Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review

Flagstad, Ilexa; MacCormick, Lauren M.; Heare, Austin; Parikh, Harsh R.; Albersheim, Melissa; Atchison, Jared; Breslin, Mary A.; Davis, Patrick; Feinstein, Shawn; Hak, David J.; Labrum, Joseph T.; Lufrano, Reuben; Lund, Erik A.; Connelly, Daniel; Matar, Robert N.; Nadeau, Jason; Chaffin, Danielle Ries de; Rodriguez-Buitrago, Andres; Schmidt, Tegan; Shaw, Nichole; Simske, Natasha M.; Siy, Alexander B.; Titter, Julie; Vang, Sandy; Wagstrom, Emily; Westberg, Jerald R.; Hahn, Jesse C.; Mauffrey, Cyril; Mir, Hassan R.; O’Toole, Robert V.; Obremskey, William T.; Sanders, Roy; Schmidt, Andrew H.; Vallier, Heather A.; Whiting, Paul S.; Cunningham, Brian P.

doi:10.1097/bot.0000000000002055

Cited by 5 publications

(3 citation statements)

References 30 publications

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“…Comparing by fracture type addressed, Ristevski et al [1] reported a mean LOS of 39.7, 31.4, and 15.6 days for the prophylaxis, fracture, and combination subgroups undergoing SS bilateral femoral nailing procedures, respectively, although no comparison to a TS cohort was made. Similar results have also been shown in the trauma literature by Flagstad et al [48] who compared SS vs. TS bilateral femoral IMN and noted a significantly shorter LOS for SS versus TS cases (16.4 vs. 28.5 days; p < 0.01). Length of stay depends substantially on attaining pain control and functional independence and the SS approach may help expedite reaching this goal due to earlier stabilization of the weight-bearing bones and resumption of weight-bearing status [3,7].…”

Section: Blood Loss and Transfusionsupporting

confidence: 88%

“…However, determination of optimal timing between the two surgeries is not clear as it depends on multiple factors and is difficult to decipher from existing studies due to limited, unclear, and heterogeneous data. Moreover, the selection of patients for SS vs. TS seems biased [22,31,48] and may influence the timing. Thus, it should be tailored to each patient's unique clinical situation and needs.…”

Section: Surgical Technique and Implant Considerationsmentioning

confidence: 99%

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Safety and Efficacy of a Single-Stage versus Two-Stage Intramedullary Nailing for Synchronous Impending or Pathologic Fractures of Bilateral Femur for Oncologic Indications: A Systematic Review

Nian,

Ganesan,

Baidya

et al. 2023

Cancers

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Although intramedullary nail (IMN) fixation is the standard of care for most impending and/or complete pathologic fractures of the femur, the optimal timing/sequence of the IMN in cases of synchronous bilateral femoral disease in advanced cancer is not well established. Thus, we compared the outcomes of single-stage (SS) vs. two-stage (TS) IMN of the bilateral femur with a systematic review of the literature on this topic. Bilateral SS and TS IMN cases were identified from 14 studies extracted from four databases according to PRISMA guidelines. Safety (complications, reoperations, mortality, survival, blood loss, and transfusion) and efficacy (length of stay [LOS], time to start rehabilitation and adjuvant therapy, functional scores, and cost) were compared between the groups. A total of 156 IMNs in 78 patients (36 SS and 42 TS) were analyzed. There were one surgical (infection in TS requiring reoperation; p = 0.860) and fifteen medical complications (five in SS, ten in TS; p = 0.045), with SS being associated with lower rates of total and medical complications. Survival, intraoperative mortality, and postoperative same-admission mortality were similar. No cases of implant failure were reported. Data on LOS, rehabilitation, and adjuvant therapy were scarcely reported, although one study favored SS over TS. No study compared cost or functional scores. Our study is the largest and most comprehensive of its kind in supporting the safety and efficacy of a SS bilateral femur IMN approach in these select patients. Further investigations with higher levels of evidence are warranted to optimize treatment protocols for this clinical scenario.

