The flipped third fragment in femoral shaft fractures: A reason for open reduction?

Layon, Daniel R.; Morrell, Aidan T.; Lee, Christopher

doi:10.1016/j.injury.2020.09.049

Cited by 8 publications

(11 citation statements)

References 14 publications

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“…Layon et al . found wedge fragments may successfully be treated without open reduction of the third fragment 6 . Leighton et al .…”

Section: Discussionmentioning

confidence: 99%

“…However, there are conflicting opinions in the literature with some authors emphasizing the importance of anatomical reduction. Layon et al found wedge fragments may successfully be treated without open reduction of the third fragment 6 . Leighton et al reported similar satisfactory rates and complication rates between closed and open intramedullary nailing for femoral shaft fracture 18 .…”

Section: Comparison Of Two Techniques Managing Wedgementioning

confidence: 99%

“…even listed their reasons for preferring open nailing as follows: no requirement for fracture table, less requirement of fluoroscopy, anatomic reduction can be accomplished more easily, ability to maintain rotational stability, and comminuted or segmental fracture can be managed more easily 13 . Therefore, according to the literature, whether or not to fix the third fragment of the femoral shaft fracture remains a controversial issue 6 , 7 , 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

“…Some surgeons strictly adhere to the principle of closed reduction with intramedullary nailing leaving the third fragment untouched (Figure 1). Layon et al found wedge fragments may successfully be treated without open reduction of the third fragment 6 . They believe that minimizing surgical damage and using indirect reduction techniques contribute to faster bone healing because the vascularity of bone is preserved allowing earlier recovery 7 .…”

Section: Introductionmentioning

confidence: 99%

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The Butterfly Fragment in Wedge‐Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods

Tsai

Wang

Lee

et al. 2022

Orthopaedic Surgery

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Objective Our study compared the results of wedge‐shaped femoral shaft fracture following intramedullary (IM) nailing with or without fixation of the third fragment. Methods We retrospectively reviewed patients presenting with femoral shaft fracture with AO/OTA type 32‐B from 2011 to 2016. Patients were divided into two groups: closed reduction without touching the third fragment and open reduction with fixation of the third fragment. The fragment ratio, fragment length, nail size, dynamization or not, mRUST scores, union rate, and union time were compared between the two groups. Risk factors of non‐union were also investigated, including sex, age, fracture pattern, fracture location, dynamization, nail size, fragment ratio, fragment size, and postoperative fragment displacement. Results A total of 80 patients met inclusion criteria, 20 patients with wedge‐shaped shaft femoral fracture were managed with IM nailing and open reduction with fixation of the third fragment. Sixty patients were treated with IM nail without touching the third fragment. The union rate for the fixation and non‐fixation groups were 60.0% and 81.7%, respectively. The mean union time for the fixation group was 19 months vs 14 months for the non‐fixation group. Multi‐regression analysis showed larger nail size (odds ratio: 2.26) and fixation of the third fragment (odds ratio: 0.18) influenced fracture healing. Conclusions Fixation of the third fragment in wedge‐shaped shaft femoral fracture results in a longer union time and lower union rate. In the management of femoral fracture with a third fragment, a larger nail size is recommended and fixation should be performed in a closed manner. Fixation of the fragment may achieve better fracture reduction. However, disruption of the vasculature and surrounding structures may further result in nonunion of the fracture site.

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“…Layon et al . found wedge fragments may successfully be treated without open reduction of the third fragment 6 . Leighton et al .…”

Section: Discussionmentioning

confidence: 99%

Section: Comparison Of Two Techniques Managing Wedgementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Butterfly Fragment in Wedge‐Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods

Tsai

Wang

Lee

et al. 2022

Orthopaedic Surgery

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“…Compared with a steel plate, the advantages of an intramedullary nail in its closed reduction and the postoperative fracture union rate have made it the gold standard for the treatment of femoral shaft fractures [1][2][3] . However, fractures with large single fragment present unique challenges, and are present in up to 10-34% of femoral shaft fractures 4 . For Winquist type -femoral shaft fractures with a femoral fragment, delayed union or nonunion may occur if the fracture fragment is displaced by a large amount or reversed after the femoral intramedullary nail is inserted into the medullary cavity.…”

Section: Introductionmentioning

confidence: 99%

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

Yang

Huo

et al. 2022

Preprint

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Objective: To investigate the effect of the degree of displacement of a femoral shaft fracture with a single fracture fragment on fracture healing after intramedullary nailing. Methods: 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 (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 fracture 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 radiographic union score of the femur, the fracture union rate and the mean union time of the fracture, the effect of the degree of displacement of the fracture fragment on fracture healing were evaluated. Results: All the indexes of the four graded groups were statistically significant. The best fracture healing was the grade Ⅰ displacement, with a fracture union rate of 89.2% and a mean union time of 7.7 months. The poorest fracture healing was for the grade Ⅲ and grade Ⅳ displacements, with a union rate of 25.0% and 20.0%, respectively, and a mean union time of 13.7 months and 17.0 months, respectively. The union rate was 65.4% and the mean union time was 8.7 months for grade Ⅱ displacement. Conclusions: A fracture 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. Fracture 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.

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Gösling

2022

Unfallchirurg

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The flipped third fragment in femoral shaft fractures: A reason for open reduction?

Cited by 8 publications

References 14 publications

The Butterfly Fragment in Wedge‐Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods

The Butterfly Fragment in Wedge‐Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods

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

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