Nailing Of Femoral Shaft Fractures Research Articles

Use of Lesser Trochanter Profile as a Rotational Alignment Guide in Intramedullary Nailing for Femoral Shaft Fracture

Malrotation after nailing of femoral shaft fractures occurs in about 25% of cases. It can cause substantial functional problems. The lesser trochanter (LT) profile has been used to assess rotational alignment. However, the extent to which the LT profile is symmetrical between limbs, whether the LT profile varies as a function of age or sex, and the efficacy of the LT profile technique remain unknown. The purpose of this study was to determine if there was a significant side-to-side length difference in the LT profile (LTD) according to age and sex. We attempted to determine the amount of medial prominence of the lesser trochanter relative to the medial cortex of the femoral shaft (the LT profile) using 3-dimensional computed tomography (3D-CT) images of normal femora obtained bilaterally (366 subjects) in anatomic positions. We also compared the left and right sides to determine the amount of natural asymmetry by age and sex. In addition, we compared the side-to-side difference in the LT version with the LTD to determine whether the LTD represented the difference in femoral rotation. The LTD was <4 mm (meaning an LT version difference of <10°) in 83% of the subjects, but was ≥4 mm (an LT version difference of ≥10°) in 17%. Subset analysis demonstrated that the differences were greatest in women >70 years of age. The largest LTD (both sexes) was observed in individuals over 70 years of age (2.62 ± 1.37 mm, compared with <55 years: 1.55 ± 1.36 mm and 55 to 70 years: 2.27 ± 1.70 mm). There was no significant difference between sexes in the under-70 age groups. However, the LTD was significantly greater in women over 70 years than in men over 70 years (3.10 ± 1.42 versus 2.41 ± 1.30 mm). Since the LTD demonstrated side-to-side symmetry within 4 mm, or 10° of rotation, in 83% of all subjects, we consider the LT profile to be useful as a guide to assess rotational reduction clinically. However, surgeons should recognize that, in 17% of cases, using this technique could result in malrotation of ≥10°. The rate of malrotation may be even higher in women over 70, for whom supplemental techniques to ensure correct rotation may be appropriate.

Comparison of Open and Closed Nailing for Femoral Shaft Fractures: A Retrospective Analysis.

IntroductionOpen and closed nailing are the two reduction methods used for the fixation of femoral shaft fractures. The study aims to assess the clinical and functional outcomes of open and closed nailing for closed femoral shaft fractures.MethodologyA total of 398 patients who underwent intramedullary nailing fixation of nonpathological femoral shaft fracture between January 2016 to December 2019 were reviewed retrospectively. Two hundred seventy-four underwent closed nailing, and 124 were considered for open nailing.ResultsThe primary outcome reviewed was the union rate of fracture. Other outcomes analyzed were complications, intraoperative blood loss, time to union, and the duration of the procedure. Patients in the open group had a union of fracture in 15.71 weeks, closed nailing group had a union in 15.53 weeks (p-value 0.495). Patients with open nailing had a mean Radiological union scale in tibial (RUST) fracture score of 11.435, whereas the closed nailing group had a mean of 11.664 (p-value 0.187). Operative time was higher in the open group when compared to the closed nailing group (p-value 0.000). However, intraoperative blood loss was more in open nailing in comparison to closed nailing. Furthermore, 15 patients with closed nailing had non-union, whereas 11 had non-union after open nailing (p-0.204). Superficial infection and deep infection requiring debridement were equally observed among the two treatment groups.ConclusionFixation of femoral shaft fractures with open nailing has similar outcomes in union rates, time to union, and rates of significant complication similar to those of close nailing.

