Department of Orthopedics, Atlanta Medical Center, Atlanta, Georgia 30312, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):696-8. doi: 10.1097/TA.0b013e31823cc5ae.
Nailing of open femur fractures has been described, but the literature on this subject often used antegrade nailing techniques. A retrograde nailing technique carries the risk of contamination and infection of the knee, infection, and nonunion. The purpose of this study was to have a case series examining the intermediate term outcome of retrograde nailing of open femur fractures.
A retrospective review of all open femur fractures treated between 2008 and 2010 at a Level II trauma center was performed. Demographic and injury patterns were reviewed for the 35 patients who were treated with retrograde nailing. The main outcome measures evaluated were infection (knee or femur) and nonunion.
There were 11 grade I, 18 grade II, and 6 grade IIIA fractures (no IIIB or IIIC injuries). Healing occurred in 34 of 35 fractures with 1 (3%) nonunion and 2 (6%) deep infections, both occurring in IIIA fractures. There were no cases of knee joint infections, but two patients (6%) developed arthrofibrosis requiring manipulation. Implant removal of a prominent screw was required in one patient.
Early retrograde nailing of open femur fractures has infection and healing rates consistent with existing literature. There seems to be little risk for knee infection, but the increased incidence of arthrofibrosis requiring manipulation is higher than previously published. These findings suggest that early retrograde nailing may be considered an acceptable treatment option for open femur fractures.
IV, case series.
已有人描述过开放性股骨骨折的钉固定术，但该主题的文献通常使用顺行钉固定技术。逆行钉固定技术会增加膝关节污染和感染、感染和骨不连的风险。本研究的目的是通过一系列病例来检查逆行钉固定开放性股骨骨折的中期结果。
回顾性分析了 2008 年至 2010 年在二级创伤中心治疗的所有开放性股骨骨折患者。对 35 例接受逆行钉固定治疗的患者的人口统计学和损伤模式进行了回顾。评估的主要结果指标为感染（膝关节或股骨）和骨不连。
11 例为 I 型骨折，18 例为 II 型骨折，6 例为 IIIA 型骨折（无 IIIB 或 IIIC 型损伤）。35 例骨折中有 34 例愈合，1 例（3%）发生骨不连，2 例（6%）发生深部感染，均发生在 IIIA 型骨折中。无膝关节感染病例，但 2 例（6%）患者发生需要手法松解的关节纤维性挛缩。1 例患者需要取出突出的螺钉。
早期逆行钉固定开放性股骨骨折的感染率和愈合率与现有文献一致。膝关节感染的风险似乎很小，但需要手法松解的关节纤维性挛缩发生率高于先前报道。这些发现表明，早期逆行钉固定可能是开放性股骨骨折的一种可接受的治疗选择。
IV，病例系列研究。
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