Results of expandable intramedullary nailing in femoral shaft fractures

Year 2017, Volume: 9 Issue: 2, 66 - 72, 01.06.2017

Sinan Zehir , Ercan Şahin , Serkan Sipahioğlu

https://doi.org/10.21601/ortadogutipdergisi.263896

Abstract

Objective: To evaluate the use
and results of expandable intramedullary nails applied to adult AO-32A and 32B
femoral shaft fractures.

Patients
and methods: This retrospective
study included 71 patients (25 females, 46 males; mean age 37.2 years, range
17-83 years) applied with expandable intramedullary nailing treatment for AO-32A
and 32B femoral shaft fractures, with at least a 1-year follow-up period.
Operating time was recorded from the operating notes. At the final follow-up
examinations, patients were evaluated clinically according to the Thoresen
criteria and lower limb length differences were recorded. Bone union and
continuity of reduction were examined radiologically.

Results: 64 nails were applied
with an open surgical approach and 7 nails with a closed surgical approach.
Operating time was mean 78 mins (range, 60-135 mins). In 63 (88.7%) cases, bone
union was delayed and the mean time to union was 18 weeks (range, 13-32 weeks).
According to the Thoresen criteria at the final follow-up examination, the
results were very good in 51 (71.8%) cases, good in 12 (16.9%), fair in 6
(8.4%) and poor in 2 (2.8%). Shortness of 3cm was determined in 1 case, 2cm in
3 cases, 1cm in 1 case and <1cm in 2 cases. Anterior knee pain developed in
7 cases. The nail applied did not expand in 3 (4.2%) cases. In 15 (21.1%)
cases, following inflation after application of the nail, expansion of the
femur medulla developed around the fracture line and in 1 case this caused
injury to the lateral circumflex femoral artery. Superficial infection was
observed in 4 (5.6%) cases, which recovered with antibiotic treatment.  

Conclusion: As the application of
expandable intramedullary nails is difficult and could cause complications,
they should be used with limited indications. 

Keywords

Femur fractures, intramedullary nailing, expandable nail

Yetişkin femur cisim kırıklarında genişleyebilir intramedüller çivi uygulamasının sonuçları

Abstract

Amaç:
Çalışmamızda AO-32A ve 32B yetişkin femur
cisim kırıklarında genişleyebilir intramedüller çivilerin kullanımı ve
sonuçlarını değerlendirdik.

Hastalar
ve metod: En az 1 yıllık
takipleri olan,  AO-32A ve 32B yetişkin
femur cisim kırığı nedeniyle genişleyebilir intramedüller çivi tedavisi
uygulanmış 71 hasta (25 kadın, 46
erkek; ortalama yaş 37,2 yıl; yaş aralığı, 17-83 yıl)  retrospektif olarak çalışmaya alındı. Ameliyat
süreleri ameliyat notlarından kayıt edildi. Hastalar son kontrollerinde klinik
olarak Thoresen kriterlerine göre değerlendirildi ve alt ekstremite uzunluk
farkları not edildi. Radyolojik olarak ise kırığın kaynamasına ve redüksiyonun
devamlılığına bakıldı.

Bulgular: 64 çivi açık cerrahi yaklaşımla, 7 çivi ise kapalı
cerrahi yaklaşımla uygulandı ve ortalama ameliyat süresi 78 dakika (60-135
dakika) olarak bulundu. Olguların 63 (%88,7)’ünde kaynama gerçekleşti ve
ortalama kaynama süresi 18 hafta (13-32 hafta) idi. Son kontrollerde yapılan
muayenede Thoresen kriterlerine göre 51 (%71,8) çok iyi,  12 (%16,9) 
iyi,  6 (%8,4) orta ve 2(%2,8)
olguda kötü sonuç alındı. 1 olguda 3 cm kısalık, 3 olguda 2 cm kısalık, bir
olguda 1 cm kısalık ve 2 olguda ise <1 cm kısalık vardı. 7 olguda diz ön ağrısı gelişti. 
3 (%4,2) olguda uygulanan çivi şişirilemedi. 15 (%21,1)  olguda çivi uygulandıktan sonra şişirilmeyi
takiben kırık hattı etrafında femur medullasının genişleme, bir olguda lateral
sirkumfleks femoral arter yaralanması oluştu. Olguların 4 (%5,6)’ünde yüzeyel
enfeksiyon görüldü ve antibiyotik tedavisi ile iyileşme sağlandı.

Sonuç: Genişleyebilir intramedüller çiviler uygulama
zorluğu ve sebep olabileceği komplikasyonlar nedeniyle sınırlı endikasyonlarla
kullanılmalıdır.

