Mechanical evaluation of revision surgery for femoral shaft nonunion initially treated with intramedullary nailing: Exchange nailing versus augmentation plating
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Femoral shaft
Femoral fracture
Clinical analysis on the treatment for femoral shaft fractures with intramedullary interlocking nail
Objective To discuss the application of intramedullary interlocking nail in the treatment of femoral shaft fractures.Methods Retrospective analysis was given to 98 cases of femoral shaft fractures treated with intramedullary interlocking nails from January,1998 to December,2003.Results All cases were followed up,and 97 cases healed 13 to 24 weeks after operation(average 18.1 weeks).Joint function of coax,knee,ankle,recoveried.It bleeded 100～1200ml;Surgery time:50～140min,average 70.8min.In one case the far-end nail could not lock hole after operation,the host nail of one patient break three months later,far-end nail break in one patient four months later,no other complications was found.Conclusion Intramedullary interlocking nail is effective in the treatment of femoral shaft fracture.
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To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation.The 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.The 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.Compared 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.对附加钢板技术治疗股骨干髓内钉术后骨不连的历史、现状和进展进行综述。.广泛查阅国内外关于附加钢板技术治疗股骨干髓内钉术后骨不连的临床研究文献，并进行综合分析。.自 1997 年附加钢板技术已成功用于治疗股骨干髓内钉术后骨不连，根据原髓内钉是否失效，可分为保留原髓内钉和更换原髓内钉两类。该技术不仅适用于简单骨不连，还可用于合并严重畸形的复杂性骨不连。相比更换髓内钉、更换外侧钢板和双钢板技术，附加钢板技术手术创伤更小，骨折愈合时间更短，骨折愈合率更高，患者能更早重返社会和工作。然而，该技术也存在一些问题有待解决，包括双皮质螺钉固定困难、缺乏适合股骨干解剖型附加钢板以及缺乏术后功能和生活质量的评估研究。.相比其他翻修固定方式，附加钢板技术能够获得更高的骨折愈合率和更好的临床预后。然而，术后患者能否在功能和生活质量方面进一步获益还有待证实。此外，还需要更高质量的临床对照研究深入证明其是否确实优于其他翻修固定方式。.
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Objective:To analyze the causes of femoral nonunion,and to investigate clinical effects of interlocking intramedullary nails for the treatment of femoral nonunion. Methods:From January 2001 to January 2009,31 patients with femoral nonunion were treated with interlocking intramedullary nail. Among the patients,19 patients were male and 12 patients were female,ranging in age from 18 to 73 years,with an average of 32.5 years. Twenty-four patients had nonunion of femoral shaft,and 7 patients had nonunion at the distal femur. The patients with nonunion of femoral shaft were treated with normal interlocking intramedullary nails and the patients with nonunion at the distal femur were treated with supracondylar femur interlocking nails. The reamed technique was used in all patients. All the patients were treated with internal fixation with interlocking intramedullary nails and autogenous bone transplantation. Results:All the patients were followed up,and the duration ranged from 14 to 72 months,with a mean of 23 months. Thirty patients got bony union,and an average healing time was 4.6 months (3 to 6 months). Another patient healed after bone re-transplantation and intramedullary nail fixation. All the hip joints recovered to normal function. The average HSS knee score was 89.97±5.21 at 1 year after operation. Conclusion:The use of interlocking intramedullary nail for the treatment of femoral nonunion has follow advantages:reliable fixation,good stability,in favor of early functional exercise of extremities and joints. Reaming combined with autologous bone graft may be good treatment methods.
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Objective: Evaluation of reamed intramedullary nailing for the treatment of replacement after intramedullary nailing of femoral stem hypertrophic nonunion of the clinical curative effect and the operation indications.Methods: From 1998 April to 2009 June using reamed intramedullary nailing in the treatment of 11 cases of replacement after intramedullary nailing of femoral stem hypertrophic nonunion.There were 9 male,2 female,age 23-61 years old.An average of 36.2 years,the fracture site in the femur on 1 / 3 in 2 cases;in 6 cases 1 / 3;1 / 3 in 3 cases.The original fracture Winquist-Hansen type: type I in 2 cases,II 3 cases,III 4 cases,IV 2 cases.Results: 11 patients were followed up,time: 11 to 56 months,an average of 27.4 months,2 cases of limb shortening in 1 cm.Another 4 patients did not obtain bony healing.In 3 cases the additional plate again with autologous iliac bone graft,1 cases of distal locking nail dynamization,again after the intervention to obtain bony healing,healing time of 6-16 months,mean 8.3 months.Conclusion: Reamed intramedullary nailing is the replacement treatment after intramedullary nailing of femoral hypertrophic nonunion by traditional methods,based on the mechanical stability and clinical observations,more suitable for femoral nonunion.
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Objective:To explore the optimal operation manners of interlocking intramedullary nail in treating femoral shaft fractures and its therapeutic effects.Method: Forty five cases (48 limbs) of femoral shaft fractures treated with inter locking intramedullary nail were reviewed.The diaplasis of the fracture was close or open with only a little incision, and the two sides of the fracture were locked with nails by a tris dimension aim implement.Result: All cases were followed up (averaged 13.5 months).91.1 percent of all cases showed excellent function of joints and limbs, and 89.6 percent showed union of fracture (averaged 6.8 months).Infections were found in 1 case (2.1 percent) and nail broken in 1 case (2.1 percent) too.Conclusion: Inter locking intramedullary nail is the first choice in treating femoral shaft fractures.Static locking should be a routine way, and closed reduction, limited enlarging marrows cavity and no or minimal stripping periosteum should be emphasized in the operation of femoral shaft fractures.
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Objective To investigate the effect of interlocking intramedullary nailing for femoral fracture nonunion. Methods 23 cases of femoral fracture nonunion were treated with interlocking intramedullary nailing and early CPM exercises. Results 23 cases were followed up for 6~24 months. All fractures healed in 12~19 weeks, 16.3 on average. The knee function was improved in all cases significantly. Conclusions It is an ideal way to treat femoral fracture nonunion with interlocking intramedullary nailing.
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Clinical Analysis on the Treatment for Femoral Shaft Fractures with Intramedullary Interlocking Nail
Objective To discuss the application of intramedullary interlocking nail in the treatment of femoral shaft fractures.Methods Retrospective analysis was given to 112 cases of femoral shaft fractures treated with intramedullary interlocking nails from February,1996 to April,2003.Results 98 cases out the 112 were followed up,and they all healed 13 to 26 weeks after operation (average 18.2 weeks)with no complications such as infection,fracture nonunion,break of the nail and others.Conclusions Intramedullary interlocking nail is effective in the treatment of femoral shaft fracture.
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