Reamed intramedullary nailing of diaphyseal multifragmentary femur fractures (AO/OTA 32-C) without fluoroscopy guidance: prospective analysis of methods and short-term outcomes in a low-resource setting.

التفاصيل البيبلوغرافية
العنوان:	Reamed intramedullary nailing of diaphyseal multifragmentary femur fractures (AO/OTA 32-C) without fluoroscopy guidance: prospective analysis of methods and short-term outcomes in a low-resource setting.
المؤلفون:	Adesina SA; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria. stephen.adesina@bowen.edu.ng.; Bowen University, P.M.B 284, Iwo, Osun State, Nigeria. stephen.adesina@bowen.edu.ng., Amole IO; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.; Bowen University, P.M.B 284, Iwo, Osun State, Nigeria., Adefokun IG; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria., Adegoke AO; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.; Bowen University, P.M.B 284, Iwo, Osun State, Nigeria., Odekhiran EO; National Orthopaedic Hospital, Igbobi, P.M.B 2009, Yaba, Lagos, Nigeria., Akinwumi AI; Adeleke University, P.M.B 250, Ede, Osun State, Nigeria., Ojo SA; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.; Bowen University, P.M.B 284, Iwo, Osun State, Nigeria., Durodola AO; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.; Bowen University, P.M.B 284, Iwo, Osun State, Nigeria., Awotunde OT; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.; Bowen University, P.M.B 284, Iwo, Osun State, Nigeria., Ikem IC; Department of Orthopaedic Surgery and Traumatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria., Eyesan SU; Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.; Bowen University, P.M.B 284, Iwo, Osun State, Nigeria.
المصدر:	European journal of orthopaedic surgery & traumatology : orthopedie traumatologie [Eur J Orthop Surg Traumatol] 2024 Jul 04. Date of Electronic Publication: 2024 Jul 04.
Publication Model:	Ahead of Print
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Springer-Verlag France Country of Publication: France NLM ID: 9518037 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1068 (Electronic) Linking ISSN: 16338065 NLM ISO Abbreviation: Eur J Orthop Surg Traumatol Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Paris : Springer-Verlag France
مستخلص:	Purpose: To describe the methods and outcomes of reamed intramedullary nailing (IMN) of diaphyseal multifragmentary femur (AO/OTA C2 and C3) fractures (DMFFs) in a low-resource setting without fluoroscopy and fracture table. Methods: The prospective study involved 35 DMFFs among 318 femur fractures treated ≤ 3 weeks post-injury with SIGN nails. The fractures were fixed without fluoroscopy, fracture table and power reaming. Closed, mini-open or open reduction was done. Anatomical length and alignment were ensured using a surgical support triangle during retrograde nailing, and by an assistant during antegrade nailing. Follow-ups were done at 6 weeks, 12 weeks and 6 months. Results: DMFFs constituted 11.0% of the 318 fractures. Twenty-four (68.6%) were males. The mean age was 39.0 years (range 17-75 years). About 94.3% were injured in road traffic accidents. Fracture reduction was closed in 18, mini-open in 8 and full-open in 9. The operative times were significantly shorter for closed than open reduction (p = 0.001). Five fractures received a supplemental fixation with plate or lag screws. By the 12th post-operative week, 97.1% demonstrated continuing radiographic healing, 94.1% tolerated painless weight-bearing and 91.2% could squat & smile. There was no infection or noticeable rotational malunion. Five fractures healed with a limb-length discrepancy of < 2 cm. Conclusion: The study demonstrates the feasibility of reamed IMN of DMFFs without fluoroscopy. The outcomes were satisfactory. Although the small sample size and short follow-up period are limitations, the study could serve as a basis for future larger studies in low-resource settings. (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)
