Fixation Of Femoral Shaft Fractures Research Articles

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 hours) versus delayed (>24 hours) 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 hours, delayed definitive fixation (DDF) as fixation of both fractures after 24 hours, and early staged fixation (ESF) as fixation of one femur within 24 hours and the other femur after 24 hours. 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 hours and total hospital LOS by 27 hours. ConclusionEarly definitive fixation (≤ 24 hours) is preferred over delayed definitive fixation (>24 hours) 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.

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

Outcome of Titanium Elastic Nailing System in Diaphyseal Femoral Fractures of Children in the Age Group of 4-12 years

Background: Femoral shaft fractures are the most common major pediatric injuries treated by orthopedic surgeons. Management of femoral diaphyseal fracture in the age group of 4-12 years is controversial. The purpose of this study is to demonstrate the effectiveness of intramedullary fixation of femoral shaft fractures by using Titanium Elastic Nailing System (TENS). Methodology: Twenty-six (26) children in the range of 4-12 years with recent (&lt;3 days) femoral shaft fracture (24 closed, 02 Grade-I compound) were stabilized with Titanium Elastic Nail (TEN), between January 2019 and June 2022 in Eastern Medical College Hospital, Cumilla and Cumilla Trauma Centre. The diameter of the individual nail was selected as per Flynn’s formula and the results were evaluated by Flynn’s criteria. All patients were followed radiologically as well as clinically until fractures healed and for any complications. Results: Among the twenty-six (26) cases 18 were boys and 8 were girls. Twenty-three (23) cases were managed by closed reduction while three (3) cases required open reduction. The time duration of surgery ranged 20-45 minutes. The hospital stay ranged between 5 to 8 days (mean 6.5 days). The mean duration of follow-up was 21 months (range: 3 - 39 months). All fractures were radiologically united at 8-12 weeks (mean 10 weeks) and full weight bearing was possible in a meantime of 9.5 weeks. According to Flynn’s criteria, excellent results were found in 24 (92.3%) cases and satisfactory in 2 (7.7%) cases. Limb lengthening was noticed in 6 cases and rotational mal alignment was seen in 1 case. Conclusion: Intramedullary fixation with Titanium Elastic Nail may be the preferred method for the treatment of femoral fractures in children aged 4-12 years. As it is a safe, minimally invasive, surgeon-friendly technique and shows very good functional and cosmetic results. Eastern Med Coll J. July 2023; 8 (2): 1-6

Comparative Outcomes of Elastic Stable Intramedullary Nailing vs. Plate Fixation in Pediatric Femoral Shaft Fractures. A Prospective Study.

Pediatric femoral fractures are common in emergency rooms, with treatment options varying by age. This study compares elastic stable intramedullary nailing (ESIN) and plate fixation for diaphyseal femoral fractures in children aged 5-10. Conducted at Al-Kindi Teaching Hospital, Baghdad, from December 2017 to December 2019, this prospective study included 32 children with closed transverse diaphyseal femoral fractures. Patients were divided into two groups: 16 treated with ESIN (Group 1) and 16 with plate fixation (Group 2). Criteria excluded comminuted, open, or pathological fractures. Group 1 had a mean age of 7.1 years and weight of 23.7 kg; Group 2 had a mean age of 7.8 years and weight of 30.9 kg. ESIN resulted in shorter operative times (58.4 minutes), earlier weight-bearing, and quicker fracture union (8.8 weeks) compared to plate fixation (76.3 minutes, 11.9 weeks). Blood loss was significantly less in Group 1 (32.8 ml) versus Group 2 (205.0 ml). No significant differences in wound healing or leg length discrepancies were observed. 1. Our study indicates a preference for Elastic Stable Intramedullary Nailing (ESIN) over plate fixation for pediatric femoral shaft fractures in children aged 5-10 years. 2. ESIN is associated with shorter operative times and faster commencement of weight-bearing, critical in pediatric recovery. 3. While ESIN is generally preferable, plate fixation may be better suited in certain clinical scenarios, emphasizing the importance of personalized treatment. 4. Based on our findings, ESIN is recommended for treating transverse diaphyseal femur fractures in the specified pediatric age group. 5. Recommends further studies, including randomized controlled trials, for a more comprehensive understanding of these treatments' long-term outcomes.

