Nailing femoral shaft fracture with postless distraction technique: a new technique enabled by shape-conforming pad.
Femur fracture
Postless technique
Pudendal neurapraxia
Urological complications
Journal
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
ISSN: 1590-9999
Titre abrégé: J Orthop Traumatol
Pays: Italy
ID NLM: 101090931
Informations de publication
Date de publication:
18 Mar 2021
18 Mar 2021
Historique:
received:
22
05
2020
accepted:
23
02
2021
entrez:
19
3
2021
pubmed:
20
3
2021
medline:
6
7
2021
Statut:
epublish
Résumé
Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications. We reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications. Median age was 53 years, and median weight was 70 kg (range 50-103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% "excellent" reduction for subtrochanteric fractures, while 81 versus 79% "excellent" reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique. Our results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail. IV.
Sections du résumé
BACKGROUND
BACKGROUND
Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications.
METHODS
METHODS
We reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications.
RESULTS
RESULTS
Median age was 53 years, and median weight was 70 kg (range 50-103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% "excellent" reduction for subtrochanteric fractures, while 81 versus 79% "excellent" reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique.
CONCLUSIONS
CONCLUSIONS
Our results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail.
LEVEL OF EVIDENCE
METHODS
IV.
Identifiants
pubmed: 33738638
doi: 10.1186/s10195-021-00573-z
pii: 10.1186/s10195-021-00573-z
pmc: PMC7973345
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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