References:	Meinberg EG, Agel JMA, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium—2018. J Orthop Trauma 32:S1-170. https://doi.org/10.1097/BOT.0000000000001063. (PMID: 10.1097/BOT.000000000000106329256945) Agarwal-Harding KJ, von Keudell A, Zirkle LG, Meara JG, Dyer GSM (2016) Understanding and addressing the global need for orthopaedic trauma care. J Bone Joint Surg Am 98(21):1844–53. https://doi.org/10.2106/JBJS.16.00323. (PMID: 10.2106/JBJS.16.0032327807118) Cho WT, Jang JH, Park SR, Sohn HS (2024) Radiographic outcomes and non-union factor analysis in fragmentary segmental femoral shaft fractures (AO/OTA 32C3) treated with reamed antegrade nailing. Sci Rep 14(1):8364. https://doi.org/10.1038/s41598-024-59136-x. (PMID: 10.1038/s41598-024-59136-x3860031211006881) Kempf I, Grosse A, Beck G (1985) Closed locked intramedullary nailing: its application to comminuted fractures of the femur. J Bone Joint Surg Am 67(5):709–720. (PMID: 10.2106/00004623-198567050-000053997923) Haonga BT, Mrita FS, Ndalama EE, Makupa JE (2015) Short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary sign nail at Muhimbili Orthopaedic Institute in Tanzania. Tanzan J Health Res 17(3):1–7. https://doi.org/10.4314/thrb.v17i3.8. (PMID: 10.4314/thrb.v17i3.8) Babalola OM, Ibraheem GH, Ahmed BA, Olawepo A, Agaja SB, Adeniyi A (2016) Open intramedullary nailing for segmental long bone fractures: an effective alternative in a resource-restricted environment. Niger J Surg 22(2):90–95. https://doi.org/10.4103/1117-6806.188983. (PMID: 10.4103/1117-6806.188983278432725013749) Collinge CA, Sanders RW (2000) Percutaneous plating in the lower extremity. J Am Acad Orthop Surg 8(4):211–216. https://doi.org/10.5435/00124635-200007000-00001. (PMID: 10.5435/00124635-200007000-0000110951109) Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM (1999) Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am 81(11):1538–1544. https://doi.org/10.2106/00004623-199911000-00005. (PMID: 10.2106/00004623-199911000-0000510565645) Phillips J, Zirkle LG, Gosselin RA (2012) Achieving locked intramedullary fixation of long bone fractures: technology for the developing world. Int Orthop 36(10):2007–2013. https://doi.org/10.1007/s00264-012-1625-3. (PMID: 10.1007/s00264-012-1625-3228471183460075) Adesina SA, Eyesan SU, Amole IO, Akinwumi AI, Awotunde OT, Durodola AO, Owolabi JI (2022) Solid locked intramedullary nailing for expeditious return of bone-setting-induced abnormal fracture union victims to work in South-western Nigeria. Sci Rep 12(1):21432. https://doi.org/10.1038/s41598-022-25862-3. (PMID: 10.1038/s41598-022-25862-3365098319744724) Adesina SA, Eyesan SU, Amole IO, Awotunde OT, Akinwumi AI, Durodola AO, Ikem IC (2021) Closed reduction and locked intramedullary nailing of diaphyseal long bone fractures without intraoperative imaging and fracture table. Int Orthop 46:51–59. https://doi.org/10.1007/s00264-021-05091-5. (PMID: 10.1007/s00264-021-05091-534131767) Zirkle LG, Shearer D (2009) SIGN technique for retrograde and antegrade approaches to femur. Tech Orthop 24:247–252. https://doi.org/10.1097/BTO.0b013e3181c3e617. (PMID: 10.1097/BTO.0b013e3181c3e617) Wu H, Liu M, Challa ST, Morshed S, Eliezer EN, Haonga BT, Zirkle L, Shearer DW (2019) Development of squat-and-smile test as proxy for femoral shaft fracture-healing in patients in Dar es Salaam. Tanzania J Bone Joint Surg Am 101(4):353–359. https://doi.org/10.2106/JBJS.18.00387. (PMID: 10.2106/JBJS.18.0038730801374) Adesina SA, Amole IO, Adefokun IG, Adegoke AO, Akinwumi AI, Odekhiran EO, Durodola AO, Ojo SA, Eyesan SU (2024) Retrograde intramedullary nailing with supplemental plate and lag screws allows early weight bearing following distal end-segment femur fractures (AO/OTA 33) in a low-resource