Case Series of Femoral Shaft Fractures Innovatively Managed by Using Reamed Material as Internal Bone Graft for Early Fracture Union

Abstract

BACKGROUNDFemur fracture treatment has constantly evolved over time from various conservative methods to various newer modalities of fixation. Since the incidence of malunion and non-union in conservative methods was more, gradually the treatment shifted to fixation as the primary mode of treatment. After IM nailing was introduced it has almost become a gold standard for femur fracture fixation. Reaming femoral canal is an integral part of nailing procedure. Previously, reamed material which stuck to the reamers were often ignored and neglected. Hence, recent interest has been in the judicial use of reamed material obtained through reaming. We thought if we could accumulate the reamed material in the fracture site, even with closed nailing, we could achieve the objective of using this potential bone graft material effectively. At this juncture, we have devised this new idea of reaming the proximal femoral canal before reducing the fracture, thereby depositing the reamed material in the fracture site and studied the effect. MATERIALS AND METHODSThis is a case series study carried out in KAP Viswanatham Government Medical College/MGM Government Hospital, Trichy from 2013 to 2016 of 40 cases of femoral shaft fractures satisfying inclusion/exclusion criteria. Entry portal created as in any other standard nailing procedure and after entry portal is made, we did not pass the guide wire into the distal fragment and did not reduce the fracture. Instead, the fracture was left as it is and the guide wire was passed up to the fracture site only. Instead of using routine cutting reamers, we used a slightly modified reamer. Serial reaming was done until the fracture site was reached and up to the maximum size. Then as per standard IM nailing technique, appropriate-sized nail was inserted and locked. RESULTSBridging bony callus was visible in 4 -6 weeks in 22 cases of which 17 were simple and 5 comminuted. They subsequently united radiologically in 8 -10 weeks and complete union seen in 10 -12 weeks. In the rest 18 cases, bony callus was visible in 6 -8 weeks. These 18 patients had radiological union in 10 -12 weeks and complete union in 12 -14 weeks. In our study, all 40 cases went for complete union. CONCLUSIONIn our study, all 40 cases united well clinically and radiologically. And we also noted that there was early union occurring in all 40 cases. There was no incidence of non-union in our study. We advocate this simple modification in reamer and the reaming technique to obtain early union in femoral shaft fractures. Hence, we conclude this is a useful and safe mode of fixing femoral shaft fractures to avoid potential second surgery for grafting.