Is there a place for open intramedullary nailing in femoral shaft fractures?

Abstract

Background:Femoral shaft fractures are among the most common fractures following high trauma injuries. Different kinds of treatment have been suggested for these injuries.Aim:The aim of this study was to compare the results femoral fractures treated by mini open and close intramedullary nailing (IMN) technique.Materials and Methods:A total of 48 adult patients were operated due to fracture of the femur with close or open IMN technique between September 2010 and September 2011. 23 patients operated with close. IMN technique was included in Group I while 24 patients operated with mini open IMN technique constituted Group II. In Group I, all patients. Were operated on the fracture table in the supine position while in Group II, all patients underwent surgery on standard tables in the lateral position.Results:The mean age of patients was 27.3 years, ranging between 16 and 62. The mean age of the close nailing and open nailing groups was 30.5 and 24.5 respectively (P = 0.052). Only one patient from the open nailing group failed to unite. The mean time for union in close and open nailing groups was 13 + 2.4 and 17.7 + 2.3 weeks respectively (P = 0.001). No infection or limb length discrepancies were observed in the two groups.Conclusion:Although close nailing is the preferred methods in most cases, but in poly-traumatized patients or in centers where there are no fracture tables or C-arm, open nailing is a good option.

Closed reduction and locked intramedullary nailing of diaphyseal long bone fractures without intra-operative imaging and fracture table

“…Many authors have described a number of techniques for achieving closed reduction of femur fractures but these techniques still require some forms of intra-operative imaging or fracture table, and extra skin incisions [19][20][21]. However, mini-open reduction as we did for some of the fractures has been reported by previous studies with outcome comparable to that of closed reduction [22][23][24].…”

Patterns, Management, and Outcome of Traumatic Femur Fracture: Exploring the Experience of the Only Level 1 Trauma Center in Qatar

“…Further supporting the notion of trochanteric entry nails, another study on cadavers found lesser structural and iatrogenic injury to the surrounding structures and the gluteal musculature with trochanteric nailing [ 38 ]. In our series, open reduction was performed in about one-third of patients and this approach was secondary to difficult closed reduction procedure, which has consistently been described as a safe alternative technique [ 39 , 40 ]. In this study, external fixation for the treatment of femoral shaft was primarily performed for open fractures.…”

Descriptive Analysis Of Femur Fracture Patterns, Management And Outcome: Descriptive Observational Study From A Level 1 Trauma Center

“…The authors also suggested the ease of learning the technique of entry through greater trochanteric tip that resulted in improved functional outcomes; although there is no differece in the rates of union among the two entry sites. Another prospective cohort study on antegrade femoral nailing reported similar higher rate of union, lower complication rates, and comparable functional results of trochanteric insertion as compared to the piriformis fossa nailing [34]. In addition, the authors demonstrated lesser uoroscopy and operation time with greater trochanter entry in obese patients.…”