Antegrade nailing in femoral shaft fracture patients - comparison of outcomes of isolated fractures, multiple fractures and severely injured patients

Yoon, Yong-Cheol; Song, Hyung Keun; Han, Jong Seong; Lee, Kyung Cheon

doi:10.1016/j.injury.2021.01.044

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…The incidence of femoral shaft fractures is 2.1–18.4/100 000 19 ; most cases are caused by high-energy injuries and often accompanied by fractures in other parts, such as the proximal femur 20 . If treatment is delayed or inappropriate, limb deformities and dysfunction can occur, seriously affecting patients’ postoperative recovery and endangering their physical and mental health.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Li,

Wang,

Zhou

et al. 2024

Sci Rep

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Closed femoral shaft fracture is caused by high-energy injuries, and non-union exists after operation, which can significantly damage patients’ body and mind. This study aimed to explore the factors influencing postoperative non-union of closed femoral shaft fractures and establish a predictive nomogram. Patients with closed femoral shaft fractures treated at Hebei Medical University Third Hospital between January 2015 and December 2021 were retrospectively enrolled. A total of 729 patients met the inclusion criteria; of them, those treated in 2015–2019 comprised the training cohort (n = 617), while those treated in 2020–2021 comprised the external validation cohort (n = 112). According to multivariate logistic regression analysis, complex fractures, bone defects, smoking, and postoperative infection were independent risk factors. Based on the factors, a predictive nomogram was constructed and validated. The C-indices in training and external validation cohorts were 0.818 and 0.781, respectively; and the C-index of internal validation via bootstrap resampling was 0.804. The Hosmer–Lemeshow test showed good fit of the nomogram (P > 0.05) consistent with the calibration plot results. The clinical effectiveness was best at a threshold probability of 0.10–0.40 in decision curve analysis. The risk prediction for patients with fractures using this nomogram may aid targeted prevention and rehabilitation programs.

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Section: Discussionmentioning

confidence: 99%

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Li,

Wang,

Zhou

et al. 2024

Sci Rep

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“…In terms of the fracture healing rate, most scholars believe that the degree of third fracture fragment displacement has a greater impact on femoral shaft fracture healing than third fracture fragment size [1,7,24]. This is due to the fact that when third fracture fragments are displaced for a large distance, they tend to be accompanied by periosteal stripping at the fracture end, blood supply disruption, potential soft tissue injury or even combined with open wounds, while open fractures and greater fracture severity lead to a higher risk of nonunion [25]. In addition, the greater the distance between the third fracture fragment and the main axis of the femoral shaft, the lower the concentration of bone morphogenetic protein-2 (BMP-2), which is also one of the causes of nonunion [26].…”

Section: Discussionmentioning

confidence: 99%

Analysis of the influence of circumference and displacement of the third fracture fragment on the healing of femoral shaft fractures treated with intramedullary nailing

Yin,

Yang,

et al. 2024

Preprint

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To investigate the effect of circumference and displacement of the third fracture fragments on fracture healing after intramedullary nailing of femoral shaft fractures with third fracture fragment. A retrospective cohort study was conducted to analyze the data of 142 patients suffered femoral shaft fractures with the third fracture fragments admitted to the First People's Hospital of Lianyungang from February 2016 to December 2021, among whom there were 88 males and 54 females, with an average age of 42.2 years; 81 cases with right side and 61 cases on the left side; 78 cases of isthmic fractures and 64 cases of non-isthmic fractures. The time from injury to operation was (4.3 ± 3.3) days. According to the circumference of the third fracture fragments, the fracture fragments were divided into 3 types: type 1: the circumference of the third fracture fragments was less than 1/3 of the diaphyseal circumference at the fracture site in 71 cases; type 2: the circumference of the third fracture fragments was greater than 1/3 of the diaphyseal circumference at the fracture site and less than 2/3 of the diaphyseal circumference in 52 cases; type 3: the circumference of the third fracture fragments was greater than 2/3 of the diaphyseal circumference at the fracture site in 19 cases. Based on the diaphyseal diameter, the degree of displacement of the third fracture fragment was classified into three degrees: degree I: third fracture fragment displacement was less than 1/3 of the diaphyseal diameter at the fracture site in 95 cases; degree II: third fracture fragment displacement was greater than 1/3 of the diaphyseal diameter at the fracture site while less than 2/3 of the diaphyseal diameter at the fracture site in 31 cases; degree III: third fracture fragment displacement was greater than 2/3 of the diaphyseal diameter at the fracture site in 16 cases. All patients underwent closed reduction and intramedullary nailing of femoral fractures, and no intervention was performed for displaced third fragments during surgery. Postoperative follow-up was performed to compare the fracture healing rate, healing time, and the modified Radiographic Union Scale for Tibia (mRUST) at 9th month after surgery in each group. All 142 patients were followed up after operation, with an average of (14.7 ± 4.1) months, and the overall healing rate was 73.4%. When the third fracture fragment was displaced in degree I, the healing rates were 98.1%, 90.3%, and 90.0% (P = 0.375), the healing times were (8.7 ± 0.8) months, (9.0 ± 0.7) months, and (9.4 ± 0.9) months (P = 0.054), and the mRUST at 9th month were (13.1 ± 1.5), (12.9 ± 1.9), and (12.5 ± 1.5) (P = 0.552) among the three subgroups of circumference classification, respectively, without statistical significance. When the third fracture fragments were displaced in degree II and III, the healing rates were 52.9%, 23.8%, and 11.1% (P = 0.053) and the healing time was (8.9 ± 1.1) months, (10.8 ± 2.5) months, and (12.0 ± 0.0) months (P = 0.097) among the three subgroups of circumference classification, respectively, without statistical significance; the mRUST score at 9th month in the type 1 group (11.6 ± 2.9) was higher than that in the type 2 group (9.3 ± 2.1) and the type 3 group (8.8 ± 1.6) (P = 0.017). Logistic regression analysis showed that greater displacement of third fracture fragments and greater circumference were associated with lower fracture healing rates (P < 0.05). In the treatment of femoral shaft fractures with intramedullary nails, when the fracture fragment is displaced to degree I, the circumference size has little effect on fracture healing, and no intervention is required during surgery. When the third fracture fragment is displaced to degree II and III and the circumference of which is type 1, no intervention of the third fracture fragment can also obtain a higher mRUST score; whereas, provided that the circumference of which is type 2 or type 3, it significantly affects the fracture healing. Intraoperative intervention to reduce the distance of displacement of the fragment is required to reduce the incidence of nonunion. The displacement of third fracture fragments has a greater impact on fracture healing than its circumference.

