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Objective@#To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model.@*Methods@#A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018. According to the different treatment time, the 251 patients included in this study were divided into the modeling group and the verification group. In the modeling group, postoperative fracture nonunion rate, general data, fracture related factors, surgical reduction related factors, mechanical and biological factors were calculated, and the influencing factors of fracture nonunion were screened by univariate analysis. Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model. The influencing factors were re-evaluated through the verification group, and the differentiation and calibration of the model were evaluated.@*Results@#Fracture nonunion occurred in 34 of 149 patients in the modeling group. Among the 13 potential influencing factors, univariate analysis and logistic regression analysis showed that postoperative hip varus, intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion. Postoperative reduction of medial cortex was a protective factor for fracture nonunion, and a regression equation was established. Based on the logistic regression model, the Nomogram diagram was drawn. In the verification group, fracture nonunion occurred in 24 of 149 patients. The area under the ROC curve was AUC=0.883>0.7, indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation. The goodness of fit test: the H-L test (χ2=2.921, P=0.712) showed that the model had a good calibration.@*Conclusion@#The risk factors of fracture nonunion were hip varus, failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture, and postoperative reduction of medial cortex was the protective factor. The risk assessment model has moderate differentiation and good calibration, which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.
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Objective To study the influencing factors of fracture nonunion after intramedullary nailing for subtrochanteric fracture and construct a risk assessment model.Methods A retrospective analysis was performed on 251 patients with intramedullary nail fractures of the femoral subtrochanteric fracture from February 2006 to January 2018.According to the different treatment time,the 251 patients included in this study were divided into the modeling group and the verification group.In the modeling group,postoperative fracture nonunion rate,general data,fracture related factors,surgical reduction related factors,mechanical and biological factors were calculated,and the influencing factors of fracture nonunion were screened by univariate analysis.Indicators with statistical differences in univariate analysis were analyzed using Logistic regression model for multivariate analysis to build the risk assessment model.The influencing factors were re-evaluated through the verification group,and the differentiation and calibration of the model were evaluated.Results Fracture nonunion occurred in 34 of 149 patients in the modeling group.Among the 13 potential influencing factors,univariate analysis and logistic regression analysis showed that postoperative hip varus,intramedullary nail fixation failure and complete open reduction were the risk factors of fracture nonunion.Postoperative reduction of medial cortex was a protective factor for fracture nonunion,and a regression equation was established.Based on the logistic regression model,the Nomogram diagram was drawn.In the verification group,fracture nonunion occurred in 24 of 149 patients.The area under the ROC curve was AUC=0.883 ＞ 0.7,indicating that there was a moderate differentiation to evaluate the occurrence of fracture nonunion after operation.The goodness of fit test:the H-L test (x2=2.921,P=0.712) showed that the model had a good calibration.Conclusion The risk factors of fracture nonunion were hip varus,failure of intramedullary nail fixation and complete open reduction after intramedullary nailing of subtrochanteric fracture,and postoperative reduction of medial cortex was the protective factor.The risk assessment model has moderate differentiation and good calibration,which can provide reference for the risk assessment of fracture nonunion after subtrochanteric fracture operation.
