Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing
Abstract Objective To investigate the effect of the degree of displacement of a femoral shaft fracture with the third fragment on fracture healing after intramedullary nailing. Methods In total, 216 patients with closed comminuted femoral fracture admitted to Lianyungang Hospital affiliated to Xuzho...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-022-03275-2 |
| _version_ | 1828352585654861824 |
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| author | Shuo Yang Yelin Yang Yongfeng Huo Jian Yu Luxin Sheng Xiao Sun Xinhui Liu Jian Yin Zhaoyang Yin |
| author_facet | Shuo Yang Yelin Yang Yongfeng Huo Jian Yu Luxin Sheng Xiao Sun Xinhui Liu Jian Yin Zhaoyang Yin |
| author_sort | Shuo Yang |
| collection | DOAJ |
| description | Abstract Objective To investigate the effect of the degree of displacement of a femoral shaft fracture with the third fragment on fracture healing after intramedullary nailing. Methods In total, 216 patients with closed comminuted femoral fracture admitted to Lianyungang Hospital affiliated to Xuzhou Medical University from February 2010 to February 2016 were analyzed retrospectively. Among these patients, 142 were males and 74 were females, the mean age was 38 years (range 17–64 years), and 95 cases were on the right, while 121 cases were on the left. All patients were treated with a femoral interlocking intramedullary nail. Referring to the femoral shaft diameter, the degree of displacement of the third fragment was classified into four grades: grade I (displacement was less than a third of the diameter of the shaft): 121 cases; grade II (greater than a third of the diameter and less than two thirds): 52 cases; grade III (greater than two thirds of the diameter): 28 cases; and grade IV (fracture fragment turnover): 15 cases. According to the modified Radiological Union Scale for Femur (mRUSF), the fracture union rate and the mean union time of the fracture, the effect of the degree of displacement of the third fragment on fracture healing was evaluated. Results In total, 216 patients with a mean follow-up of 15.9 months (range 6–31 months) met the inclusion criteria. The best fracture healing was the grade I displacement, with a union rate of 89.2% and a mean union time of 7.7 months. The poorest fracture healing was for the grade IV displacement, with a union rate of 13.3% and a mean union time of 16.5 months. The healing was moderate in the grade II and III displacements, with a union rate of 46.2% and 28.6%, respectively, and a mean union time of 8.6 months and 13.5 months, respectively (P < 0.05). Conclusions The third fragment with grade I displacement requires no intervention, whereas fractures with grade IV displacement should be reduced to as near as possible to the diaphyseal bone defect to avoid nonunion. The third fragments with the grade II or III displacement should be treated with closed reduction whenever possible to achieve a displacement within the range of grade I to minimize the incidence of nonunion. |
| first_indexed | 2024-04-14T01:55:03Z |
| format | Article |
| id | doaj.art-24603f3111534790b2074667b1d29f64 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T01:55:03Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-24603f3111534790b2074667b1d29f642022-12-22T02:19:07ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2022-08-0117111110.1186/s13018-022-03275-2Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailingShuo Yang0Yelin Yang1Yongfeng Huo2Jian Yu3Luxin Sheng4Xiao Sun5Xinhui Liu6Jian Yin7Zhaoyang Yin8Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang)Department of Orthopedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical UniversityDepartment of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang)Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang)Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang)Department of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang)Department of Orthopedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical UniversityDepartment of Orthopedic Surgery, The Affiliated Jiangning Hospital with Nanjing Medical UniversityDepartment of Orthopedic Surgery, Lianyungang Hospital, the Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang)Abstract Objective To investigate the effect of the degree of displacement of a femoral shaft fracture with the third fragment on fracture healing after intramedullary nailing. Methods In total, 216 patients with closed comminuted femoral fracture admitted to Lianyungang Hospital affiliated to Xuzhou Medical University from February 2010 to February 2016 were analyzed retrospectively. Among these patients, 142 were males and 74 were females, the mean age was 38 years (range 17–64 years), and 95 cases were on the right, while 121 cases were on the left. All patients were treated with a femoral interlocking intramedullary nail. Referring to the femoral shaft diameter, the degree of displacement of the third fragment was classified into four grades: grade I (displacement was less than a third of the diameter of the shaft): 121 cases; grade II (greater than a third of the diameter and less than two thirds): 52 cases; grade III (greater than two thirds of the diameter): 28 cases; and grade IV (fracture fragment turnover): 15 cases. According to the modified Radiological Union Scale for Femur (mRUSF), the fracture union rate and the mean union time of the fracture, the effect of the degree of displacement of the third fragment on fracture healing was evaluated. Results In total, 216 patients with a mean follow-up of 15.9 months (range 6–31 months) met the inclusion criteria. The best fracture healing was the grade I displacement, with a union rate of 89.2% and a mean union time of 7.7 months. The poorest fracture healing was for the grade IV displacement, with a union rate of 13.3% and a mean union time of 16.5 months. The healing was moderate in the grade II and III displacements, with a union rate of 46.2% and 28.6%, respectively, and a mean union time of 8.6 months and 13.5 months, respectively (P < 0.05). Conclusions The third fragment with grade I displacement requires no intervention, whereas fractures with grade IV displacement should be reduced to as near as possible to the diaphyseal bone defect to avoid nonunion. The third fragments with the grade II or III displacement should be treated with closed reduction whenever possible to achieve a displacement within the range of grade I to minimize the incidence of nonunion.https://doi.org/10.1186/s13018-022-03275-2Third fragmentMinimally invasive reductionIntramedullary nailFemoral shaft fracture |
| spellingShingle | Shuo Yang Yelin Yang Yongfeng Huo Jian Yu Luxin Sheng Xiao Sun Xinhui Liu Jian Yin Zhaoyang Yin Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing Journal of Orthopaedic Surgery and Research Third fragment Minimally invasive reduction Intramedullary nail Femoral shaft fracture |
| title | Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing |
| title_full | Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing |
| title_fullStr | Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing |
| title_full_unstemmed | Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing |
| title_short | Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing |
| title_sort | effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing |
| topic | Third fragment Minimally invasive reduction Intramedullary nail Femoral shaft fracture |
| url | https://doi.org/10.1186/s13018-022-03275-2 |
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