Comparison of the clinical results of closed intramedullary nailing in femoral shaft fractures between 1997-1999 and 2015-2019

Comparison of the clinical results of closed intramedullary nailing in femoral shaft fractures between 1997-1999 and 2015-2019

Determine the Mean Duration of Union in Femoral Shaft Fracture in Children Treated with Elastic Intra-Medullary Nailing

Objective: The aim of this study is to determine the functional outcomes and mean duration of union in femoral shaft fracture in children treated with elastic intra-medullary nailing. Study Design:Retrospective Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and District Headquarter Teaching Hospital Gomal Medical College Dera Ismail Khan for duration from May 2020 to January 2021 (09 months). Methods: Total sixty eight patients with age ranges between 5-12 years were presented in this study. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Complete patients were treated with elastic intramedullary nailing. Radiological assessment was done. Mean union time and complications associated to procedure were examined. Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 8 months postoperatively. Complete data was analyzed by SPSS 22.0 version. Results: Out of 68 patients, there were 48 (68.6%) males and 20 (31.4%) females. Most of the patients 41 (60.35) were aged between 8-12 years and the rest 27 (39.65%) were between 5-8 years.34 (50%) fractures were caused because of road accidents, falling from height were 20 (29.41%), due to sports were 10 (14.70%) and 4 (5.9%) were due to simple fall. 32 (47.06%) patients had left side fracture and 36 (52.94%) had right side fracture. Mean union time among patients was 4.14±2.72 months and there was no any case of non union. According to Flyn’s criteria, 50 (73.53%) cases had excellent results, 14 (20.6%) patients had good and fair results were among 4 (5.9%) cases. Complications were observed bone stiffness, delayed union and varus deformity among all cases. Conclusion: We concluded in this study thatElastic intramedullary nailing for femoral shaft fractures in children is safe and effective treatment modality. Union of bone achieved all the patients and majority of patients had excellent functional outcomes. Keywords: Femoral shaft fractures, Children, Elastic intra-medullary nail

Response to: Flexible Intramedullary Nailing of Femoral Shaft Fractures in Children Weighing ≥40 kg: A Systematic Review and Meta-Analysis.

BACKGROUND Pediatric femur fractures are commonly treated with flexible intramedullary nails (FIN). However, there is controversy regarding the effect of patient weight on outcomes and complications. The purpose of this meta-analysis was to review the literature and describe implant choice, analyze complication, and reoperation rates; as well as the report clinical and radiographic outcomes of FIN in pediatric patients weighing ≥40 kg with femoral shaft fractures. METHODS A systematic review was performed of all retrospective and prospective studies focusing on the use of FIN in heavy children in Medline, Cochrane, and Web of Science databases. Data extraction was performed and summarized using descriptive statistics. Quality assessment was performed using the Newcastle-Ottawa Scale. Meta-analysis was performed for complications using pooled data from included studies. RESULTS The initial search strategy yielded 177 references, and after exclusions, 5 studies were included. The majority of studies were retrospective, and the most commonly used implants in heavier patients were titanium FIN and stainless steel Enders FIN. There were higher rates of radiographic nonunion and malunion, complications, and reoperations for refracture; and nonunion in heavier children treated with FIN. Meta-analysis performed on 4 applicable studies showed the overall complication rate was higher in the heavier patients compared with lighter patients (30.6% vs. 11.1%) with a relative risk of 1.20 [95% confidence interval (CI), 1.02-1.41]. Heavier patients also had higher rates of major complications (relative risk, 1.32; 95% CI, 1.03-1.69) but similar minor complications (relative risk, 1.13; 95% CI, 0.90-1.41). CONCLUSIONS Heavier children have worse radiographic outcomes and higher complication rates with the use of FIN for femoral shaft fractures. Additional research is needed to determine the effect of FIN material on clinical outcomes in heavier children, and the relationship between weight and other known risk factors for poor outcome in FIN, such as length stability. LEVEL OF EVIDENCE Level III-systematic review of level-III studies.

