What is the fracture displacement influence to fracture non-union in intramedullary nail treatment in subtrochanteric fracture?

Abstract

IntroductionThe fracture displacement in intramedullary nail in femoral subtrochanteric fracture may cause fracture non-union. We retrospectively analysed our recent experience to clear the influence about fracture displacement in intramedullary nail in femoral subtrochanteric fracture. Materials and methodsThis study includes 36 patients in the intramedullary nail group followed up for more than 12 months; these patients suffered from femoral subtrochanteric fracture from 2009.1–2014.12 in our hospital. The operation time, amount of bleeding, length of hospital stay, fracture healing time, Harris function score of hip joint, fracture displacement, TAD and postoperative complications were summarized. ResultsThe average follow up time was 20.2 months, average operation time was 126 min, average amount of bleeding was 258 ml, average hospitalization was 13.1 days, average fracture healing time was 6.8 months, average fracture displacement was 1.23 cm, average TAD was 19.7 mm and average hip Harris function score was 82.5 points. Five cases suffered non-union. Only the fracture displacement degree made significant correlation with fracture non-union. All union patients had a fracture displacement less than 2.2 cm and all non-union patients had a fracture displacement more than 2.5 cm. ConclusionIntramedullary nail treatment must focus on fracture reduction and recovery of femoral medial support with assisted incision technique or closed cerclage wire technique when necessary. In our opinions, only the fracture displacement degree made significant correlation with bone non-union and all cases achieved bone union when it less than 2.2 cm according to our statistics. But it still need further research to find out the displacement of fracture fragments could be tolerant.