Results of the Pediatric Shaft Femur Fracture Treated with Closed Rigid Lateral Trochanteric Entry Intramedullary Nail in North Indian Population

Objectives The femoral shaft fractures constitute 1.6% of the pediatric fractures. Intramedullary nailing is a common mode of fixation in older children and adolescents. The rigid intramedullary locking nail is a preferred choice over flexible nails in overweight patients and children older than 11 years of age. The adolescent age group with skeletal immaturity deserves special attention from the surgeons because of grave complications like avascular necrosis of the femur head and angular deformities. The aim of this study is to report the outcome of an adolescent femur shaft fracture treated with a rigid intramedullary interlocking nail in North Indian patients. Material and Methods This is a retrospective analysis performed by retrieving records of 19 patients. Patients with open fractures, polytrauma and neurovascular injuries were excluded. The preoperative and post-operative radiographic orthogonal views were analyzed to assess parameters like alignment, union and avascular necrosis (AVN). Results The mean age was 12.3 years. The mean follow-up was 1.5 years. The average time for union was 8 weeks. All the fractures were united in an acceptable alignment and rotation. There was no avascular necrosis, angular deformity and infection. The mean femur length discrepancy was 7 mm. Conclusion The rigid intramedullary interlocking nail is a valuable option for the fixation of femoral shaft fractures in an adolescent age group with a good union rate and minimal complications.

The Effect of Skeletal Fixation on Nerve Healing in a Rat

Objective To investigate the effect of rigid internal skeletal fixation of a rat femoral shaft fracture on the healing of an induced sciatic nerve crush injury as assessed by functional outcomes. Methods Thirty-six male Lewis rats were divided into two groups. A unilateral sciatic nerve crush injury and a same-level transverse femur fracture were created in all animals. Animals in the first group underwent immediate open reduction internal fixation (ORIF) with a stainless steel plate and screws. Animals in the second group were treated non-operatively (NON) without internal or external fixation or bracing. At each of the six-time points relevant to different nerve degeneration and regeneration stages, three animals in each group underwent bilateral limb assessments of electrophysiology, muscle mass, and nerve histomorphometry. Results Outcome measurements of the ORIF group (n=17) and NON group (n=16) showed the ORIF group to have both significantly greater tibialis anterior muscle force generation and sciatic nerve conduction velocity across the zone of injury for the overall groups. Force and conduction velocity measurements were greater for the ORIF group at selective time points in the subgroup analysis. Histologic analysis confirmed a greater cross-sectional area of the sciatic nerve in the ORIF group. Conclusion This study provides information about the influence of the stability of the skeletal and soft tissue environment on the nerve healing process. The significantly greater maximum force generation and conduction velocity and the increased cross-sectional areas with greater axon counts observed in our ORIF group support our hypothesis that rigid internal skeletal fixation of a fracture promotes superior recovery of a concomitant peripheral nerve injury. The findings of this study suggest that superior healing of the peripheral nerve injury may occur with stable skeletal fixation.

Bundled Bone Grafting Effectively Promotes Callus Growth and Accelerates Fracture Healing in the Operation of Nonunion or Bone Defects

This study aims to investigate the clinical application potential of bundled bone grafting in the management of nonunion or bone defects after internal fixation. A total of 34 patients with nonunion or partial bone defects after internal fixation of femoral shaft fracture at our hospital from March 2018 to January 2020 were included in this study. They were randomly divided into a control group treated with filling/compressed bone grafting (n = 17) and a test group receiving bundled bone grafting (n = 17) patients receiving bundled bone grafting. The healing rate of fracture, the length and healing time of callus growth, and the lower extremity function were assessed in the two groups. The test group exhibited a significantly higher fracture healing rate compared to the control group (100% vs. 76.47%, P &lt; 0.05). Moreover, the test group demonstrated superior callus growth length when compared to the control group [(2.64±0.48) cm vs. (1.72 ±0.35) cm, P &lt; 0.05]. Additionally, the test group exhibited a significantly shorter healing time than the control group [(6.73 ± 1.24) months vs. (8.12 ± 1.48) months, P &lt; 0.05]. The total efficacy rate for lower extremity function in the test group was significantly higher at 94.12% compared to the control group’s rate of 64.71%. In conclusion, the utilization of bundled bone grafting can promote callus growth and accelerate fracture healing in the management of nonunion or bone defects after internal fixation.