setting. Eur J Orthop Surg Traumatol 34(3):1519–1527. https://doi.org/10.1007/s00590-023-03828-z. (PMID: 10.1007/s00590-023-03828-z38265741) Adesina SA, Amole IO, Akinwumi AI, Adegoke AO, Durodola AO, Owolabi JI, Awotunde OT, Adefokun IG, Ojo SA, Eyesan SU (2023) Follow-up non-attendance after long-bone fractures in a low-resource setting: a prospective study of predictors and interventions to increase attendance rates. BMC Health Serv Res 23(1):1405. https://doi.org/10.1186/s12913-023-10453-3. (PMID: 10.1186/s12913-023-10453-33809330210720235) Gosselin RA (2009) The increasing burden of injuries in developing countries: direct and indirect consequences. Tech Orthop 24(4):230–232. https://doi.org/10.1097/BTO.0b013e3181bfd56c. (PMID: 10.1097/BTO.0b013e3181bfd56c) Kesemenli C, Subasi M, Necmioglu S, Kapukaya A (2002) Treatment of multifragmentary fractures of the femur by indirect reduction (biological) and plate fixation. Injury 33(8):691–699. https://doi.org/10.1016/s0020-1383(02)00166-3. (PMID: 10.1016/s0020-1383(02)00166-312213420) Sreen S, Daroch MS, Vashisht D, Kapil N (2017) Role of closed intramedullary interlocking nailing in comminuted fractures of long bones in lower limbs. Int J Res Med Sci. 5(9):4122–26. https://doi.org/10.18203/2320-6012.ijrms20173995. (PMID: 10.18203/2320-6012.ijrms20173995) Millar MJ, Wilkinson A, Navarre P, Steiner J, Vohora A, Hardidge A, Edwards E (2018) Nail Fit: Does nail diameter to canal ratio predict the need for exchange nailing in the setting of aseptic, hypertrophic femoral nonunions? J Orthop Trauma 32(5):245–250. https://doi.org/10.1097/BOT.0000000000001110. (PMID: 10.1097/BOT.000000000000111029401087) Kook I, Park KC, Kim DH, Sohn OJ, Hwang KT (2023) A multicenter study of factors affecting nonunion by radiographic analysis after intramedullary nailing in segmental femoral shaft fractures. Sci Rep 13(1):7802. https://doi.org/10.1038/s41598-023-34939-6. (PMID: 10.1038/s41598-023-34939-63717940410183035) Liao JC, Hsieh PH, Chuang TY, Su JY, Chen CH, Chen YJ (2003) Mini-open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table. Chang Gung Med J 26(9):660–668. (PMID: 14651164) Adesina SA, Amole IO, Oyewusi OO, Adefokun IG, Odekhiran EO, Adeniji DO, Adegoke AO, Ojo SA, Owolabi JI, Eyesan SU (2023) Locked intramedullary nailing of diaphyseal femur fractures without intraoperative fluoroscopy, fracture table and power reaming: retrograde affords greater procedural efficiency than antegrade approach. Int Orthop 47(7):1845–1853. https://doi.org/10.1007/s00264-023-05832-8. (PMID: 10.1007/s00264-023-05832-837140596) Rodriguez-Fontan F, Tucker NJ, Strage KE, Mauffrey C, Parry JA (2022) Antegrade versus retrograde nailing of proximal femur fractures: a cortical diameter based study. J Orthop 12(34):385–390. https://doi.org/10.1016/j.jor.2022.10.005. (PMID: 10.1016/j.jor.2022.10.005) Tahir M, Ahmed N, Faraz A, Shafiq H, Khan MN (2021) Comparison of open and closed nailing for femoral shaft fractures: a retrospective analysis. Cureus 13(6):e16030. https://doi.org/10.7759/cureus.16030. (PMID: 10.7759/cureus.16030343365178319164) Chen YH, Liao HJ, Lin SM, Chang CH, Rwei SP, Lan TY (2022) Radiographic outcomes of the treatment of complex femoral shaft fractures (AO/OTA 32-C) with intramedullary nailing: a retrospective analysis of different techniques. J Int Med Res 50(6):3000605221103974. https://doi.org/10.1177/03000605221103974. (PMID: 10.1177/0300060522110397435676773)
فهرسة مساهمة:	Keywords: Diaphyseal multifragmentary fractures; Femur; Fluoroscopy; Low-resource setting; Reamed intramedullary nailing
تواريخ الأحداث:	Date Created: 20240704 Latest Revision: 20240704
رمز التحديث:	20240704
DOI:	10.1007/s00590-024-04040-3
PMID:	38963548
قاعدة البيانات:	MEDLINE

Find this article in full text from Springer Verlag.

Full Text Finder

الوصف
تدمد:	1432-1068
DOI:	10.1007/s00590-024-04040-3