Hoy Robert C, Soderquist Melissa, Shah Ronit, Kurucan Etka, Galos David
Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, USA.
Department of Orthopaedic Surgery and Sports Medicine, Temple University Hospital, Philadelphia, PA, USA.
Injury. 2025 Apr;56(4):112268. doi: 10.1016/j.injury.2025.112268. Epub 2025 Mar 14.
Time to union in civilian firearm injuries is variable and not well described in the literature. This study measures the time to union for femoral and tibial shaft fractures treated with an intramedullary nail (IMN). Time to union is compared across open, closed, or ballistic trauma (BT) fractures. The goal of the study is to answer the questions: (1) Do tibial shaft fractures heal in specific temporal patterns based on mechanism of injury and (2) Do these temporal healing patterns apply to both the tibia and femur?
Included patients had tibial or femoral shaft fractures (OTA/AO 32 and 42) treated at an urban level 1 trauma center between 2015 and 2020 with IMN. Patients were eligible if radiographic imaging was available for any four of five follow-up timepoints, absence of preexisting hardware, and BT was from low velocity handgun injuries. Radiographic union scale (RUS) was compared amongst six groups (Open, Closed or BT for Femur and Tibia fractures), at 60-90 days, 91-180 days, 181- 270 days, and 271-365 days and greater than 365 days. Statistical comparison was performed using a two-way ANOVA and Tukey's multiple comparisons.
Included in the study were 114 patients, with 20 patients in each group except the OPEN femur fracture group with 14.
At the 91-180 day time point, CLOSED tibia RUS was significantly higher than for BT and OPEN tibia RUS. At 181-270 days, CLOSED tibia RUS was significantly higher than OPEN tibia. At 271-365 days and >365, CLOSED and BT RUS were significantly higher than OPEN RUS.Femur: At the 91-180 day time point, OPEN femur RUS was significantly lower than CLOSED and BT femur RUS. At later timepoints, all three groups achieved union with mean RUS>10.
This study demonstrates that healing of tibial shaft fractures from BT is not significantly different from closed fractures after 180 days post-operatively. Additionally, femoral shaft fractures from a BT healed similarly to closed and open fractures after 180 days post-operatively.
Prognostic Level III.
民用火器伤的骨愈合时间各不相同，且在文献中描述不多。本研究测量了使用髓内钉（IMN）治疗的股骨干和胫骨干骨折的骨愈合时间。比较了开放性、闭合性或弹道伤（BT）骨折的骨愈合时间。本研究的目的是回答以下问题：（1）胫骨干骨折是否根据损伤机制以特定的时间模式愈合？（2）这些时间愈合模式是否适用于胫骨和股骨？
纳入的患者为2015年至2020年期间在城市一级创伤中心接受IMN治疗的胫骨干或股骨干骨折（OTA/AO 32和42）。如果在五个随访时间点中的任意四个时间点有影像学检查结果、不存在既往内固定装置且BT为低速手枪伤，则患者符合入选标准。在60 - 90天、91 - 180天、181 - 270天、271 - 365天以及大于365天这几个时间段，比较了六组（股骨和胫骨骨折的开放性、闭合性或BT组）的影像学骨愈合量表（RUS）。使用双向方差分析和Tukey多重比较进行统计学比较。
本研究共纳入114例患者，除开放性股骨骨折组有14例患者外，其余每组各有20例患者。
在91 - 180天时间点，闭合性胫骨RUS显著高于BT和开放性胫骨RUS。在181 - 270天，闭合性胫骨RUS显著高于开放性胫骨。在271 - 365天及大于365天，闭合性和BT组的RUS显著高于开放性组。
在91 - 180天时间点，开放性股骨RUS显著低于闭合性和BT股骨RUS。在随后的时间点，所有三组均达到骨愈合，平均RUS>10。
本研究表明，术后180天后，BT所致的胫骨干骨折愈合情况与闭合性骨折无显著差异。此外，术后180天后，BT所致的股骨干骨折愈合情况与闭合性和开放性骨折相似。
预后III级。
