Treatment of long-segment fracture in middle-up part of femoral shaft with long proximal femoral nail antirotation of AO/ASIF

Abstract

Objective To investigate the operative method and evaluate the clinical outcomes of long proximal femoral nail ant-rotation(PFNA-long)in treating long-segment fracture in middle-up part of femoral bone.Methods From June 2006 to December 2009,32 cases of long-segment fracture in middleup part of femoral shaft were treated by closed reduction or limited open reduction and fixation with PFNA-long,including 30 males and 2 females with an average age of 3.8.8 years(range,20-69).All patients had closed fractures in shaft of femur.The average time from injury to operation was 4.2 days(range,3 hours to 12 days).All fractures were fixed with the PFNA-long.The patients were followed at 1,2,3,6,9,12 month after surgery,respectively,and next time at least once per year.The clinical outcomes were evaluated according to Harris criteria and radiological examinations.Results The mean operating time of all cases was 55 minutes(range,35-90),and the mean blood loss during surgery was 75.6 ml(ranged,30-150 ml).All patients walked with walking aid 4-7 days after surgery.They were followed up for 9-37 months.All fractures healed after 3.1-5.4 months(mean 3.7 months).No complications such as infection,lower limb vein infarction,cut-out or breakage of the implants occurred.But 2 cases had hip internal reverse-lamb shortening malformation,According to Harris criteria,the clinical results were excellent in 23 cases,good in 7,and moderate in 2,and the excellent and good rate was 93.75%(30/32).Conclusion PFNA-long is an effective and minimally invasive method for long-segment fracture in middle-up part of femoral shaft,with minimally invasive,high fixation-strength and accord with biomechanics characteristics;and with a high rate of bone union,early functional recovery and less complications. Key words: Femoral fractures; Fracture fixation,intramedullary; Internal fixators