Femoral Shaft Fractures Research Articles

Nailing precision: a systematic review and meta-analysis of randomized controlled trials comparing piriformis and trochanteric entry points for femoral antegrade nailing.

Entry point selection, a crucial aspect of femoral antegrade nailing, can impact nail fit and consequently fracture reduction. In adults, the standard entry portals used are the piriformis fossa and the tip of the greater trochanter. Previous systematic reviews comparing the two techniques have not been limited to Randomized Controlled Trials (RCTs) and have not consistently included the same available RCTs. A systematic search of comparative studies regarding entry portal selection in femoral antegrade nailing was conducted on seven databases. Only Prospective RCTs comparing trochanteric and piriformis entry in the management of trochanteric or diaphyseal femur fractures were eligible for inclusion. Ultimately, only 6 RCTs were found eligible for inclusion. Five of the six included studies reported on operative time. The resulting mean difference (MD) illustrated a significant decrease in operative time by approximately 21.26min (95% CI - 28.60 to - 13.92, p < 0.001) using trochanteric entry. Fluoroscopy exposure was reported on by four studies, however, only two studies were included in the analysis due to different reporting methods. Trochanteric entry used significantly less fluoroscopy than piriformis entry (MD -50.33s, 95% CI - 84.441 to - 16.22, p = 0. 004). No significant difference in malalignment rates, delayed union rates, nonunion rates, pain scores, or complication rates was found. The significant differences found in operating time and fluoroscopy time align with those in other studies. While we were not able to pool the data on functional outcome scores, none of the included studies found a significant difference in scores by their last follow-up. Both approaches demonstrate comparable functional outcomes and safety profiles, indicating the choice of entry point should be at the discretion of the surgeon based on technique familiarity and fracture characteristics.

Substantial rise in usage of elastic stable intramedullary nailing in treatment of unstable paediatric femoral shaft fractures by antegrade and retrograde methods: the real impact

Substantial rise in usage of elastic stable intramedullary nailing in treatment of unstable paediatric femoral shaft fractures by antegrade and retrograde methods: the real impact

Findings Associated With Nonaccidental Trauma in Children With Isolated Femoral Diaphyseal Fractures.

Pediatric patients with isolated femoral diaphyseal fractures are difficult to assess for nonaccidental trauma (NAT). The purpose of this study was to determine (1) if there are any demographic features of isolated femoral diaphyseal fractures associated with suspected NAT and (2) if there are clinical signs associated with isolated femoral diaphyseal fractures associated with suspected NAT. All patients with femoral diaphyseal fractures from January 2010 to June 2018 were reviewed. We included patients younger than 4 years old with isolated femoral diaphyseal fractures. We excluded patients 4 years old and older, polytraumas, motor vehicle collisions, and patients with altered bone biology. Diagnosis of suspected NAT was determined by review of a documented social work assessment. We recorded fracture characteristics including location along femur as well as fracture pattern and presence of associated findings on NAT workup including the presence of retinal hemorrhage, subdural hematoma, evidence of prior fracture, or cutaneous lesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these associated findings were calculated. Totally, 144 patients met the inclusion criteria. Social work was consulted on 50 patients (35%). Suspected NAT was diagnosed in 27 patients (19%). The average age of patients with suspected NAT was 0.82 and 2.25 years in patients without NAT ( P <0.01). The rate and type of skin lesions present on exam were not different between the 2 groups. Patients with suspected NAT had no findings of retinal hemorrhage or subdural hematoma, but 5 of 27 patients (19%) had evidence of prior fracture on skeletal survey. The sensitivities of retinal hemorrhage, subdural, and skeletal survey were 0%, 0%, and 19% and the specificities of all were 100%. The NPVs were 39%, 27%, and 63%, respectively. The PPV of skeletal survey was 100%. Since there were no patients in this study with positive findings of retinal hemorrhage or subdural hematoma, the PPV for these could not be assessed. In the current study, signs of NAT such as skin lesions, retinal hemorrhage, subdural hematoma, and evidence of prior fracture on skeletal survey may not be helpful to diagnosis suspected NAT in patients with an isolated femoral diaphyseal fracture. Level III-diagnostic study.

Elastic Stable Intramedullary Nailing in Length Stable Versus Unstable Pediatric Femoral Shaft Fractures: A Comparison of Clinical, Radiographic, and Pedobarographic Outcomes.

