The Efficacy of Single-stage Open Intramedullary Nailing of Neglected Femur Fractures
| Autor: | Thilak S. Jepegnanam, Viju Daniel Varghese, Azad Sait, Thomas Matthai, P. R. J. V. C. Boopalan |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Time Factors Knee Joint medicine.medical_treatment Bone healing Bone Nails Bone grafting law.invention Intramedullary rod Young Adult Postoperative Complications Clinical Research law Humans Medicine Orthopedics and Sports Medicine Femur Range of Motion Articular Aged Fracture Healing Single stage business.industry General Medicine Middle Aged Neurovascular bundle Biomechanical Phenomena Fracture Fixation Intramedullary Surgery Radiography Treatment Outcome Orthopedic surgery Female business Femoral Fractures |
| Zdroj: | Clinical Orthopaedics and Related Research®. 472:759-764 |
| ISSN: | 1528-1132 0009-921X |
| DOI: | 10.1007/s11999-013-3293-z |
| Popis: | Neglected femur fractures are not rare in the developing world. Treatment options include single-stage open reduction and intramedullary nailing, or open release, skeletal traction, and then second-stage open intramedullary nailing, with bone grafting. Single-stage procedures have the potential advantage of avoiding neurovascular complications secondary to acute lengthening, but they require a second operation, with potentially increased resource use and infection risk.We sought to determine the (1) likelihood of union, (2) complications and reoperations, and (3) functional results with single-stage open intramedullary nailing without bone grafting in patients with neglected femur fractures.Between January 2003 and December 2007, 17 consecutive patients presented to our practice with neglected femoral shaft fractures. All were treated with single-stage nailing without bone grafting. There were 15 men and two women with a median age of 27 years. The average time from fracture to treatment was 13 weeks (range, 4-44 weeks). Eleven patients underwent open nailing with interlocked nails and six were treated with cloverleaf Kuntscher nails. Patients were followed for a minimum of 6 months (mean, 33 months; range, 6-72 months). The mean preoperative ROM of the knee was 28° (range, 10°-150°) and femoral length discrepancy was 3.1 cm (range, 1-5 cm).All fractures united and the mean time to union was 16 weeks (range, 7-32 weeks). There were no neurologic complications secondary to acute lengthening. The mean postoperative ROM of the knee was 130° (range, 60°-150°). All patients were able to return to preinjury work. Sixteen patients regained their original femoral length.One-stage open intramedullary nailing of neglected femoral diaphyseal fractures without bone grafting was safe and effective, and obviated the need for a two-stage approach. Although the findings need to be replicated in larger numbers of patients, we believe this technique may be useful in treating patients with this injury, and may offer advantages in resource-constrained environments. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink