Radiographic, Bone Densitometry and Clinic Outcomes Assessments in Femoral Shaft Fractures Fixed by Plating or Locking Retrograde Nail

Abstract

Introduction: Distal femoral shaft fractures are characterized by increasing incidence and complexity and are still considered a challenging problem (high morbidity and mortality). No consensus on best surgical option has been achieved. Aim: This study aims is to investigate radiographic, mineral bone densitometry and clinical outcomes of locking retrograde intramedullary (LRN) nailing and anatomical locking plate to surgically treat distal femoral shaft fractures in young adults based on the hypothesis that there is no statistical difference among the two surgical options in terms of results (radiographic, bone densitometry and outcomes assessment). Methods: Retrospective study: 30 patients divided into 2 groups (Group 1 LRN, Group 2 Nailing). Average age was 42.67±18.32 for Group 1 and 42.84 ±18.32 for Group 2 (range of age 18-65 for both groups). Gender Ratio (male: female) was 2.75 (11:4) for both Group 1 and 2. AO Classification, NUSS and RUSH score, VAS, Dexa scans, plain radiographs were used. Evaluation endpoint: 12 months after surgery (mean follow up 16.24). Results: No statistical difference in terms of surgery time, transfusions, wound healing. Similar results with regard to average time of bone healing, RUSH scores, VAS, regression between RUSH and VAS, average correlation clinical-radiographic results and patients outcomes. Only one patient of each group had reduction of mineral bone densitometry values. Conclusion: No statistical difference about the use of LNR or Nailing for treatment of distal femur shaft fractures in terms of radiographic, bone densitometry and outcomes has been found accordingly to our results. Good subjective and objective results are provided by both techniques. The choice among the two techniques must be based on surgeons’ experience, indications and subjective patients’ aspects. The absence of relevant similar data in the published literature does not allow definitive validation (or rejection) of our hypothesis. A more powered study with bigger cohort is needed for definitive validation.

Management of Infected Non-union Following Femoral Shaft Fracture in a Patient with Klippel-Trenaunay Syndrome: A Case Report

“…However, consensus about the best management option remains controversial. Rollo et al reported no statistical difference for the use of locking retrograde IMN or plate in terms of surgery time, blood transfusion, and wound healing [ 9 ]. In contrast, IMN has been reported as significantly favorable for a patient’s post-operative quality-of-life [ 10 ].…”

A novel closed reduction technique for treating femoral shaft fractures with intramedullary nails, haemostatic forceps and the lever principle

“…Given the external rotation, abduction, and flexion displacement of the proximal fragment in subtrochanteric fractures, it is difficult to achieve reduction using this technique alone, and the use of a second reduction tool, such as a ball spike, the Schanz pin and a periosteal elevator, may be necessary. We did not apply this technique to retrograde nail because the tension resulting from the traction play a very important role in our reduction process, and the reduction is always achieved by flexing the knee to reduce the muscle force in the retrograde nail fixation process [24]. Heterotopic ossification was observed during the follow-up period (Fig.…”

Optimal entry point for antegrade and retrograde femoral intramedullary nails

“…Therefore, utilization of retrograde femoral nailing has gained popularity and has become widely accepted. 29 , 30 , 31 …”