Efficacy of Hematoma Block after Intramedullary Rod Fixation of Femoral Shaft Fractures: A Prospective, Double-Blinded, Randomized Controlled Trial.

To evaluate the efficacy of an intraoperative, post-fixation fracture hematoma block on postoperative pain control and opioid consumption in patients with acute femoral shaft fractures. Prospective, double-blinded, randomized controlled trial. Academic Level I Trauma Center.Patients/Participants: 82 consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation. Patients were randomized to receive an intraoperative, post-fixation fracture hematoma injection containing either 20 mL of normal saline or 0.5% ropivacaine in addition to a standardized multimodal pain regimen that included opioids. Visual analog scale (VAS) pain scores and opioid consumption. The treatment group demonstrated significantly lower VAS pain scores than the control group in the first 24-hour postoperative period (5.0 vs 6.7, p=0.004), 0-8 hours (5.4 vs 7.0, p=0.013), 8-16 hours (4.9 vs 6.6, p=0.018), and 16-24 hours (4.7 vs 6.6, p=0.010) postoperatively. In addition, the opioid consumption (morphine milligram equivalents) was significantly lower in the treatment group compared to the control group over the first 24-hour postoperative period (43.6 vs 65.9, p=0.008). No adverse effects were observed secondary to the saline or ropivacaine infiltration. Infiltrating the fracture hematoma with ropivacaine in adult femoral shaft fractures reduced postoperative pain and opioid consumption compared with saline control. This intervention presents a useful adjunct to multimodal analgesia to improve postoperative care in orthopaedic trauma patients. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Surgical fixation of ipsilateral femoral neck and shaft fractures: a matter of debate?

Segmental femoral fractures represent a rare but complex clinical challenge. They mostly result from high-energy mechanisms, dictate a careful initial assessment and are managed with various techniques. These often include an initial phase of damage control orthopaedics while the initial manoeuvres of patient and soft tissue resuscitation are employed. Definitive fixation consists of either single-implant (reconstruction femoral nails) or dual-implant constructs. There is no consensus in favour of one of these two strategies. At present, there is no high-quality comparative evidence between the various methods of treatment. The development of advanced design nailing and plating systems has offered fixation constructs with improved characteristics. A comprehensive review of the existing evidence with a step-by-step description of these different definitive fixation strategies based on three case examples was conducted. Furthermore, the rationale for using single vs dual-implant strategy in its case is presented with supportive references. The prevention of complications relies mainly on the strict adherence to basic principles of fracture fixation with an emphasis on careful preoperative planning, the quality of the reduction, and the application of soft tissue-friendly surgical methods.

DOES TITANIUM ELASTIC NAIL (TEN) FOR FEMUR SHAFT FRACTURE IN CHILDREN HAVE SUPERIOR FUNCTIONAL OUTCOMES THAN SPICA CAST APPLICATION? AN EXPERIENCE FROM TERTIARY CARE HOSPITAL

This study aimed to compare functional outcomes in children with femur shaft fractures treated with ether titanium elastic nail or spica cast application. This prospective cohort study was conducted at the Department of Orthopedic and Spine, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, from 1st June 2020 to 31st December 2022. This study involved 60 children of both genders, aged 3-6 years, presenting with femoral shaft fractures (Winquist I &amp; II), randomly allocated into two groups for treatment. Patients in Group E were treated with titanium elastic nails, while a hip spica cast was applied to patients in Group S. Functional outcome was measured with the meantime to walk independently, which was noted and compared between the two groups. Patients had a mean age of 4.42±1.12 years, while the mean weight was 18.23±2.09 Kg. There were 21 (35.0%) female and 39 (65.0%) male patients with a male-to-female ratio of 1.9:1. The mean time to walk independently was significantly shorter in children treated with titanium elastic nail as compared to hip spica cast (5.60±1.28 vs. 8.93±1.98 weeks; p&lt;0.001). A similar significant difference was observed between groups across various subgroups of patients based on age, gender, and weight. We concluded that internal fixation of pediatric femoral shaft fractures utilizing titanium elastic nail had superior functional outcomes as compared to hip spice cast application in terms of significantly shorter mean time to walk independently along with the minimally invasive nature of the procedure and better patient hygiene and cosmesis advocate preferred use of titanium elastic nails for management of such fractures.

Fixation of Traumatic Femoral Shaft Fracture in Port Harcourt: Comparison of Locked Intramedullary Nailing and Plating.