EOS stereographic assessment of femoral shaft malunion after intramedullary nailing. A prospective series of 48 patients at 9 months’ follow-up

IntroductionThe aim of the present study was to assess femoral shaft malunion following anterograde intramedullary nailing, using low-dose EOS stereoradiography. The study hypothesis was that our surgical technique is associated with radiological rotation disorder rates equivalent to those reported in the literature. MethodsAll patients with unilateral femoral shaft fracture treated by anterograde nailing between January 2014 and December 2016 and followed up in our structure were included in a single-center prospective study. The main endpoint was≥15° transverse malrotation compared to the contralateral side as measured on EOS stereoradiography. Correlations between malrotation and Harris Hip and SF12 functional scores were assessed, as were risk factors for onset of shaft malunion in rotation. Forty-eight patients with a mean age of 31.4 years were analyzed at a mean 9.3 months’ follow-up. ResultsStereoradiographic malrotation was found in 29.2% of patients. Mean anteversion was 18.5±13.8°. In 2.1% of patients, symptomatic rotation disorder required revision surgery. No correlations emerged between transverse malrotation and functional scores (p>0.05). Risk factors for malrotation comprised multi-site fracture (p=0.04), surgeon's inexperience (p=0.04), and open reduction (p=0.01). ConclusionThe present radiologic malrotation rate was comparable to those reported in the literature, using the EOS stereoradiographic system, which provides precise assessment of rotation disorder following closed nailing of femoral shaft fracture. Level of evidenceIII; prospective study without control group.

For Intramedullary Nailing of Femoral Shaft Fractures, Talon Fixation is Helpful to Cope With the Troublesome Distal Locking, But Conventional Distal Locking With Screws Offers a More Stable Construct. Talon Femoral Nail Versus Conventional Femoral Nail

A novel-design femoral nail (FN) with distal talon deployment (Talon-FN) has emerged in the market to cope with problematic distal locking. We aimed to compare the radiological and functional outcomes of the Talon-FN with a conventional FN (Con-FN) for the treatment of femoral shaft fracture (FSFs). This retrospective study included 85 patients (57 men, 28 women; mean age: 46.8±23.9 years) with FSFs (AO types 32-A and B) who were treated with FNs (Talon-FN: 41, Con-FN: 44) during October 2014-2018. Knee injury and Osteoarthritis Outcome Score Physical Function Shortform, Hip injury and Osteoarthritis Outcome Score Physical Function Shortform, Short musculoskeletal function assessment bother and dysfunction indexes were used for functional assessment. The mean follow-up time was 25.8±6.7 months. The complication rates were 19.6% and 20.5% for Talon-FN and Con-FN, respectively (p=0.92). Malunion was the most common complication for each FN type (Talon-FN: 9.8%, Con-FN: 9.1%). All of the Talon-FN group's malunions were axial (shortening and malrotation) and happened gradually. In contrast, the Con-FN group's malu-nions were angular (varus and valgus) and caused by initial malreduction. The Talon-FN group's two patients with shortening (4.9%) had AO 32-B type fractures, and the other two with malrotation (4.9%) had AO 32-A3 type fractures, all of four fractures were localized distal to the femoral isthmus. The post-operative functional outcomes were similar between the groups (all p>0.05). The mean op-eration/fluoroscopy time and the mean blood loss were lower in the Talon-FN group, while the mean union time was shorter in the Con-FN group (all p<0.01). No nonunion was noted in either group. The reoperation rates were similar at approximately 5% (p=0.95). Our study results revealed that the Talon-FN shortens the operation/fluoroscopy time and decreases the intra-operative blood loss with similar functional outcomes. However, the Con-FN seems to offer a more stable construct against axial malunion with a shorter bone union time. The Talon-FN should not be used in FSFs distal to the femoral isthmus with certain types of fractures prone to shortening and malrotation.

The flipped third fragment in femoral shaft fractures: A reason for open reduction?

ObjectivesFirst introduced by Kuntscher in the 1940s, closed intramedullary nailing of femoral shaft fractures has become the standard of care, with reported union rates up to 99% in some series. However, fractures with large intercalary segments, which are present in 10-34% of femoral shaft fractures, present unique challenges. In particular, how to treat flipped intercalary segments has remained controversial, with some advocating open reduction of these fractures. The purpose of this study was to evaluate the union rates of femoral shaft fractures with flipped intercalary segments treated with closed reduction and intramedullary nail fixation. MethodsA retrospective review of patients with femoral shaft fractures and flipped intercalary segments from January 2000 until January 2018 was performed at a single academic level one tertiary care referral center. All patients between the ages of 16-80 with minimum 6-month follow-up were included. Union rates were evaluated using the radiographic union score of the femur (RUSF). Patients with non-diaphyseal femur fractures, pathologic fractures, incomplete radiographic or clinical follow-up, or open reduction at the time of initial surgery were excluded. ResultsTwenty-six patients (18 male and 8 female) with a mean age of 32 years (SD 12.8, range 19-65 years) and mean follow-up of 15.9 months (range, 6–82 months) met inclusion criteria. Seven patients had open fractures. The mean size of the flipped intercalary segments was 71.3 mm (range: 30-174 mm), with mean displacement of 6.6 mm (range: 1-37 mm). The mean radiographic union scale in femoral (RUSF) at 6 months was 9 (standard deviation: 1.35). There were two patients who went on to non-union. The overall union rate was 92% (24 patients); the non-union rate was 8% (2 patients). ConclusionsThough uncommon, femoral shaft fractures with flipped intercalary segments present unique challenges to surgical treatment. While previous studies have found the presence of large intercalary segments to be associated with higher rates of non-union, the results of this study challenge prior evidence. In conclusion, the presence of flipped intercalary segments may not require different surgical management than the treatment of conventional femoral shaft fractures. Level of evidenceIV

Clinical and radiographic outcomes following retrograde SIGN fin nailing for femoral shaft fractures.

Purpose:The Surgical Implant Generation Network (SIGN) intramedullary nail was designed for use in resource limited settings which often lack fluoroscopy, specialized fracture tables, and power reaming. A newer design iteration, the SIGN Fin nail, was developed to further simplify retrograde femoral nailing by making proximal interlocking screw placement unnecessary. Instead, the leading end of the Fin nail achieves stability through an interference fit within the proximal femoral canal. While the performance of the traditional SIGN nail has been reported previously, no large series has examined long-term clinical and radiographic outcomes of femoral shaft fractures treated with the SIGN Fin nail.Methods:The SIGN online surgical database was used to identify all adult femoral shaft fractures treated with the SIGN Fin nail since its introduction. All patients with minimum 6 month clinical and radiographic follow-up were included in the analysis. Available demographic, injury, and surgical characteristics were recorded. Fracture alignment was evaluated on final follow-up radiographs using a previously validated on-screen protractor tool. Coronal and sagittal plane alignment measurements were recorded as deviation from anatomic alignment (DFAA), with units in degrees. Fracture healing was assessed on final follow-up radiographs, with union defined as any bridging callus and/or cortical remodeling across one cortex on orthogonal views. Clinical outcomes available in the database included knee range of motion (ROM) greater than 90° and weight-bearing status at final follow-up. Clinical and radiographic outcomes were then compared between patients with united and nonunited fractures.Results:The database query identified 249 femoral shaft fractures stabilized with the Fin nail in 242 patients who had minimum 6 month clinical and radiographic follow-up. Final follow-up radiographs were performed at an average of 48 weeks postoperatively. Average coronal and sagittal plane alignment measured on final follow-up radiographs were 2.18° and 2.58°, respectively. The rate of malalignment (DFAA > 10° in either plane) at final follow-up was 6%. Two hundred twenty-nine fractures (92%) were united at final follow-up. Overall, 209 (84%) of patients achieved full weight bearing and 214 (86%) achieved knee ROM >90° at final follow-up. Compared to patients with united fractures, those with nonunion were less likely to achieve full weight bearing (20% vs 90%, P < .001) and knee ROM >90° (30% vs 91%, P < .001). There was no significant difference in mean DFAA between united and nonunited fractures in the coronal (2.1° vs 3.8°, P = .298) or sagittal (2.5° vs 3.5°, P = .528) planes.Conclusion:The SIGN Fin nail achieves satisfactory radiographic alignment and clinical outcomes at minimum 6 month follow-up. The overall union rate is comparable to that achieved with the standard SIGN nail. Ease of implantation makes the Fin nail an attractive option in resource-limited settings.