Pediatric diaphyseal femoral fracture (PDFF) is one of the most common injuries requiring hospitalization. Elastic stable intramedullary nailing (ESIN) is commonly used for PDFFs in ages 5 to 11. The optimal treatment method for length unstable PDFF is a subject of ongoing debate. This study aimed to compare clinical, radiographic, and pedobarographic outcomes of ESIN between length stable and unstable PDFF. We retrospectively reviewed patients undergoing ESIN treatment for isolated PDFF between 2016 and 2021. Exclusion criteria were (1) history of ipsilateral or contralateral lower extremity fractures, (2) highly comminuted or segmental fractures, (3) body weight >50kg, and (4) comorbidities affecting bone quality, range of motion, or neurologic status. The patients were divided into 2 groups according to length stability. Clinical, radiographic, and pedobarographic data were then assessed to compare groups. Twenty-five patients were included (17 length stable and 8 length unstable PDFF) with a mean age of 73.6±17.8 months. There was no significant difference between groups in age, side of injury, body weight, follow-up duration, and nail-canal diameter ratio. Mean deformity in the fracture site in the early postoperative x-rays was not significantly different between groups ( P =0.661). After a mean follow-up of 27.8±14.2 months (range, 12-67), there was no significant difference in mechanical axis deviation, distal femur joint orientation angle, or limb-length discrepancy in both groups. The pedobarographic assessment revealed that the length unstable group had a significantly higher external foot progression angle in the injured extremity (9.8°±6.9° vs. 1.3°±5.6°, P =0.031). However, the length stable group had no significant difference in the foot progression angle (4.9°±5° vs. 3°±4.3°, P =0.326). There was no significant difference in either group for other pedobarographic parameters. ESIN is a safe and effective option for length-unstable PDFF, yet attention should be paid to the rotational alignment. Although significant external rotation deformity occurs in length-unstable PDFF, it has no implications for the other pedobarographic parameters. Level IV.

Femoral shaft displacement and Winquist classification provide predictive characteristics for combined femoral neck and femoral shaft fractures

ObjectivesThe goal of this study is to establish radiographic features and characteristics of patient injury in cases of femoral shaft fractures that predict the presence of ipsilateral femoral neck fractures (IFNFs). MethodsPatient data was retrospectively assessed from a single level I trauma center through the electronic health record using (Current Procedural Terminology) CPT codes for both isolated and combined ipsilateral femoral shaft and neck fractures. Demographic information, injury characteristics, and independently reviewed radiographic features were collected and compared against the same information from a group of isolated femoral shaft fractures. Multivariable logistic regression was performed to identify risk factors for concomitant IFNFs and their respective odds ratios. A probability algorithm for assessing ipsilateral femoral neck fractures based on independent multivariate predictors was constructed and used. ResultsA total of 113 patients with either isolated femoral shaft fractures or combined femoral shaft and IFNF (n = 33) met inclusion criteria and were identified for this study. Fracture displacement was most strongly associated with increased risk of combined injury with an aOR of 25.64 (95 %CI = 5.96–110.28) for every 100 % displacement. Motorcycle crash (MCC) was the mechanism associated with the highest risk of combined injury, with an aOR of 9.85 (95 % CI = 1.99–48.74). Combined injury was also correlated with lower Winquist score and presentation with a closed fracture, with aORs of 0.38 (95 %CI = 0.21 - 0.68) and 11.61 (95 %CI = 1.93–69.94), respectively. Presence of at least 3 of the statistically significant variables produced a positive predictive value (PPV) of ≥ 89 % for combined femoral shaft and IFNF. ConclusionsIdentification of combined femoral shaft and IFNF is of critical importance when caring for orthopedic trauma patients. While diagnosis remains a challenging task, MCC mechanism, >100 % fracture displacement, and lower Winquist classification were found to be associated with combined injuries. The combination of these variables might assist in predicting the probability of combined injury and potentially guide decision making on the appropriateness of obtaining single sequence MRI or implementing prophylactic femoral neck fixation. Level of evidenceLevel III

Low Rate of Early Periprosthetic Fractures in Direct Anterior Total Hip Arthroplasty with a Triple-Tapered Wedge Stem.

Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has been steadily increasing in recent years. While the DAA may offer some benefits compared to other approaches, there are still risks involved including relatively higher rates of periprosthetic femur fractures, especially when combined with cementless femoral stem use. The purpose of this study is to evaluate the early postoperative femoral complications with a short triple-wedge tapered stem used in primary THA via a DAA. A retrospective review was conducted of the arthroplasty registry of our institution from April 2022 to August 2023 to identify patients who underwent a primary THA via a DAA with the Short Medacta Stem (SMS) (Medacta International, Castel San Pietro, Switzerland). Patients were excluded if the stem was used for a revision surgery, they were within 90 days of surgery, or they refused research consent. Inclusion criteria was met in 262 patients (302 hips). Data was collected after reviewing the chart, and reports and radiographic measurements, including Dorr type and canal fit ratios, were obtained from preoperative and postoperative radiographs, respectively. A total of 302 total hips were included, 161 patients were male (53.3%) and 141 were female (46.7%), with an average age of 66.5 years (27-88, +/- 10.7 years). Average follow up was 0.3 years (range, 0.05-1.71 years). The majority of patients had a Dorr B femur (81.7%). The Median stem size used was an 8 (range, 2-15), and 89.4% of those had a collar. Average canal fill ratio was 0.83 (range, 0.43-0.98, +/- 0.07). Overall, there were two Vancouver B2a periprosthetic femoral shaft fractures (0.66%) that required revision surgery to a modular stem. In addition, there were two Vancouver Ag greater trochanteric fractures (0.66%) with acceptable alignment that did not require revision surgery. Demographic information about the patients with femoral complications is summarized in Table I. Average age of patients with femoral complications was 69.5 years, with an average canal fit ratio of 0.88. We found that the triple-wedge implant had a low rate of early femoral complication in primary THA from an anterior approach and is safe for use in THA from a DAA. More follow up is needed to evaluate continuing implant survivorship and patient outcomes.

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

PurposeFemoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach.Material and MethodsThis was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated.ResultsA total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57).ConclusionsBoth options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.

Two big bones, one big decision: When to fix bilateral femur fractures

PurposeFor polytrauma patients with bilateral femoral shaft fractures (BFSF), there is currently no consensus on the optimal timing of surgery. This study assesses the impact of early (≤ 24 h) versus delayed (>24 h) definitive fixation on clinical outcomes, especially focusing on concomitant versus staged repair. We hypothesized that early definitive fixation leads to lower mortality and morbidity rates. MethodsThe 2017–2020 Trauma Quality Improvement Program was used to identify patients aged ≥16 years with BFSF who underwent definitive fixation. Early definitive fixation (EDF) was defined as fixation of both femoral shaft fractures within 24 h, delayed definitive fixation (DDF) as fixation of both fractures after 24 h, and early staged fixation (ESF) as fixation of one femur within 24 h and the other femur after 24 h. Propensity score matching and multilevel mixed effects regression models were used to compare groups. Results1,118 patients were included, of which 62.8% underwent EDF. Following propensity score matching, 279 balanced pairs were formed. EDF was associated with decreased overall morbidity (12.9% vs 22.6%, p = 0.003), lower rate of deep venous thrombosis (2.2% vs 6.5%, p = 0.012), a shorter ICU LOS (5 vs 7 days, p < 0.001) and a shorter hospital LOS (10 vs 15 days, p < 0.001). When compared to DDF, early staged fixation (ESF) was associated with lower rates of ventilator acquired pneumonia (0.0% vs 4.9%, p = 0.007), but a longer ICU LOS (8 vs 6 days, p = 0.004). Using regression analysis, every 24-hour delay to definitive fixation increased the odds of developing complications by 1.05, postoperative LOS by 10 h and total hospital LOS by 27 h. ConclusionEarly definitive fixation (≤ 24 h) is preferred over delayed definitive fixation (>24 h) for patients with bilateral femur shaft fractures when accounting for age, sex, injury characteristics, additional fractures and interventions, and hospital level. Although mortality does not differ, overall morbidity and deep venous thrombosis rates, and length of hospital and intensive care unit stay are significantly lower. When early definitive fixation is not possible, early staged repair seems preferable over delayed definitive fixation.

Comparing the Outcomes of Titanium and Stainless Steel Flexible Nails in Repairing Pediatric Long Bone Fractures.

Traditionally, pediatric femoral fracture treatment favored conservative methods, relying on casting and the inherent bone remodeling ability in immature bones. Surgical intervention was deferred until age 6, as nonoperative approaches often resulted in complications. Titanium elastic nailing (TENS) emerged as an effective treatment for diaphyseal femoral fractures in ages 6 to 16. However, the choice between TENS and stainless steel elastic nailing (SSENS) remains debated due to inconsistent findings. This study aimed to evaluate the effectiveness of both nailing systems in pediatric long bone fractures. A retrospective chart review at William Beaumont Hospital Royal Oak included 83 patients aged 6 to 16 treated with TENS or SSENS between January 2011 and January 2021. Data collected encompassed nail related issues, time to fracture union, full weight bearing, and nail removal. In the TENS group (n=29), the average age was 8.8±2.4 years, and the average BMI was 17.2±3.4. The SSENS group (n=54) had an average age of 9.3±2.7 and an average BMI of 19.7±8.4. Time to fracture union for TENS was 93.8±60.5 days, while SSENS was 82.2±40.0 days. This study found no statistically significant differences in nail-related complications, time to fracture union, full weight bearing, or nail removal between TENS and SSENS in pediatric long bone fractures. The choice between these systems should be based on individual circumstances. Limitations include a small sample size and the study's retrospective nature.

Aftermath Türkiye’s double earthquake: detailed analysis of fracture characteristics and acute management from a level I trauma center

BackgroundThis research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under crisis conditions in a Level I Trauma Center after Türkiye’s February 6, 2023, earthquakes.MethodsThe study was a retrospective examination of the medical records of 243 fracture cases associated with the earthquakes. The age, gender, time of admission, types of extremity and pelvic fractures, anatomical localizations, and surgical treatment methods for fractures were recorded. The results of these parameters were evaluated in detail, together with the results of other surgical treatments performed in the hospital in the first week after the disaster, such as fasciotomy, amputation, and wound debridement.ResultsMost of the 243 (119 males and 124 females) patients with extremity fractures and pelvic fractures receiving surgical treatment were adults (n = 182, 74.9%). The most common lower extremity fractures among all fracture cases were tibial shaft (30.8%) and femoral shaft (20.6%) fractures. A total of 33 patients had surgical procedures for the treatment of two or more significant bone fractures involving either the extremity or the pelvic ring. The analysis showed that the median age of patients who underwent surgery due to extremity and pelvic fractures was 36 years, with a range of 1 to 91 years, which was statistically increased compared to patients who received surgery for other musculoskeletal injuries such as fasciotomy, amputation and debridement (p < 0.001).ConclusionFractures were one of the most common musculoskeletal injuries in the first days after earthquakes, and the management of fractures differs significantly from soft tissue injuries and amputation surgeries as they require implants, special instruments, and imaging devices. The delivery of healthcare is often critically impaired after a severe earthquake. Shortages of consumables such as orthopedic implants, power drills, fluoroscopy equipment, and the need for additional staff should be addressed immediately after the earthquake, ideally by the end of the first day.

Serum complement C3 and C4 levels in patients undergoing intramedullary nailing for fracture shaft femur: A prospective study

Serum complement C3 and C4 levels in patients undergoing intramedullary nailing for fracture shaft femur: A prospective study

Characterizing Trauma Patients with Delays in Orthopaedic Process Measures.

Early operative intervention in orthopaedic injuries is associated with decreased morbidity and mortality. Relevant process measures (e.g. femoral shaft fixation <24 hours) are used in trauma quality improvement programs to evaluate performance. Currently, there is no mechanism to account for patients who are unable to undergo surgical intervention (i.e. physiologically unstable). We characterized the factors associated with patients who did not meet these orthopaedic process measures. A retrospective cohort study of patients from 35 ACS-COT verified Level 1 and Level 2 trauma centers was performed utilizing quality collaborative data (2017-2022). Inclusion criteria were adult patients (≥18 years), ISS ≥5, and a closed femoral shaft or open tibial shaft fracture classified via the Abbreviated Injury Scale version 2005 (AIS2005). Relevant factors (e.g. physiologic) associated with a procedural delay >24 hours were identified through a multivariable logistic regression and the effect of delay on inpatient outcomes was assessed. A sub-analysis characterized the rate of delay in "healthy patients". We identified 5,199 patients with a femoral shaft fracture and 87.5% had a fixation procedure, of which 31.8% had a delay, and 47.1% of those delayed were "healthy." There were 1,291 patients with an open tibial shaft fracture, 92.2% had fixation, 50.5% had an irrigation and debridement and 11.2% and 18.7% were delayed, respectively. High ISS, older age and multiple medical comorbidities were associated with a delay in femur fixation, and those delayed had a higher incidence of complications. There is a substantial incidence of surgical delays in some orthopaedic trauma process measures that are predicted by certain patient characteristics, and this is associated with an increased rate of complications. Understanding these factors associated with a surgical delay, and effectively accounting for them, is key if these process measures are to be used appropriately in quality improvement programs. Level III; Therapeutic/Care Management.

