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

Hamahashi, Kosuke; Uchiyama, Yoshiyasu; Kobayashi, Yohnosuke; Ebihara, Goro; Ukai, Taku; Watanabe, Masahiko

doi:10.1136/tsaco-2018-000203

Cited by 18 publications

(27 citation statements)

References 26 publications

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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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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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“…Firstly, we felt the treatment of the femoral fracture was insufficient as there was a critical defect of the lateral cortex of the femur that was disregarded. In fact, several studies highlight the importance that the presence of a third fragment in femoral shaft fractures may have in the development of non-union [ 10 ]. Secondly, the patient was still symptomatic in regard to his iliac wing fracture.…”

Section: Discussionmentioning

confidence: 99%

“Bone-shot fracture” – An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report

Vieira

Costa

Negrão

et al. 2021

Trauma Case Reports

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Case A young adult male sustained a high-energy crash suffering multiple injuries including a comminuted right femoral shaft fracture and an ipsilateral iliac wing fracture. The iliac fracture was caused by a femoral fragment which was projected and pierced the iliac wing. The patient underwent surgery with retrieval of the femoral fragment and fixation of the iliac and femoral fractures. The lesions healed uneventfully. Conclusion This is the first reported case of an iliac fracture caused by a projectile of autologous bone. High-energy trauma may present unusual or never seen injury patterns to the trauma surgeon.

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“…Traditionally, closed reduction is said to preserve the soft tissue integrity and blood supply, leading to satisfactory prognoses [2,[18][19][20]. However, several studies have shown that open reduction has similar to superior outcomes [6, [21][22][23]. In our study, the open reduction group had a shorter time to union (7.39 vs. 9.18 months, p = 0.025) and signi cantly better strength of union in the early postoperative stage.…”

Section: Discussionmentioning

confidence: 99%

“…The vascular supply to the reversed fragments may be strangulated and become compromised in the setting of an altered morphology [6]. Hamahashi et al concluded that among the risk factors of delayed union, displacement is the only risk factor that could be modi ed with intraoperative reduction [21]. Achieving a quality reduction, eliminating the third-fragment effect, and facilitating bone union are more likely with the open reduction technique than with closed reduction.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, three out of four patients with complications in the closed reduction group had large gaps; furthermore, one patient had a femoral malrotation due to poor reduction and biomechanical abnormalities and required re-operation in the acute postoperative phase. The effect of the presence of a third fragment and residual gap has been investigated in several studies [6, 21,22]. The residual gap persists after closed reduction [3,4], indicating a worse bone environment from huge fragment diastasis, potential soft tissue interposition, and poor axial loadbearing ability [2,3].…”

Section: Discussionmentioning

confidence: 99%

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Radiographic Outcomes of Treatment of Complex Femoral Shaft Fractures by Intramedullary Nailing: A Retrospective Analysis of Different Techniques

Chen¹,

Lin²,

Chang³

et al. 2021

Preprint

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BackgroundThis study aimed to determine whether the outcomes of femoral diaphyseal fractures (AO/OTA/32-C) were dependent on the treatment technique (closed vs. open reduction and internal ﬁxation with an interlocking nail).This retrospective study was conducted at a level III trauma center. A total of 47 consecutive patients with femoral diaphyseal fractures (AO/OTA/32-C) were included. All patients underwent reduction and fixation and were divided into two groups according to the surgical techniques used: closed reduction and open reduction groups. The radiographic union score of the femur, mean union time, re-operation rate, and complication rate were assessed.ResultsAt 12 postoperative months, the union rate was 80.76% in the open reduction group and 82.35% in the closed reduction group; however, the difference was not significant (p=0.787). The rate of anatomical-to-small gaps was 96.15% and 47.05% in the open and closed reduction groups, respectively (p=0.01). The radiographic union score of the femur at 6 postoperative months (9.30 vs. 7.76, p=0.02) and postoperative months (9.94 vs. 10.80, p=0.03) was significantly higher in the open reduction group. Further, the required time to union in the open reduction group was significantly shorter (7.39 vs. 9.18 months, p=0.025). The difference in the need for revision surgery was not significant between the two groups (19.23% vs. 23.52%, p=0.964). ConclusionsCompared to closed reduction, intramedullary nailing of severe comminuted femoral shaft fractures with open reduction has similar outcomes and carries no increased risk of complications. Surgeons should consider open reduction if the outcomes of closed reduction are not satisfactory. This will aid in restoring anatomical reduction, enable primary bone grafting, and result in an optimal union rate, better strength of union, and shorter time to union.

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

Cited by 18 publications

References 26 publications

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

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

“Bone-shot fracture” – An unusual iliac wing fracture caused by a projectile of autologous bone fragment. A case report

Radiographic Outcomes of Treatment of Complex Femoral Shaft Fractures by Intramedullary Nailing: A Retrospective Analysis of Different Techniques

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