Unreamed Retrograde Intramedullary Nailing of Fractures of the Femoral Shaft
Autor: | Watson Jt, Berton R. Moed, David E. Karges, Teefey Js, Kathryn E. Cramer |
---|---|
Rok vydání: | 1998 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent Nonunion Dynamization Bone Nails law.invention Intramedullary rod law Fracture fixation medicine Humans Orthopedics and Sports Medicine Femur Prospective Studies Aged business.industry General Medicine Middle Aged medicine.disease Fracture Fixation Intramedullary Surgery Radiography Treatment Outcome Knee pain Evaluation Studies as Topic Orthopedic surgery Female Implant medicine.symptom business Femoral Fractures |
Zdroj: | Journal of Orthopaedic Trauma. 12:334-342 |
ISSN: | 0890-5339 |
Popis: | Objective: To evaluate the efficacy of unreamed retrograde intramedullary (IM) nailing of fractures of the femoral shaft in a second series of patients using modifications suggested from our initial study. Design: Prospective. Setting: Level I trauma center. Methods: Based on the findings of a previous study, we began a clinical series incorporating changes consisting of (a) inclusion of any patient with a femoral shaft fracture amenable to IM nailing (i.e., closed physes), (b) primary use of a split patellar tendon intercondylar distal femoral entry portal, and (c) the use of a full-length femoral implant having variable size availability and dynamization capability. Over a twelve-month period, thirty-four patients with thirty-five femoral shaft fractures were treated. The protocol called for planned dynamization in statically locked stable fractures and unstable fractures showing minimal healing at six to twelve weeks. Functional outcome was assessed by using the Knee Society clinical rating system. Results: Incorporating the concepts of canal fill and early dynamization, there were only two nonunions (6 percent) in this series as compared with 14 percent in the previously reported series with an overall shorter time to union (12.6 versus 15 weeks). There were no infections or malunions. Postoperative complaints of knee pain were minimal (knee score average: 98 points) and knee function was excellent (knee score average: 97 points). Conclusions: Although not advocated as a replacement for other techniques, unreamed retrograde nailing is presented as a safe and beneficial fracture fixation method that should be added to the orthopaedic surgeon's treatment armamentarium. The operative technique is quick and simple, and blood loss is minimal. Early nail dynamization and early weight-bearing are important in minimizing the risk of nonunion. |
Databáze: | OpenAIRE |
Externí odkaz: |