The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study

Vicenti, Giovanni; Carrozzo, M; Caiaffa, Vincenzo; Abate, Antonella; Solarino, Giuseppe; Bizzoca, Davide; Maddalena, Roberto; Colasuonno, Giulia; Nappi, Vittorio; Rifino, Francesco; Moretti, Biagio

doi:10.1007/s00264-018-4178-2

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…With ever increasing cases of comminuted femoral fracture caused by the transportation industry and severe trauma, femoral intramedullary nail fixation has become the gold standard for femoral long bone fracture treatment. Compared with conventional LCP plate internal In particular, femoral shaft fractures with large single fragments present unique challenges to internal fixation [10][11][12]. Salminen et al [13] reported that among femoral shaft fracture cases, the probability of the presence of the third fragment was 10.5%, and a nonunion occurred in 34% of these cases.…”

Section: Discussionmentioning

confidence: 99%

“…Salminen et al [13] reported that among femoral shaft fracture cases, the probability of the presence of the third fragment was 10.5%, and a nonunion occurred in 34% of these cases. In the opinion of Vicenti et al [12], there are four factors that influence the healing of the third shaft fracture with a fracture fragment: the size and displacement of the fracture fragments, the angulation between the fracture fragments and the shaft, and the fracture gap, of which the size and displacement of the fracture fragments are the most influential among these four factors. When the fracture fragment size is greater than 40 mm or the displacement greater than 12 mm, this increases the rate of bone nonunion.…”

Section: Discussionmentioning

confidence: 99%

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

Yang

Huo

et al. 2022

J Orthop Surg Res

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Yang

Huo

et al. 2022

J Orthop Surg Res

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“…When they compared the union rates according to the fragment size and degree of fragment displacement by logistic regression analysis, no signi cant effect of fragment size on union has been observed. Vicenti et al [23] reported a prognostic algorithm about how to manage the third fragment of the femoral shaft fractures treated by intramedullary nail and determined 40 mm fragment size as the cut-off value and the leading parameter that in uences the fracture healing in rst six months or more. They also reported that the amount of third fragment displacement may result in delayed union.…”

Section: Discussionmentioning

confidence: 99%

Butterfly Fragment in the Femoral Shaft Fractures Treated by Intramedullary Nail: Do We Need to Reduce It or Not?

Dabak

Ci̇van

Özdemi̇r

2020

Preprint

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Background: Limited data is available regarding the effect of gap size, fragment size and position of fragment on union in fragmented femur shaft fracture. The aim of the study is to analyze the effect of these parameters on union and determine cut-off values that necessitate reduction of fragment. Methods: Total of 59 patients with fragmented femur shaft fracture were reviewed and the effect of fragment size, gap size and fragment position on union were evaluated on 3rd, 6th and 12th month graphies from medical record of patients. Union rate was determined due to Radiographic Union Score of Femur. Patients were divided into small gap ( 10 mm) or large gap (10 mm), reverse fragment or non-reverse fragment and small fragment (50 mm) or large fragment (50mm) groups. Kruskal–Wallis Variance Analysis and Mann Whitney U test was used for comparisons among groups. The post-hoc Mann Whitney U-Test with Bonferroni Correction was used when the Kruskal Wallis Variance Analysis determined a significant difference.Results: In comparison of union scores of groups in regarding gap size and fragment size, there was not significant difference between groups at 3rd, 6th and 12th months. Union scores in the 3rd month (p=0,011) and 6th month (p=0,039) were lower in the reverse group than non-reverse group. But there was not statistically significant difference between two groups at 12th month (p=0.819). There was no significant difference in union rates in respect to intramedullary nail types. There was an indirect correlation between age and mean union score at 12th month. Conclusions: we could not determine any cutoff value regarding gap width and fragment size in the treatment of the femoral shaft fractures by IMN. Although there was a tendency to decrease in union scores due to the increase in the gap size, any significant difference was not determined. Only the reverse position of fragment had an adverse effect on the union until 6th months but the union score of reverse group reached the result of the non-reverse group by 12th months.

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“…1 FNFs, affect around 1.5 million people per year worldwide, and have a significant impact on patients' health status, potentially leading to an increased disability, reduced quality of life and higher mortality. [2][3][4] In Italy, FNFs have an estimated annual prevalence of 78,000, with 90% of injuries occurring in patients aged over 65 years. 5 Nonetheless, with rising life expectancy across the globe, the number of FNFs worldwide will drastically increase in the next few decades, reaching 6.3 million by 2050.…”

Section: Introductionmentioning

confidence: 99%

“…1 FNFs, affect around 1.5 million people per year worldwide, and have a significant impact on patients’ health status, potentially leading to an increased disability, reduced quality of life and higher mortality. 2–4…”

Section: Introductionmentioning

confidence: 99%

Hip hemiarthroplasty with modular neck: is it useful in residents’ learning curve? A prospective clinical trial

et al. 2020

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Background: The number of femoral neck fractures (FNFs) worldwide will drastically increase in the next few decades, reaching 6.3 million by 2050. In the future, therefore, newly-qualified orthopaedic surgeons will treat this kind of injury more frequently than in past decades. This prospective observational study aims to assess whether hip hemiarthroplasty with modular neck, performed via the Hardinge approach, can be safely carried out by orthopaedic residents. Methods: Patients referred to our Level I trauma centre, between January 2016 and June 2017, with displaced intra-articular femoral fractures, were prospectively recruited. All patients underwent cemented modular bipolar hip hemiarthroplasty (Profemur Z, MicroPort Orthopedics Inc., Arlington, TN, USA) via the Hardinge approach, with the patient positioned in lateral decubitus. The surgical procedures were performed by the same surgical and anesthesiology team, under spinal anaesthesia. All patients underwent clinical and radiographic follow-up up to 24 months. Complications and re-operations were recorded. Clinical evaluation was performed using the Harris Hip Score (HHS), Osteoporosis Quality of Life Questionnaire QUALEFFO-41 and EuroQol-5D (EQ-5D) questionnaire. Anteroposterior pelvis x-rays were performed preoperatively, postoperatively and at 1, 3, 6, 12 and 24 months follow-up. Results: 118 patients met the inclusion criteria (male: 50; female: 68; mean age: 74.3 years; range 65–88 years) and were included in the current study. 67 patients out of 118 (56.8%) were managed by senior orthopaedic surgeons (Group A), whereas the remaining 51 patients out of 118 (43.2%) were treated by orthopaedic residents (Group B). Hip hemiarthroplasties performed by senior surgeons showed the prevalent use of straight (short or long) necks, whereas, in surgical procedures performed by residents, there was a significantly higher use of varus/valgus, anteverted or retroverted necks. The overall complication rate was significantly higher in Group-B patients, compared with Group-A patients ( p = 0.002). The length of hospital stay and the mean clinical scores at 24 months follow-up showed no significant differences. Conclusions: Hip hemiarthroplasty with modular neck can be safely employed during the learning curve of orthopaedic residents. Great efforts, however, should be made in future to improve residents’ training in the management of FNFs.

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The impact of the third fragment features on the healing of femoral shaft fractures managed with intramedullary nailing: a radiological study

Cited by 4 publications

References 18 publications

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

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

Butterfly Fragment in the Femoral Shaft Fractures Treated by Intramedullary Nail: Do We Need to Reduce It or Not?

Hip hemiarthroplasty with modular neck: is it useful in residents’ learning curve? A prospective clinical trial

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