Orthopaedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Policlinico Consorziale, Bari, Italy.
Department of Orthopaedics and Traumatology, Di Venere Hospital, Bari, Italy.
Int Orthop. 2019 Jan;43(1):193-200. doi: 10.1007/s00264-018-4214-2. Epub 2018 Nov 17.
INTRODUCTION: Femoral shaft fractures with third fragments have a high non-union rate, which may reach 14%. This study aims to assess the impact of the radiological features of the third fragment, evaluated on post-operative X-rays, on the outcome of femoral shaft fractures type 32-B managed with intramedullary nailing, in order to obtain an algorithm which could predict the fracture healing time. MATERIALS AND METHODS: We have retrospectively evaluated a series of 52 patients. On post-operative X-rays, four radiological parameters were evaluated: the third fragment angle, the fracture gap, the third fragment size, and the mean third fragment displacement. All the patients underwent a radiologic follow-up at one, two, three, six, nine and 12 months post-operatively, to assess the bone healing. The patients were then divided into three groups, according to the fracture healing time: within six months (group A), between six and 12 months (group B), or fracture non-union after 12 months (group C). RESULTS: In 28 patients, out of 52 (53.85%), the fracture healing was observed at 6-month follow-up; in 18 patients, out of 52 (34.62%), the fracture healed within 12 months after trauma; and in six patients, out of 52 (11.54%), no fracture healing was observed at 12-month follow-up. The mean third fragment size was significantly different in each group (p < 0.05), while the mean third fragment displacement was significantly higher in group C, compared with group A (p = 0.0006) and group B (p = 0.0027). In group B, a positive correlation was found between the fracture healing time and the mean third fragment size (R = 0.594, p = 0.036); in group C, the fracture union time was positively related to the third fragment size (R = 0.689, p = 0.013) and the mean third fragment displacement (R = 0.7107, p = 0.006). Regression analysis showed that the third fragment size and the mean third fragment displacement are the most important features which affect the fracture healing time. CONCLUSIONS: The third fragment size (cutoff 40 mm) is the leading parameter to influence the fracture healing within or in more than six months. The mean third fragment displacement (cutoff 12 mm); on the other hand, impacts on the fracture delayed rather than absent healing.
引言：股骨干骨折伴第三骨块的不愈合率较高，可达 14%。本研究旨在评估术后 X 线评估的第三骨块的影像学特征对髓内钉治疗 32-B 型股骨干骨折的结局的影响，以获得一种可以预测骨折愈合时间的算法。
材料和方法：我们回顾性评估了 52 例患者。术后 X 线片上评估了四个影像学参数：第三骨块角度、骨折间隙、第三骨块大小和第三骨块平均移位。所有患者术后均进行 1、2、3、6、9 和 12 个月的影像学随访，以评估骨愈合情况。然后根据骨折愈合时间将患者分为三组：6 个月内（A 组）、6-12 个月内（B 组）或 12 个月后骨折不愈合（C 组）。
结果：52 例患者中，28 例（53.85%）在 6 个月随访时骨折愈合；52 例患者中，18 例（34.62%）在创伤后 12 个月内骨折愈合；52 例患者中，6 例（11.54%）在 12 个月随访时未观察到骨折愈合。每组的第三骨块大小均有显著差异（p<0.05），而 C 组的第三骨块平均移位明显高于 A 组（p=0.0006）和 B 组（p=0.0027）。B 组中，骨折愈合时间与第三骨块大小呈正相关（R=0.594，p=0.036）；C 组中，骨折愈合时间与第三骨块大小（R=0.689，p=0.013）和第三骨块平均移位（R=0.7107，p=0.006）呈正相关。回归分析显示，第三骨块大小和第三骨块平均移位是影响骨折愈合时间的最重要特征。
结论：第三骨块大小（截断值 40mm）是影响 6 个月内或 6 个月以上骨折愈合的主要因素。第三骨块平均移位（截断值 12mm）则影响骨折延迟愈合而非不愈合。
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