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<p><b>OBJECTIVE</b>To explore causes and strategies for postoperative bone nonunion after bone transport of lower limb bone of chronic osteomyelitis with bone defect.</p><p><b>METHODS</b>From June 2012 to December 2015, clinical data of 38 patients with lower limb bone of chronic osteomyelitis with bone defect were retrospectively analyzed, including 23 males and 15 females aged from 20 to 56 years old with an average of 36.5 years old; 5 cases occurred on 5 femoral osteomyelitis and 33 cases were tibial;the time from injury to bone transport ranged from 2 to 19 months with an average of 7.4 months; the distance of bone defect ranged from 4 to 12 cm with an average of 7.3 cm. Bone transport were performed at 1 week later after operations, and transport directions were from near-end to far-end for 30 cases, from far-end to near-end for 3 cases and bidirectional transport for another 5 cases. The alignment and transport speed were adjusted and weight-bearing was encouraged. Regular follow-up was performed and X-ray films were taken to observe complications such as poor mineralization in transport gaps, nonunion of docking sites, and recurrent fracture. Paley scoring was used to evaluate clinical effects.</p><p><b>RESULTS</b>All patients were followed up for 12 to 36 months with an average of 23.1 months. No recurrence of osteomyelitis, but multiple complications associated with poor bony healing occurred. In the process of bone transport, 3 cases occurred poor mineralization in transport gaps, 17 cases occurred ununion of docking sites, 5 cases suffered fracture gap, 1 case occurred fracture without remove of external fixation, and 4 cases occurred facture after remove of external fixation. The time of taken fixation ranged from 9 to 27 months with an average of 16.3 months; index of external fixation ranged from 1.7 to 2.7 months/cm with an average of 2.24 months/cm. According to Paley's scoring, bony results showed 12 cases excellent, 16 good, 3 moderate and 7 poor;and functional results showed 14 cases excellent, 18 good, 3 moderate and 3 poor.</p><p><b>CONCLUSIONS</b>Bone transport technique could effectively solve clinical problems of long bone osteomyelitis with bone defect. However, long treatment period influence prognosis. Therefore, indications should be chosen strict, and operations should be precise and accurate, also monitored across whole process and followed up in time. Doctors should be actively guide corresponding prevention strategies.</p>
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Objective To investigate the clinical effect of bone transport technique in the treatment of large segment infective nonunion of femoral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 33 patients with large segment infective nonunion of femoral shaft admitted to Chinese PLA General Hospital from June 2012 to October 2015.There were 25 males and eight females,aged 19-58 years (mean,34.6 years).In terms of the initial injury,23 patients were with open fracture and 10 with closed fracture.All patients previously received 1-9 times of operation,with an average of 2.3 times.The duration from injury to operation ranged from 7-60 months,with an average of 34 months.All patients underwent treatment with bone transport technique.After thorough debridement,the length of femoral defect ranged from 6 cm to 18 ema,with an average of 10.5 cm.The single arm limb reconstruction external fixator was placed on the lateral side of the femur under C-ann X-ray fluoroscopy.The wound healing,bone healing time,external fixation index (EFI),and complications were recorded.The function of the affected limb was evaluated using the modified criteria of Association for the Study and Application of the Method of Ilizarov (ASAMI).Results All patients were followed up for 21-53 months (average,38.5 months).Femoral defects were completely repaired,with no recurrent infection reported.Bone healing time ranged from 8 months to 25 months (average,13 months).The external fixation index (EFI) ranged from 1.13 months/cm to 1.83 months/cm,with an average of 1.26 months/cm.The infection rate of the nail tract was 55％ (18/33).There were 12 patients with Type A,five with Type B,and one with Type C.The function of the affected limb was graded as excellent in 18 patients,good in six,fair in five,and poor in four,with an excellent and good rate of 73％ (24/33).Conclusions In the treatment of large segment infective nonunion of femoral shaft,bone transport technique can eontrol the infection,promote defect repair,and restore the function of affected limbs.
