Use of Reconstruction Nails to Manage Ipsilateral Displaced Femoral Neck-Shaft Fractures: Assessment of a New Approach

Lin, Sen-Yuen; Lo, Ching-Kan; Cheng, Shun-Chien; Kuo, Ming-Chieh; Chin, Lin-Show

doi:10.1177/230949900201000214

Cited by 12 publications

(10 citation statements)

References 17 publications

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“…9,14 Reconstructive intramedullary interlocking nailing enables rigid fixation of concomitant femoral neck and shaft fractures with a single implant, with a 100% union rate of the femoral neck and shaft fractures reported. 8,9,15 Nonetheless, further displacement of femoral neck fractures was frequently noted after the interlocking nail insertion. 5,14 It is important to fix the neck fracture first before inserting an interlocking nail to avoid displacement of the neck.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Hip Screw and Compression Plate Fixation of Ipsilateral Femoral Neck and Shaft Fractures

Abalo

Dossim

Bangna

et al. 2008

J Orthop Surg (Hong Kong)

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Purpose. To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures. Methods. Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification. Results. The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6º varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Surgery 2008;16(1):35-8 shaft fractures is reliable in achieving bone union with few complications. Journal of Orthopaedic

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Section: Discussionmentioning

confidence: 99%

Dynamic Hip Screw and Compression Plate Fixation of Ipsilateral Femoral Neck and Shaft Fractures

Abalo

Dossim

Bangna

et al. 2008

J Orthop Surg (Hong Kong)

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“…[7][8][9] Second, reaming, which is applied to enlarge the diameter of the femoral shaft before implanting the intramedullary nail, can result in floating intermediate fragments that might cause soft tissue injury and blood vessel lesions. [19][20][21] We have also observed the abovementioned problems in treating patients with IMFSFs in our clinical practice. Therefore, to attenuate or even resolve these issues, we designed the reductor-T tape pin as a novel intramedullary reduction device and explored the efficacy and safety of antegrade nailing with this device via a percutaneous technique in patients with IMFSFs.…”

Section: Discussionmentioning

confidence: 69%

“…7–9 Second, reaming, which is applied to enlarge the diameter of the femoral shaft before implanting the intramedullary nail, can result in floating intermediate fragments that might cause soft tissue injury and blood vessel lesions. 19–21…”

Section: Discussionmentioning

confidence: 99%

Percutaneous antegrade nailing with reductor-T tape pin is effective and well tolerated in patients with ipsilateral multisegmental femoral shaft fractures

Wang

Liu

et al. 2019

J Int Med Res

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Objective This study was performed to investigate the efficacy and safety of percutaneous antegrade nailing with a reductor-T tape pin in the treatment of ipsilateral multisegmental femoral shaft fractures (IMFSFs). Methods Nineteen patients with IMFSFs underwent antegrade nailing with a reductor-T tape pin by percutaneous techniques. The operation time, reduction time, fluoroscopy time, blood loss, fracture union time, and complications were recorded. Results All 19 patients (100%) achieved technical success. The mean and median operation time were 62.42±16.27 and 60 (range, 40–105) minutes, respectively; the mean and median reduction time were 11.47±3.78 and 10 (range, 8–22) minutes, respectively; the mean and median fluoroscopy time were 16.63±6.10 and 15 (range, 10–35) s, respectively; and the mean and median blood loss were 185.26±62.75 and 180 (range, 110–350) mL, respectively. Additionally, all 19 patients (100%) achieved fracture union within a mean and median time of 3.95±1.75 and 3 (range, 3–9) months, respectively; most patients [n=14 (73.7%)] achieved fracture union within 3 months. No obvious complications occurred during the study. Conclusion Antegrade nailing with a reductor-T tape pin by a percutaneous technique is effective and well tolerated in patients with IMFSFs.

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“…However, for surgical assessment and surgical strategy, it is critical to understand that the fragment between the proximal fracture and the shaft fracture is the so-called intermediate fragment. Lin et al considered this intermediate fragment the key fragment of the fracture and called it the “floating” fragment which required stable fixation and, more specifically, rotational stability [ 7 ]. Regarding the surgical strategy, both fracture components, the proximal and the shaft fracture, require anatomic reduction and anatomic realignment of axis and torsion.…”

Section: Discussionmentioning

confidence: 99%

“…Additional rotational stability of the intermediate fragment can be achieved by insertion of cables via a minimally invasive approach and utilization of a special cable clamp. Prerequisite for additional cable fixation is an oblique or spiral fracture configuration [ 7 , 10 , 11 ]. Alternatively, some authors suggest application of an auxiliary plate osteosynthesis with monocortical screw fixation to increase rotational stability of the intermediate fracture fragment [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of ipsilateral multi-level femoral fractures

Rüden

Tauber

Woltmann

et al. 2015

Journal of Orthopaedic Surgery and Research

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BackgroundConcurrent ipsilateral fractures of the proximal and shaft of the femur are rare complex fracture combinations. In this prospective cohort study, we evaluated clinical and radiological long-term results after operative treatment using several surgical strategies: the so-called “rendezvous” surgical technique, e.g., the combination of retrograde intramedullary nailing and dynamic hip screw (DHS) osteosynthesis, or the all-in-one device technique, e.g., long cephalomedullary nail, compared with two non-overlapping implants (e.g., conventional technique).MethodsIn a 10-year-period from 2004 to 2013, we treated 65 patients with complex ipsilateral multi-level femoral fractures. Median age was 45 years (range 19–90 years). Fractures were classified according to the AO/OTA classification. Four patients died during intensive care unit treatment due to multi-organ failure prior to definitive osteosynthesis. Clinical long-term outcome using the functional system of Friedman/Wyman as well as radiological outcome was evaluated 2 years after trauma (range 13–42 months).ResultsAll-in-one device was used in 36 patients, “rendezvous” technique in 9 patients, and the conventional technique in the remaining 16 patients. Two years after trauma, complete fracture healing was found in 57 out of 61 patients (“rendezvous”: 9, all-in-one device: 33, conventional: 15; p-value: 0.66). There was no significant difference regarding the complication rate in the cohort groups (“rendezvous”: 3, all-in-one device: 13, conventional: 5; p-value: 0.94). Using the functional assessment system of Friedman/Wyman 2 years after trauma, a good clinical result was found in 77.7% in the “rendezvous” group, in 77.8% in the all-in-one device group, and in 75% in the conventional group.ConclusionThe indication for operative stabilization of ipsilateral multi-level femoral fractures is considered an urgent and emergency procedure. Based on the successful long-term results of this study, we prefer the “rendezvous” technique with fracture stabilization from distally to proximally. Both fracture components require stable fixation. It is advisable to stabilize the shaft fracture primarily using external fixation (damage control orthopedics) and the proximal femoral fracture using early definitive internal fixation. In a second and staged operation, the external fixator is removed and the shaft fracture is stabilized using retrograde nail osteosynthesis with overlapping of the DHS and nail implants.

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Use of Reconstruction Nails to Manage Ipsilateral Displaced Femoral Neck-Shaft Fractures: Assessment of a New Approach

Abstract: The new approach to manage ipsilateral femoral neck-shaft fractures by using reconstruction nails obtains relatively good clinical results.

Cited by 12 publications

References 17 publications

Dynamic Hip Screw and Compression Plate Fixation of Ipsilateral Femoral Neck and Shaft Fractures

Dynamic Hip Screw and Compression Plate Fixation of Ipsilateral Femoral Neck and Shaft Fractures

Percutaneous antegrade nailing with reductor-T tape pin is effective and well tolerated in patients with ipsilateral multisegmental femoral shaft fractures

Surgical treatment of ipsilateral multi-level femoral fractures

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