Poor prognostic factors of femoral shaft fractures in children treated by elastic intramedullary nailing.

Introduction: Femoral shaft fractures in pediatric patients are treated by elastic intramedullary nailing using titanium or stainless-steel nails. The elastic stable intramedullary nailing behaves as an internal splint, promoting early mobilization. This type of treatment involves a minimally invasive approach, no damage to the growth plates, and no impairment of femoral head blood supply. Purpose: The aim of our study was to identify the negative predicting factors that might lead to an increased complication rate after elastic stable intramedullary nailing of femoral shaft fractures in children. Methods: We conducted a retrospective study on 137 patients with femoral shaft fractures treated by elastic stable intramedullary nailing. Patients’ age ranged between 4 and 17 years. We used data from the medical records of the patients to evaluate postoperative complications. Plain radiographs were analyzed to determine the fracture type, fracture location, and postoperative complications such as delayed union, angular deformities, and limb length discrepancies. Multivariate analysis was conducted to identify predictors for poor outcomes. Results: Complications occurred in 29 patients (21%) and consisted of delayed union, axial deformities, or lower limb length discrepancies. In the group of patients that suffered from complications, mechanism of injury, age, and weight were significant. They were older by an average of 5 years; half of them weighed more than 50 kg and over a half were involved in a road traffic accident. Conclusions: Elastic nailing is a successful tool to treat femoral shaft fractures. Three factors were demonstrated to influence the outcome. The mechanism of injury, age > 11 years, and weight > 50 kg are the most important and are predictors for development of complications such as delayed union or deformity.

Orthopaedic Trauma in Low-resource Settings: Measuring Value.

There is increasing recognition of both the impact and value of trauma care in low- and middle-income countries (LMICs). However, data supporting the value of musculoskeletal trauma care specifically are lacking. This review discusses methods of economic analysis relevant to low-resource settings and provides a review of cost studies related to orthopaedic trauma care in these settings. In general, microcosting methods are preferred in LMICs because of the lack of databases with aggregate cost data. It is important that studies use a societal perspective that includes the indirect costs of treatment in addition to direct costs of medical care. Cost-effectiveness studies most commonly report cost per disability-adjusted life year, particularly in LMICs, but quality-adjusted life years are an acceptable alternative that is based on more empiric data. There are solid economic data supporting potential cost savings and improved outcomes with intramedullary nailing for femoral shaft fractures. Trauma care hospitals and educational initiatives have also been found to be highly cost-effective. However, very little data exist to support other interventions in orthopaedic trauma. Orthopaedic surgeons should strive to understand these methodologies and support the conduct of rigorous economic analysis to better establish the value of musculoskeletal trauma care in LMICs.

Effect of Nail Size, Insertion, and Δ Canal-Nail on the Development of a Nonunion After Intramedullary Nailing of Femoral Shaft Fractures.