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Objective To evaluate the effect of proximal femoral nail antirotation (PFNA) with autogenous bone grafting for salvage of failed internal fixation of intertrochanteric hip fracture.Methods Between January 2007 and June 2012,21 cases of intertrochanteric fractures who had failed internal fixation initially were treated with revision open reduction and PFNA internal fixation and autogenous bone grafting.There were 9 men and 12 women with the mean age of 54 years (range,27-76 years).In the initially failed internal fixation,dynamic hip screw (DHS) was used in 7 cases,locking proximal femoral plate (LPFP) in 8 cases,Gamma nail in 2 cases,proximal femoral nail (PFN) in 2 cases and home-made reconstruction nail in 2 cases.Results Mean operation time was 150 minutes (range,100-240 minutes) and mean blood loss was 800 ml (range,400-2,000 ml).There were no serious complications during operation.Mean follow-up was 26 months (range,6-66 months).Bone healing was achieved at mean 4 months (range,3-8 months) in all cases.Harris hip score was (42.1 ±3.2) points (range,36-48 points) before operation and (87.2 ± 3.8) points (range,62-94 points) at the final follow-up,with significant improvement in hip function (P ＜ 0.05).At the final follow-up,no avascular necrosis of the femoral head or hip degeneration occurred and mean neck-shaft angle was 130° (range,110°-142°).Conclusions Once the fracture patients with strong ability of action,massive proximal femoral residuals,and non-serious hip injury,revision PFNA internal fixation with autogenous bone grafting is effective.Complete preoperative evaluation and attention to specific technical details may improve success rate and reduce complications.
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Objective To explore the effect and safety of compression and distraction technique by external fixation without grafting in treatment of noninfectious nonunion of tubular fractures.Methods 43 patients were randomly divided into 2 groups by visiting sequence with random number,odd into the observation group,even into the control group.The observation group(22 cases) adopted the external fixation retractor pressure treatment,the control group(21 cases) was given extemal fixation combined with locking plate treatment.The efficacy of two groups was compared.Results 43 patients were followed up for 6 ～ 15 months,average 7.5 months.The bone healing time was 3 ～ 14 months,average 5.1 months.43 patients were all healed.The total effective rate of the observation group was 81.8％,which was significandy higher than 66.7％ in the control group (Z =9.654,P =0.001).There were no significant differences in adverse reactions and complications between the two groups (x2 =0.068,P =0.795).Conclusion The compression and distraction technique by external fixation in the treatment of noninfectious nonunion of tubular fractures has obvious curative effect,it can be widely used in clinical practice.
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Objective To study the clinical outcome of percutaneous vertebroplasty (PVP) for the s disease who had been suffering severe back pain even after conservative therapy for months were treated with PVP. Their preoperative CT images indicated nonunion of factures and "vacuum signs". Dynamic X-ray films demonstrated formation of pseudoarthrosis in the involved vertebral bodies in some eases. Their back pain was evaluated with visual analogue scale (VAS). Their preoperative and postoperative VAS scores and radiological indexes were compared. Results The mean VAS scores were 7.0±1.2 preoperatively, but 3.1±1.5 at the follow-up (P < 0.05) . The height of anterior margin of involved vertebral body was (2.1±0.3) cm pre-operatively, but (2.3±0.2) cm at the follow-up (P < 0.05). The ratio of anterior margin height to posterior margin height of the involved vertebral body was 0. 67±0. 10, but 0.84±0.08 at the follow-up (P<0.05), The focal kyphosis angle was 27.3°± 6.4° preoperatively but 20.7°±5.0° at the follow-up (P < 0.05). No pulmonary embolisms or neurological injuries happened. Conclusion PVP is an effective method for anterior margin of the involved vertebral body partially, and decrease the focal kyphosis.
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Objective To investigate the causes of non-union and delayed union of fractures and to report the surgical techniques and outcomes of the treatments. Methods 107 cases of non-union, 54 cases of delayed union and 2 cases of congenital non-union of tibia were treated between July 1990 and December 2004 in our hospital. The treatments were evaluated retrospectively to analyze the causes of the disorder and the treatment outcomes at the follow-up. 18 cases of delayed union were treated conservatively while the other 145 cases in this series underwent surgery. Results Except in the 2 cases of congenital non-union of tibia, iatrogenic factors were found to be responsible for nonunion or delayed union in all the other 161 cases. 153 cases were followed up for an average of 17 (6 to 28) months only to reveal bone union in all the cases with a mean healing time of 10 (6 to 14) months. All the limbs regained good function. Conclusion Since development of non-union and delayed union of fractures chiefly result from iatrogenic technical defects, satisfactory results can be achieved as long as appropriate treatments are performed according to different etiological factors.