Safety and efficacy of a novel cephalomedullary nail in femoral shaft fractures: a retrospective observational cohort in 33 patients
Tóm tắt
Despite advances in femoral shaft fracture fixation, the nonunion rate remains relatively high; and there is limited data on the efficacy and failure rate of specific implants. A novel cephalomedullary nail provides the ability to treat femur shaft fractures in isolation, with associated ipsilateral femur injuries, and provides various options for proximal and distal fixation exists on the market; but literature remains limited on the safety and efficacy of this implant. The aim of this study is to evaluate the early failure rate of this cephalomedullary nail, while comparing the nonunion rate to what is currently presented in the literature. This study is the first of its kind in evaluation of a specific implant for treatment of femoral shaft fractures and ipsilateral pathology. Patients over 18 years of age, with traumatic femur shaft fractures, treated with this particular cephalomedullary nail and available for a minimum of 3-month follow-up were included for analysis. Data was collected by retrospective chart review and review of existing radiographs. Demographic data, injury details, AO/OTA fracture classification, and implant details were recorded for each patient. Primary outcome measured was implant failures (screw or nail breakage). Secondary outcomes measured included malunion, nonunion, deep infection, post-operative complications, and need for reoperation. Of the 33 patients included for analysis, 1 patient went on to non-union. There were no cases of implant failure. The single nonunion was a high-energy mechanism, open fracture, and higher level AO/OTA classification. The remaining 32 reached radiographic union at 3 months. The nonunion rate of this novel cephalomedullary nail is comparable to what is reported in the literature. This nail is a safe and effective implant to treat femoral shaft fractures with a variety of ipsilateral femoral shaft injuries and reliably leads fracture union. Further studies are needed analyzing implant failure and comparing specific implants.
Tài liệu tham khảo
Wood GW. Intramedullary nailing of femoral and tibia shaft fractures. J Orthop Sci. 2006;11(6):657–69.
Wiss DA, Gibson T. Intramedullary nailing of the femur and tibia: indications and techniques. Curr Orthop. 1994;8(4):245–54.
Winquist, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures: a report of five hundred and twenty cases. J Bone Joint Surg Am. 1984;66(4):529–39.
Duan X, Li T, Mohammed AQ, Xiang Z. Reamed intramedullary nailing versus unreamed intramedullary nailing for shaft fracture of femur: a systematic literature review. Arch Orthop Trauma Surg. 2011;131(10):1445–52.
TRIGEN META-TAN Surgical Technique. http://www.smith-nephew.com/global/assets/pdf/products/surgical/meta-tan%20st.pdf.
Canadian Orthopaedic Trauma Society. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial. J Bone Joint Surg Am. 2003;85-A(11):2093–6.
Harwood PJ, Guannoudis PV, Probst C, Krettek C, Pape HC. The risk of local infective complications after damage control procedures for femoral shaft fracture. J Orthop Trauma. 2006;20(3):181–9.
Taitsman LA, Lynch JR, Agel J, Barei DP. Risk factors for femoral nonunion after femoral shaft fracture. J Trauma. 2009;67(6):1389–92.
Yong-Gang MA, Ge-Liang H, Wei H, Liang F. Surgical factors contributing to nonunion in femoral shaft fracture following intramedullary nailing. Chin J Traumatol. 2016;19(2):109–12.
Metsemakers WJ, Roels N, Belmans A, Reynders P, Nijs S. Risk factors for nonunion after intramedullary nailing of femoral shaft fractures: remaining controversies. Injury. 2015;46(8):1601–7.
Lynch JR, Taitsman LA, Barei DP, Nork SE. Femoral nonunion: risk factors and treatment options. J Am Acad Orthop Surg. 2008;16(2):88–97.
Ricci WM, Gallagher B, Haidukewych GJ. Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orhtop Surg. 2009;17(5):296–305.
Kim JW, Oh CW, Oh JK, et al. Treatment of infra-isthmal femoral fracture with an intramedullary nail: is retrograde nailing a better option than antegrade nailing? Arch Orthop Trauma Surg. 2018;138(9):1241–7.
Chen W, Zhang T, Wang J, et al. Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation. Int Orthop (SICOT). 2016;40(1):167–72.
Yoon RS, Gage MJ, Galos DK, et al. Trochanteric entry femoral nails yield better femoral version and lower revision rates-a large cohort multivariate regression analysis. Injury. 2017;48(6):1165–9.
Elmi A, Rohani AR, Tabrizi A, Esmaili SM. Comparison of outcome of femoral shaft fracture fixation with intramedullary nail in elderly patient and patients younger than 60 years old. Arch Bone Jt Surg. 2014;2(2):103–5.
Helmy N, Jando V, Lu T, et al. Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral shaft fractures. J Orthop Trauma. 2008;22(1):10–5.
Archdeacon M, Ford K, Wyrick J, et al. A prospective functional outcome and motion analysis evaluation of the hip abductors after femur fracture and antegrade nailing. J Orthop Trauma. 2008;22(1):3–9.
Šmejkal K, Lochman P, Trlica J, et al. Impaired healing after surgery for femoral fractures. Acta Chir Orthop Traumatol Cechoslov. 2015;82(5):358–63.