To determine whether intramedullary nail (IMN) diameter, antegrade versus retrograde insertion, or the difference between the canal and IMN diameter affect femoral shaft fracture healing. Retrospective analysis of a prospective database. Level One Regional Trauma Center. Seven hundred thirty-three femoral shaft fractures (OTA/AO 32) treated with an IMN between 1999 and 2017. After exclusion criteria, 484 fractures remained in the final analysis. Closed section, cannulated, interlocked, titanium alloy IMN using a reamed insertion technique. Nonunion, IMN size (10, 11.5, and 13 mm), antegrade versus retrograde insertion, Δ canal-nail diameter (ΔD) after reaming (<1, 1-2, or >2 mm). IMN diameters used were as follows: 314/10 mm (64%), 137/11.5 mm (28%), and 33/13 mm (8%). Forty-five percent were placed in antegrade versus 55% retrograde. Four hundred fifty-six fractures (94.2%) healed uneventfully. There were no IMN failures. 10/484 IMNs (2%) had broken interlocking screws; only 4 were associated with a NU. Average time to union was 23 weeks (12-119). Twenty-eight (5.8%) developed NU. There was no statistical correlation between (1) the NU rate and IMN diameter: 10 mm, 6.3%; 11.5 mm, 5.1%; 13 mm, 3% (P = 0.8, power = 0.85), (2) the NU rate and ΔD: 7.1% <1 mm, 5.6% 1-2 mm, 20% >2 mm (P = 0.36), (3) the NU rate and fracture location: Prox = 11%, Mid = 5%, Dist = 3% (P = 0.13), or (4) the NU rate and antegrade (7.2%) versus retrograde (4.2%) insertion (P = 0.24). Similar healing rates occurred regardless of IMN diameter, Δ canal-nail diameter after reaming, or insertion site. This indicates that a closed section, cannulated, interlocked, titanium alloy IMN with a diameter of 10 mm can be considered the standard diameter for the treatment of acute femoral shaft fractures, regardless of entry point. This should be associated with less reaming and therefore shorter operative times, and possibly less hospital implant inventories as well. Larger diameter IMN should be reserved for revision surgery. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Flexible intramedullary nailing of femoral shaft fractures: closed versus open reduction.

Children's femoral shaft fractures are commonly treated with flexible intramedullary nailing after closed or open reduction, but there is little information concerning indications for open reduction. The purpose of this study was to determine radiographic and clinical features likely to lead to open reduction before flexible intramedullary nailing. Record review identified 158 femoral shaft fractures treated with flexible intramedullary nailing. In addition to patient demographics and mechanism of injury, data obtained included surgeon name, estimated blood loss, type of reduction, type and diameter of nail, type of operating table, the use of percutaneous reduction techniques or supplemental casting, time to and duration of surgery, total time in operating room, and time to union. Fracture ratios were calculated based on established radiographic protocol. Of 158 fractures, 141 were treated with closed reduction and 17 with open reduction. The anteroposterior fracture index (1.3 ± 0.4, P = 0.0007), surgeon (P = 0.002), and flattop operating table (0.05) were associated with open reduction. Smaller lateral diameter of bone at the fracture site, transverse fracture, and surgeon were all found to be independent risk factors for open reduction; patient characteristics, including age, sex, and BMI, did not seem to influence the choice of open reduction. Fractures with a lower fracture index or pattern resembling a transverse fracture rather than oblique or spiral had an increased risk of converting to an open reduction. Surgeon preference and use of flattop tables also had a significant influence on how the fracture was treated.

Interlocking nailing of femoral shaft fractures with an extremely narrow medullary canal is associated with iatrogenic fractures

IntroductionControversy exists regarding the use of reamed interlocking nailing in femoral shafts with extremely narrow medullary canals (diameter ≤ 9 mm). The aims of this study were to (1) investigate the association of age and sex on femoral canal diameter in patients with a simple femoral shaft fracture and (2) compare the outcomes and complications of interlocking nailing between wide and extremely narrow intramedullary canals. Patients and methodsFor the purposes of this retrospective cohort study, consecutive patients with simple femoral shaft fractures were recruited between January 2009 and December 2016. The patient demographic data were analyzed. Then, fractures treated with interlocking nailing were divided into the wide group (canal diameter > 9 mm) and narrow group. The primary outcome was union rate, and the secondary outcomes were complications such as thermal necrosis, fat embolism syndrome, iatrogenic fracture, and implant failure. ResultsThis study included 340 femoral shaft fractures. The average canal diameter was 9.97 ± 1.79 mm, with significantly wider canals in men than in women. Overall, 289 of the patients had undergone interlocking nail fixation, and a similar union rate and complications were noted between the wide canal and narrow canal groups, with the exception of the incidence of iatrogenic fracture. ConclusionsFemoral shaft fractures associated with extremely narrow medullary canals are more common in women than in men. There was a similar union rate found when using interlocking nailing in a femoral shaft fracture in cases with extremely narrow and wider canals. Iatrogenic fracture is the only significant risk when using interlocking nailing in femoral shafts with extremely narrow canals.