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“…The most important finding of the present study was that IC significantly increased the nonunion rate in simple femoral shaft fractures at 12 and 24 months after surgery. Studies have demonstrated that a greater fracture severity was associated with a higher nonunion rate [ 19 , 20 ]. Noumi et al conducted a retrospective analysis involving 89 femoral shaft open fractures treated with IMN [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

The characteristics and influence of iatrogenic fracture comminution following antegrade interlocking nailing for simple femoral shaft fractures, a retrospective cohort study

Wang

Chuang

et al. 2022

BMC Musculoskelet Disord

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Aim The incidence and characteristics of iatrogenic comminution (IC) are unknown, and the influence of IC on fracture union is unclear. This study was aimed to investigate the (1) incidence and characteristics of IC and (2) the outcomes of IC following antegrade interlocking nailing of simple femoral shaft fractures. Methods We retrospectively collected data on patients who experienced simple femoral shaft fractures and underwent antegrade interlocking nailing between February 2009 and December 2016. The incidence and characteristics of IC were examined. According to the presence of IC, patients were divided into two groups: an IC group and a non-IC (NIC) group. Demographic information and nonunion rates were compared between the two groups. Potential risk factors for IC (age, gender, body mass index (BMI), nail fit ratio, reduction technique, and greater trochanter nail entry) were analyzed using univariate and multivariate logistic regression. The aforementioned variables, along with IC occurrence, were also assessed as potential risk factors for nonunion at 12 and 24 months after operation using multivariate logistic regression. Results Of the 211 total patients, IC occurred in 20.9% (n = 44) of patients. Most ICs were found at the level of the isthmus, and involved the medial cortex. Compared with the NIC group, higher nonunion rates were observed in the IC group at 12 months (31.8% vs. 12.5%, p = 0.002) and 24 months (18% vs. 6.5%, p = 0.017) after surgery. Age older than 35 years old was related with the occurrence of IC in univariate analysis. Multivariate analysis found no risk factor associated with IC. Open reduction technique, IC occurrence and higher BMI were identified as the risk factors of nonunion at 12 months and 24 months after surgery in multivariate analysis. Conclusion IC is a non-rare complication in antegrade interlocking nailing of simple femoral shaft fractures and was associated with higher nonunion rate. Age older than 35 years old showed a trend toward increasing risk of iatrogenic fracture comminution. In multivariate analysis, open reduction technique, IC occurrence and higher BMI significantly correlated with fracture nonunion. Level of evidence Level IV.

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Antegrade nailing in femoral shaft fracture patients - comparison of outcomes of isolated fractures, multiple fractures and severely injured patients

Cited by 8 publications

References 29 publications

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Development and validation of predictive nomogram for postoperative non-union of closed femoral shaft fracture

Analysis of the influence of circumference and displacement of the third fracture fragment on the healing of femoral shaft fractures treated with intramedullary nailing

The characteristics and influence of iatrogenic fracture comminution following antegrade interlocking nailing for simple femoral shaft fractures, a retrospective cohort study

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