Is it safe and effective to leave Titanium Elastic Nail (TEN) tips outside the skin in pediatric femoral diaphyseal fractures?

Aim: In this study, we aimed to retrospectively evaluate the use of nail tips outside and under the skin in TEN (Titanium Elastic Nail) application in pediatric femur diaphyseal fractures. Patients and methods: Forty-six patients (47 fractures) who underwent TEN due to femoral diaphyseal fractures between January 2016 and July 2019 were examined retrospectively. While the patients whose TEN ends were left outside the skin were called Group 1, the patients whose TEN ends were left under the skin were called Group 2.. Age, gender, fracture side, and follow-up periods were evaluated. Clinical evaluation; hip and knee ROM (range of motion), rotational or angular deformities, pin bottoms, incision scars, infective findings; In radiological evaluation; angulation, deformity and length differences were examined on two-way radiography. Implant removal times and all complications were evaluated. Results: 21 fractures (Group 1) TEN ends were left outside the skin; In 26 fractures (Group 2), the TEN ends were left under the skin. Both groups had similar distributions in terms of age, gender and fracture sides. The follow-up period of Group 2 was significantly longer (p&amp;lt;0.05), but the minimum follow-up period in both groups was 9 months. There was a significant difference in the distribution of coronal and sagittal angulations in both groups (p&amp;lt;0.05), but all of the angulations were within acceptable limits in their age groups. Pin bottom discharge of both groups had similar distribution. (p&amp;gt;0.05) In terms of implant removal time, Group 1 achieved this in a shorter time compared to Group 2. (p&amp;lt;0.05) Union was achieved without any problems in all fractures in both groups. No notable angulation defects, rotation defects or shortness were observed in the patients. No patient developed infection in deep tissues. Conclusions: In pediatric femur diaphyseal fractures, in addition to removing the implants in a short time under outpatient clinic conditions and without the need for anesthesia by leaving the TEN ends outside the skin; leaving the implant tip outside seems to be quite advantageous, since union or angulation problems are similar to nail tips being left inside. However, nail root infection is still a serious concern; therefore, we believe that this problem can be solved with close monitoring and parental education.

Functional outcomes of femoral diaphyseal fractures using titanium elastic nail: A retrospective study

Background: Femoral Diaphyseal is common fracture in pediatrics. The Titanium Elastic Nail is designed to stabilized the long bone fracture in children where the implant flexibility is paramount and medullary canal is narrow. This study evaluates the functional outcome and complications of using elastic nail. Materials and Methods: This was a single centric, retrospective and clinical investigation study. The study was consisting of thirty-eight children (29 boys, 9 girls) aged group of 9-15 years who underwent femoral diaphyseal fracture treatment in Gautemala between March 2018 to June 2019 were recruited. The patient outcome was analyzed by physical examination, radiographs, VAS and ASA score by one year follow up. Results: The result showed better outcomes in all the patients with decline in the VAS score. All patients were available for the follow up of one year. The bone union was achieved in mean time of 7.1 weeks. The study reveal that no mechanical failure related to nail, bend or corrosion was seen in the patients. Finally, all the patient’s bone healed with time without any adverse effect and severe complications. Conclusion: The elastic nailing fixation is an efficient method for treating long bone fracture in children’s.

