Ziegenhain Franziska, Canal Claudio, Halvachizadeh Sascha, Mittlmeier Anne, Pape Hans-Christoph, Hierholzer Christian, Neuhaus Valentin
Division of Trauma Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, 8091, Zuerich, Switzerland.
Department of Surgery, Spital Thurgau, Pfaffenholzstr. 4, 8501, Frauenfeld, Switzerland.
Eur J Trauma Emerg Surg. 2025 May 20;51(1):211. doi: 10.1007/s00068-025-02883-x.
Femoral shaft fractures are a common entity in trauma surgery. The gold standard is closed reduction and intramedullary nailing. However, in some fracture patterns, the surgeon may choose to open the fracture for reduction. The purpose of this retrospective study was to analyze the outcome of femoral shaft fractures treated with open reduction, cerclage wiring and intramedullary nailing.
We included adult patients with femoral shaft fractures treated with open reduction, cerclage wiring and intramedullary nailing at a level 1 trauma center in Switzerland during an 11-year period. The data collection was conducted retrospectively. Patient characteristics including age, sex and existing comorbidities were analyzed. Detailed information regarding the fracture patterns and surgical procedures was recorded. Outcome measures included the rates of malunion and nonunion, the time required for union, incidence of surgical site infections, and the frequency of revision surgeries.
We included a total of 69 patients, comprising 48 males and 21 females with a mean age of 50 years. A majority suffered a high velocity trauma (67%). The most common fracture type was multifragmentary subtrochanteric fracture. Approximately 57% of the patients underwent definitive surgical care within the first 24 h. Number of cerclages applied ranged from 1 to 4, with 18% positioned above the lesser trochanter. Delayed union occurred in 10% of cases, while nonunion was noted in 19% of patients. Complications included femoral head necrosis in 3 (4%) patients, and surgical site infections were documented in 3 (4%) cases.
Our findings give rise to closed reduction and internal fixation as a treatment of choice of femoral shaft fractures. We suggest the use of ORIF combined with cerclages, if closed reduction cannot be sufficiently achieved. However, a risk-benefit ratio should be assessed to minimize the risk of a higher complication rate with the use of ORIF.
股骨干骨折是创伤外科中的常见病症。金标准是闭合复位和髓内钉固定。然而，在某些骨折类型中，外科医生可能会选择切开骨折进行复位。本回顾性研究的目的是分析切开复位、环扎钢丝固定和髓内钉固定治疗股骨干骨折的结果。
我们纳入了在瑞士一家一级创伤中心接受切开复位、环扎钢丝固定和髓内钉固定治疗股骨干骨折的成年患者，研究为期11年。数据收集采用回顾性方式。分析患者特征，包括年龄、性别和现有合并症。记录有关骨折类型和手术操作的详细信息。结果指标包括畸形愈合和不愈合率、愈合所需时间、手术部位感染发生率以及翻修手术频率。
我们共纳入69例患者，其中男性48例，女性21例，平均年龄50岁。大多数患者遭受高速创伤（67%）。最常见的骨折类型是多段性转子下骨折。约57%的患者在最初24小时内接受了确定性手术治疗。使用的环扎钢丝数量为1至4根，18%位于小转子上方。10%的病例发生延迟愈合，19%的患者出现不愈合。并发症包括3例（4%）患者发生股骨头坏死，3例（4%）病例记录有手术部位感染。
我们的研究结果表明闭合复位内固定是股骨干骨折的首选治疗方法。如果无法充分实现闭合复位，我们建议使用切开复位内固定联合环扎钢丝固定。然而，应评估风险效益比，以尽量降低使用切开复位内固定导致较高并发症发生率的风险。
