Design and clinical application of a new distraction reduction device for closed reduction and internal fixation of femoral shaft fracture

Abstract

Objective To evaluate a new self-designed device to assist closed reduction of femoral shaft fracture. Methods From January 2012 to June 2014, 18 cases of femoral shaft fracture received closed reduction and internal fixation with anterograde intramedullary nails on a popular fluoroscopic orthopedic table. The new self-designed distraction reduction device was used during the operation. The patients contained 14 males and 4 females, aged from 21 to 48 years (mean, 33.6 years). Fracture AO classification was type 32A2 in 8 cases, 32A3 in 5 cases, 32B1 in 3 cases and 32B2 in 2 cases. Mean pre-operation time was 5.5 days (range, 3-10 days). Results Operation time ranged from 85 to 130 minutes (mean, 96 minutes). Intraoperative bleeding ranged from 120 to 180 ml (mean, 150 ml). X-ray fluoroscopy time ranged from 20 to 40 seconds (mean, 25 seconds). Frequency of nailing into the distal fracture end was 1 to 3 times (mean, 1.5 times). One case had additional small incision for open reduction. Fourteen cases experienced external rotational deformity of the femur from 2° to 6° (mean, 3.6°) after surgery, and four cases were free of rotational deformity. All patients were followed up for 6 to 20 months (mean, 12.8 months). All patients had fracture healing in a period of 4.5 to 8.5 months (mean, 5.5 months). No iatrogenic fracture, infections, nail breakage or other complications occurred. At the final follow-up, knee score according to the system of hospital for special surgery (HSS) was found to be excellent in 12 cases, good in 4, and fair in 2, giving an excellent-to-good rate of 89%. Conclusion The new self-designed distraction device is an easy-to-operate instrument that is useful in assisting distraction and reduction of the femoral shaft fracture difficult to be fixed with routine methods as well as intramedullary nailing just on a popular fluoroscopic orthopedic table. Key words: Femoral fractures; Fracture fixation, intramedullary; Bone nails; Surgical instruments