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Section: Blood Loss and Transfusionsupporting

confidence: 88%

Section: Surgical Technique and Implant Considerationsmentioning

confidence: 99%

Safety and Efficacy of a Single-Stage versus Two-Stage Intramedullary Nailing for Synchronous Impending or Pathologic Fractures of Bilateral Femur for Oncologic Indications: A Systematic Review

Nian,

Ganesan,

Baidya

et al. 2023

Cancers

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“…Interlocking nails are considered by many to be the standard of care for stabilization of critical-sized bone defects (Rhorer, 2009;Dejardin et al, 2012;Shen et al, 2016;Flagstad et al, 2021;Kang et al, 2021;Viberg et al, 2021). Intramedullary fixation is commonly used for both rodent and large animal critical gap healing models (Lindsey et al, 2006;Schoen et al, 2008;Rhorer, 2009;MSc et al, 2013;Quirk et al, 2016;Shiels et al, 2018;Ozmeric et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Angle-stable interlocking nailing in a canine critical-sized femoral defect model for bone regeneration studies: In pursuit of the principle of the 3R’s

Saunders

Déjardin

Soltys-Niemann

et al. 2022

Front. Bioeng. Biotechnol.

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Introduction: Critical-sized long bone defects represent a major therapeutic challenge and current treatment strategies are not without complication. Tissue engineering holds much promise for these debilitating injuries; however, these strategies often fail to successfully translate from rodent studies to the clinical setting. The dog represents a strong model for translational orthopedic studies, however such studies should be optimized in pursuit of the Principle of the 3R’s of animal research (replace, reduce, refine). The objective of this study was to refine a canine critical-sized femoral defect model using an angle-stable interlocking nail (AS-ILN) and reduce total animal numbers by performing imaging, biomechanics, and histology on the same cohort of dogs.Methods: Six skeletally mature hounds underwent a 4 cm mid-diaphyseal femoral ostectomy followed by stabilization with an AS-ILN. Dogs were assigned to autograft (n = 3) or negative control (n = 3) treatment groups. At 6, 12, and 18 weeks, healing was quantified by ordinal radiographic scoring and quantified CT. After euthanasia, femurs from the autograft group were mechanically evaluated using an established torsional loading protocol. Femurs were subsequently assessed histologically.Results: Surgery was performed without complication and the AS-ILN provided appropriate fixation for the duration of the study. Dogs assigned to the autograft group achieved radiographic union by 12 weeks, whereas the negative control group experienced non-union. At 18 weeks, median bone and soft tissue callus volume were 9,001 mm3 (range: 4,939–10,061) for the autograft group and 3,469 mm3 (range: 3,085–3,854) for the negative control group. Median torsional stiffness for the operated, autograft treatment group was 0.19 Nm/° (range: 0.19–1.67) and torque at failure was 12.0 Nm (range: 1.7–14.0). Histologically, callus formation and associated endochondral ossification were identified in the autograft treatment group, whereas fibrovascular tissue occupied the critical-sized defect in negative controls.Conclusion: In a canine critical-sized defect model, the AS-ILN and described outcome measures allowed refinement and reduction consistent with the Principle of the 3R’s of ethical animal research. This model is well-suited for future canine translational bone tissue engineering studies.

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Outcomes of simultaneous versus staged intramedullary nailing fixation of multiple long bone lower extremity fractures

Miller,

Phillips,

Krech

et al. 2023

Injury

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Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review

Cited by 5 publications

References 30 publications

Safety and Efficacy of a Single-Stage versus Two-Stage Intramedullary Nailing for Synchronous Impending or Pathologic Fractures of Bilateral Femur for Oncologic Indications: A Systematic Review

Safety and Efficacy of a Single-Stage versus Two-Stage Intramedullary Nailing for Synchronous Impending or Pathologic Fractures of Bilateral Femur for Oncologic Indications: A Systematic Review

Angle-stable interlocking nailing in a canine critical-sized femoral defect model for bone regeneration studies: In pursuit of the principle of the 3R’s

Outcomes of simultaneous versus staged intramedullary nailing fixation of multiple long bone lower extremity fractures

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