• Injury · Apr 2014

    Effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail.

    • Shih-Jie Lin, Chi-Lung Chen, Kuo-Ti Peng, and Wei-Hsiu Hsu.
    • Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.
    • Injury. 2014 Apr 1; 45 (4): 752-6.

    ObjectiveOur study aimed to determine whether the displacement and morphology of a fragment in femur fracture with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association/32-B/32-C (AO/OTA/32-B/32-C) classification affect the outcomes following closed reduction and internal fixation with an interlocking nail.DesignThis was a retrospective study.SettingThe study was conducted at a Level III trauma centre.PatientsA total of 50 consecutive patients presenting femoral shaft fracture with AO/OTA-type 32-B/32-C were included in the present study.InterventionsPatients were divided into two groups according to the displacement of the fragments. In the large displacement group, patients were further subgrouped according to whether a reversed morphology of the fragment was present.Outcomes MeasurementThe radiographic union score of femur (RUSF), the mean union time and the re-operation rate were assessed.ResultsThe union rate of small- and large-gap groups at 12 months postoperatively was 75.9% and 21.1%, respectively (p=0.000). The mean union time of those union cases in these two groups was 7.8 and 13.0 months, respectively (p=0.000). The union rate of the non-reversed and reversed groups at 12 months postoperatively was 30% and 11.1%, respectively (p=0.179). The mean RUSF at 12 months in the non-reversed and reversed groups was 8.8 and 8.3, respectively (p=0.590). However, we found that patients presenting a reversed fragment had an increased risk of more than one re-operation (p=0.030).ConclusionsA fragmentary displacement of >1cm in AO/OTA-type 32-B/32-C femoral shaft fracture after nailing affected bone healing. Among the large-gap group patients, an unreduced reverse fragment presented a negative prognostic factor for re-operation.Level Of EvidencePrognostic level III.Copyright © 2013 Elsevier Ltd. All rights reserved.

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