi ◽

◽

Shayan Amjadi ◽

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Intraoperative Imaging ◽

Femoral Shaft ◽

Shaft Fracture ◽

Delayed Union ◽

Adverse Outcomes ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Neck Fracture

Occult ipsilateral femoral neck fractures associated with femoral shaft fractures are frequently missed. They may lead to adverse outcomes, such as fracture displacement and delayed treatment followed by poor outcomes, including delayed union, malunion, nonunion, and osteonecrosis, which may lead to early arthroplasty. These adverse effects can be prevented by the awareness of this combined injury pattern, the adequate preoperative and intraoperative imaging of the femoral neck, and proper treatment. A 27-year-old man was admitted with a displaced fracture of the right femur. Fluoroscopic evaluation was performed after the intramedullary nailing of the shaft fracture. The evaluation revealed an ipsilateral displaced femoral neck fracture, which was fixed with two cannulated screw inserted anterior to the nail. Between 2% and 9% of all femoral shaft fractures are associated with ipsilateral femoral shaft fractures. This case report necessitates the increase of awareness for the presence of associated femoral shaft and neck fractures in patients undergoing antegrade femoral nailing. Also, we recommend appropriate preoperative, intraoperative, and postoperative imaging.

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A STUDY ON FRACTURE OF FEMUR SHAFT TREATMENT WITH INTRAMEDULLARY INTERLOCKING NAILING

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i12.2333 ◽

2021 ◽

Vol 5 (12) ◽

Author(s):

Ashok Meena ◽

D S Meena ◽

Narendra Saini ◽

Poonam Meena

Keyword(s):

Traffic Accidents ◽

Femoral Shaft Fracture ◽

Road Traffic ◽

Femoral Shaft ◽

Shaft Fracture ◽

Delayed Union ◽

Interlocking Nailing ◽

Shaft Fractures ◽

Femur Diaphysis ◽

Femur Shaft

Background: Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. Closed reduction and intramedullary interlocking nailing is the surgical treatment of choice for the closed shaft fractures of femur. Present study conducted to study the principles of intramedullary interlocking nailing and to assess the outcome of the patient. Methods: The present study comprises of 30 cases of fracture shaft of the femur in adults about >20 years old. All the fractures, which were included in the study were traumatic in origin, most of them are due to road traffic accidents. Results: The delayed union rate in our series was 6.67%. There were no non-unions. Conclusions: It is concluded that closed intramedullary interlocking nailing method given good result in treatment of shaft fractures of femur. Keywords: Intramedullary nailing, Femur, Diaphysis fractures, Interlocking

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Short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary sign nail at Muhimbili Orthopaedic Institute in Tanzania

Tanzania Journal of Health Research ◽

10.4314/thrb.v17i3.8 ◽

2015 ◽

Vol 17 (3) ◽

Author(s):

Billy T. Haonga ◽

Felix S. Mrita ◽

Edmundo E. Ndalama ◽

Jackline E. Makupa

Keyword(s):

Femoral Shaft Fracture ◽

Callus Formation ◽

Femoral Shaft ◽

Shaft Fracture ◽

Limb Length ◽

Short Term ◽

Term Outcome ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Image Intensifiers

Background: Comminuted femoral shaft fractures are complex to treat because of increased risk of limb length discrepancies and mal-rotation deformities. Currently the interlocking intramedullary nail using image intensifiers is a suggested treatment for comminuted femoral shaft fractures. This study aimed to evaluate the short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary SIGN nail without image intensifiers at Muhimbili Orthopaedic Institute (MOI) in Tanzania.Methods: A prospective hospital base study was conducted on patients with closed comminuted femoral shaft fractures admitted at MOI from March 2011 to February 2012. A total of 91 adult patients (18 to 84 years) were enrolled in the study. Of the total patients, 80 (88%) patients were male, 11 were lost to follow-up, and 80 patients completed follow-ups of 18 weeks post operatively. Structured questionnaires and checklist forms were used to collect information. Operations were carried out either by antegrade or retrograde SIGN nail. Post operatively control radiographs, the lower limb length and mal-rotation deformities were assessed.Results: Comminuted femoral shaft fracture accounted for 20.3% of all adult femoral shaft fractures admitted at MOI. Deep wound infection occurred in 2.5%. Shortening of 2-3cm was seen in 3.8% of the patients. No patient had shortening of more than 3cm. External rotation deformity of more than 20 degrees occurred in 6.3% of the cases. Internal rotation deformity of more than 15 degrees was seen in 7.9%. Knee flexion of less than 90 degree was encountered in 7.5% of patients. By 18th week 95% of the patients had callus formation. Conclusion: SIGN nail appears to be an effective treatment for comminuted femoral shaft fractures in settings where image intensifiers and fracture tables are not readily available. They have excellent to good outcomes in rate of callus formation, limb length and limb alignment outcomes.