Fixation of Traumatic Femoral Shaft Fracture in Port Harcourt: Comparison of Locked Intramedullary Nailing and Plating.

The Effect of Surgeon and Hospital Volume on Morbidity and Mortality After Femoral Shaft Fractures.

The aim of this study was to characterize the case volume dependence of both facilities and surgeons on morbidity and mortality after femoral shaft fracture (FSF) fixation. Adults who had an open or closed FSF between 2011 and 2015 were identified in the New York Statewide Planning and Research Cooperative System database. Claims were identified by International Classification of Disease-9, Clinical Modification diagnostic codes for a closed or open FSF and International Classification of Disease-9, Clinical Modification procedure codes for FSF fixation. Readmission, in-hospital mortality, and other adverse events were compared across surgeon and facility volumes using multivariable Cox proportional hazards regression, controlling for patient demographic and clinical factors. Surgeon and facility volumes were compared between the lowest and highest 20% to represent low-volume and high-volume surgeons/facilities. Of 4,613 FSF patients identified, 2,824 patients were treated at a high or low-volume facility or by a high or low-volume surgeon. Most of the examined complications including readmission and in-hospital mortality showed no statistically significant differences. Low-volume facilities had a higher 1-month rate of pneumonia. Low-volume surgeons had a lower 3-month rate of pulmonary embolism. There is minimal difference in outcomes in relation to facility or surgeon case volume for FSF fixation. As a staple of orthopaedic trauma care, FSF fixation is a procedure that may not require specialized orthopaedic traumatologists at high-volume facilities.

Conversion hip arthroplasty for failed internal fixation of ipsilateral femoral neck and shaft fractures: a case report

BackgroundIpsilateral femoral neck and hip fractures are uncommon high energy injuries. In the literature no single method of treatment has emerged as superior to the others. A recent publication has documented the successful application of the rendezvous technique using dual-implants for treating these injuries. However in some cases, this technique may fail and revision surgery is required.Case presentationA 67-year old man sustained ipsilateral fractures of his femur and femoral neck in a road traffic accident. His injuries were treated by a dual construct consisting of a retrograde femoral nail and dynamic hip screw. Three months after surgery the hip screw cut out of the femoral head necessitating revision to a total hip arthroplasty. Surgery was carried out using a single stage two part procedure on a standard operating table without having to reposition or redrape the patient. There were no postoperative complications and at 1 year from surgery the patient is satisfied with the result and has returned to work.ConclusionConversion hip arthroplasty in the presence of dual implants is a technically challenging and unpredictable procedure, with an increased risk of complications. Our surgical approach provides a framework for orthopedic surgeons to safely perform this complex procedure.

Severe Obesity Worsens 30-Day Surgical Outcomes and Projected Costs in Operative Femoral Shaft and Tibial Shaft Fractures.

To assess the impact of severe obesity on 30-day adverse event rates, hospital length of stay (LOS), readmissions, and projected costs after operative fixation of tibia and femur fractures. An analysis of the American College of Surgeons National Surgical Quality Improvement Project database from 2012 to 2019 of isolated femoral shaft and tibial shaft fracture fixation cases was conducted. Adverse events, LOS, readmission rates, and operative time were queried for severe obesity, defined as body mass index greater than 40, compared with other patients. Student t tests were used to assess continuous variables. Fisher exact test and odds ratios were used for categorical variables. A cost-analysis was also performed to quantify the effect of severe obesity on projected health care expenditures. A total of 10,436 patients were included with 7.0% of patients categorized as severely obese. Severely obese patients had higher infectious complication rates (9.0% vs. 6.7%, P = 0.013, OR 1.36, 95% CI 1.04-1.78), readmission rates (7.9% vs. 5.6%, P-value = 0.008, OR 1.44, 95% CI 1.08-1.91), longer LOS (5.8 days SD ±10.2 vs. 5.0 days SD ±7.9 days, P-value = 0.008), and longer operative times (mean 115 minutes ± 56 minutes SD vs. 103 minutes SD ±54 minutes, P-value = <0.001). Severe obesity resulted in an estimated $4258.07 additional health care expenditures per patient compared with nonobese patients. This amounted to a projected added total expenditure of $3.09 million USD in the overall cohort. Severe obesity is associated with significantly worse 30-day outcomes and higher readmission rates for patients undergoing operative fixation of tibial shaft and femoral shaft fractures. Health policy considerations should be made to incentivize care for this patient population, particularly in trauma where modification of risk factors before surgery is often not feasible. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Short Term Clinical, Functional and Radiological of Fixation of Paediatric Femoral Shaft Fracture by Titanium Elastic Nail in Paediatric Patients

