Surgical treatment for ipsilateral femoral neck and shaft fracture / 中国骨伤

OBJECTIVE@#To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture, and analyze their indications.@*METHODS@#From June 2015 to December 2020, 21 patients with ipsilateral femoral shaft and femoral neck fracture were treated, including 14 males and 7 females, aged 23 to 69 years old with an average of(38.1±12.9) years old. According to different femoral shaft fracture sites, some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure, InterTan or PFNA Ⅱ), some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft (dual structure), and postoperative function and complications were recorded during follow-up. In 10 cases of single-structure fixation, the femoral necks were all basicervical fractures, and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation, 9 cases in 11 were basal type of femoral neck, 2 cases in 11 were neck type, and the femoral shaft fractures were located in the isthmus and the distal isthmus.@*RESULTS@#All patients were followed up for 12 to 27 months. No femoral head necrosis, deformity, delay or nonunion occurred in the patients with single-structure fixation, and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up, Harris score of patients with single-structure fixation was 91.8±4.1, with 8 cases were excellent and 2 cases were good. The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis, except 1 case of femoral shaft fracture had delayed union;At the final follow-up, Harris score of patients with dual-structure fixation was 92.4±5.9, 7 cases were excellent, 3 cases were good, and 1 case was fair.@*CONCLUSION@#Good reduction and fixation is the key to the treatment of such fractures. Both the single-structure fixation and the dual-structure fixation are good methods, and it should be selected according to the locations of femoral shaft and femoral neck fractures. Single-structure fixation is a good choice for femoral shaft fractures located at the proximal isthmus and basal femoral neck fractures. For isthmus and distal femoral shaft fractures combined with ipsilateral femoral neck fractures, dual-structure fixation is recommended.

Surgical Treatments for Femoral Shaft Fractures: A Narrative Review

@#Femoral shaft fractures are increasingly common due to various traumatic injuries. Intramedullary nail (IMN) is considered the gold standard treatment for these fractures, but comorbidities often require thorough trauma life support and intensive care. The primary goal of treatment is rigid fixation, early mobilisation, and long-term functional recovery. This article reviews current concepts in the treatment of femoral shaft fractures, including the effects of early or delayed operation, differences between antegrade or retrograde intramedullary nailing, alternative methods to using a fracture table, methods to predict nail length before operation, assessing femoral rotation during an operation, and complications.

Comparative Study of Outcome of Treatment of Fracture Shaft of Femur by Open Intramedullary Kuntscher抯 Nail and Closed Intramedullary Interlocking Nail

Fractures of the femoral shaft are one of the most common injuries treated by orthopedic surgeons. These fractures are often associated with polytrauma and can be life-threatening.For physiologically stable individuals, Intramedullary Nailing (IMN) is the most prevalent therapy. Early healing and long-term functional recovery are the goals of fixation. Treatment of modern-day femoral shaft fractures results in excellent outcomes. Aims : To assess the results of intramedullary nailing of femoral shaft fractures by both open and closed methods. Methods : Primary, non-randomized, prospective cohort study, Patients having fracture shaft of femur who was admitted in MGM Medical College & LSK Hospital, Kishanganj was taken for the study, The study period from October 2019 to April 2021. Total 40 cases were enrolled, Open Kuntcher抯 Nail-20 cases & Closed Interlocking Nail-20 cases. Results : Male cases are predominantly high than females among the two groups. Maximum number of fracture (70% in Closed Interlocking Nail group and 80% in Open K-nail group) Radiological union within 15 weeks.Maximum number of the cases found excellent results in both groups. ie, 70% & 65% respectively. In this study, we have not found any poor & fair patients after surgical outcome. Chi-square value 0.1139 & P-value- is 0.735. Conclusion : Except for the period from injury to surgery and operating time, there was no significant difference between the two groups in terms of demographic data, fracture type, and associated co-morbidities and radiological union. When utilised to fix short oblique and transverse fractures near the isthmus of the femur, Kuntscher抯 intramedullary nailing can yield a comparable rate of union to interlocking intramedullary nailing.

