Analysis of the influence of circumference and displacement of the third fracture fragment on the healing of femoral shaft fractures treated with intramedullary nailing.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
06 Aug 2024
06 Aug 2024
Historique:
received:
28
12
2023
accepted:
31
07
2024
medline:
7
8
2024
pubmed:
7
8
2024
entrez:
6
8
2024
Statut:
epublish
Résumé
The effect of circumference and displacement of the third fracture fragment on fracture healing after intramedullary nailing of femoral shaft fractures with a third fracture fragment was investigated. A retrospective cohort study was conducted to analyze the data of 142 patients who suffered femoral shaft fractures with a third fracture fragment and were admitted to the First People's Hospital of Lianyungang from February 2016 to December 2021. According to the circumference of the third fracture fragments, these were divided into three types of type 1: 71 cases; type 2: 52 cases; and type 3: 19 cases. On the basis of the diaphyseal diameter, the degree of displacement of the third fracture fragment was classified into three degrees of degree I: 95 cases; degree II: 31 cases; and degree III: 16 cases. Postoperative follow-up was performed to compare the fracture healing rate, healing time, and the modified Radiographic Union Scale for Tibia (mRUST) at 9th month after surgery in each group. All 142 patients were followed up after operation, with an average of (14.7 ± 4.1) months, and the overall healing rate was 73.4%. When the third fracture fragments were displaced in degree II and III, the mRUST score at 9th month in the type 1 group was higher than that in the type 2 and 3 groups (P = 0.017). Logistic regression analysis showed that greater displacement of third fracture fragments and greater circumference were associated with lower fracture healing rates (P < 0.05). After intramedullary nailing of femoral fractures, the degree of third fragment displacement and circumference affect fracture healing, and the former has a greater impact. When the third fracture fragment is displaced to degree II or III and its circumference is type 2 or type 3, it significantly affects the fracture healing. Intraoperative intervention to reduce the distance of third displacement of the fragment is required to reduce the incidence of non-union.
Identifiants
pubmed: 39107419
doi: 10.1038/s41598-024-69137-5
pii: 10.1038/s41598-024-69137-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
18173Subventions
Organisme : scientific research project of Jiangsu Provincial Health Commission
ID : LGY2022052
Organisme : Lianyungang Health Science and Technology Project Fund
ID : 202107
Informations de copyright
© 2024. The Author(s).
Références
Lee, J., Kim, H. & Lee, K. Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing. Orthop. Traumatol. Surg. Res. OTSR 102, 175–181. https://doi.org/10.1016/j.otsr.2015.11.014 (2016).
doi: 10.1016/j.otsr.2015.11.014
pubmed: 26826804
Wolinsky, P., McCarty, E., Shyr, Y. & Johnson, K. Reamed intramedullary nailing of the femur: 551 cases. J. Trauma 46, 392–399. https://doi.org/10.1097/00005373-199903000-00007 (1999).
doi: 10.1097/00005373-199903000-00007
pubmed: 10088839
Layon, D., Morrell, A. & Lee, C. The flipped third fragment in femoral shaft fractures: A reason for open reduction?. Injury 52, 589–593. https://doi.org/10.1016/j.injury.2020.09.049 (2021).
doi: 10.1016/j.injury.2020.09.049
pubmed: 32998826
Salminen, S., Pihlajamäki, H., Avikainen, V. & Böstman, O. Population based epidemiologic and morphologic study of femoral shaft fractures. Clin. Orthop. Related Res. https://doi.org/10.1097/00003086-200003000-00026 (2000).
doi: 10.1097/00003086-200003000-00026
Pihlajamäki, H., Salminen, S. & Böstman, O. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J. Orthop. Trauma 16, 394–402. https://doi.org/10.1097/00005131-200207000-00005 (2002).
doi: 10.1097/00005131-200207000-00005
pubmed: 12142827
Santolini, E., West, R. & Giannoudis, P. Leeds-Genoa Non-Union Index: A clinical tool for asessing the need for early intervention after long bone fracture fixation. Int. Orthop. 44, 161–172. https://doi.org/10.1007/s00264-019-04376-0 (2020).
doi: 10.1007/s00264-019-04376-0
pubmed: 31440889
Lin, S., Chen, C., Peng, K. & Hsu, W. Effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail. Injury 45, 752–756. https://doi.org/10.1016/j.injury.2013.10.015 (2014).
doi: 10.1016/j.injury.2013.10.015
pubmed: 24268188
Vicenti, G. et al. The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: A radiological study. Int. Orthop. 43, 193–200. https://doi.org/10.1007/s00264-018-4214-2 (2019).
doi: 10.1007/s00264-018-4214-2
pubmed: 30488127
Yang, S. et al. Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing. J. Orthop. Surg. Res. 17, 380. https://doi.org/10.1186/s13018-022-03275-2 (2022).
doi: 10.1186/s13018-022-03275-2
pubmed: 35962386
pmcid: 9373464
Böstman, O., Varjonen, L., Vainionpää, S., Majola, A. & Rokkanen, P. Incidence of local complications after intramedullary nailing and after plate fixation of femoral shaft fractures. J. Trauma 29, 639–645. https://doi.org/10.1097/00005373-198905000-00019 (1989).
doi: 10.1097/00005373-198905000-00019
pubmed: 2724381
Liu, Y. Interlocking intramedullary nail fixation in the treatment of femoral stem fractures. Guide China Med. 8, 90. https://doi.org/10.3969/j.issn (2009).
