CLOSED LOCKED NAILING OF COMPLEX FEMORAL FRACTURES

Citation
Jc. Borel et al., CLOSED LOCKED NAILING OF COMPLEX FEMORAL FRACTURES, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 79(7), 1993, pp. 553-564
Citations number
NO
Categorie Soggetti
Surgery,Orthopedics
ISSN journal
00351040
Volume
79
Issue
7
Year of publication
1993
Pages
553 - 564
Database
ISI
SICI code
0035-1040(1993)79:7<553:CLNOCF>2.0.ZU;2-W
Abstract
Complex fractures of the femoral shaft rise problems due to high energ y trauma with major soft-tissues injuries and bone comminution so incr easing operative difficulties, risk of infection and delayed union. Ou r aim was to apraise the outcome of these problems when using a closed intramedullary locked nailling.There were 52 men and 16 women. Aged 1 6 to 83 years. 52 patients had multiple-injuries. There were 17 open f ractures. The 68 cases were subdivided according to a classification i n 3 types. Stable fractures type A and B1 were excluded. The shaft was divided into 5 zones. Patients were initially treated by skeletal tra ction closed nailing was performed 1-36 days later (average 9.5). All patients were reviewed until complete healing. Final follow-up was 6 t o 35 months postoperatively (average 15). A dynamisation was performed in 19 cases at a average delay of 12 weeks. Sixty six of the 68 fract ures united. Open fractures united after 26.4 weeks, in average and cl osed fractures after 23.25 weeks (p <.05). There was no correlation be tween time of surgery following the injury and the delay of healing. S hortening was noted in 4 cases. 8 patients had an angulation 5-15 degr ees of in the varus or the valgus plane. 3 patients (4.4 per cent) had more than 5 degrees of angulation in the AP plane. An external rotati on deformity of 10-35 degrees was noted in 4 patients. The incidence o f deformities was the main problem. It could be minimize by a precise technique. Mobility of the knee was the other problem, but it appeared generally to depend much more on knee injury than on femoral fracture .