Patterns of Non-union of Femoral Shaft Fracture in Basra Teaching Hospital. A Retrospective review.

Mofeed Alwaaly

doi:10.33762/bsurg.2021.131908.1012

Abstract

Background and objectives: Long bone fractures are witnessed almost every day in the orthopedic practice. Femoral shaft fractures (FSF) generally are due to high energy trauma in working age group. non-union of FSF is not infrequently encountered challenge. This study reviews cases of FSF that ends up with non-union in Basra Teaching Hospital to explore some factors related to non-union. Patients and methods: A retrospective case series were conducted in Basra Teaching Hospital from January 2012 - June 2014 including 124 patient with FSF. Thirty three patients were identified during the study period (18 months), demographic criteria and injury patterns, initial treatment, early complications, subsequent interventions and fate of the patients are described. Results: Among 33 patients with nonunion FSF, 23 were males and 10 females, aged from 15 to 60 years (mean = 35). High energy trauma is the chief source of FSF in this analysis . After 9 - 12 months from initial trauma, patients ends up with non-union, 9 atrophic, 13hypertrophic and 11 infected non-union. Thirty patients underwent revision surgery, with addition of bone graft , three patients no revision surgery, within the study period ( 18 months ), 25achieved successful union or showing signs of progressive union , 3 had united fractures with chronic osteomyelitis , 5 non-united fractures . Conclusion: nonunion of FSF a great challenge to the orthopedic surgeon and the patient life and development, to overcome this problem both the surgeon and the patient should cooperate to avoid this tragedy story.

Highlights

Though there is no widely accepted definition for non-union, broadly it refers to the cessation of bone healing process in the expected time frame for certain fracture, a commonly cited definition is based to the guidance document released by the American Food and Drug Administration at 1998 that defines non-union as “established when a minimum of 9 months has elapsed since injury and the fracture shows no visible progressive signs of healing for 3 months” 1
Systemic and local factors interplay to contribute for the normal bone healing process, systemic diseases and condition as well as local factors that contribute for the development of non-union were discussed thoroughly across the literature, this study was prepared to explore which conditions are commonly involved when dealing with a patient with non-union of femoral shaft fractures in the daily practice of orthopaedic surgeons serving in Basrah Teaching Hospital
Thirty three patients were identified during the study period (18 months), demographic criteria and injury patterns, initial treatment, early complications, subsequent interventions and fate of the patients are described below: 1- Age and Gender distribution : among 33 patients, 23 were males and 10 females, aging from 15 to 60 years

Summary

Introduction

Though there is no widely accepted definition for non-union , broadly it refers to the cessation of bone healing process in the expected time frame for certain fracture , a commonly cited definition is based to the guidance document released by the American Food and Drug Administration at 1998 that defines non-union as “established when a minimum of 9 months has elapsed since injury and the fracture shows no visible progressive signs of healing for 3 months” 1. Non-union is usually defined as a failure to achieve clinical union at 6–12 months following fixation or if there is no healing progress during the last 3 months or an implant failure is obvious 2, 3, 4. Systemic and local factors interplay to contribute for the normal bone healing process, systemic diseases and condition as well as local factors that contribute for the development of non-union were discussed thoroughly across the literature , this study was prepared to explore which conditions are commonly involved when dealing with a patient with non-union of femoral shaft ( and perhaps other long bone ) fractures in the daily practice of orthopaedic surgeons serving in Basrah Teaching Hospital. Patterns of Non-union of Femoral Shaft Fracture in Basrah Teaching Hospital.

Patients and methods

Results

Method of fixation

Discussion

Conclusion