Open intramedullary nailing for segmental long bone fractures: An effective alternative in a resource-restricted environment

Babalola, OM; Ibraheem, Gbadebo; Ahmed, BA; Olawepo, A; Agaja, Samuel B; Adeniyi, Adebowale

doi:10.4103/1117-6806.188983

Cited by 16 publications

(4 citation statements)

References 38 publications

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“…Intramedullary nailing for the treatment of femoral shaft fractures was introduced by Groves in United Kingdom and Kuntcher in Germany 16 – 18 . Today, reduction and fixation with reamed intramedullary nailing is considered the gold standard for the treatment of most femoral shaft fractures 5 – 7 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Thus, poor reduction may occur with the traction table 11 . Then, open reduction was indispensable to accomplish the IMN fixation if the guiding wire could not pass through the distal fracture site 12 , 13 . However, this surgical procedure would seriously damage the blood supply to fragments, which may lead to oligotrophic nonunion 14 – 16 .…”

Section: Introductionmentioning

confidence: 99%

Traction table versus double reverse traction repositor in the treatment of femoral shaft fractures

Zhang

Yin

et al. 2018

Sci Rep

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A novel reduction technique of intramedullary nailing (IMN) for femoral shaft fractures was introduced, and in this study, its therapeutic effect was compared with patients treated with the traditional traction table. From November 2012 to August 2015, the patients with femoral shaft fractures fixed with anterograde IMN were reviewed. Seventy-four patients treated with the traction table and forty-eight patients treated with the double reverse traction repositor (DRTR) met the inclusion criteria of this study. The surgical time, blood loss, open reduction rate and complications were reviewed in this study. The fracture healing was assessed by the radiographs conducted at each follow-up. The functional outcome (hip and knee flexion, Harris Hip Score, and Lysholm knee score) was evaluated at the final follow-up. Average surgical time, blood loss, hip and knee flexion, and Harris Hip Score showed no difference (P > 0.05) between the two groups. However, the DRTR was superior to the traction table in fracture healing, Lysholm knee score, open reduction and complications rate (P < 0.05). Thus, we concluded that minimally invasive treatment of femoral shaft fractures could be obtained with the DRTR.

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“…For instance, cerclage wiring was performed in 12 cases (31.6%) and it improved the reduction quality and reduced the comminuted segment fracture gap. Although no difference in union rate or infection rate has been reported in open and closed IM nail fixations 32 , extra caution is needed when performing an open reduction to minimize soft tissue injury since segmental femoral shaft fracture is a high-energy injury. Other methods, such as various percutaneous reduction techniques and forward or backward striking techniques, are thought to be more advantageous than open reductions for reducing the residual gap 30 , 31 .…”

Section: Discussionmentioning

confidence: 99%

A multicenter study of factors affecting nonunion by radiographic analysis after intramedullary nailing in segmental femoral shaft fractures

Kook

Park

Kim

et al. 2023

Sci Rep

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The factors affecting the outcomes of segmental femoral shaft fractures are currently unknown. We evaluated the outcomes of intramedullary (IM) nail fixation and investigated factors affecting nonunion of femoral shaft segmental fractures. A total of 38 patients who underwent IM nail fixation for femoral shaft segmental fractures (AO/OTA 32C2) at three university hospitals with a minimum 1-year follow-up period were retrospectively reviewed. The patients were divided into union (n = 32) and nonunion (n = 6) groups. We analyzed smoking status, diabetes mellitus, location of the segmental fragment, segment comminution, filling of the IM nail in the medullary canal, residual gap at the fracture site, use of a cerclage wire or blocking screws as factors that may affect the surgical outcome. In the union group, the average union time was 5.4 months (4–9 months). In the nonunion group, five patients required additional surgery within an average of 7.2 months (5–10 months) postoperatively, whereas one patient remained asymptomatic and did not require further intervention. On comparing the two groups, insufficient canal filling of the IM nail (union, 25.0%; nonunion, 83.3%; p = 0.012) and the presence of a residual gap at the fracture site after reduction (union, 31.3%; nonunion, 83.3%; p = 0.027) were significantly different. In the multivariate analysis, only insufficient canal filling of the IM nail was found to be a factor affecting nonunion, with an odds ratio of 13.3 (p = 0.036). In this study, a relatively high nonunion rate (15.8%) was observed after IM nail fixation. Insufficient IM nail canal filling and a residual gap at the fracture site post reduction were factors affecting segmental femoral shaft fracture nonunion after IM nail fixation.

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Open intramedullary nailing for segmental long bone fractures: An effective alternative in a resource-restricted environment

Cited by 16 publications

References 38 publications

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

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

Traction table versus double reverse traction repositor in the treatment of femoral shaft fractures

A multicenter study of factors affecting nonunion by radiographic analysis after intramedullary nailing in segmental femoral shaft fractures

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