Biomechanical Comparison of Novel and Traditional LCP Fixation for Femoral Shaft Fractures / 医用生物力学

Objective To compare biomechanical properties of the traditional and novel locking compression plate （LCP） for treating femoral shaft fracture, so as to provide theoretical basis for selecting more effective bone plate. Methods The bending strength and fatigue tests on the plate were performed, and the finite element analysis on deformation, stress and life of the plate were conducted by using ANSYS Workbench. Results The average bending yield load and bending strength of the novel LCP were 1.4 times of that of the traditional LCP, and the average cycle times of the novel and traditional LCP were 106 and 47 091, respectively. The difference of service life for two LCPs was 33.8%. ConclusionsThe failure probability of the novel LCP is smaller than that of the traditional LCP, and the novel LCP has more effective biomechanical stability.

Removing a Bent Femoral Intramedullary Nail Cost Effectively: A Case Report

@#A bent intramedullary (IM) nail becomes challenging and technically demanding to the orthopaedic surgeon for nail extraction. A broken nail can be easily removed through the fracture site. However, a bent nail has to be broken before it can be removed. Several studies and case reports outline the strategies and techniques for removing a bent IM nail. However, there is a paucity of guidelines and standard protocol describing the best and inexpensive strategy. We report a case where two years following surgery for intramedullary nailing of the right femur, the IM mail was bent following secondary trauma. We used a technique based on the principles of an ability to fully cut the nail and extract it in two pieces by using a Jumbo cutter which is available in the orthopaedic armamentarium. This technique is simple yet economical, with the likelihood of causing less soft tissue damage and thermal necrosis.

Prevention and treatment of complications in the treatment of femoral shaft closed fracture with core drilling intramedullary nail / 中国骨伤

OBJECTIVE@#To summarize the complications of core drilling intramedullary nail in the treatment of femoral shaft closed fracture and explore the treatment strategy.@*METHODS@#From August 2014 to June 2018, a total of 215 patients with closed femoral shaft fractures were treated with closed reduction core drill intramedullary nail, including 129 males and 86 females, aged from 18 to 62 years, with an average of (44.2±10.6) years old. The time from injury to operation was 3 to 21 days. There were 102 cases of AO type A fracture, 82 cases of AO type B fracture and 31 cases of AO type C fracture. The time of operation, the amount of blood loss during operation, the duration of hospitalization, the time of fracture healing and the HSS score of knee joint function at the last follow-up were recorded. The observation of complications included:iatrogenic fracture, core drill broken, core drill twist, postoperative infection, and fracture nonunion.@*RESULTS@#The average operation time was (63.2± 15.6) min and intraoperative blood loss was (150.0±34.5) ml. All the incisions reached grade A healing. Patients were follow up for a mean of (18.5±3.2) months, the average hospital stay was (4.3±1.2) days, and the average fracture healing time was (5.6±2.3) months. At the final follow-up, the average HSS score of knee joint was 90.3±4.7. Related complications occurred in 37 cases (17.2%). The core drill related complications occurred in 13 cases (6.0%), including core drill broken in 5 cases (2.3%), core removal in 1 case and slotting in 4 cases;core drill twist in 8 cases (3.7%). After the core was cut, the core was removed. Similar complicationsof conventional intramedullary nail:iatrogenic fracture was performed in 12 cases (5.6%), including 10 cases of fracture end split and 2 cases of distal perimedullary fracture of intramedullary nail. The patients with cleavage at the fracture end were not treated after judging their stability, and the patients with fracture around the distal end of the intramedullary nail were fixed with auxiliary steel plate during operation;1 case(0.4%) with delayed infection after operation, debridement and external fixation was replaced and healed after bone transfer; fracture nonunion occurred in 11 cases (5.1%), of which 7 cases (3.3%) were hypertrophic nonunion and healed with additional plate. Atrophic nonunion occurred in 4 cases (1.9%), which healed after additional steel plate and bone graft.@*CONCLUSION@#Core drilling intramedullary nail is an effective method for the treatment of closed femoral shaft fracture, and the complications include core drill related complications and conventional intramedullary nail similar complications. Accurate preoperative evaluation, careful operation during operation and early postoperative symptomatic treatment can effectively reduce the occurrence of related complications.

