Treatment of femoral fractures (Lambiris type Ⅲ or Ⅳ) with antegrade interlocking intramedullary nails combined with less invasive stabilization system / 中华创伤骨科杂志

ABSTRACT

Objective:To evaluate antegrade interlocking intramedullary nails combined with less invasive stabilization system (LISS) in the treatment of femoral fractures (Lambiris type Ⅲ or Ⅳ).Methods:The clinical data of 27 patients were retrospectively analyzed who had been treated for femoral fractures of Lambiris type Ⅲ or Ⅳ at Department of Orthopedic Surgery, Wuhan Fourth Hospital from February 2015 to May 2019. They were 21 males and 6 females, aged from 22 to 57 years (average, 41.3 years). According to the Lambiris classification, 24 cases were classified as type Ⅲ (17 as type Ⅲa, 5 as type Ⅲb and 2 as type Ⅲc) and 3 cases as type Ⅳ. The time from injury to operation ranged from 2 to 9 days (average, 4.3 days). All the fractures were fixated with anterograde femoral interlocking nails and femoral LISS. Recorded were operation time, intra-operative blood loss, hospital stay, bone healing time, and Harris hip score, Hospital for Special Surgery (HSS) knee score and complications at the final follow-up.Results:In this cohort, operation time averaged 2.1 h (from 1.8 to 2.5 h), intraoperative blood loss 361 mL (from 310 to 480 mL), and hospital stay 15.1 d (from 11 to 18 d). All the 27 patients were followed up for 13 to 38 months (average, 25.3 months) after operation. All the fractures united well after an average duration of 29.2 weeks (from 28 to 36 weeks). By the Harris hip scores at the final follow-up, the hip function was evaluated as excellent in 18 cases, as good in 6 and as acceptable in 3, giving an excellent and good rate of 88.9%(24/27); by the HSS knee scores at the final follow-up, the knee function was excellent in 16 cases, good in 7 and acceptable in 4, giving an excellent and good rate of 85.2%(23/27). Follow-ups observed no fracture nonunion, malunion, refracture, internal fixation failure or other complications.Conclusion:In the treatment of femoral fractures of Lambiris type Ⅲ or Ⅳ, antegrade interlocking intramedullary nails combined with LISS has advantages of rigid fixation, a high rate of fracture union, limited complications, and good functional recovery.