scholarly journals Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation

2019 ◽  
Vol 8 (8) ◽  
pp. 1119 ◽  
Author(s):  
Gianluca Testa ◽  
Andrea Vescio ◽  
Domenico Costantino Aloj ◽  
Giacomo Papotto ◽  
Luigi Ferrarotto ◽  
...  
Keyword(s):  
External Fixation ◽  
Intramedullary Nailing ◽  
Gold Standard ◽  
Femoral Shaft ◽  
Bone Union ◽  
Definitive Treatment ◽  
Ao Classification ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

Background: Femoral shaft fractures result from high-energy trauma. Despite intramedullary nailing (IMN) representing the gold standard option of treatment, external fixation (EF) can be used temporarily for damage control or definitively. The purpose of this study is to compare two different options, anterograde IMN and monoaxial EF, for the treatment of femoral shaft fractures. Methods: Between January 2005 and December 2014, patients with femoral shaft fractures operated on in two centers were retrospectively evaluated and divided into two groups: the IMN group (n = 74), and the EF group (n = 73). For each group, sex; laterality; age; and AO classification type mean follow-up, mean union time, and complications were reported. Results: Both groups were found to have no statistical differences (p > 0.05) in sex, laterality, age, and AO classification types. In the IMN group the average surgery duration was 79.7 minutes (range 45–130). The average time for bone union was 26.9 weeks. Major complications occurred in 4 (5.4%) patients. In the EF group the average follow-up duration was 59.8 months (range 28–160). The average time for bone union was 24.0 weeks. Major complications occurred in 16 (21.9%) patients. Conclusions: IMN is the gold standard for definitive treatment of femoral shaft fractures. In patients with severe associated injuries, EF should be a good alternative.

A Comparative Study between Intramedullary Fixation and External Fixation of Femur Shaft Fracture in Polytrauma Patients in Jharkhand

2021 ◽  
Vol 8 (32) ◽  
pp. 2933-2937
Author(s):  
Supantha Panja
Keyword(s):  
Comparative Study ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
Complication Rate ◽  
Gold Standard ◽  
Femoral Shaft ◽  
High Energy ◽  
Definitive Treatment ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures

BACKGROUND Femoral shaft fractures result from high energy trauma and maybe associated with life threatening conditions. Typical in younger people is associated with polytrauma. Though intramedullary nailing (IMN) is the gold standard option of treatment, external fixation (EF) can also be used temporarily or definitively, in such cases. The aim of this study was to compare the functional outcome of these two procedures. METHODS This prospective comparative study was conducted at our centre over a period of 6 years. Age, sex of the patients, laterality, type of fracture with mean follow up, union time, and complications such as delayed union, angular deformities, and limb length discrepancies were tabulated and compared. RESULTS There were more cases of open fractures in the EF group compared to IMN group. In the IMN group the average surgery duration was 95.76 minutes and it was 69.4 minutes in the EF group. The average time for bone union was 25.66 weeks in IMF group and 28.22 weeks in EF group. Complication rate was higher in EF group with 11 complications (7 major & 4 minor) compared to IMN group with only 6 cases presenting with complications (3 each of major & minor). CONCLUSIONS Though IMN is the gold standard in treatment of femoral shaft fractures, EF in polytrauma is an alternative method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate. KEYWORDS Femoral Shaft Fractures, Intramedullary Nailing, External Fixation, Polytrauma, Definitive Treatment

scholarly journals Treatment of femoral shaft fractures with monoaxial external fixation in polytrauma patients

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1333 ◽  
Author(s):  
Gianluca Testa ◽  
Domenico Aloj ◽  
Alessandro Ghirri ◽  
Eraclite Petruccelli ◽  
Vito Pavone ◽  
...  
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Weight Bearing ◽  
Femoral Shaft ◽  
Definitive Treatment ◽  
Operative Trauma ◽  
Femoral Shaft Fractures ◽  
Fracture Stabilization ◽  
Shaft Fractures

Background: Femoral shaft fractures, typical in younger people, are often associated with polytrauma followed by traumatic shock. In these situations, despite intramedullary nailing being the treatment of choice, external fixation could be used as the definitive treatment. The aim of this study is to report evidence regarding definitive treatment of femoral shaft fractures with monoaxial external fixation. Methods: Between January 2006 and December 2015, 83 patients with 87 fractures were treated at the Department of Orthopaedics and Traumatology CTO of Turin, with a monoaxial external fixation device. Mean age at surgery, type of fracture, mean follow-up, time and modalities of treatment, non-weight bearing period, average healing, external fixation removal time, and complications were reported. Results: The average patient age was 31.43±15.19 years. In 37 cases (42.53%) the right femur was involved. 73 (83.91%) fractures were closed, and 14 (16.09%) were open. The average follow-up time was 61.07±21.86 weeks.  In 68 (78.16%) fractures the fixation was carried out in the first 24 hours, using a monoaxial external fixator. In the remaining 19 cases, the average delay was 6.80±4.54 days. Mean non-weight bearing time was 25.82±27.66 days (ranging from 0 to 120). The 87 fractures united at an average of 23.60±11.37 weeks (ranging from 13 to 102). The external fixator was removed after an average of 33.99±14.33 weeks (ranging from 20 to 120). Reported complications included 9.19% of delayed union, 1.15% of septic non-union, 5.75% of malunion, and 8.05% cases of loss of reduction. Conclusions: External fixation of femoral shaft fractures in polytrauma is an ideal method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate.

