Four pins assisted reduction of complex segmental femoral fractures: a technique for closed reduction

Abstract

Complex segmental femoral fractures are usually not amenable to closed reduction. The purpose of this study was to evaluate a series of patients who had undergone four pins assisted reduction and intramedullary nail fixation to determine the therapeutic effect of this closed reduction technique. Between December 2010 and January 2013, 15 consecutive patients with segmental femoral fractures were treated with four pins assisted reduction at our hospital. The patient was placed in a supine position on a radiolucent fracture table and a gentle traction was attempted on the limb. Usually, the proximal fracture segment exhibited the typical deformity of flexion, external rotation, and abduction, the middle segment exhibited adduction and distal fracture segment exhibited flexion. Four Schanz pins were placed percutaneously to fix one cortex and did not penetrate into the medullary cavity, and the "T" sharp handles were fixed on the Schanz pins. The fragments were then reduced by reversing the deforming forces for segmental fractures by two assistants. And then, the reduction could be easily achieved and intramedullary nail fixation was performed. Radiographs were evaluated for the quality of the reduction and fracture union. Closed reduction was achieved in all patients using the four pins technology. All 15 fractures united uneventfully. No patient had a rotational malunion or limb length discrepancy at the time of the last follow-up. Thirteen of the fifteen (86.7%) patients had anatomic reduction and two of them (13.3%) had minor varus alignment of 3° and 5°. Knee stiffness was observed in 2 patients and no implant failure was observed. Surgical treatment of complex segmental femoral fractures with four pins assisted reduction and intramedullary nail fixation techniques can result in excellent reductions and a high union rate.

Retracted: An Often Easily Missed Injury in the Presence of Orthopaedic Trauma: A Case Series of Derived Injury

“…We should have a focus, because the process of prevention may cause irritation and interference to the surrounding soft tissues. We should make necessary treatment to the injury to minimize the derived injury, including hemostasis of the blood vessel injury, cold compress for soft tissue contusion, homeopathic treatment, and fixation of the external stent for fracture. On the basis of homeopathic treatment, the irritation and interference to soft tissues should be reduced to the minimum.…”

Segmental femoral fracture malunion: evidence and prognostic analysis of medical intervention in the third century BC

“…The distal fracture segment demonstrated posterior displacement due to the traction exerted by the muscle groups surrounding the knee joint (Fig. 4 b), such as the gastrocnemius muscle, as well as the gravitational force exerted on the limb 34 . However, abduction and external rotation displacement of the proximal fracture fragment and posterior displacement of the distal fracture fragment were rectified.…”

Segmental Femoral Fracture Malunion: Evidence and Prognostic Analysis of Medical Intervention in the 3rd Century BC

“…The mid-segment of the fracture demonstrated adduction and angulation outward due to the tension exerted by the hip adductor muscle groups. The distal fracture segment demonstrated posterior displacement due to the traction exerted by muscle groups surrounding the knee joint, such as the gastrocnemius muscle, as well as the gravitational force exerted on the limb (Zheng et al, 2014). However, abduction and external rotation displacement of the proximal fracture fragment and posterior displacement of the distal fracture fragment were recti ed.…”