Which of the three different intramedullary nail designs is superior in the treatment of femoral shaft fractures?

Year 2023, Volume: 6 Issue: 2, 467 - 475, 27.03.2023

Taner Alıç , Cemal Güler , Murat Çalbıyık , Ercan Hassa

https://doi.org/10.32322/jhsm.1227816

Cited By: 1

Abstract

Aim: The aim of this study a retrospective comparison was the clinical and radiological results results of patients with femoral shaft fracture made oftreated with three different types of intramedullary nail (IMN).
Material and Method: The study included 54 patients operated on in our clinic because of femoral shaft fracture. The records were retrospectively examined of 18 patients applied with locked IMN (LIMN), 17 with blade expandable IMN (BEIMN), and 19 with talon distalfix IMN (TDIMN). The groups were compared statistically in respect of age, gender, BMI, affected side, operating time (mins), radiation exposure (number of shots), time to union (weeks), visual analog scale (VAS) score, soft tissue problems associated with implant irritation, amount of shortening (mm), coronal, sagittal and torsional angulation (degrees).
Results: The mean VAS score of the TDIMN group was determined to be statistically significantly higher than that of the LIMN and BEIMN groups (p=0.008, p=0.045). The operating times were similar in the BEIN and TDIMN groups (p=0.768) and significantly shorter than in the LIMN group (p<0.001). Radiation exposure was similar in the TDIMN and BEIMN groups (p=0.039), and the number of shots in the LIMN group was significantly higher than in the other two groups (p<0.001). The coronal angulation values were lower in the TDIMN group than in the BEIMN and LIMN groups (p=0.001, p=0.020). The sagittal angulation values were lower in the TDIMN group than in the BEIMN and LIMN groups (p=0.001, p<0.001). No significant difference was determined between the groups in respect of time to union, limb shortness, rotational deformity, and soft tissue problems related to implant irritation (p>0.05).
Conclusion: TDIMN is less resistant to axial loads due to its hook structure design. In fact, this is sometimes seen as a hook break. High VAS scores explain this. The sagittal and coronal angulation of the TDIMN is less, but the time to union, rotational angulation, and shortness development are similar in all three nails. This showed that all three nails did not have a significant advantage over each other in providing fracture stability.

Keywords

Femoral shaft fracture, intramedullary nail, distal hook, locking, blade expandable

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