Trochanteric entry VS piriformis entry in case of antegrade nailing of femoral shaft fracture treatment: A prospective randomised comparative study

Background: Intramedullary nailing is the best modality for femoral shaft fractures as it is biological fixation with good apposition with minimal tissue damage and fxation is bio mechanically superior to plates and fixators with immediate rehabilitation and fewer complications. The optimal entry point for antegrade intramedullary nailing of femoral shaft fractures remains controversial. Since the study by Ricci et al, there have been a number of randomized, controlled trials (RCTs) and cohort studies comparing the efficacy of the 2 entry points on various patient-and procedure-related outcomes. As per our knowledge, there has been very less systematic review of the literature on optimal entry point during antegrade nailing of femoral shaft fracture. Aims and ObjectivesAims: To compare the operative and fluoroscopic time required for IM nail fixation, time taken for taking entry, the amount of blood loss, and other complication in the form of iatrogenic neck femur fracture in surgery of femoral shaft fractures using the GT (greater trochanter) versus PF (Pyriformis fossa) entry point. A secondary objective was to determine whether there were any differences in complications (delayed and non union), fracture alignment and healing and functional outcomes in the form of thorensen score, and HHS (harris hip score) between the 2 entry points. Materials and Methods: The present pilot project was conducted in a time span of 2 year and 4 months. The patients admitted with femoral diaphyseal fractures were alternately selected for antegrade nailing through PF group and greater trochanter entry (GTE group) approach. Total number of patient in each group was 30 (n = 30).

Satisfactory postoperative alignment following retrograde SIGN Fin nailing for femoral shaft fractures

Purpose:In developing countries, long bone fractures following trauma are a significant contributor to morbidity, and operating room resources are often limited in these settings. The Surgical Implant Generation Network (SIGN) Fin nail may reduce the challenges of retrograde intramedullary nailing of femoral fractures without fluoroscopy. In contrast to the traditional SIGN nail placed in a retrograde fashion, the Fin nail does not require proximal interlocking screws. Instead, the nail achieves stability through an interference fit within the proximal femoral canal. The purpose of this study is to compare postoperative alignment in femoral shaft fractures treated with either a retrograde SIGN Fin nail or a standard retrograde SIGN nail.Method:Using the SIGN online surgical database, we identified all femoral shaft fractures treated with a retrograde SIGN Fin nail at 2 African hospitals. Two examiners independently classified fracture patterns using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification system. Using an on-screen protractor tool, postoperative coronal and sagittal plane alignment were measured and recorded as deviation from anatomic alignment (DFAA), with units in degrees. Available patient demographics and surgical details were also recorded. Fin nail cases were matched in a 1:1 ratio to retrograde standard SIGN nail cases based on AO/OTA fracture type.Results:Twenty-eight retrograde Fin nail cases were identified, and 28 matched retrograde SIGN nail cases were selected. The Fin nail and retrograde SIGN nail groups were well matched in terms of demographics, AO/OTA fracture type, and surgical characteristics. There was no significant difference in postoperative coronal or sagittal plane alignment between the groups. There were no cases in either group of average postoperative malalignment >5° in any plane.Conclusion:The SIGN Fin nail appears to achieve satisfactory radiographic alignment without the need for proximal interlocking screws, making it an attractive implant for retrograde femoral shaft fracture fixation in resource-limited settings. Further research is required to validate these findings and determine long-term Fin nail clinical outcomes.

