Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing

Abstract

Objective To investigate the effect of the degree of displacement of a femoral shaft fracture with the third fragment on fracture healing after intramedullary nailing. Methods In total, 216 patients with closed comminuted femoral fracture admitted to Lianyungang Hospital affiliated to Xuzhou Medical University from February 2010 to February 2016 were analyzed retrospectively. Among these patients, 142 were males and 74 were females, the mean age was 38 years (range 17–64 years), and 95 cases were on the right, while 121 cases were on the left. All patients were treated with a femoral interlocking intramedullary nail. Referring to the femoral shaft diameter, the degree of displacement of the third fragment was classified into four grades: grade I (displacement was less than a third of the diameter of the shaft): 121 cases; grade II (greater than a third of the diameter and less than two thirds): 52 cases; grade III (greater than two thirds of the diameter): 28 cases; and grade IV (fracture fragment turnover): 15 cases. According to the modified Radiological Union Scale for Femur (mRUSF), the fracture union rate and the mean union time of the fracture, the effect of the degree of displacement of the third fragment on fracture healing was evaluated. Results In total, 216 patients with a mean follow-up of 15.9 months (range 6–31 months) met the inclusion criteria. The best fracture healing was the grade I displacement, with a union rate of 89.2% and a mean union time of 7.7 months. The poorest fracture healing was for the grade IV displacement, with a union rate of 13.3% and a mean union time of 16.5 months. The healing was moderate in the grade II and III displacements, with a union rate of 46.2% and 28.6%, respectively, and a mean union time of 8.6 months and 13.5 months, respectively (P < 0.05). Conclusions The third fragment with grade I displacement requires no intervention, whereas fractures with grade IV displacement should be reduced to as near as possible to the diaphyseal bone defect to avoid nonunion. The third fragments with the grade II or III displacement should be treated with closed reduction whenever possible to achieve a displacement within the range of grade I to minimize the incidence of nonunion.

Analysis of the influence of circumference and displacement of the third fracture fragment on the healing of femoral shaft fractures treated with intramedullary nailing

“…When the circumference of third fracture fragment was type 2 and type 3 or the displacement distance was degree II and degree III, the fracture healing was signi cantly affected (P < 0.05). We followed up 216 patients with femoral shaft fractures and found that when the third fracture fragment was displaced by degree I after intramedullary nails, no additional intervention was required during the operation and a good fracture healing rate could be obtained; when the third fracture fragment was displaced by degree II or III, intervention of the fracture fragment was required during the operation to reduce the displacement distance of the fracture fragment, which could signi cantly reduce the incidence of postoperative nonunion [9]. In this study, we found that in presence of degree I displacement of the fracture fragment, the circumference size of it had little effect on fracture healing.…”

“…Based on the diaphyseal diameter, the degree of displacement of the third fracture fragment was classi ed into three degrees: degree I: third fracture fragment displacement was less than 1/3 of the diaphyseal diameter at the fracture site; degree II: third fracture fragment displacement was greater than 1/3 of the diaphyseal diameter at the fracture site while less than 2/3 of the diaphyseal diameter at the fracture site; degree III: third fracture fragment displacement was greater than 2/3 of the diaphyseal diameter at the fracture site. According to previous studies [9], when third fracture fragments are of degree I displacement, non-intervention of third fracture fragments can also achieve a good therapeutic effect. However, when fractures are of degree II and III displacement, they need to be additionally reduced as much as possible and approach the defect of femoral shafts to avoid postoperative nonunion.…”

Extracorporeal shock wave treatment for post‑surgical fracture nonunion: Insight into its mechanism, efficacy, safety and prognostic factors (Review)

“…Currently, the most commonly used treatment modalities for patients with PSFN include drug therapy (such as skeleton growth factor and teriparatide) and surgical therapy (autogenous bone grafting and internal fixation surgery), with surgical therapy being regarded as the gold standard (7)(8)(9). Although the union rate is as high as 70.4-89.2% (reported in different countries during 2011-2021) after surgical intervention, a non-negligible proportion of patients with PSFN still face post-surgical complications due to its invasiveness (10)(11)(12). Therefore, less invasive methods are needed to improve the prognosis of patients with PSFN.…”