Comparison of three different internal fixation methods in treatment of ipsilateral femoral neck and shaft fracture / 中国组织工程研究

BACKGROUND: Ipsilateral femoral shaft and neck fracture is a rare clinical injury, and its treatment has attracted more and more attention from scholars. At present, there are many internal fixation methods. OBJECTIVE: To retrospectively analyze efficacy of three internal fixation methods in the treatment of ipsilateral femoral shaft and neck fracture, and its indications. METHODS: Thirty-three cases of ipsilateral femoral neck and shaft fracture treated by three different internal fixation implants between January 2015 and September 2018 were retrospectively studied. Patients were divided into three groups according to different internal fixation: intramedullary nail only group (group A; n=11), retrograde nail with cannulated screw group (group B; n=10) and plate with cannulated screw group (group C; n=12). The general clinical data, the intraoperative situations, the postoperative follow-up conditions and complications were compared among the three groups. RESULTS AND CONCLUSION: (1) There was no significant difference between the three groups with regard to age, gender, cause of injury, AO fracture classification, Garden classification and average time from injury to surgery (P > 0.05). (2) There were statistically significant differences among the three groups in incision length (P 0.05); the incision length was smaller in groups A and B than in group C (P 0.05). (3) There were no significant differences among the three groups in time to bony union in both femoral shaft and neck, complication rate, and excellent and good rate of Harris hip score (P > 0.05). (4) Femoral neck fracture delayed healing occurred in one case of the group A; re-fracture occurred in one case of the group B; and the fracture end was located under the femoral tuberosity; screw loosening occurred in one case of the group C. (5) It is indicated that all three internal fixation methods can achieve good therapeutic effects. The operator can choose the skilled internal fixation method according to the specific conditions of the patient.

Biomechanical analysis of elastic nail combined with end caps and wire fixation for long oblique femoral shaft fractures / 中国组织工程研究

BACKGROUND: The use of elastic nails to treat children with unstable fractures or heavier children often results in shortening, angular or rotational deformities. OBJECTIVE: To provide a theoretical basis for internal fixation choice for femoral long oblique fracture by elastic nails combined with end caps or wire using biomechanical test. METHODS: An identical length oblique midshaft fracture was created in eight small adult cadaveric femurs harvested from four donors. Two 3.5-mm titanium elastic nails were introduced intramedullary into all femur models. According to the different fracture fixations, all models were divided into four groups (group A: titanium elastic nail, group B: titanium elastic nail+wire, group C: titanium elastic nail+caps, group D: titanium elastic nail+wire+caps). Nondestructive axial compression, four-point bending and torsion tests were conducted. Stiffness, displacement and torque were analyzed. RESULTS AND CONCLUSION: (1) In the axial compression tests, stiffness was increased by 509% and displacement was decreased by 74% using the titanium elastic nail+cap combination compared with titanium elastic nail alone (group A) (P <0.01). (2) The titanium elastic nail+wire combination (group B) showed larger stiffness (P < 0.01) and smaller displacement (P < 0.01) in the sagittal plane bending test; and as well as larger stiffness (P < 0.01) and smaller displacement (P < 0.01) in coronal plane bending test; and larger stiffness in torsion test (P < 0.01). The end caps with wire in group D improved the stiffness significantly in all directions. (3) The results have demonstrated that end caps fixation helps to increase the axial stability of the long oblique fracture model, and combined wire fixation increases the structural stability under torsional and bending loads, which provides a good reference for clinical treatment of children with unstable femoral shaft fractures.

