Causes analysis and handling of postoperative complications of femoral shaft fracture treated with intramedullary interlocking nails / 中华创伤杂志

ABSTRACT

Objective　To investigate the causes and preventive methods of postoperative complications of femoral shaft fracture treated with intramedullary interlocking nails. 　Methods　A total of 116 patients with femoral shaft fractures admitted to our hospital from 1994 to 1999 were retrospectively studied in this article. They were all treated with intramedullary interlocking nails. The locking nails were removed from the 14 patients with delayed union to convert the fixation from static to dynamic. For the 6 patients with bone nonunion, the locking nails were removed, and new locking nails and bone grafts were employed. And for the 4 patients with bone infection, the foci were cleaned and the locking nails were removed, then certain external fixation was applied.　Results　Followed up for 1 year, the fractures of 14 patients with delayed union were completely healed. For the 6 patients with bone nonunion, reoperation was needed in 4 patients and a third operation needed in 2 patients, and they all healed after being followed up for one and half a year. For the 4 patients with bone infection, only 3 patients healed. The whole effective rate was 95.8%. 　Conclusions　Although the intramedullary interlocking nails used for femoral shaft fractures have advantages than other internal fixations, the complications of delayed healing, nonunion, bone infection and breaking nails are often found. The effective measures to reduce the complications include strict master of the operative indications, suitable materials for the implant and conversion of the fixation from static to dynamic in time, careful selection of debriding the realm or debriding no realm, complete debridement and strict abacterial procedures.