Wilson Nathaniel M, Shaw Jordan T, Malaba Mbonisi, Yugusuk Fasto L T, Nyambati Philemon, Siy Alexander B, Galat Daniel D, Koech Kiprono, Nugent Dylan, Whiting Paul S
Department of Orthopedics and Rehabilitation, University of Wisconsin, 1685 Highland Avenue, Madison, WI.
Department of Orthopaedics, AIC Kijabe Hospital, Kijabe, Kenya.
OTA Int. 2019 Apr 1;2(3):e024. doi: 10.1097/OI9.0000000000000024. eCollection 2019 Sep.
In developing countries, long bone fractures following trauma are a significant contributor to morbidity, and operating room resources are often limited in these settings. The Surgical Implant Generation Network (SIGN) Fin nail may reduce the challenges of retrograde intramedullary nailing of femoral fractures without fluoroscopy. In contrast to the traditional SIGN nail placed in a retrograde fashion, the Fin nail does not require proximal interlocking screws. Instead, the nail achieves stability through an interference fit within the proximal femoral canal. The purpose of this study is to compare postoperative alignment in femoral shaft fractures treated with either a retrograde SIGN Fin nail or a standard retrograde SIGN nail.
Using the SIGN online surgical database, we identified all femoral shaft fractures treated with a retrograde SIGN Fin nail at 2 African hospitals. Two examiners independently classified fracture patterns using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification system. Using an on-screen protractor tool, postoperative coronal and sagittal plane alignment were measured and recorded as deviation from anatomic alignment (DFAA), with units in degrees. Available patient demographics and surgical details were also recorded. Fin nail cases were matched in a 1:1 ratio to retrograde standard SIGN nail cases based on AO/OTA fracture type.
Twenty-eight retrograde Fin nail cases were identified, and 28 matched retrograde SIGN nail cases were selected. The Fin nail and retrograde SIGN nail groups were well matched in terms of demographics, AO/OTA fracture type, and surgical characteristics. There was no significant difference in postoperative coronal or sagittal plane alignment between the groups. There were no cases in either group of average postoperative malalignment >5° in any plane.
The SIGN Fin nail appears to achieve satisfactory radiographic alignment without the need for proximal interlocking screws, making it an attractive implant for retrograde femoral shaft fracture fixation in resource-limited settings. Further research is required to validate these findings and determine long-term Fin nail clinical outcomes.
在发展中国家，创伤后长骨骨折是导致发病的重要因素，而且在这些地区手术室资源往往有限。外科植入物新一代网络（SIGN）Fin钉可能会减少在无透视情况下进行股骨骨折逆行髓内钉固定的挑战。与以逆行方式置入的传统SIGN钉不同，Fin钉不需要近端锁定螺钉。相反，该钉通过与股骨近端髓腔的过盈配合来实现稳定性。本研究的目的是比较采用逆行SIGN Fin钉或标准逆行SIGN钉治疗股骨干骨折后的对线情况。
利用SIGN在线手术数据库，我们在2家非洲医院识别出所有采用逆行SIGN Fin钉治疗的股骨干骨折病例。两名检查人员使用骨科内固定研究学会/骨科创伤协会（AO/OTA）分类系统独立对骨折类型进行分类。使用屏幕量角器工具，测量并记录术后冠状面和矢状面的对线情况，以与解剖对线的偏差（DFAA）表示，单位为度。还记录了可用的患者人口统计学资料和手术细节。根据AO/OTA骨折类型，将Fin钉病例与逆行标准SIGN钉病例按1:1的比例进行匹配。
共识别出28例逆行Fin钉病例，并选择了28例匹配的逆行SIGN钉病例。Fin钉组和逆行SIGN钉组在人口统计学资料、AO/OTA骨折类型和手术特征方面匹配良好。两组术后冠状面或矢状面对线情况无显著差异。两组中均没有术后任何平面平均畸形>5°的病例。
SIGN Fin钉似乎无需近端锁定螺钉就能实现令人满意的影像学对线，使其成为资源有限地区股骨干骨折逆行固定的一种有吸引力的植入物。需要进一步研究来验证这些发现并确定Fin钉的长期临床结果。
