The risk factors of nonunion after intramedullary nailing fixation of femur shaft fracture in middle age patients

Abstract

Although the optimal treatment for femur shaft fracture is intramedullary nailing fixation, nonunion still occurs. We determined the oligotrophic nonunion rate among femur fractures managed operatively and identified risk factors for reoperation. This was a retrospective clinical study. The data of the patients between 40 and 70 years old with diaphyseal femur fracture who have received reamed and interlocked intramedullary nailing fixation in our hospital from February 2014 to April 2018 were collected. They were followed at regular intervals for at least 1 year after the operation. The primary outcome was nonunion of the fracture site that required reoperation in accordance with the radiographic union scale for tibial shaft fracture (RUST), which is a reasonable score system for lower limb diaphyseal fracture. Three of them were hypertrophic nonunion (1.9%) and the other 13 cases were oligotrophic nonunion (8.6%) at postoperative 12 months follow-up. All of the postoperative plain films showed adequate reduction quality. The three hypertrophic nonunion cases were all obese male with fracture site comminution. Fracture at the proximal third junction, hypertension (HTN) and diabetes mellitus (DM) was significantly associated with oligotrophic nonunion of the fracture site from logistic regression analysis. The mean RUST score 3 months after the operation was not significantly different between the union group and nonunion group but was significantly lower 6 months after the operation in the nonunion group. In conclusion, intramedullary nailing of the femur shaft fractures was associated with a low risk of nonunion at the 1-year follow-up in the middle age group. Those with comorbidity such as obese, HTN, and DM, with fracture site at the proximal third junction or comminution should be followed up closely and rehabilitation with cause aggressively. Radiographic scale as the RUST score at postoperative 6 months could be used to predict this complication.

Risk factors for nonunion following surgically managed, traumatic, diaphyseal fractures: a systematic review and meta-analysis

“…The included studies were designed as follows: one was prospective ( 14 ), one was uncertain ( 15 ), and the remaining 28 were retrospective ( 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ) ( Table 1 ). The studies included 38 465 patients, of which 3,975 suffered from nonunion.…”

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

“…In general, the factors identified can be classified into four categories: patient-related factors, environment factors, injury-related factors, and surgery-related factors. Wu et al reported that fracture site comminution; fracture at the proximal third junction; and comorbidities such as obesity, hypertension, and diabetes mellitus were associated with a higher risk of nonunion [ 23 ]. A systematic review conducted by Santolini et al highlighted 10 risk factors for long bone fracture nonunion [ 24 ].…”

Perforation of the Knee Joint Following Antegrade Intramedullary Nailing of a Comminuted Femoral Diaphyseal Fracture: A Case Report

“…Ten of these type B femur fractures went on to delayed union (defined as the absence of union after three months) and were either treated with nail dynamization or went on to union without intervention. There are various risk factors that increase the risk for nonunion, including obesity, hypertension, diabetes, fracture site at the proximal third of the femur, or a comminuted fracture pattern [ 8 - 9 ]. In addition to nonunion, another potential complication is the penetration of the femoral anterior cortex intraoperatively; several studies have explored the risk factors and prevention of this issue [ 1 - 4 ].…”