scholarly journals Lateral vs. Supine Positioning for Femoral Intramedullary Nailing: A Systematic Review of Comparative Studies

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Mohamed Sarraj ◽  
Daniel E Axelrod ◽  
Sarah Zhu ◽  
Herman Johal
Keyword(s):  
Systematic Review ◽  
Intramedullary Nailing ◽  
Full Text ◽  
Comparative Studies ◽  
Femoral Shaft ◽  
Definitive Treatment ◽  
Femoral Shaft Fractures ◽  
Shaft Fractures ◽  
Lateral Positioning ◽  
Full Text Screening

Femoral shaft fractures are devastating injuries that usually result from high-energy mechanisms in victims of poly-trauma. Reamed and statically locked intramedullary nailing (IMN) is the definitive treatment modality for femoral shaft fractures. Patients are most commonly positioned either supine or lateral decubitus. There remains considerable concern regarding the safety of lateral positioning in the traumatized patient, particularly in the management of a potentially difficult airway or concomitant C-spine injuries. We therefore undertook a systematic review of intraoperative positioning among patients with femoral shaft fractures following PRISMA guidelines. Title and abstract screening, full text screening, and data abstraction were all completed in duplicate. Methodological Index for Nonrandomized Studies (MINORS) scores were used to evaluate methodological quality. Results: 3018 studies were included in initial screening, with three studies ultimately meeting all inclusion criteria. A total of 1,949 patients were analyzed, with 684 patients treated in lateral positioning and 1,215 patients in supine positioning. Level of agreement was strong across title (κ = 0.872; 95% CI 0.794 to 0.951), abstract (κ = 0.801; 95% CI 0.585 to 1.000), and full-text screening (κ = 1.000). The consensus mean MINORS score of included studies was 17.67 ± 0.58, indicating good to high quality of evidence. Neither patient positioning offered obvious benefits such as fewer complications or shorter operative time.  Furthermore, length of admission, days in ICU or on ventilator, and overall morbidity were not found to be significantly different between positions. Lateral positioning for intramedullary nailing of mid-shaft femur fractures appears to be a safe alternative to the standard supine positioning. There is a lack of both prospective and retrospective comparative studies investigating functional clinical outcomes in the literature.

scholarly journals Clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments: a retrospective analysis of risk factors for delayed union

2019 ◽  
Vol 4 (1) ◽  
pp. e000203
Author(s):  
Kosuke Hamahashi ◽  
Yoshiyasu Uchiyama ◽  
Yuka Kobayashi ◽  
Goro Ebihara ◽  
Taku Ukai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intramedullary Nailing ◽  
Intramedullary Nail ◽  
Open Fracture ◽  
Femoral Shaft ◽  
Delayed Union ◽  
Ao Classification ◽  
Femoral Shaft Fractures ◽  
The Third ◽  
Shaft Fractures

BackgroundThis study retrospectively evaluated the clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments and analyzed the risk factors for delayed union.MethodsRetrospective analyses involving 51 patients who underwent intramedullary nailing of femoral shaft fractures with third fragments (AO classification type B, 35 cases; type C, 16 cases) were conducted. Delayed union was defined as either more than 10 months required for callus formation in more than three of the four cortical bone surfaces observed in the frontal and lateral radiographic views or the requirement for additional surgery such as nail conversion or bone transplantation. Seventeen patients developed delayed union (D group). Thirty-four patients achieved bony union within 9 months (U group). The following background variables were compared between groups: age at the time of the injury; AO classification; ratio of open fracture; waiting period before surgery; rate of the infraisthmal fracture; diameter of the intramedullary nail; ratio of the intramedullary nail to the femur; length and displacement of the third fragment; and use of open reduction, poller screws, or dynamization.ResultsSignificant differences were found between the D and U groups for age (32.2±14.1 vs. 25.3±9.6 years), open fracture ratio (35.3% vs. 11.8%), and displacement of the third fragment (13.7±6.4 vs. 9±6.3 mm). Multiple logistic regression analysis only identified displacement of the third fragment as a risk factor for delayed union (p=0.03; OR 1.13; 95% CI 1.01 to 1.26).DiscussionDelayed union was observed in 17 cases (33.3%) after intramedullary nailing of femoral shaft fractures with third fragments. Displacement of the third fragment influenced delayed union.Level of evidenceLevel III.

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