Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Egypt.
Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Egypt.
Injury. 2021 Mar;52(3):602-605. doi: 10.1016/j.injury.2020.10.012. Epub 2020 Oct 2.
Intramedullary nailing is an acceptable treatment option for femoral shaft fracture in young patients but not extensively studied in the elderly with osteoporotic fractures. Plate fixation for osteoporotic femoral shaft fractures have a high rate of complications and delayed healing time, and the most acceptable treatment is intramedullary nailing. This study evaluated the healing time and incidence of complications in osteoporotic femoral shaft fractures after intramedullary nailing.
PATIENTS &METHODS: This was a retrospective study that included 16 patients above 60 years old with osteoporotic femoral shaft fractures operated between January 2015 and December 2018. Patients with metastatic fractures or with atypical fractures were excluded. Thirteen patients had low-energy injuries such as a simple fall from standing height or lower and twisting injuries. The remaining 3 patients sustained high-energy-mechanism of injury. No patient received bisphosphonate except 2 patients received oral bisphosphonate for a period of 6 and 8 months, respectively.
Sixteen patients (12 females and 4 males) with mean age 69.5 ± 3.7 presented with femoral shaft fracture were operated with intramedullary nail, 10 patients were fixed with trochanteric entry nails with proximal neck screws, and 6 patients were fixed with piriformis entry nails. In 9 patients, closed reduction of fracture was achieved while 7 patients required open reduction, of which 5 fracture required cerclage wire addition. The mean bone healing time was 5.35±1.2 months. Intraoperative extension of femoral fractures during intramedullary nail insertion was observed in two cases that required open reduction and addition of cerclage wires around the fracture. The overall incidence of complications was 18.7%.
Intramedullary nailing for osteoporotic femoral shaft fracture is a good acceptable option in elderly patients with reasonable healing time with no major complications.
髓内钉是治疗年轻患者股骨干骨折的一种可接受的治疗方法，但在老年骨质疏松性骨折患者中尚未广泛研究。对于骨质疏松性股骨干骨折，钢板固定的并发症发生率高，愈合时间延迟，最可接受的治疗方法是髓内钉。本研究评估了骨质疏松性股骨干骨折患者髓内钉固定后的愈合时间和并发症发生率。
这是一项回顾性研究，纳入了 2015 年 1 月至 2018 年 12 月期间接受手术治疗的 16 名 60 岁以上的骨质疏松性股骨干骨折患者。排除转移性骨折或非典型骨折患者。13 例患者为低能量损伤，如单纯从站立高度或更低处摔倒或扭伤，其余 3 例患者为高能量损伤机制。除 2 例患者分别接受了 6 个月和 8 个月的口服双膦酸盐治疗外，没有患者接受双膦酸盐治疗。
16 例患者（12 例女性和 4 例男性），平均年龄 69.5±3.7 岁，采用髓内钉治疗股骨干骨折，10 例采用转子入口钉加近端颈螺钉固定，6 例采用梨状肌入口钉固定。9 例患者骨折闭合复位，7 例患者需行切开复位，其中 5 例骨折需加用环形钢丝。平均骨愈合时间为 5.35±1.2 个月。术中观察到 2 例髓内钉插入过程中股骨骨折延长，需行切开复位并在骨折周围加用环形钢丝。总的并发症发生率为 18.7%。
对于老年骨质疏松性股骨干骨折患者，髓内钉是一种可接受的治疗方法，愈合时间合理，无重大并发症。
