ObjectiveTo review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation.MethodsThe results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed.ResultsThe AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment.ConclusionCompared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.
Objective To compare the effectiveness of proximal femoral nail antirotation (PFNA) and reconstruction nail with minimally invasive technique for ipsilateral femoral shaft and extracapsular hip fractures in young and middle-aged patients. Methods Sixty-nine young and middle-aged patients with ipsilateral femoral shaft and extracapsular hip fractures were treated between January 2000 and August 2010, and their data were analyzed retrospectively. Of them, fractures were fixed by reconstruction nail in 44 cases (reconstruction nail group) and by PFNA in 25 cases (PFNA group). There was no significant difference in gender, age, weight, injury cause, fracture type, or disease duration between 2 groups (P gt; 0.05). The operation time, blood loss, fracture healing time, complications, and functional outcomes were compared between 2 groups to evaluate the effectiveness. Results The operation time and blood loss in the PFNA group were significantly less than those in the reconstruction nail group (P lt; 0.05). The follow-up time was 12-38 months (mean, 20 months ) in the PFNA group and was 12-48 months (mean, 22 months) in the reconstruction nail group. No complication occurred as follows in 2 groups: wound infection, deep venous thrombosis, pulmonary embolism, breakage of the implants, avascular necrosis of the femoral head, or serious rotation and shortening deformity of lower limbs. In the PFNA group and the reconstruction nail group, 1 patient underwent technical difficulty in nail implant and 7 patients underwent technical difficulty in proximal locking screw, respectively; 3 patients and 6 patients had intra-operative iatrogenic fracture of femoral shaft, respectively; and delayed union of femoral shaft was observed in 1 patient and 2 patients, respectively. The complication rate was 20% (5/25) in the PFNA group and 34% (15/44) in the reconstruction nail group, showing no significant difference (χ2=1.538, P=0.215). No significant difference was found in fracture healing time between 2 groups (P gt; 0.05). At last follow-up, there was no significant difference in Harris hip score and Evanich knee score between 2 groups (P gt; 0.05). Conclusion PFNA or reconstruction nail with minimally invasive technique is a good method to treat ipsilateral femoral shaft and extracapsular hip fractures, but the PFNA is superior to the reconstruction nail because of simple operation.
Objective To describe the design and application of a new intramedullary controlled dynamic nailing(ICDN).〓〖WTHZ〗Methods The new ICDN was made of a stainlesssteel alloy, consists of a nail shaft, innerrod, tensile screw, end cape and two interlocked screws. From December 2005 toFebruary 2007, 48 cases of femoral shaft fractures were treated with ICDN. There were 16 females and 32 males with a mean age of 36.6 years (range, 16-48years). Injury was caused by traffic accident in 26 cases, falling from a height in14, sportsrelated in 7 and crush injury in 1 case. According to Winquist classification, Thirtyseven cases were classified as typeⅠ(13 cases of typeⅠ-1,23 cases of Ⅰ-2 and 1 case of Ⅰ-3), eleven as type Ⅱ fracture ( 2 cases oftype Ⅱ-1, 8 cases of Ⅱ-2 and 1 case of Ⅱ-3). The time from injury to admission was an hour to a week. Emergency operation was performed in 19 cases and the other 29 patients were given operation within 3 days. Results All cases were followed up for an average of 5 months (3-12 months). Among them, the average healing period was 21 weeks (826 weeks) and no nonunion, delayed union and breakage of nailings occurred. The complications included 2 infections, 5 pains, and 4 deformities. Based on Johner and Ｗrubs standard, the results were excellent in 39 cases, good in 7 cases and fair in 2 cases, The excellent and good rate was 95.8%. Conclusions ICDN has excellent biomechanical characteristics which can provide a flexible fixation in treating femoral shaft fractures. The operation is simple and is one of the good techniquesin treating femoral shaft fractures.
