Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur

Park, Kyungho; Kim, Kwanwoo; Kim, Choong-Young

doi:10.1007/s00264-010-0983-y

Cited by 31 publications

(21 citation statements)

References 16 publications

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“…Although this technique provides the advantage of early weight bearing, it does not allow for correction of unacceptable deformity unless exchange nailing is performed. Park et al [11] performed a biomechanical study in 13 matched cadaveric femur fracture models to compare the mechanical rigidity between plate fixation with the nail in situ and interlocking nail, and found a 2.6-fold increase in bending stiffness and a 3.3-fold increase in torsional stiffness in plate augmentation compared to interlocking nailing.…”

Section: Discussionmentioning

confidence: 99%

Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?

Jhunjhunwala

Dhawale

2015

Eur J Trauma Emerg Surg

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Section: Discussionmentioning

confidence: 99%

Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?

Jhunjhunwala

Dhawale

2015

Eur J Trauma Emerg Surg

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“…Too much motion in complex femoral fractures results in non‐union following interlock nailing. Augmentation plating has the ability of providing rotational stability to facilitate union . Therefore, considering the complexity and instability of segmental femoral fractures, IMN and plate combination appears to be a good method which not only neutralize the shear forces, but also provide rotational stability.…”

Section: Discussionmentioning

confidence: 99%

Results of combining intramedullary nailing and plate fixation for treating segmental femoral fractures

Liu¹,

Wu²,

Lin³

et al. 2019

ANZ Journal of Surgery

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Key words fixation, intramedullary nail and plate combination, segmental femoral fracture. Correspondence AbstractBackground: Intramedullary nailing (IMN) is generally accepted as the standard treatment for femoral shaft fractures. However, segmental femoral fractures are considered to be a special injury type associated with high complication rates. Combined IMN and plate is proved to be a reliable method for treating complex tibia fractures with less operation time and high union rates. Therefore, the purpose of our study is to evaluate the outcome of following combined IMN and plate fixation for segmental femoral fractures. Methods: Between February 2013 and January 2016, 18 consecutive patients with femoral shaft fracture with AO/OTA type 32-C2 were treated via combined IMN and plate. Surgical details, operative and postoperative complications, the rate of union and time to union were evaluated. Results: There were 14 men and four women with a mean age of 37.8 years (range 27-52 years). All patients were followed up for a minimum of 12 months. Of the patients, 13 were closed fractures, three were Gustilo type I open fractures and two were Gustilo type II open fractures. All patients achieved union within 18.9 weeks (range 12-28 weeks) and none of them had malunion. There were no deep infections, and two patients with superficial wound infections were successfully treated with antibiotics. Conclusion: Combining IMN and plate fixation appears to be a reliable method for the treatment of segmental femoral shaft fractures with less operation time, high union rates and ability to maintain alignment, therefore it provides another choice for treating segmental femoral fractures.

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“…Especially for non-isthmal femoral nonunion, ERN may not provide enough mechanical stability while ACP should be preferred. In a cadaveric fracture model study by Park et al, the augmentive plate group had a 3.3-fold increase in torsional stiffness and 2.6-fold increase in bending stiffness, compared with interlocking IMN group [ 30 ]. Therefore, when making surgical decisions and recommendations to patients, the possible failure of the ERN must be considered.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with development of re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing

Chen

et al. 2018

J Orthop Surg Res

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BackgroundCurrently, there remains a lack of consensus regarding factors predictive of complication such as re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing (IMN). A better understanding of prognostic factors could potentially reduce the risk of re-nonunion happening and allow patients to maximize their recovery in the most expeditious manner. Our study aims to identify risk factors in the development of re-nonunion after primary revision inclusive of exchanging reamed nailing (ERN) and augmentative compression plating (ACP) with IMN in situ for femoral shaft nonunion subsequent to failed IMN.MethodsA retrospective study was performed for 63 cases (61 patients) of femoral shaft nonunion subsequent to failed IMN, who were made primary revision with either ERN or ACP from June 2007 to June 2015. The following set of variables was selected based on the speculation that they would contribute to the outcome: sex (male or female), age, body mass index(BMI), smoking, alcohol abuse, cause of injury, fracture type, type of IMN (antegrade or retrograde), use of IMN locking screws(dynamic or static), site of nonunion, primary nonunion time, pathological type of nonunion, bone defect (mm), primary revision method (ERN or ACP), and adjuvant autogenous bone grafting (ABG) (yes or no). Univariate analysis and multiple regression were used to identify risk factors in the development of re-nonunion after primary revision with either ERN or ACP for femoral shaft nonunion subsequent to failed IMN. The minimum follow-up time was 1.5 years (standard deviation [SD] = 1.2, range 1.5–8 years).ResultsOf 63 cases (61 patients) of femoral shaft nonunion subsequent to failed IMN, primary revision with ERN was performed in 33 (52.4%) cases and primary revision with ACP was performed in 30 (47.6%) cases. Adjuvant ABG procedure was undertaken in 39 (61.9%) cases during primary revisions. Re-nonunion was diagnosed as in 18 (28.6%) cases after primary revision with either ERN or ACP. There was a significant difference in time to union between patients treated with primary ERN and those with primary ACP (log-rank, p = 0.006). Furthermore, the difference was also statistically significant between patients with adjuvant ABG procedure and those without it (log-rank, p = 0.009). The relative risk factors included smoking, BMI, site of nonunion, bone defect, primary revision method, and adjuvant ABG procedure. However, primary revision method and adjuvant ABG procedure were shown to be two independent risk factors in multiple logistic regression analysis.ConclusionsPatients with excessive tobacco use, BMI ≥ 30 kg/m2, bone defect ≥ 5 mm, primary revision with ERN, and no adjuvant ABG procedure had a higher likelihood of developing re-nonunion. Of these risk factors, primary revision with ERN and no adjuvant ABG procedure were two strongest risk factors.

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Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur

Abstract: Thirteen matched pairs of cadaveric femurs were placed into two groups. In each group, a transverse fracture was created at a point 70% distal between the lesser trochanter and the adductor tubercle. One femur out of each matched pair was then stabilised with an interlocking

Cited by 31 publications

References 16 publications

Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?

Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?

Results of combining intramedullary nailing and plate fixation for treating segmental femoral fractures

Factors associated with development of re-nonunion after primary revision in femoral shaft nonunion subsequent to failed intramedullary nailing

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