doi: 10.3969/j.issn
Litrenta, J. et al. Determination of radiographic healing: An assessment of consistency using RUST and modified RUST in metadiaphyseal fractures. J. Orthop. Trauma. 29, 516–520. https://doi.org/10.1097/bot.0000000000000390 (2015).
doi: 10.1097/bot.0000000000000390
pubmed: 26165265
Plumarom, Y. et al. Sensitivity and specificity of modified RUST score using clinical and radiographic findings as a gold standard. Bone Joint Open 2, 796–805. https://doi.org/10.1302/2633-1462.210.Bjo-2021-0071.R1 (2021).
doi: 10.1302/2633-1462.210.Bjo-2021-0071.R1
pubmed: 34587782
pmcid: 8558446
Mısır, A. et al. Reliability of RUST and modified RUST scores for evaluation of union in pediatric and adult femoral shaft fractures. Acta Orthop. Traumatol. Turcica 55, 127–133. https://doi.org/10.5152/j.aott.2021.20074 (2021).
doi: 10.5152/j.aott.2021.20074
Kizkapan, T. et al. Reliability of radiographic union scale in tibial fractures and modified radiographic union scale in tibial fractures scores in the evaluation of pediatric forearm fracture union. Joint Diseases Relat. Surg. 32, 185–191. https://doi.org/10.5606/ehc.2021.78465 (2021).
doi: 10.5606/ehc.2021.78465
Nakamura, A. et al. Cell sheet transplantation of cultured mesenchymal stem cells enhances bone formation in a rat nonunion model. Bone 46, 418–424. https://doi.org/10.1016/j.bone.2009.08.048 (2010).
doi: 10.1016/j.bone.2009.08.048
pubmed: 19716454
Singh, D., Garg, R., Bassi, J. & Tripathi, S. Open grade III fractures of femoral shaft: Outcome after early reamed intramedullary nailing. Orthop. Traumatol. Surg. Res. OTSR 97, 506–511. https://doi.org/10.1016/j.otsr.2011.02.012 (2011).
doi: 10.1016/j.otsr.2011.02.012
pubmed: 21641292
Bhandari, M. et al. A lack of consensus in the assessment of fracture healing among orthopaedic surgeons. J. Orthop. Trauma 16, 562–566. https://doi.org/10.1097/00005131-200209000-00004 (2002).
doi: 10.1097/00005131-200209000-00004
pubmed: 12352564
Whelan, D. et al. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J. Bone Joint Surg. Br. 84, 15–18. https://doi.org/10.1302/0301-620x.84b1.11347 (2002).
doi: 10.1302/0301-620x.84b1.11347
pubmed: 11837825
Wiss, D., Fleming, C., Matta, J. & Clark, D. Comminuted and rotationally unstable fractures of the femur treated with an interlocking nail. Clin. Orthop. Related Res. 212, 35–47 (1986).
Winquist, R. & Hansen, S. Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop. Clin. N. Am. 11, 633–648 (1980).
doi: 10.1016/S0030-5898(20)31463-2
Claes, L., Eckert-Hübner, K. & Augat, P. The effect of mechanical stability on local vascularization and tissue differentiation in callus healing. J. Orthop. Res. 20, 1099–1105. https://doi.org/10.1016/s0736-0266(02)00044-x (2002).
doi: 10.1016/s0736-0266(02)00044-x
pubmed: 12382978
Lienau, J. et al. Initial vascularization and tissue differentiation are influenced by fixation stability. J. Orthop. Res. 23, 639–645. https://doi.org/10.1016/j.orthres.2004.09.006 (2005).
doi: 10.1016/j.orthres.2004.09.006
pubmed: 15885486
Hamahashi, K. et al. Clinical outcomes of intramedullary nailing of femoral shaft fractures with third fragments: A retrospective analysis of risk factors for delayed union. Trauma Surg. Acute Care Open 4, e000203. https://doi.org/10.1136/tsaco-2018-000203 (2019).
doi: 10.1136/tsaco-2018-000203
pubmed: 31058233
pmcid: 6461209
Yoon, Y., Song, H., Han, J. & Lee, K. Antegrade nailing in femoral shaft fracture patients—Comparison of outcomes of isolated fractures, multiple fractures and severely injured patients. Injury 52, 3068–3074. https://doi.org/10.1016/j.injury.2021.01.044 (2021).
doi: 10.1016/j.injury.2021.01.044
pubmed: 33563415
Mundy, G. Nutritional modulators of bone remodeling during aging. Am. J. Clin. Nutr. 83, 427S-430S. https://doi.org/10.1093/ajcn/83.2.427S (2006).
doi: 10.1093/ajcn/83.2.427S
pubmed: 16470007
Burç, H. et al. The intramedullary nailing of adult femoral shaft fracture by the way of open reduction is a disadvantage or not?. Indian J. Surg. 77, 583–588. https://doi.org/10.1007/s12262-013-0931-3 (2015).
doi: 10.1007/s12262-013-0931-3
pubmed: 26730068
Ehlinger, M. et al. Vascular complication after percutaneous femoral cerclage wire. Orthop. Traumatol. Surg. Res. OTSR 104, 377–381. https://doi.org/10.1016/j.otsr.2017.10.020 (2018).
doi: 10.1016/j.otsr.2017.10.020
pubmed: 29414721
Devendra, A., Avinash, M., Chidambaram, D., Dheenadhayalan, J. & Rajasekaran, S. Vascular injuries due to cerclage passer: Relevant anatomy and note of caution. J. Orthop. Surg. (Hong Kong) 26, 2309499018762616. https://doi.org/10.1177/2309499018762616 (2018).
doi: 10.1177/2309499018762616
pubmed: 29540100