Introduction: Femoral shaft fracture is the most common major paediatric orthopaedic. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Elastic stable intramedullary nailing is one for treating these fractures and has a reliable methodology. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Objective: To evaluate the short term clinical, functional and radiological outcome of intramedullary fixation of displaced femoral shaft fractures in skeletally immature children using titanium elastic nails. Methods: A prospective study was conducted in the Department of Ortho Surgery, National Institute of traumatology and orthopedic rehabilitation (NITOR), Dhaka, Bangladesh from July to December 2020. 52 femoral shaft fractures in child aged 6-14 years were fixed with titanium intramedullary elastic nail in the department of Orthopaedics, NITOR, Bangladesh. Two nails of proper and equal diameter were used for fracture fixation. No external splint was used after surgery. Outcomes assessed on the basis of Flynn et al., scoring criterion. Results: The results of the 52 included in our study. All patients achieved complete healing at a mean of 9.1 (Range 8- 10) weeks. 44 fractures were reduced by closed means but 8 needed open reduction. No major complication was recorded. Most common minor complication was entry site skin irritation recorded in 8 patients. 84.61% had excellent result and 15.38% had satisfactory. Conclusion: The treatment of paediatric shaft femur fracture has been drastically changed over the last two decades to internal fixation by elastically stable intra- medullary nail (ESIN). It allows early ambulation and shorter hospital stay and higher parent satisfaction. It also provides flexural, translational and rotational stability as well.

The surgical outcomes of fixing ipsilateral femoral neck and shaft fractures: single versus double implants fixation

BackgroundCombined ipsilateral femoral neck and shaft fractures are rare and present a challenging management dilemma. This study aims to assess the outcome of concomitant fixation of the ipsilateral femoral neck and shaft fracture using single versus dual surgical implants.MethodsA single-center retrospective analysis of patients who underwent fixation of ipsilateral femoral neck and shaft fractures was performed over a 13-year period. Different techniques were employed to fix the complex injury. Both the reduction and the union time were assessed radiographically.ResultsA total of 36 patients with ipsilateral femoral neck and shaft fractures were retrospectively identified and included in the study. Twenty-four patients (66.6%) were managed with a single cephalomedullary nail, while the remaining cases were treated with two devices. All cases were operated on within an average of 3.7 ± 7.1 days. Eight patients (22.2%) developed postoperative complications. The average follow-up period was 7.3 ± 6.8 months. Although there was no statistically significant difference between the two groups, the femoral neck fractures showed shorter union time in patients treated with one implant compared to patients treated with two implants (3.0 ± 2.3 months vs. 4.2 ± 2.6 months). Another observation was that higher percentages of implant removal/failure and malunion/nonunion were seen in patients who had one implant compared to the two implants group (12.5% vs. 8.3%).ConclusionEarly surgical fixation of both fractures is associated with good outcome results. No difference in outcome was observed between both groups.

In-Hospital Morbidity and Mortality With Delays in Femoral Shaft Fracture Fixation.

To investigate trends in the timing of femur fracture fixation in trauma centers in the United States, identify predictors for delayed treatment, and analyze the association of timing of fixation with in-hospital morbidity and mortality using data from the National Trauma Data Bank. Patients with femoral shaft fractures treated from 2007 to 2015 were identified from the National Trauma Data Bank and grouped by timing of femur fixation: <24, 24-48 hours, and >48 hours after hospital presentation. The primary outcome measure was in-hospital postoperative mortality rate. Secondary outcomes included complication rates, hospital length of stay (LOS), days spent in the intensive care unit LOS (ICU LOS), and days on a ventilator. Among the 108,825 unilateral femoral shaft fractures identified, 74.2% was fixed within 24 hours, 16.5% between 24 and 48 hours, and 9.4% >48 hours. The mortality rate was 1.6% overall for the group. When fixation was delayed >48 hours, patients were at risk of significantly higher mortality rate [odds ratio (OR) 3.60; 95% confidence interval (CI), 3.13-4.14], longer LOS (OR 2.14; CI 2.06-2.22), longer intensive care unit LOS (OR 3.92; CI 3.66-4.20), more days on a ventilator (OR 5.38; CI 4.89-5.91), and more postoperative complications (OR 2.05; CI 1.94-2.17; P < 0.0001). Our study confirms that delayed fixation of femoral shaft fractures is associated with increased patient morbidity and mortality. Patients who underwent fixation >48 hours after presentation were at the greatest risk of increased morbidity and mortality. Although some patients require optimization/resuscitation before fracture fixation, efforts should be made to expedite operative fixation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Safety and efficacy of a novel retrograde route for femoral bone graft harvesting by Reamer-Irrigator-Aspirator: a pilot study on 24 patients