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Transcutaneous CO2 application accelerates fracture repair in streptozotocin-induced type I diabetic rats

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-001129 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001129

Author(s):

Takahiro Oda ◽

Takahiro Niikura ◽

Tomoaki Fukui ◽

Keisuke Oe ◽

Yu Kuroiwa ◽

...

Keyword(s):

Endochondral Ossification ◽

Callus Formation ◽

Femoral Shaft ◽

Shaft Fracture ◽

Diabetic Rats ◽

Fracture Repair ◽

Female Rats ◽

Control Group ◽

Type I ◽

Biomechanical Assessment

IntroductionDiabetes mellitus (DM) negatively affects fracture repair by inhibiting endochondral ossification, chondrogenesis, callus formation, and angiogenesis. We previously reported that transcutaneous CO2 application accelerates fracture repair by promoting endochondral ossification and angiogenesis. The present study aimed to determine whether CO2 treatment would promote fracture repair in cases with type I DM.Research design and methodsA closed femoral shaft fracture was induced in female rats with streptozotocin-induced type I DM. CO2 treatment was performed five times a week for the CO2 group. Sham treatment, where CO2 was replaced with air, was performed for the control group. Radiographic, histologic, genetic, and biomechanical measurements were taken at several time points.ResultsRadiographic assessment demonstrated that fracture repair was induced in the CO2 group. Histologically, accelerated endochondral ossification and capillary formation were observed in the CO2 group. Immunohistochemical assessment indicated that early postfracture proliferation of chondrocytes in callus was enhanced in the CO2 group. Genetic assessment results suggested that cartilage and bone formation, angiogenesis, and vasodilation were upregulated in the CO2 group. Biomechanical assessment revealed enhanced mechanical strength in the CO2 group.ConclusionsOur findings suggest that CO2 treatment accelerates fracture repair in type I DM rats. CO2 treatment could be an effective strategy for delayed fracture repair due to DM.

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BONE HEALING PATTERNS OF INTERLOCKED INTRAMEDULLARY NAIL-FIXATED FEMORAL SHAFT FRACTURES: AGE-MATCHED RADIOGRAPHIC PRESENTATION OF UNION PATTERN

Journal of Musculoskeletal Research ◽

10.1142/s0218957717500105 ◽

2017 ◽

Vol 20 (02) ◽

pp. 1750010

Author(s):

Myung-Sang Moon ◽

Dong-Hyeon Kim ◽

Bong-Keun Park ◽

Min-Geun Yoon

Keyword(s):

Callus Formation ◽

Femoral Shaft ◽

Fracture Union ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Complete Fracture ◽

Sixth Decade ◽

Radiographic Presentation ◽

Periosteal Callus ◽

Eighth Decade

Design: Study on the union pattern of femoral shaft fractures after interlocked intramedullary fixation. Objective: To assess the fracture healing pattern — the so-called callus types — and its formation speed, and age influence. Setting: Orthopedic and traumatic services. Material and methods: Among all the healed femoral shaft fractures, 10 patients at least in each decade from late teens to eighth decade who were regularly followed radiographically with a certain interval upto complete fracture union were chosen. Results: All the fractures healed primarily with external periosteal callus which was followed sometimes later by intercortical uniting callus with disappearance of fracture line. Conclusion: All the nailed femoral shaft fractures healed primarily by periosteal bridging callus irrespective of age, fracture type, and use of interlocking screws, though some less external callus formation after sixth decade was observed.

