Department of Orthopaedics Unit III, Christian Medical College, Vellore, 632004, Tamilnadu, India,
Clin Orthop Relat Res. 2014 Feb;472(2):759-64. doi: 10.1007/s11999-013-3293-z. Epub 2013 Sep 21.
Neglected femur fractures are not rare in the developing world. Treatment options include single-stage open reduction and intramedullary nailing, or open release, skeletal traction, and then second-stage open intramedullary nailing, with bone grafting. Single-stage procedures have the potential advantage of avoiding neurovascular complications secondary to acute lengthening, but they require a second operation, with potentially increased resource use and infection risk.
QUESTIONS/PURPOSES: We sought to determine the (1) likelihood of union, (2) complications and reoperations, and (3) functional results with single-stage open intramedullary nailing without bone grafting in patients with neglected femur fractures.
Between January 2003 and December 2007, 17 consecutive patients presented to our practice with neglected femoral shaft fractures. All were treated with single-stage nailing without bone grafting. There were 15 men and two women with a median age of 27 years. The average time from fracture to treatment was 13 weeks (range, 4-44 weeks). Eleven patients underwent open nailing with interlocked nails and six were treated with cloverleaf Kuntscher nails. Patients were followed for a minimum of 6 months (mean, 33 months; range, 6-72 months). The mean preoperative ROM of the knee was 28° (range, 10°-150°) and femoral length discrepancy was 3.1 cm (range, 1-5 cm).
All fractures united and the mean time to union was 16 weeks (range, 7-32 weeks). There were no neurologic complications secondary to acute lengthening. The mean postoperative ROM of the knee was 130° (range, 60°-150°). All patients were able to return to preinjury work. Sixteen patients regained their original femoral length.
One-stage open intramedullary nailing of neglected femoral diaphyseal fractures without bone grafting was safe and effective, and obviated the need for a two-stage approach. Although the findings need to be replicated in larger numbers of patients, we believe this technique may be useful in treating patients with this injury, and may offer advantages in resource-constrained environments.
在发展中国家, neglected femur fractures 并不罕见。治疗方案包括一期切开复位髓内钉固定,或切开松解、骨牵引,然后二期切开髓内钉固定,植骨。一期手术有避免急性延长引起的神经血管并发症的潜在优势,但需要进行二次手术,可能会增加资源的使用和感染的风险。
问题/目的:我们旨在确定(1)一期切开髓内钉固定治疗 neglected femur fractures 是否具有愈合的可能性,(2)并发症和再次手术的情况,以及(3)无植骨的功能结果。
2003 年 1 月至 2007 年 12 月,17 例 neglected femoral shaft fractures 患者连续就诊于我们的科室。所有患者均采用一期无植骨髓内钉固定治疗。患者为 15 名男性和 2 名女性,中位年龄为 27 岁。骨折至治疗的平均时间为 13 周(4-44 周)。11 例患者行切开复位交锁髓内钉固定,6 例患者行 cloverleaf Kuntscher 钉固定。所有患者随访时间至少 6 个月(平均 33 个月,6-72 个月)。术前膝关节活动度的平均 ROM 为 28°(10°-150°),股骨长度差异为 3.1cm(1-5cm)。
所有骨折均愈合,平均愈合时间为 16 周(7-32 周)。无急性延长引起的神经并发症。术后膝关节活动度的平均 ROM 为 130°(60°-150°)。所有患者均能恢复到受伤前的工作。16 例患者恢复了原来的股骨长度。
一期切开复位髓内钉固定治疗 neglected femoral diaphyseal fractures 无需植骨是安全有效的,避免了二期手术。虽然需要在更多数量的患者中复制这些发现,但我们认为该技术可能对治疗这类患者有用,并且在资源有限的环境中可能具有优势。