Complications of Ilizarov method treatment for infected nonunion femoral shaft fracture

Background: Infected non-union of the femur is complicated by the involvement of soft tissue and bone, long-term resistant multi-bacterial infection, limb length discrepancy, deformities, joint stiffness, and multiple draining sinuses, and poses a challenge for orthopedic surgeons. This study aimed to analyze the complications of Ilizarov method treatment for infected non-union femoral shaft fracture. Methods: This prospective observational study was conducted at the national institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh, from May 2018 to August 2020. A total of 20 patients were selected as study subjects by purposive sampling technique. All data were collected using a pre-formed questionnaire. Data were processed and analyzed using computer software program SPSS version 22.0. Result: The mean bone gap created during the operation was 2.7±1.7 cm of them, in 12 (60%) patients, it was 0 to 2 cm, and in 8 (40%) patients it was more than 2 cm. The mean time needed for radiological union was 7.85±2.1 months ranging from 5 months to 11 months. In 10 (50%) patients, union was achieved within 4 to 7 months, and in 10 (50%) patients it was 8 to 11 months. Regarding limb length discrepancy, in 5 (25%) cases there was no limb length discrepancy (LLD). Twelve patients had 1 cm to 2.4 cm LLD and 3 (15%) patients had ≥2.5 cm LLD. The mean LLD was 1.2±0.9 cm. Regarding complications, in 10 (50%) cases, there was no complication and 10 (50%) patients had complications. The complications were pin tract infection in 7 (35%) patients and wire loosening in 3 (15%) patients. Conclusions: The study concludes that while the Ilizarov ring fixator proves to be a dependable and successful method for stabilizing, correcting length discrepancies, and eliminating infections, it is not without its share of complications. The findings of this research indicate a 50% complication rate among the patients undergoing this treatment.

Outcomes of Titanium Elastic Nails (TENS) for Unstable Femoral Shaft Fracture Among children aged 6-13 years in Nepal: A Prospective Study

Introduction: Because of the innate fracture healing capacity in pediatric age group Titanium Elastic Nailing System (TENS) is an ideal stabilization method for diaphyseal femur fractures, especially in length stable fractures (transverse and short oblique) owing to its load sharing properties and minimum complications. However, the outcome of TENS in axially unstable pediatric femoral diaphyseal fractures (long oblique, spiral and comminuted) is not uniform and is still debated. Objectives: Analysis of radiological and functional outcomes of length unstable pediatric femoral fractures treated with titanium elastic nails (TENS) in the age group of 6–13 years. Methodology: A prospective study of 42 unstable pediatric femoral fractures treated with TENS from November 2022 to October 2023 at Birat Medical College Teaching Hospital, Biratnagar, Nepal was conducted and analyzed with functional and radiological outcomes. Results: As per Flynn's criteria 37 patients (88.1%) had excellent results, 4 patients (9.5%) had successful results, and 1patient (2.3%) had poor result. The mean time to full weight bearing after radiological fracture union was 8.1 weeks. Conclusion: Closed reduction and TENS fixation is an effective surgical procedure even for length unstable femoral diaphyseal fractures in children if appropriate surgical techniques and post-surgical care are followed.

Outcome of Early Retrograde Closed Intramedullary Fixation of Fracture Shaft of Femur by Titanium Elastic Nail in Children

Background: Paediatric femoral shaft fractures are common in orthopaedic practice and can be managed using various modalities, each with its advantages and disadvantages. The Titanium Elastic Nailing System has emerged as a promising treatment option, offering potential advantages over traditional methods. Objective: This study aimed to evaluate the functional and radiological outcomes and operative complications of paediatric femoral shaft fractures treated with the Titanium Elastic Nailing System. Methods: A prospective interventional study was conducted from July 2020 to July 2021. Thirty children aged 6-14 years (mean age 11.32 ±3.76) were selected using purposive sampling and strict inclusion/exclusion criteria. Patients were followed up for at least 24 weeks at four-week intervals, and outcomes were assessed using Flynn's TEN scoring criteria. Results: All 30 patients completed the study. Radiological union was achieved in 80.0% of cases within 7-10 weeks, with 90.0% of patients able to bear full weight by the 12th week. Minor complications occurred in 20.0% of cases, while no major complications were reported. 80.0% of cases had excellent outcomes, 20.0% were satisfactory, and no poor outcomes were observed. Conclusion: The Titanium Elastic Nailing System is an excellent method for treating paediatric femoral shaft fractures, demonstrating high rates of radiological union and functional recovery with a low incidence of complications.

Prevalence and risk factors for proximal deep vein thrombosis at admission in patients with traumatic fractures: a multicenter retrospective study.