【Abstract】 Objective To discuss the techniques and advantages of closed reduction and intramedullary nail ing intreating femoral shaft fracture without cannulated femoral reamer. Methods From January 2006 to June 2007, 24 cases offemoral shaft fracture were treated with closed reduction and intramedullary nail ing. Among them, there were 14 males and 10 females, with the average age of 38.3 years (ranging from 18 years to 63 years), with 7 left legs and 17 right legs. The average course of the disease was 7.6 days (ranging from 3 days to 20 days). According to the AO typing, there were 5 cases of type A, 6 of type B, 7 of type C1, 2 of type C2 and 4 of type C3. Closed reduction was achieved with manipulation and reaming of femoral canal was instructed by fluoroscopy. Results The operation time lasted from 100 minutes to 170 minutes, with the average time of 128.3 minutes. One patient was given a transfusion of 400 mL, and others were not. Twenty cases were followed up with the average time of 13.1 months (ranging from 6 months to 24 months). A mild to large amount of bony callus was showed on X-ray films 6 to 12 weeks postoperatively. Walking without crutches began at the average week of 22.2 (ranging from 15 to 30) postoperatively. Range of motion of the knee was 0° to 145.5°. No infection or break of the internal fixator occurred. Myositis ossificans with pain and insufficient flexion of hip (120°) happened in 1 case and the pain disappeared after non-steroid anti-inflammatory drugs were taken. Nonsymptomatic myositis ossificans occurred in 2 cases and no treatment was needed. Conclusion Closed reductionand intramedullary nail ing can help to protect the blood supply of fracture fragments and provide central fixation. The operation process will be more compl icated if cannulated femoral reamer is not available.
There were several methods, such as free single and folded fibulae autograft, composed tissue autograft, however, it is still very difficult to repair long segment bone defect. In December 1995, we used free juxtaposed bilateral fibulae autograft to repair an 8 cm of femoral bone defect in a 4 years old child in success. The key procedure is to strip a portion of the neighboring periosteal sleeve of juxtaposed fibulae to make bare of the opposite sides of the bone shafts, suture the opposite periosteal sleeves, keep the nutrient arteries, and reconstruct the blood circulation of both fibular by anastomosis of the distal ends of one fibular artery and vein to the proximal ends of the other fibular artery and vein, and anastomosis of the proximal ends of the fibular artery and vein to lateral circumflex artery and vein. After 22 months follow up, the two shafts of juxtaposed fibulae fused into one new bone shaft. The diameter of the new bone shaft was nearly the same as the diameter of the femur. There was only one medullary cavity, and it connected to the medullary cavity of femur. This method also cold be used to repair other long segment bone defect.
Objective To explore the value of electromagnetic navigation interlocking intramedullary nail in the treatment of femoral shaft fracture. Methods Between July 2012 and October 2013, 53 cases of femoral shaft fracture were treated. There were 40 males and 13 females, aged 16-52 years (mean, 38.3 years). The causes of injury were traffic accident in 28 cases, falling from height in 11 cases, falling in 7 cases, crush injury in 4 cases, and other in 3 cases. Of 53 cases, there were 3 cases of open fracture (Gustilo I degree) and 50 cases of closed fracture. Fracture was located in the proximal femur in 17 cases, middle femur in 29 cases, and distal femur in 7 cases. According to Winquist classification, 7 cases were rated as type I, 8 cases as typeⅡ, 22 cases as typeⅢ, and 16 cases as type IV; according to AO classification, 18 cases were rated as type 32-A, 28 cases as type 32-B, and 7 cases as type 32-C. The time from injury to operation was 3-11 days (mean, 5 days). Distal interlocking intramedullary nail was implanted using electromagnetic navigation. Results The distal locking nail operation with interlocking intramedullary nail was successfully completed under electromagnetic navigation; the one-time success rate of distal locking nail operation reached 100%; and the locking nail time was 5.0-9.5 minutes (mean, 7.0 minutes). Healing of incision by first intention was obtained after operation, and no complication of skin necrosis, infection, and sinus tract occurred. Fifty-three cases were all followed up 5-12 months (mean, 9 months). One case had hip pain and weaken middle gluteal muscle strength, and the symptoms disappeared after removing the nail. During the follow-up period, no broken nails, nail exit, infection, or re-fracture occurred. All fractures achieved clinical healing, and the healing time was 8-22 weeks (mean, 14.5 weeks). In 49 patients followed up 8 months, the Lysholm score was excellent in 44 cases, good in 4 cases, and acceptable in 1 case, with an excellent and good rate of 98%. Conclusion Electromagnetic navigation system is safe and reliable, with the advantages of high positioning accuracy, short operation time, and no radiation, the clinical application of the system for distal locking nail operation can obtain excellent short-term effectiveness.