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Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating

Journal of Nepal Medical Association ◽

10.31729/jnma.490 ◽

2004 ◽

Vol 43 (155) ◽

Author(s):

Bikram Prasad Shrestha ◽

P Kumar ◽

GK Singh

Keyword(s):

Dynamic Compression ◽

Femoral Shaft ◽

Delayed Union ◽

Permanent Disability ◽

Femoral Shaft Fractures ◽

Advantages And Disadvantages ◽

Interlocking Nailing ◽

Shaft Fractures ◽

Segmental Fracture ◽

Bridge Plating

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value<0.05. Mean hospital stay in nailing group was 12.8±2.75 day and plating group 21.1±2.73 days, p>0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection.Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.

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Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study

10.32920/ryerson.14668737.v1 ◽

2021 ◽

Author(s):

Saeid Samiezadeh ◽

Pouria Tavakkoli Avval ◽

Zouheir Fawaz ◽

Habiba Bougherara

Keyword(s):

Mechanical Performance ◽

Bone Fractures ◽

Stress Shielding ◽

Femoral Shaft ◽

Delayed Union ◽

Fracture Site ◽

Long Bone ◽

Fe Model ◽

Non Union ◽

Shaft Fractures

Background: Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the above mentioned complications. Methods: In this study, a new hybrid concept for nails made of carbon fibers/ fl ax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages. Results: Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23 N ( P b 0.05), and the mean stress in the vicinity of fracture by 2.11 MPa ( P b 0.05) at 45% gait cycle, while only 0.33 mm and 0.39 mm ( P b 0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur. Interpretation: Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants.

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Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study

10.32920/ryerson.14668737 ◽

2021 ◽

Author(s):

Saeid Samiezadeh ◽

Pouria Tavakkoli Avval ◽

Zouheir Fawaz ◽

Habiba Bougherara

Keyword(s):

Mechanical Performance ◽

Bone Fractures ◽

Stress Shielding ◽

Femoral Shaft ◽

Delayed Union ◽

Fracture Site ◽

Long Bone ◽

Fe Model ◽

Non Union ◽

Shaft Fractures

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Role of Open Cerclage Wires Used in Patients with Comminuted Fractures of Femoral Shaft Treated with Intramedullary Nails

10.21203/rs.3.rs-49503/v1 ◽

2020 ◽

Author(s):

Tzu-Hao Wang ◽

Hao-Chun Chuang ◽

Fa-Chuan Kuan ◽

Chih-Kai Hong ◽

Ming-Long Yeh ◽

...

Keyword(s):

Femoral Shaft Fracture ◽

Femoral Shaft ◽

Shaft Fracture ◽

Fracture Treatment ◽

Union Rate ◽

Intramedullary Nails ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Significant Difference ◽

Cerclage Wiring

Abstract IntroductionThe role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesize that open cerclage wiring is applicable to patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and MethodsThis retrospective cohort study used data of consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into wire and no wire groups according to the surgical technique used and their union rate was recorded. The patients were then divided into union and nonunion groups and their perioperative data were analyzed.ResultsIn total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini–open wound without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures united smoothly, and no significant difference was observed in any perioperative data between union and nonunion groups.DiscussionAugmented open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or far displaced. Thus, open cerclage wiring can be used for fracture treatment, without decreasing the union rate.

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Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing

SICOT-J ◽

10.1051/sicotj/2020031 ◽

2020 ◽

Vol 6 ◽

pp. 34

Author(s):

Alexandru Ulici ◽

Elena Odagiu ◽

Oana Haram ◽

Adelina Ionescu ◽

Gabriel Alin Sterian ◽

...

Keyword(s):

Postoperative Complications ◽

Intramedullary Nailing ◽

Femoral Shaft ◽

Delayed Union ◽

Elastic Stable Intramedullary Nailing ◽

Mechanism Of Injury ◽

Femoral Shaft Fractures ◽

Shaft Fractures ◽

Fractures In Children ◽

Elastic Intramedullary Nailing

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

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