A new femoral distractor used in close reduction and internal fixation with antegrade intramedullary nail for femoral shaft fractures

Abstract

Objective To introduce a novel femoral distractor which is applied in close reduction and internal fixation (CRIF) with antegrade intramedullary nail for femoral shaft fractures. Methods From September 2010 to March 2015, 85 patients with femoral shaft fracture were treated by CRIF with antegrade intramedullary nail in which our self-designed novel distractor was used. They were 64 males and 21 females, with an average age of 36.6 years. By AO classification, we had 32 cases of type 32-A, 40 cases of type 32-B, and 13 cases of type 32-C. The intervals between injury and surgery averaged 7.5 days (range, from 1 to 16 days). The fracture was located at the upper shaft in 26 cases, at the middle shaft in 57 cases, at the middle shaft and ipsilateral neck in one, and at the lower shaft and ipsilateral intertrochanteric site in one. Their operation time, intraoperative blood loss, intra- and post-operative complications, and fracture union time were recorded and analyzed. Results Successful close reduction was achieved in all the 85 patients with no ia-trogenic injury to major vessels or nerves. Operation time averaged 105.5 minutes; time for X-ray exposure av-eraged 25.8 seconds; intraoperative blood loss averaged 209.2 mL . The 85 patients received follow-ups from 8 to 24 months (mean, 16.3 months). Fracture union was achieved in 83 cases after an average duration of 7.8 weeks (range, from 4 to 12 weeks), but nonunion occurred in 2 cases. One-year follow-ups revealed recovery of normal function of the affected knee in all, with no limb shortening >10 mm, rotational angulation >15°, or lateral or anteroposterior angulation >10°. No incision infection, deep vein thrombosis or pulmonary embolism happened during the entire follow-up. Conclusion Our self-designed novel distractor can facilitate CRIF with antegrade intramedullary nail for femoral shaft fractures, and avoid the complications and inconvenience associated with a traction table. Key words: Femoral fractures; Fracture fixation, intramedullary; Bone nails; Reduction system