Ipsilateral Femoral Neck and Shaft Fracture Management Single Implant versus Multiple Implants

Introduction: Fracture of shaft and ipsilateral neck of femur is a challenging problem to orthopaedics surgeons. The treatment is often difficult, and there are many protocols for the management of these fractures. Objectives: To assess the efficiency of multiple implants method for management of ipsilateral fracture neck and shaft femur using plate and screws or retrograde nail for femoral shaft fractures and cannulated screws or sliding hip screw for femoral neck fracture, evaluate the efficiency of reconstruction nail as a single implant method for management of fracture both neck and shaft femur as well as to compare the results of two management methods. Material and Methods: A total of 20 adult patients with ipsilateral femoral neck and shaft fractures were included in our study. Standard radiographs were obtained. Patients were divided into single implant group (Group I; 10 patients) and multiple implants group (Group II; 10 patients). All patients were followed prospectively for a minimum of 1 year. Fracture union was confirmed radiologically, and functional evaluation was done as per Harris Score. Results: 70% of both groups achieved successful fracture union with the remaining 30% with either nonunion, malunion or necrosis of the femoral head but with non- significant difference between both groups. Conclusion: Upon comparing single versus multiple implants methods, equivalent results, were clinically and radiologically obtained with both techniques. However, it is difficult to draw a definite conclusion as the number of cases is relatively small. A study with a larger population scale probably gives a definite conclusion.

Ipsilateral Femoral Neck and Shaft Fracture Management Single Implant versus Multiple Implants

Introduction: Fracture of shaft and ipsilateral neck of femur is a challenging problem to orthopaedics surgeons. The treatment is often difficult, and there are many protocols for the management of these fractures. Objectives: To assess the efficiency of multiple implants method for management of ipsilateral fracture neck and shaft femur using plate and screws or retrograde nail for femoral shaft fractures and cannulated screws or sliding hip screw for femoral neck fracture, evaluate the efficiency of reconstruction nail as a single implant method for management of fracture both neck and shaft femur as well as to compare the results of two management methods. Material and Methods: A total of 20 adult patients with ipsilateral femoral neck and shaft fractures were included in our study. Standard radiographs were obtained. Patients were divided into single implant group (Group I; 10 patients) and multiple implants group (Group II; 10 patients). All patients were followed prospectively for a minimum of 1 year. Fracture union was confirmed radiologically, and functional evaluation was done as per Harris Score. Results: 70% of both groups achieved successful fracture union with the remaining 30% with either nonunion, malunion or necrosis of the femoral head but with non- significant difference between both groups. Conclusion: Upon comparing single versus multiple implants methods, equivalent results, were clinically and radiologically obtained with both techniques. However, it is difficult to draw a definite conclusion as the number of cases is relatively small. A study with a larger population scale probably gives a definite conclusion.

Clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments: a retrospective analysis of risk factors for delayed union

BackgroundThis study retrospectively evaluated the clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments and analyzed the risk factors for delayed union.MethodsRetrospective analyses involving 51 patients who...

Observational study on titanium elastic nailing in femoral shaft fractures in children

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nowadays femoral fractures in children are more commonly managed with operative fixation rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Our aim of study was to assess the outcome of titanium elastic nailing in femoral shaft fracture in children.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Twenty five children in age group 5-15 years with femoral shaft fracture were stabilized with two titanium nails. Children were followed up for one year. The operative outcome was evaluated using criteria of Flynn. Complications associated with procedure were recorded and analyzed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The final outcome was excellent in 67% (19 of 25) of patients, satisfactory in 16% (4 of 25) of patients and poor in 8% (2 of 25) of patients. Poor outcome was due to limb length discrepancy, pain in the knee and angular misalignment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that titanium elastic nailing is an ideal method of femoral shaft fixation in children.&lt;/p&gt;