3D printing pre-operation assisted with custom-made plate for internal fixation of femoral shaft fractures after poliomyelitis / 中国组织工程研究

BACKGROUND: Patients with poliomyelitis often have abnormalities in the femur and the conventional plant matching degree of fracture is low. There are few reports on individualized treatment for severe deformity of femoral shaft fracture in poliomyelitis. OBJECTIVE: To summarize the clinical features of femoral shaft fracture in poliomyelitis and discuss the operative outcome of 3D printing pre-operation assisted with custom-made plate. METHODS: From May 2015 to May 2018, data of 19 patients with poliomyelitis surgically treated with 3D printing pre-operation assisted with custom-made plate were retrospectively analyzed. There were 11 males and 8 females with an average age of 52.5 years (range, 38-62 years). There were 7 cases on the left side, and 12 cases on the right side. According to AO/OTA classification of femoral shaft fracture, there were type A1 in 6 cases, type A2 in 3 cases, type A3 in 1 case, type B1 in 4 cases, type B2 in 4 cases and type C1 in 1 case. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The 3D printed 1:1 femur model and custom-made plate were designed. Operation was simulated in vitro in femoral model. The placement of the plate was identified. The direction and length of the screws were measured and recorded. The final internal fixation of fracture was performed according to the pre-operation results. Hip and knee functions in the affected limb were assessed based on Harris evaluation criterion and hospital for special surgery knee score evaluation criterion. RESULTS AND CONCLUSION: (1) All 19 patients were followed up for 12-18 months. Bone healing was obtained in all fractures, with a healing time of 5-12 months, averaging 6.6 months. (2) Harris score was (84.95±5.18) before injury, and (84.42±4.83) 1 year after operation. Hospital for special surgery knee score was (84.53±4.36) before injury, and (83.63±3.90) 1 year after operation. Statistical analysis showed no statistical difference between the two groups before and after the injury (P > 0.05). (3) All patients had no internal fixation loosening or fracture. One patient had delayed bone healing and healed after iliac bone grafting. One patient developed wound infection after surgery, and received adequate drainage. Wound was healed after intravenous application of sensitive antibiotics. (4) Patients with poliomyelitis often have abnormalities in the femur with varying degrees of osteoporosis. For femoral shaft fractures that cannot be fixed with conventional internal fixation, 3D printing pre-operation combined with custom-made steel plate provides a new choice for the treatment of femoral shaft fractures in poliomyelitis.

Treatment of femoral shaft fracture with lateral traction frame closed reduction and intramedullary nail fixation / 中国组织工程研究

BACKGROUND: At present, there are relatively few studies on the closed reduction of intramedullary nail treatment for femoral shaft fractures. OBJECTIVE: To investigate the effect of closed reduction and intramedullary nailing in the treatment of femoral shaft fractures in the lateral position. METHODS: From January 2015 to October 2018, 54 patients with femoral shaft fractures were treated with intramedullary nailing at Department of Orthopedics and Traumatology, the Third Affiliated Hospital of Zunyi Medical University. The patients were randomly assigned to three groups, including 17 cases in the supine mechanical traction group, 17 cases in the lateral artificial traction group, and 20 cases in the lateral mechanical traction group. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Closed reduction success rate, operation time, intraoperative blood loss, fracture healing time, and hospital for special surgery knee score at 6 months after surgery were compared in the three groups. RESULTS AND CONCLUSION: (1) All patients were followed up for 6 to 15 months. (2) The success rate of fracture closure was 100% in the lateral mechanical traction group, 82% in the lateral artificial traction group, and 59% in the supine mechanical traction group. There was no significant difference between supine mechanical traction group and lateral artificial traction group (P > 0.05). The success rate was significantly higher in the lateral mechanical traction group than in the supine mechanical traction group (P=0.002). There was no significant difference between the lateral mechanical traction group and the lateral artificial traction group (P > 0.05). (3) No significant difference was found in operation time between the supine mechanical traction group and the lateral artificial traction group (P > 0.05). The operation time was significantly shorter in the lateral mechanical traction group than in the supine mechanical traction group and lateral artificial traction group (P 0.05). (5) Fracture healing time was significantly longer in the supine mechanical traction group than in the lateral artificial traction group (P=0.030) and lateral mechanical traction group (P 0.05). (6) No significant difference in hospital for special surgery knee score at 6 months after surgery was detected among the three groups (P > 0.05). (7) These results suggested that application of lateral recumbent traction frame closure and intramedullary nailing for the treatment of femoral shaft fractures has the advantages of high success rate, short operation time, less intraoperative blood loss and short fracture healing time. It is worthy of clinical application.