Keywords

Femur kırıkları, intramedüller çivileme, genişleyebilen çivi

References

• 1. Duman E, Ateş Y. Femur Cisim Kırıkları: Türk Ortopedi ve Travmatoloji Birliği Derneği Dergisi Ocak 2009,cilt 7 Sayı 1-2 sayfa 1-7
• 2. Canale ST, Campbell’s Operative Orthopaedics, 10th Ed, Vol: 3 p:2825 – 2859, Mosby, 2003.
• 3. Rüedi TP, Murphy WM, AO Principles of Fracture Management
• 4. Thoresen OB, Alho A, Ekeland A. İnterlocking İntramedullary Nailing in Femoral Shaft Fractures. J bone Joint Surgery 1985; 67-A: 1313-20
• 5. Schandelmaier P, Farouk O, Krettek C, Reimers N, Mannü J, Tscherne H: Biomechanics of femoral interlocking nails Injury int. J.Care Injured 31(2000) 437 - 443
• 6. Heim D, Regazzoni P, Tsakiris DA, Aebi T, Schlegel U, Marbet GA. Intramedullary nailing and pulmonary embolism: does unreamed nailing preventembolization? An invivo study in rabbits. J Trauma 1995;38:899-906
• 7. Pape HC, Regel G, Dwenger A: The risk of early intramedullary nailing long bone fractures in multiply traumatized patients complications. Orthop 1995;10:15-23
• 8. Chapman MW: The effect of reamed and nonreamed intramedullarynailing on fracture healing. Clin Orthop 1998;355:230-238
• 9. Bekmezci T, Tonbul M, Kocabaş R, Yalaman O. Early treatment results with expandable intramedullary nails in lower extremity shaft fractures. Ulus Travma Derg. 2004;10(2):133-137
• 10. Bekmezci T, Baca E, Kaynak H, Kocabaş R, Tonbul M, Yalaman O. Early results of treatment with expandable intramedullary nails in femur shaft fractures. Acta Orthop Traumatol Turc 2006;40(1):1-5
• 11. Cilli F, Mahiroğullari M, Pehlivan O, Keklikçi K, Kuşkucu M, Kiral A, Avşar S. Treatment of femoral shaft fractures with expandable intramedullary nail. Ulus Travma Acil Cerrahi Derg. 2009 Jul;15(4):383-9.
• 12. Sudhir K Kapoor, Himanshu Kataria, Tankeswar Boruah, Satya R Patra, Aashish Chaudhry, and Saurabh Kapoor Expandable self-locking nail in the management of closed diaphyseal fractures of femur and tibia. Indian J Orthop. 2009 Jul-Sep; 43(3): 264–270.
• 13. Steinberg EL, Elis Y, Shasha N, Luger E. Early results of retrograde expandable nail fixation of 29 distal femoral fractures. Surg Innov. 2011 Dec;18(4):400-5
• 14. Steinberg EL, Keynan O, Sternheim A, Drexler M, Luger E. Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system. Injury. 2009 Mar;40(3):309-14
• 15. Smith WR, Ziran B, Agudelo JF, Morgan SJ, Lathi Z, Vanderheiden T, Williams A. Expandableintramedullary nailing for tibial of femoral fractures: a preliminary analysis of peri operative complications. J Othop Trauma 2006 May;20(5):310-4;discussion 315-6
• 16. Olivera ML, Lemon MA, Mears SC, Dinah AF, Waites MD, Knight TA, Belkoff SM.Biomechanical comparison of expandable and locked intramedullary femoral nails. J Orthop Trauma. 2008 Aug;22(7):446-50
• 17. Maher SA, Meyers K, Borens O, Suk M, Grose A, Wright TM, Helfet D. Biomechanical evaluation of an expandable nail for the fixation of mid shaft frctures . J Trauma. 2007 Jul;63(1):103-7
• 18. Blum J, Karagül G, Sternstein W, Rommers PM. Bending and torsional stiffness in cadaver humeri fixed with a self-locking expandable or interlocking nail system: a mechanical study. J Orthop Trauma. 2005 Sep;19(8):535-42
• 19. Bone L, Kowalski J, Rohrbacher B, Stegeman P. Reamed versus unreamed femoral nailing: A prospective randomized study. Orthop Trans 1997-1998;21:603
• 20. The Canadıan Orthopaedıc Trauma Socıety Nonunion Following Intramedullary Nailing of the Femur with and without Reaming. JBJS 2003,85-A:2093-2096
• 21. Hupel TM, Weinberg JA, Aksenov SA. Effects of unreamed, limited reamed and standart reamed intramedullary nailing on cortical bone porosity and new bone formation. J Orthop Trauma. 2001;15:18-27
• 22. Bhandari M, Guyatt GH, Tong D. Reamed versus non-reamed intramedullary nailing of lower extremity long bone fractures: A systematic overview and meta-analysis. J Orthop Trauma 2000;14:2-9
• 23. Brumback RJ, Uwage-Ero S, Lakatos RP. Intramedullary nailing of the femoral shaft fractures. Part II: Fracture healing with static interlocking femoral fiksation. J Bone Joint Surg 1998 70A:1453-1462
• 24. Panidis G, Sayegh F, Beletsiotis A, Hatziemmanuil D, Antosidis K, Natsisi K. The use of an innovative inflatable self-locking intramedullary nailing in treating and stabilizing long bone fractures. Technique-preliminaryresults. Osteo Trauma Care 2003 ;11:118-12
• 25. Smith MG, Canty SJ, Khan SA. Fixion –an inflatable or deflatable nail? Injury 2004;35:329-31
• 26. Lepore S, Capuano N, Lepore L, Jannelli P. Clinical and radiographic results with the fixion intramedullary nail: an inflatable self-locking system for long bone fractures. Osteo Trauma Care 2002;10:32-5.
• 27. Pascarella R, Nasta G, Nicolini M, Bertoldi E, Maresca A, Boriani S. The Fixion nail in the lower limb. Preliminary results. Chir Organi Mov 2002;87:169-74.
• 28. Rose DM, Smith TO, Nielsen D, Hing CB. Expandable intramedullary nails in lower limb trauma: a systematic review of clinical and radiological outcomes. Strategies Trauma Limb Reconstr. 2013 Apr;8(1):1-12