Management of nonunion of femoral shaft fracture and deformity of femur with fixator-assisted nailing / 中华骨科杂志

ABSTRACT

Objective To evaluate the effect of fixator-assisted nailing (FAN) technique for the treatment of femoral deformity,nonunion of femoral shaft fracture with deformity and malunion.Methods The data of 8 patients with nonunion of femoral shaft fracture with deformity,3 patients with femoral deformity caused by Rickets disease and 2 patients with femoral fracture malunion who received treatment FAN technique was retrospectively analyzed.There were 11 males and 2 females,with an average age of 33 years (range,16-50 years).One-stage operation was used in 10 patientsafter the fracture was distracted and reduced with external fixator,an intramedullary nail was used for final fixation.Two-stage strategy was used in 3 patients.Unilateral external fixator was used in 12 patients,ring fixator was used in 1 patient.Femoral intramedullary nailing was used in 8 patients,retro-femoral intramedullary nailing was used in 5 patients; autograft from callus of fracture site was used in 1 patient.Results The 12 patients were followed up for 12-48months with an average of 21 months.The fractures of 7 patients united 3-6 months (average,3.9 months)later after the operation.The osteotomy site of 5 patients united 3-5 months (average,3.5 months) later after the operation.The results were evaluated according to the Paley classification of functional results.There were 9 cases rated as excellent,2 as good and 1 as fair.The lower leg discrepancy (LLD) before and after operation was (48.2±23.0) mm and (27.3±24.6) mm,individually; the length of limb increased 4.6-41.0 mm (average,23.3 mm).The pre-and post-operative MAD was (27.5±24.4) mm and (6.3±8.3) mm.There was no neurovascular injury or infection occurred in any of the patients.All the patients were satisfied with the result of treatment.Conclusion FAN technique combines the accuracy,minimal invasiveness and safety of external fixation together with patient compliance of IM nail.It is an effective method to manage nonunion of femoral shaft fracture with deformity,malunion of femur,and femoral deformity cause by rickets.