BackgroundThe Reamer–Irrigator–Aspirator system was initially developed to reduce fat embolism and thermic necrosis during reamed intramedullary nail fixation of femoral shaft fractures. Currently, this system is used in extended applications including accessing large volume of autologous bone graft, as alternative for iliac crest harvesting. Antegrade femoral bone graft harvesting using the Reamer-Irrigator-Aspirator system is considered the standard technique. The aim of our study is to evaluate the efficacy (bone graft volume) and the complications (blood loss, postoperative pain, and incidence of iatrogenic fractures) of the Reamer–Irrigator–Aspirator system through the retrograde femoral route in a series of patients with post-traumatic bone defects or nonunions.MethodsA non-controlled single center retrospective observational cohort study was conducted in a level1 trauma center to evaluate all patients who were treated using the RIA system. Between November 2015 and May 2019, 24 patients (8 women and 16 men; mean age: 41 years [range 27–55 years]) with bone defects or nonunions underwent bone graft harvesting using the Reamer–Irrigator–Aspirator system through retrograde femoral route. Postoperative pain, complications, and bone graft volume were analyzed. Inclusion criteria was patients older than 18 years with a diagnosis of post-traumatic bone defect or associated tibial or femoral nonunion, with minimum 6-months follow, treated using the RIA. We hypothesized that the retrograde route of the RIA system is a safe and efficacious method for bone harvesting.ResultsThe average volume of collected graft was 45 cc (range 30–60 cc). In 83% of the cases, bone grafting was sufficient, while in 17% it was necessary to add iliac crest bone graft to completely fill the bone defect. A mean drop in postoperative hemoglobin of 4.1 g / dL (range 0.5–6.0 g / dL) was evidenced. In 4 cases (33%), a unit of packed red blood cells was required. Regarding postoperative pain, visual analogue scale after 3 months postoperatively was 1.6 in average. After 6 months, the value has decreased to 0.4. There were no perioperative or postoperative complications at 6-month follow-up.ConclusionIn this limited case series, large volumes of bone graft were harvested using the retrograde route of the RIA system and there were no intra-/ postoperative complications observed at 6-month follow-up. Therefore this novel technique appears safe and efficacious.However, it’s important to highlight that future prospective controlled studies are necessary to validate the insights from this pilot study.

A Methodical Approach to Treatment Following Failed Internal Fixation of Ipsilateral Femoral Neck and Shaft Fractures

A Methodical Approach to Treatment Following Failed Internal Fixation of Ipsilateral Femoral Neck and Shaft Fractures

Flexible Intramedullary Nail Versus Submuscular Locked Plate with the Cluster Technique in Pediatric Femoral Shaft Fractures Fixation.

The aim of this study is the comparison between the flexible intramedullary nail and submuscular Locked Plate with the cluster technique in fixation of pediatric femoral shaft fractures at the age group between 6 and 12years old with simple diaphyseal closed or Gustilo open grade I fractures. Fifty children aged 6-12years with femoral fractures were enrolled in this study. The children were randomly assigned equally to the two groups for fractures fixation. The follow-up period was 1year. A comparison of various parameters and outcomes between both groups was documented. No significant differences were detected between both groups regarding the age, gender, affected side, mechanisms of fracture, or fracture classifications. The operative time and radiation time were longer in the plating group, while the amount of blood loss was lesser in the nail group. The patients treated with plating had better results concerning knee range of motion, weight-bearing, malalignment, and length discrepancy, with fewer complications and better functional outcomes. The result of the present study supports the use of submuscular locked plate with cluster technique in the treatment of studied fractures over flexible IMN.