【Abstract】 Objective The auto-control micro-motion intramedullary locking nail (AMLN) is designed, to reducethe incidence of delayed union and non-union of femoral shaft fractures fixed by interlocking intramedullary nails, and toobserve the cl inical effect of self-design AMLN in the treatment of femoral shaft fractures. Methods The distal and promixalnails were connected by the micro-motion locking structure, which could cause 1.0-1.5 mm axial micro-motion between fracture gaps. It could produce physical stimulus and conduction between fracture gaps in the course of fracture union. From December 2003 to May 2006, 32 cases of femoral shaft fractures were treated with AMLN, including 21 males and 11 females with the average age of 31.2 years (ranging from 20 years to 43 years). The trauma resulted from fall wounds in 3 cases, crash injuries in 1 case and car accidents in 28 cases. Twenty-nine cases were fresh fractures in different parts of the femoral shaft with transverse, obl ique, spiral and comminuted fractures of type I, II, III and IV. Three cases were old non-union fractures. The fresh fractures were treated by closed AMLN fixation, while the old fractures were treated by open AMLN nails after routine implantation of self bone. Results All the 32 cases were followed up for the average time of 11.5 months (rangeing from 8 months to 22 months). The X-ray films showed the fractures were healed 4.0 to 7.5 months after the operation, with the mean time of 5.1 months, and no break of the nail happened. One nail mildly bent in the comminuted fracture, and 2 patients felt sl ightly unwell at the needl ing point. According to the Klemm criterion for function, 26 cases were excellent, 5 good, 1 fair, and the choiceness rate was 96.88%. Conclusion With a suitable design, AMLN is easy to perform and helpful to quicken fracture union, and it is effective to treat femoral shaft fractures.
ObjectiveTo investigate the effectiveness and indications of deferred dynamization for nonunion of femoral shaft fractures after static interlocking nail. MethodsBetween March 2006 and June 2012, 26 patients with nonunion of femoral shaft fractures after static interlocking nail were treated with deferred dynamization, and their data were analyzed retrospectively. There were 19 males and 7 females with a mean age of 38 years (range, 22-46 years). Nonunion was found at 10-29 months (mean, 16 months) after open reduction and static interlocking nail for fracture fixation. Referring to Papakostidis criteria for nonunion, there were 7 cases of stable/hyperplastic type, 3 cases of stable/atrophic type, 12 cases of unstable/hyperplastic type, and 4 cases of unstable/atrophic type. ResultsAll incision healed at first stage. Twenty-six patients were followed up 10-28 months (mean, 14 months). A total of 16 (61.5%) fractures healed at 4-11 months after deferred dynamization (7 cases of stable/hyperplastic type and 9 cases of unstable/hyperplastic type); the other 10 fractures failed to heal. The healing rate was 100% (7/7) in patients with stable/hyperplastic type nonunion, 75% (9/12) in patients with unstable/hyperplastic type nonunion, and 0 in patients with stable/atrophic type and unstable/atrophic type nonunion. ConclusionDeferred dynamization is an effective method for hyperplastic nonunion of femoral shaft fractures after static interlocking nail, but it is not suitable for atrophic nonunion of femoral shaft fractures.