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Abstract
BackgroundFemoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications.MethodsWe reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications.ResultsMedian age was 53 years, and median weight was 70 kg (range 50–103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% “excellent” reduction for subtrochanteric fractures, while 81 versus 79% “excellent” reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique.ConclusionsOur results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail.Level of evidence:IV
Highlights
Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia
We reviewed 50 patients treated with postless distraction nailing technique for subtrochanteric and femoral shaft fractures and compared them with our historical case series (95 patients)
Outcomes The following data were collected for all patients: age, gender, weight, diagnoses [8], type and size of nail, surgical timing, Trendelenburg angles during surgery, and quality of reduction according to Baumgaertner classification for subtrochanteric
Summary
Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications. Femoral reduction and nailing for femoral shaft fractures is usually performed with a standard traction table using a perineal post. This technique may occasionally result in perineal complications, including pudendal nerve neurapraxia and vaginal or scrotal edema. The aim of this paper is to compare post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications
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