This study aimed to determine the associated risk factors for proximal deep vein thrombosis (DVT) in patients with lower extremity and pelvic-acetabular fractures. The medical records of 4,056 patients with lower extremity and pelvic-acetabular fractures were retrospectively reviewed. The patients were classified into proximal or non-proximal DVT groups. Logistic regression models were used to determine the independent risk variables for proximal DVT. The predictive value of the related risk factors was further analyzed using receiver operating characteristic curves. The prevalence of proximal DVT was 3.16%. Sex, body mass index (BMI), fracture site, injury mechanism, diabetes, coronary heart disease (CHD), injury-to-admission interval, hematocrit, platelet counts, and D-dimer levels differed significantly between the two groups. BMI ≥ 24.0 kg/m2, femoral shaft fractures, high-energy injury, diabetes, injury-to-admission interval >24 h were independent risk factors for proximal DVT. CHD decreased the risk of proximal DVT. The platelet and D-dimer had high negative predictive value for predicting proximal DVT formation, with cut-off values of 174 × 109/L and 2.18 mg/L, respectively. BMI ≥ 24.0 kg/m2, femoral shaft fractures, high-energy injury, diabetes, injury-to-admission interval >24 h were independent risk factors for proximal DVT in patients with lower extremity and pelvic-acetabular fractures. Platelet count and D-dimer level were effective indicators for excluding proximal DVT occurrence. CHD decreased the risk of proximal DVT.

LONG-TERM FUNCTIONAL OUTCOMES AND QUALITY OF LIFE IN YOUNG ADULTS WITH INTERNAL FIXATION OF FEMORAL SHAFT FRACTURE: A CROSS-SECTIONAL STUDY

Purpose: Although internal fixation surgery of femoral shaft fracture (FSF) has high rates of union, it affects the patient’s functionality and quality of life due to additional health conditions depending on the traumatic nature of these injuries. This cross-sectional study aimed to investigate the long-term functional outcomes and quality of life of young adults who underwent internal fixation of isolated FSF to compare with healthy peers. Methods: The Harris Hip Score (HHS) and Stair Climb Test (SCT) were used to evaluate the functionality of the participants. The EuroQol 5-Dimension Questionnaire (EQ-5D) was used to assess the quality of life. Results: Twenty young adult volunteers with internal fixation surgery aged 18-55 years are included in the FSF group (mean age: 39.55±11.92 years; duration after surgery: 28±7.2 months) and 20 healthy peers (mean age: 42.75±8.83 years) as the control group. The HHS and EQ-5D scores were lower (p

Is bone-grafting or bone-healing adjunct always necessary for the treatment of non-union ? Our experience of treating non-unio by primary osteosynthesis in chronically neglected shaft of femure fractures

Non-union of bone is a frightening consequence of fracture management. This condition usually occurs when the body's natural healing process cannot bridge the gap and restore the continuity of the bone. Non-infected non-union can be classified into two main types: Hypertrophic and Atrophic. Our research aims to determine the results after primary osteosynthesis without bone graft or adjuvant in neglected shaft femur fracture aseptic non-unions.We performed a retrospective chart review to include consequative series of neglected shaft of femur fracture non-unions treated by primary osteosynthesis surgery during a span of 3 years from 2020-2022. We excluded cases with partial union, identifiable systemic or external causes of non-union and those belonging to pediatric &amp; elder age groups.We included 13 neglected cases of shaft femur fractures. Out of 13 patients, 7 (53.8%) were males. The mean age was 43 (range 23-55) years, and the mean injury presentation interval was 9 (range 4-18) months. Nine had hypertrophic, 2 had atrophic and 1 had undefinable non-union. At one year follow-up, 12 out of 13 showed completely united fractures with no functional limitation. Only one patient showed delayed union and eventually united Discussion: Treating non-union requires a comprehensive approach tailored to the fracture personality. The original AO principles (1960) of fracture healing remain the mainstay of fracture healing. Besides the gold standard autologus bone graft, many biological agents like BMP are currently available to augment bone healing. However, most of them have failed to provide consistent and promising results when there is an absence of innate osteogenic potential.In our experience, an excellent union rate can be achieved without the use of bone-grafting or bone-healing adjuvants in chronically neglected long bone fractures where no previous surgical attempt was made in absence of systemic and exteral risk factors for non-union.