Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study
Noelle L. Van RysselbergheRyan SeltzerTaylor A. LawsonJustin KuetherParker WhitePhillip GrisdelaHayley DaniellArya AmirhekmatNelson MerchanThomas SeaverAneesh V. SamineniAugustine M. SaizDaniel NgoClark DormanEden EpnerReese SvetgoffMegan TerleMark LeeSean T. CampbellGregory D. DikosStephen J. WarnerTimothy S. AchorMichael J. WeaverPaul TornettaJohn A. ScolaroJohn J. WixtedTimothy G. WeberMichael J. BellinoL. Henry GoodnoughMichael J. GardnerJulius A. Bishop
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OBJECTIVE: To compare clinical and radiographic outcomes following retrograde intramedullary nailing vs locked plating of “extreme distal” periprosthetic femur fractures, defined as those which contact or extend distal to the anterior flange. METHODS Design: Retrospective review Setting: Eight academic level I trauma centers Patient Selection Criteria: adult patients with periprosthetic distal femur fractures at or distal to the anterior flange (OTA/AO 33B-C[VB1]) treated with rIMNs or LPs. Outcome Measures and Comparisons : The primary outcome was reoperation to promote healing or to treat infection (re-operation for elective removal of symptomatic hardware was excluded from this analysis). Secondary outcomes included nonunion, delayed union, fixation failure, infection, overall reoperation rate, distal femoral alignment, and ambulatory status at final follow-up. Compared, were patients treated with rIMNs or LPs. RESULTS: 71 patients treated with rIMNs and 224 patients treated with LPs were included. The rIMN group had fewer points of fixation in the distal segment (rIMN: 3.5 +/- 1.1 vs LP: 6.0 +/- 1.1, p<0.001) and more patients who were allowed to weight-bear as tolerated immediately post-operatively (rIMN: 45%; LP: 9%, p<0.01). Reoperation to promote union and/or treat infection was 8% in the rIMN group and 16% in the LP group (p=0.122). There were no significant differences in nonunion (p >0.999), delayed union (p=0.079), fixation failure (p>0.999), infection (p=0.084), or overall reoperation rate (p>0.999). Significantly more patients in the rIMN group were ambulatory without assistive devices at final follow-up (rIMN: 35%, LP: 18%, p=0.008). CONCLUSIONS: Retrograde intramedullary nailing of extreme distal periprosthetic femur fractures has similar complication rates compared to locked plating, with a possible advantage of earlier return to weight-bearing. Surgeons can consider this treatment strategy in all fractures with stable implants and amenable prosthesis geometry, even extreme distal fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.Case: In recent years, atypical femoral fractures (AFFs) associated with bisphosphonate use have increasingly been reported, but current definitions limit their diagnosis to native femora. Atypical periprosthetic fractures are rare. We present a case of a Vancouver type-C periprosthetic fracture that was recognized as an AFF following nonunion. Conclusion: Bisphosphonate-associated AFFs can present as periprosthetic fractures. Delayed recognition of the role of bisphosphonates in a periprosthetic fracture may lead to a worse outcome, including a delay in diagnosis, delayed union, and failure of fixation.
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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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Introduction Elastic stable intramedullary nailing (ESIN) has been a common method of treatment of diaphyseal femur fracture in children. Though they are used in length stable fracture with favourable results, their use is debated in case of length unstable variants. The objective of the study was to evaluate outcome of these nails in length unstable diaphyseal femur fracture in children.
MethodsWe retrospectively reviewed seven fractures in seven children treated with ESIN for functional outcome.
ResultsTotal of seven patients with seven unstable femur fractures were studied. There was male predominance with 71.4%. The fracture united at a mean duration of 12 wks. The overall Flynn scoring showed 71.4 % excellent and 28.6 % satisfactory result.
ConclusionElastic stable intramedullary nailing can be safely used in length unstable variant of femur fracture in children.
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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 investigate the clinical effect of retrograde interlocking intramedullary nail for supracondylar femur fractures. Methods The retrograde i nterlocking intramedullary nails were used for 50 cases of fractures of the supr acondylar femur.The patients were directed to taking function exercise 72h after operation. Result 50 cases were followed up for 4～24 months,10 months on avera ge.The time of bone healing was 3～8 months.The knee function recovered well wit h excellent result rate of 96%. Conclusion Retrograde interlocking intramedullar y nails can ensure intrinsic stability with simple procedures.Function exercise can be used soon after operation to ensure quick fractures healing and have fewe r complications.It is an optimal measures for fractures of supracondylar femur.
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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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Femur fracture
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Background: Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. Closed reduction and intramedullary interlocking nailing is the surgical treatment of choice for the closed shaft fractures of femur. Present study conducted to study the principles of intramedullary interlocking nailing and to assess the outcome of the patient.
Methods: The present study comprises of 30 cases of fracture shaft of the femur in adults about >20 years old. All the fractures, which were included in the study were traumatic in origin, most of them are due to road traffic accidents.
Results: The delayed union rate in our series was 6.67%. There were no non-unions.
Conclusions: It is concluded that closed intramedullary interlocking nailing method given good result in treatment of shaft fractures of femur.
Keywords: Intramedullary nailing, Femur, Diaphysis fractures, Interlocking
Interlocking
Femoral shaft
Diaphysis
Femur fracture
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