A multicenter study of factors affecting nonunion by radiographic analysis after intramedullary nailing in segmental femoral shaft fractures

Abstract

The factors affecting the outcomes of segmental femoral shaft fractures are currently unknown. We evaluated the outcomes of intramedullary (IM) nail fixation and investigated factors affecting nonunion of femoral shaft segmental fractures. A total of 38 patients who underwent IM nail fixation for femoral shaft segmental fractures (AO/OTA 32C2) at three university hospitals with a minimum 1-year follow-up period were retrospectively reviewed. The patients were divided into union (n = 32) and nonunion (n = 6) groups. We analyzed smoking status, diabetes mellitus, location of the segmental fragment, segment comminution, filling of the IM nail in the medullary canal, residual gap at the fracture site, use of a cerclage wire or blocking screws as factors that may affect the surgical outcome. In the union group, the average union time was 5.4 months (4–9 months). In the nonunion group, five patients required additional surgery within an average of 7.2 months (5–10 months) postoperatively, whereas one patient remained asymptomatic and did not require further intervention. On comparing the two groups, insufficient canal filling of the IM nail (union, 25.0%; nonunion, 83.3%; p = 0.012) and the presence of a residual gap at the fracture site after reduction (union, 31.3%; nonunion, 83.3%; p = 0.027) were significantly different. In the multivariate analysis, only insufficient canal filling of the IM nail was found to be a factor affecting nonunion, with an odds ratio of 13.3 (p = 0.036). In this study, a relatively high nonunion rate (15.8%) was observed after IM nail fixation. Insufficient IM nail canal filling and a residual gap at the fracture site post reduction were factors affecting segmental femoral shaft fracture nonunion after IM nail fixation.

Radiographic outcomes and non-union factor analysis in fragmentary segmental femoral shaft fractures (AO/OTA 32C3) treated with reamed antegrade nailing

“…Kempf et al 29 , Wiss et al 30 and Karadimas et al 3 reported non-union rates of 10% (5/52), 2% (1/33) and 3.8% (5/131), respectively. Recently, Kook et al 31 reported a non-union rate of 15.8% (6/38) for intact segmental femoral shaft fractures treated with intra-medullary nail fixation (AO/OTA 32C2). The findings of those researches are relatively lower than what we have observed.…”

Risk factors and healthcare costs associated with long bone fracture non-union: a retrospective US claims database analysis

“…Specifically for femoral shaft fractures, two recent studies have described non-union rates ranging from 5.8% for patients from a single Level 1 trauma center treated with intramedullary nails [ 18 ] to 15.8% for patients from multiple sites with segmental shaft fractures [ 19 ]. In our study, femoral shaft fractures had a risk of non-union of 9.0% (7.8%–10.2%).…”

Evaluation of the clinical efficacy of using an inverted triangular cannulated compression screw in combination with positive or negative buttress reduction for the healing of femoral neck fractures

“…For patients younger than 65 years with femoral neck fractures, the preferred treatment methods are closed reduction internal fixation and femoral head preservation [ 2 , 3 ]. Displacement and inadequate reduction of fractures significantly contribute to nonunion [ 4 , 5 ].…”