Objective To evaluate the clinical efficacy of closed reduction intramedullary nailing in the treatment of ipsilateral femoral shaft fracture with intertrochanteric fracture and to analyze the risk factors for fracture nonunion. Methods A retrospective analysis was performed on 31 patients (23 males and 8 females, aged from 21 to 73 years old who underwent closed reduction and intramedullary fixation for ipsilateral femoral shaft fracture with intertrochanteric fracture in our hospital from January 2010 to December 2016. The intramedullary nail type, number of blocking nails, operation time, blood loss, healing time, limb shortening and hip joint HHS function score in femoral shaft patients with intertrochanteric fractures were observed and recorded. The possible factors of fracture nonunion were analyzed by single factor and multiple factors. Results All patients were followed up for 12 to 48 months, with an average of 20.1 months. Possible causes of fracture nonunion were analyzed. There were statistical significance in the number of blocking nails and fracture type (P<0.05), while there was no statistical significance in other factors such as injury mechanism, and operation time (P>0.05). Multivariate analysis was conducted for the above two factors. The number of blocking nails (OR=2.845, 95% CI 2.164-3.741) and fracture type (OR=3.388, 95% CI 1.966~5.840) were the independent risk factors. Conclusions The independent risk factors of fracture nonunion are the small number of blocking nails and the comminuted fracture of femoral shaft. Closed reduction intramedullary nailing in the treatment of ipsilateral femoral shaft with intertrochanteric fracture is safe and effective and can improve the quality of life.
Key words
/
Intramedullary nail /
Femoral shaft fracture /
Intertrochanteric fracture
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Seong YJ, Jang JH, Jeon SB, et al. Characteristics and surgical outcomes of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures treated with closed intramedullary nailing: a Review of 31 consecutive cases over four years at a single institution[J]. Hip Pelvis, 2019, 31(4):190-199. DOI: 10.5371/hp.2019.31.4.190.
[2] Rana R, Patra SK, Khuntia S, et al. Traumatic posterior dislocation of hip with ipsilateral fracture of shaft of femur: temporary fixator-assisted reduction and final fixation with interlocking nail[J]. Cureus,2019,11(8):e5488. DOI: 10.7759/cureus.5488.
[3] Mohan K, Ellanti P, French H, et al. Single versus separate implant fixation for concomitant ipsilateral femoral neck and shaft fractures: A systematic review[J]. Orthop Rev (Pavia),2019,11(2):7963. DOI:10.4081/or.2019.7963.
[4] Rajasekaran RB, Jayaramaraju D, Palanisami DR, et al. Ipsilateral acetabular fracture with displaced femoral head and femoral shaft fracture: A complex floating hip injury[J]. Case Rep Orthop, 2018, 2018: 4937472. DOI: 10.1155/2018/4937472.
[5] Puram C, Pradhan C, Patil A, et al. Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures[J]. Injury,2017,48 Suppl 2:S72-S77. DOI: 10.1016/S0020-1383(17)30498-9.
[6] Singh NK, Sharma V, Trikha V, et al. Is PFNA-II a better implant for stable intertrochanteric fractures in elderly population ? A prospective randomized study[J]. J Clin Orthop Trauma,2019, 10 (Suppl 1):S71-S76. DOI: 10.1016/j.jcot.2019.02.004.
[7] Zhang W, Antony XR, Decruz J, et al. Risk factors for mechanical failure of intertrochanteric fractures after fixation with proximal femoral nail antirotation (PFNA II): a study in a Southeast Asian population[J]. Arch Orthop Trauma Surg, 2020, 141(4): 569-575. DOI: 10.1007/s00402-020-03399-2.
[8] Radaideh AM, Qudah HA, Audat ZA, et al. Functional and radiological results of proximal femoral nail antirotation (PFNA) osteosynthesis in the treatment of unstable pertrochanteric fractures[J]. J Clin Med, 2018, 7(4): 78. DOI: 10.3390/jcm7040078.
[9] Luan F, Wang W, Liu N, et al. Digital Assessment of the implantation angle of proximal femoral nail antirotation helical blade using CT three-dimensional reconstruction[J]. J Invest Surg, 2019, 32(2):111-117. DOI: 10.1080/08941939.2017.1381788.
[10] Compton E, Andras LM, Murgai RR, et al. Isolated femoral shaft fractures in children rarely require a blood transfusion[J]. Injury, 2020, 51(3):642-646. DOI: 10.1016/j.injury.2020.01.005.
[11] Cheng T, Xia R, Yan X, et al. Double-plating fixation of comminuted femoral shaft fractures with concomitant thoracic trauma[J]. J Int Med Res, 2018, 46(1):440-447. DOI: 10.1177/0300060517720317.
PDF(2111 KB)