​Clinicoradiological Assessment of Treatment of Infective Non-union in Fracture Shaft Femur using Ilizarov Ring Fixator

Background: The management of infective non-union of long bones has always been a dare for orthopedic surgeons. Treatmentgoals were the annihilation of infection and augmenting bony union. For the span of distraction osteogenesis, physiologicalskeletal loading and active mobilization are vital.Aim: This study intended at evaluating the clinicoradiological result of using Ilizarov ring fixator in managing patients withinfective non-union fracture of shaft of the femur.Materials and Methods: A total of 40 patients with infective non-union of the femoral shaft were incorporated in the study between2017 and 2018. The follow-up period lasted for 14–20 months. Skeletal measurements and functional results were calculated,and difficulties were stratified according to the association for the study and relevance of the technique of Ilizarov guidelines.Results: The infection was eradicated in 32 patients before the fixator removal. Tremendous radiological bone healing wasfound in 32 patients and excellent functional result in 28 of 40 patients.Conclusion: Ilizarov ring fixator is a valuable method for the managing of infective non-union of femoral shaft fractures withsatisfactory radiological and clinical outcome and less serious complications.

Characteristics and Surgical Outcomes of Intertrochanteric or Subtrochanteric Fractures Associated with Ipsilateral Femoral Shaft Fractures Treated with Closed Intramedullary Nailing: A Review of 31 Consecutive Cases over Four Years at a Single Institution / 대한고관절학회지

PURPOSE: To evaluate the clinical characteristics of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures and assess the surgical outcomes of a novel, closed intramedullary nailing surgical approach designed to minimize fixation failure. MATERIALS AND METHODS: Between May 2013 and April 2017, 31 patients with intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures treated with closed intramedullary nailing or long proximal femoral nail antirotation (PFNA) were enrolled in this study. Preoperative data included age, sex, injury severity score, body mass index, location of shaft fracture, injury mechanism, accompanying traumatic injury, walking ability before injury, and surgical timing. Perioperative outcomes, including follow-up period, types of intramedullary nails, number of blocking screws used, operation time, and blood loss were assessed. Radiologic outcomes, including union rate, time from surgery to union, and femoral shortening, and clinical outcomes, including hip flexion, walking ability, and Harris hip score were also evaluated. RESULTS: A total of 29 unions (93.5%) were achieved. The time to union was 16.8 months (range, 11–25 months) for hip fractures (15.7 weeks for intertrochanteric fractures and 21.7 weeks for subtrochanteric fractures) and 22.8 months for femoral shaft fractures. There were no significant differences in surgical outcomes between the two groups except for type of intramedullary nail. CONCLUSION: Closed intramedullary nailing in the treatment of intertrochanteric or subtrochanteric fractures associated with ipsilateral femoral shaft fractures may be a good surgical option. However, fixation of femoral shaft fractures might not be sufficient depending on the implant design.

Ilizarov external fixation without bone graft for atrophic femoral shaft nonunion / 中国修复重建外科杂志

