Authors
1 Department of Orthopedics, Kashani Hospital, Isfahan, Iran
2 Department of Orthopedics, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Femoral shaft fractures are among the most common fractures following high trauma injuries. Different kinds of treatment have been suggested for these injuries.
Aim: The aim of this study was to compare the results femoral fractures treated by mini open and close intramedullary nailing (IMN) technique.
Materials and Methods: A total of 48 adult patients were operated due to fracture of the femur with close or open IMN technique between September 2010 and September 2011. 23 patients operated with close. IMN technique was included in Group I while 24 patients operated with mini open IMN technique constituted Group II. In Group I, all patients. Were operated on the fracture table in the supine position while in Group II, all patients underwent surgery on standard tables in the lateral position.
Results: The mean age of patients was 27.3 years, ranging between 16 and 62. The mean age of the close nailing and open nailing groups was 30.5 and 24.5 respectively (P = 0.052). Only one patient from the open nailing group failed to unite. The mean time for union in close and open nailing groups was 13 + 2.4 and 17.7 + 2.3 weeks respectively (P = 0.001). No infection or limb length discrepancies were observed in the two groups.
Conclusion: Although close nailing is the preferred methods in most cases, but in poly-traumatized patients or in centers where there are no fracture tables or C-arm, open nailing is a good option.
Keywords
1. | Scannell BP, Waldrop NE, Sasser HC, Sing RF, Bosse MJ. Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients. J Trauma 2010;68:633-40. |
2. | O'Beirne J, O'Connell RJ, White JM, Flynn M. Fractures of the femur treated by femoral plating using the anterolateral approach. Injury 1986;17:387-90. |
3. | Rozbruch SR, Müller U, Gautier E, Ganz R. The evolution of femoral shaft plating technique. Clin Orthop Relat Res 1998;354:195-208. |
4. | Geissler WB, Powell TE, Blickenstaff KR, Savoie FH. Compression plating of acute femoral shaft fractures. Orthopedics 1995;18:655-60. |
5. | Rokkanen P, Slätis P, Vankka E. Closed or open intramedullary nailing of femoral shaft fractures? A comparison with conservatively treated cases. J Bone Joint Surg Br Vol 1969;51:313-23. |
6. | Liao JC, Hsieh PH, Chuang TY, Su JY, Chen CH, Chen YJ. Mini-open intramedullary nailing of acute femoral shaft fracture: Reduction through a small incision without a fracture table. Chang Gung Med J 2003;26:660-8. |
7. | Bishop JA, Rodriguez EK. Closed intramedullary nailing of the femur in the lateral decubitus position. J Trauma 2010;68:231-5. |
8. | Anastopoulos G, Asimakopoulos A, Exarchou E, Pantazopoulos T. Closed interlocked nailing in comminuted and segmental femoral shaft fractures. J Trauma 1993;35:772-5. |
9. | Clawson DK, Smith RF, Hansen ST. Closed intramedullary nailing of the femur. J Bone Joint Surg Am 1971;53:681-92. |
10. | Hooper GJ, Lyon DW. Closed unlocked nailing for comminuted femoral fractures. J Bone Joint Surg Br 1988;70:619-21. |
11. | Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. 1984. J Bone Joint Surg Am 2001;83-A: 1912. |
12. | King KF, Rush J. Closed intramedullary nailing of femoral shaft fractures. A review of one hundred and twelve cases treated by the Küntscher technique. J Bone Joint Surg Am 1981;63:1319-23. |
13. | Köseoðlu E, Durak K, Bilgen MS, Küçükalp A, Bayyurt S. Comparison of two biological internal fixation techniques in the treatment of adult femur shaft fractures (plate-screws and locked intramedullary nail). Ulus Travma Acil Cerrahi Derg 2011;17:159-65. |
14. | Aiyer S, Jagiasi J, Argekar H, Sharan S, Dasgupta B. Closed antegrade interlocked nailing of femoral shaft fractures operated up to 2 weeks postinjury in the absence of a fracture table or C-arm. J Trauma 2006;61:457-60. |
15. | Crist BD, Wolinsky PR. Reaming does not add significant time to intramedullary nailing of diaphyseal fractures of the tibia and femur. J Trauma 2009;67:727-34. |
16. | Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma 1999;46:392-9. |
17. | Brumback RJ, Virkus WW. Intramedullary nailing of the femur: Reamed versus nonreamed. J Am Acad Orthop Surg 2000;8:83-90. |
18. | Debrauwer S, Hendrix K, Verdonk R. Anterograde femoral nailing with a reamed interlocking titanium alloy nail. Acta Orthop Belg 2000;66:484-9. |
19. | Wu CC, Lee ZL. Treatment of femoral shaft aseptic nonunion associated with broken distal locked screws and shortening. J Trauma 2005;58:837-40. |
20. | Taitsman LA, Lynch JR, Agel J, Barei DP, Nork SE. Risk factors for femoral nonunion after femoral shaft fracture. J Trauma 2009;67:1389-92. |
21. | Schatzker J. Open intramedullary nailing of the femur. Orthop Clin North Am 1980;11:623-31. |
22. | Leighton RK, Waddell JP, Kellam JF, Orrell KG. Open versus closed intramedullary nailing of femoral shaft fractures. J Trauma 1986;26:923-6. |
23. | Wu CC, Shih CH. Simultaneous bilateral femoral shaft fractures. J Trauma 1992;32:289-93. |
24. | Amis JA, Frank Jr DJ, Burkhead Jr WZ, Bucholz RW. The role of medullary reaming in closed nailing of femur fractures. Intramedullary Rods: Clinical Performance and Related Laboratory Testing. Vol. ASTM STP1008. J. P, Harvey, Jr., A. U. Daniels, and R. F. Games, editors., American Society for Testing and Materials, Philadelphia, 1989. p. 108-18. |