What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture?

Abstract

Introduction: The fracture displacement in intramedullary nail in femoral subtrochanteric fracture may cause fracture non-union. We retrospectively analysed our recent experience to clear the influence about fracture displacement in intramedullary nail in femoral subtrochanteric fracture. Materials and methods: This study includes 36 patients in the intramedullary nail group followed up for more than 12 months; these patients suffered from femoral subtrochanteric fracture from 2009.1-2014.12 in our hospital. The operation time, amount of bleeding, length of hospital stay, fracture healing time, Harris function score of hip joint, fracture displacement, TAD and postoperative complications were summarized. Results: The average follow up time was 20.2 months, average operation time was 126 min, average amount of bleeding was 258 ml, average hospitalization was 13.1 days, average fracture healing time was 6.8 months, average fracture displacement was 1.23 cm, average TAD was 19.7 mm and average hip Harris function score was 82.5 points. Five cases suffered non-union. Only the fracture displacement degree made significant correlation with fracture non-union. All union patients had a fracture displacement less than 2.2 cm and all non-union patients had a fracture displacement more than 2.5 cm. Conclusion: Intramedullary nail treatment must focus on fracture reduction and recovery of femoral medial support with assisted incision technique or closed cerclage wire technique when necessary. In our opinions, only the fracture displacement degree made significant correlation with bone non-union and all cases achieved bone union when it less than 2.2 cm according to our statistics. But it still need further research to find out the displacement of fracture fragments could be tolerant.

Subtrochanteric Femur Fractures Treated With Femoral Nail: The Effect of Cerclage Wire Augmentation on Complications, Fracture Union, and Reduction: A Systematic Review and Meta-Analysis of Comparative Studies

“…This would seem an important clinical differentiation. Some studies control groups had 100% open reduction, 4,25,26 or the majority reduced open (93%), 27 but most all had closed reduction 1,15,17,18,[28][29][30] or most fractures reduced closed (5%-39% opened), 9,23,31 with many studies not specifying. 2,16,24,32 There were 5 included studies that documented quality of reduction and whether the control group's fracture was opened.…”

Patellar height changes after treatment of tibia plateau fractures

“…Many studies have shown that fragmentation, increased displacement, and management of fracture configuration play important roles in fracture healing and are poor prognostic factors among different types of fractures. [22][23][24] While establishing our hypothesis, we predicted that it would not be possible to achieve full knee function in plateau fractures with complex fracture patterns; therefore, there may be a problem with patellar balance in these patients. Similarly, Palke et al 25 followed 73 patients treated 12 months and reported changes in gait patterns in all patients.…”

Intramedullary Nail Breakage and Mechanical Displacement in Patients with Proximal Femoral Fractures: A Commercial and Medicare Supplemental Claims Database Analysis

“… 19–21 Mechanical displacement of IMN occurs when there is problematic movement of the IMN (eg, rotation, angulation, etc) that may be associated with malreduction and subsequently fracture malunion, nonunion, or shortening. 22 , 23 …”

“…[19][20][21] Mechanical displacement of IMN occurs when there is problematic movement of the IMN (eg, rotation, angulation, etc) that may be associated with malreduction and subsequently fracture malunion, nonunion, or shortening. 22,23 Rates of nail breakage or mechanical displacement following surgical repair of proximal femoral fractures with IMN are not well established as these depend on multiple factors such as fracture type, patient comorbidities, surgical approach, and the type of IMN. [19][20][21] A better understanding of the rates and patterns of occurrence of IMN breakage and mechanical displacement would be helpful to evaluate the magnitude of these problems and possibly how to avoid them.…”