Objective: To explore the effectiveness of Ilizarov external fixation without bone graft in the treatment of atrophic femoral shaft nonunion. Methods: The clinical data of 12 patients with atrophic femoral shaft nonunion admitted between October 2010 and January 2017 were retrospectively analyzed. There were 8 males and 4 females, aged from 24 to 61 years, with an average age of 41.7 years. The nonunion sites located in the middle and upper femur in 7 cases and in the distal femur or supracondylar in 5 cases. The disease duration ranged from 1 to 9 years, with an average of 3.7 years. Previous operations ranged from 1 to 9 times, with an average of 2.8 times. The original fixator was removed, the fracture end of nonunion was debrided, and Ilizarov external fixator was installed. In patients with the length of bone defect less than 4 cm, direct compression fixation was performed during operation; in patients with limb shortening more than 2.5 cm, proximal femoral osteotomy and bone lengthening components were required to prepare limb lengthening after operation; all patients did not receive bone graft. The wearing time of external fixator, clinical bone healing time of nonunion fracture end, and complications were recorded. The effectiveness was evaluated by Paley's nonunion evaluation criteria. Results: All patients were followed up 24-50 months, with an average of 30 months. Bony union was achieved in all 12 cases with a healing time of 6.0-23.5 months (mean, 11.5 months). The wearing time of external fixator ranged from 7 to 25 months, with an average of 13.5 months. At last follow-up, according to Paley's nonunion evaluation criteria, the results were excellent in 6 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 83.3%. Sagittal angulation deformity of femur more than 7° occurred in 4 cases, with no significant effect on knee extension function, and no special treatment such as osteotomy was performed. Two patients had shorter limbs (>2.5 cm) after operation and were replaced by high shoes; 4 patients with trans-knee fixation lost knee joint mobility of 10-30° after operation; 10 cases of needle tract infection occurred, of which 4 cases with infection and loosening of fixed needle were replaced and re-fixed after needle extraction, the remaining 6 cases of infection without loosening of fixed needle were controlled by local dressing change, needle nursing, and oral cephalosporin anti-inflammatory drugs. No complications such as deep infection and vascular nerve injury occurred. Conclusion: Ilizarov external fixation has a high healing rate for atrophic femoral shaft nonunion, which is relatively minimally invasive and can avoid bone grafting. Its preliminary effectiveness is exact, and it is also effective for patients who have experienced multiple failed operations. It is necessary to pay attention to the nursing and rehabilitation training after external fixation.

Research progress of augmentation plate for femoral shaft nonunion after intramedullary nail fixation / 中国修复重建外科杂志

Objective: To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation. Methods: The results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed. Results: The AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment. Conclusion: Compared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.

Parametric Study on Screw Layout of Internal Fixation System of Femoral Shaft Fracture Based on Orthogonal Experiment / 医用生物力学

Objective To evaluate the effects of locked plates with different screw layouts on stability of the internal fixation system for femoral shaft fracture, so as to provide guidance for clinical study on screw layout of the internal fixation system for femoral shaft fracture. Methods Orthogonal test design method was used with 4 groups of screws at 3 parametric levels. Biomechanical properties of the internal fixation system for femoral shaft fracture under 9 screw layouts were analyzed respectively by the finite element method, and 4 inspection indices, namely, the maximum equivalent stress of the plate, the screw and the femur, and the maximum axial displacement of the internal fixation system were obtained from each group of the experiment, and the orthogonal test weight matrix analysis method was conducted for data analysis. Results The influences of different screw parameters on stability of the internal fixation system varied, and the maximum weights of the 4 sets of screw parameters in stability of the internal fixation system were 13.86%, 7.57%, 7.53% and 5.91%, respectively. Conclusions The best scheme for screw layout in orthogonal test is the screw with none-fixed threaded holes in the first group, the single cortical screws with fixed threaded holes in the second group and the double cortical screws with fixed threaded holes in the third and fourth group.

Recent advances in treatment of aseptic femoral shaft nonunion / 中国修复重建外科杂志

Objective: To review the recent advances in treatment of aseptic femoral shaft nonunion. Methods: The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. Results: There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Conclusion: Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.

Curative Effect of Double-plate Fixation on Femoral Shaft Fractures / 中国医科大学学报

Objective To investigate the curative effect and prognosis of double-plate fixation in adults with femoral shaft fractures.Methods Eighty patients with femoral shaft fractures treated in our hospital between March 2016 and February 2014 were randomly divided into an observation group and a control group,with 40 patients in each group.The observation group received treatment with double locking internal fixation,and the control group received dynamic compression plate treatment.Knee joint dysfunction,infection,and fractures were compared between the two groups.The hospital for special surgery (HSS) standard for evaluation of knee joint function and Karlstr(o)m-Olerud score for femoral fractures were used to assess the curative effect.Results In the observation group,the incidence rates of infection,knee joint dysfunction,and fracture were lower than that in the control group (P ＜ 0.05);the HSS score for knee joint function and clinical curative effect in the observation group were higher than those in the control group (P ＜ 0.05).Conclusion Double-plate fixation for adult femoral shaft fractures can effectively reduce complications and allows for early initiation of functional exercise.

