Perioperative Radiographic Predictors of Non-Union in Infra-Isthmal Femoral Shaft Fractures after Antegrade Intramedullary Nailing: A Case–Control Study

Hung, Wei-Cheng; Hsu, Chin‐Jung; Kumar, Abhishek; Tsai, Cheng-Han; Chang, Hao-Wei; Lin, Tsung-Li

doi:10.3390/jcm11133664

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…Santolini et al 22 concluded that complex fractures and high initial fracture displacement increased the risk of non-union in long bone fractures. Similarly, Hung et al 23 showed that the risk factors for non-union of femoral shaft fractures were types B and C according to AO/OTA classification, consistent with the results of this study. According to a study on the factors of non-union of shaft fractures by Jensen 24 , type B fractures have a more significant effect on non-union than type A fractures.…”

Section: Discussionsupporting

confidence: 92%

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: Discussionsupporting

confidence: 92%

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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“…Antegrade intra-medullary (IM) nailing remains the typical treatment for femoral shaft fractures, yet non-union rates remain high for infra-isthmal femoral shaft fractures based on this approach [32]. Thus, a retrospective case-control study aimed at identifying perioperative radiographic factors linked to non-union in these cases after antegrade IM nailing was performed.…”

Section: Applications Of Image Analysis In Musculoskeletal Imagingmentioning

confidence: 99%

Advances in Musculoskeletal Imaging and Their Applications

Piórkowski,

Obuchowicz,

Urbanik

et al. 2023

JCM

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Comparative Study of Exchange Nailing and Augmentative Plating for Treating Aseptic Nonunion of Femoral Shafts Post Intramedullary Nailing: A Single-Blind, Multicentric Randomized Clinical Trial

Motififard,

Mousavi,

Iranpanah

et al. 2024

JCM

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Background: Aseptic nonunion of femoral shafts after intramedullary nailing (IMN) can be a challenging condition that may lead to long-term disability and the need for multiple surgical procedures. This study compared the clinical and radiological outcomes between exchange nailing and augmentative plating with bone grafting. Methods: In this multicenter, prospective, single-blind, randomized controlled trial, patients with aseptic nonunion of the femoral shaft after IMN were randomly assigned to receive exchange nailing or augmentative plating. The primary outcomes measured were the time to bone union and union rate 12 months after revision surgery. The secondary outcomes included operative time, blood loss, hospitalization duration, pain level using the visual analog scale (VAS), knee range of motion (ROM), and complication rates. Results: The augmentative plating group had a significantly shorter mean time to union (5.39 ± 1.29 months) compared with the exchange nailing group (7.38 ± 1.97 months; p < 0.001). The union rates at 12 months were 100% in the augmentative plating group and 89.65% in the exchange nail group. Augmentative plating resulted in a shorter operation time (99.46 ± 11.08 min vs. 106.45 ± 12.22 min; p = 0.025) and reduced blood loss (514.79 ± 45.87 mL vs. 547.72 ± 54.35 mL; p = 0.016). Significant pain reduction was observed in the augmentative plating group, with preoperative VAS scores decreasing from 6.04 ± 2.28 to 2.64 ± 1.50, compared with a decrease from 5.66 ± 2.21 to 3.66 ± 2.19 in the exchange nailing group (p = 0.047). Knee ROM improved significantly in the augmentative plating group (p = 0.0176). The complication rate was lower in the augmentative plating group (3.57%) than in the exchange nail group (17.24%). Conclusions: Augmentative plating with autologous bone grafting is superior to exchange nailing for treating aseptic nonunion of femoral shafts. It is associated with faster healing, higher union rates, better clinical and functional outcomes, and fewer complications. We recommend this technique as the preferred treatment option for such complex cases.

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Perioperative Radiographic Predictors of Non-Union in Infra-Isthmal Femoral Shaft Fractures after Antegrade Intramedullary Nailing: A Case–Control Study

Cited by 3 publications

References 26 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

Advances in Musculoskeletal Imaging and Their Applications

Comparative Study of Exchange Nailing and Augmentative Plating for Treating Aseptic Nonunion of Femoral Shafts Post Intramedullary Nailing: A Single-Blind, Multicentric Randomized Clinical Trial

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