Effects of Sanqi Huayu Oral Liquid on femoral shaft comminuted fracture caused by trauma in perioperative period of high-risk groups / 中成药

AIM To investigate the effects of Sanqi Huayu Oral Liquid (Notoginseng Radix et Rhizoma,Corydalis Rhizoma) on femoral shaft comminuted fracture caused by trauma in perioperative period of high-risk groups.METHODS One hundred and twenty patients meeting the inclusion criteria were randomly and equally divided into treatment group and control group.The control group was treated by low molecular weight heparin calcium injection,while the treatment group was additionally given Sanqi Huayu Oral Liquid.Two groups' levels of serum IL-6,TNF-α and D-D were detected on pre-operation and the 1 st,3rd,7th after operation,respectively.Additionally,the adverse drug reactions were also observed.RESULTS There were no statistically significant differences in the levels of serum IL-6,TNF-α and D-D between the two groups before operation.The first day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups showed increasing trends,which had similar elevated levels without statistically significant differences.The third day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups presented downward trends,but those in the treatment group were decreased more markedly with statistically significant differences.Furthermore,the seventh day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups were lower than those before the operation,and these indices in the treatment group were lower than those in the control group with statistically significant differences.CONCLUSION Sanqi Huayu Oral Liquid can not only effectively reduce the levels of serum IL-6,TNF-α and D-D in perioperative period of high-risk groups,but also prevent the formation of deep vein thrombosis.

Fractura de cuello femoral en trauma de alta energía: ¿podemos confiar en la tomografía computarizada multicorte? caso clínico / High energy femoral neck fracture: can we trust the computerized tomography scan? case report

Las fracturas asociadas de diáfisis y cuello femoral son lesiones infrecuentes. A pesar de ser una asociación conocida, es pasada por alto entre un 19-31% de las veces. A continuación presentamos un caso de una fractura de diáfisis femoral en la cual la tomografía computarizada inicial no evidenció ningún rasgo a nivel del cuello femoral; sin embargo, este rasgo se hizo presente en las imágenes de control. Existen diversos exámenes para reconocer las fracturas de cuello femoral asociadas a diáfisis femoral, como la radiografía y la tomografía computarizada. Sin embargo, a pesar de estas imágenes, pueden no ser diagnosticadas. Con este caso reafirmamos la necesidad del uso de imágenes preoperatorias e intraoperatorias en pacientes con fracturas de diáfisis femoral de alta energía y que la tomografía computarizada multicorte de ingreso puede no evidenciar fracturas mínimamente desplazadas del cuello femoral.

Simultaneous fractures of the neck and shaft of the femur are uncommon injuries. Despite it being a known combination, it is overlooked in between 19 and 31% of cases. This case report describes a femoral shaft fracture in which the initial computed tomography did not show the femoral neck fracture, although it was present in the follow-up images. There are different imaging techniques to recognise femoral neck fractures associated with femoral shaft fractures, such as radiography and computed tomography. However, despite these images, they cannot be diagnosed. This case re-affirms the need for using imaging techniques before and during the operation in patients presenting with high energy femoral shaft fractures, in order to look for an associated femoral neck fracture. Although the use of fine-cut computed tomography scan may improve the diagnostic accuracy of this test, some femoral neck fractures will still go under-diagnosed.

Avulsion of the Femoral Attachment of Anterior Cruciate Ligament Associated with Ipsilateral Femoral Shaft Fracture in Skeletally Mature Patient: A Case Report

Avulsion fracture at the femoral attachment of the anterior cruciate ligament (ACL) is very rare and has been reported mostly in skeletally immature patients. Authors experienced a case of avulsion fracture at the femoral attachment of ACL in a skeletally mature, a 21-year-old male associated with ipsilateral femoral shaft fracture. Here, authors report on the case with a literature review. Care should be taken because an avulsion fracture at the femoral attachment of ACL can be accompanied by ipsilateral femoral shaft fracture in skeletally mature patients.