Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 3 Issue 7

Reamed Intramedullary Exchange Nailing for Aseptic Non-Union of Isthmus and Enhanced Distal Fixation Exchange Nailing for Non- Union of Distal Third Shaft Femur Fractures

Govind S Kulkarni1, Supreet N Bajwa2*, Siddharth S Vakil3, Deepak Garg4, Umesh S Shelke4 and Yash S Parikh2

1Director, MS Orthopaedics, Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathisthan, Miraj, Maharashtra, India
2Resident, D. Orthopaedics, Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathisthan, Miraj, Maharashtra, India
3Resident, MS Orthopaedics, Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathisthan, Miraj, Maharashtra, India
4Resident, DNB Orthopaedics, Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathisthan, Miraj, Maharashtra, India

*Corresponding Author: Supreet Bajwa, D Resident, D. Orthopaedics, Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathisthan, Miraj, Maharashtra, India.

Received: May 08, 2020; Published: June 12, 2020

×

Abstract

Background: The aim of this study was to evaluate the role of exchange nailing in isthmus and exchange nailing with poller screw fixation and multiplanar interlocking screws for Distal Third shaft femur aseptic non-union.

The evaluation was addressed by measuring the clinical, functional and radiological outcome of our treatment methods in both non-union groups.

Design: Retrospective study.

Methods: Between 2006 to 2014, 55 patients with Non-union of shaft femur were operated using a standardised protocol at our institute and followed up for functional and radiological outcome.

5 patients were lost to follow up and thus were excluded from this study.

Out of 50 patients, 29 were cases of Isthmus Non-union and remaining 21 were cases of Distal Third Non-union. Our approach in Isthmus group was closed Exchange nailing with 2 mm larger nail with medullary reaming. Some needed isthmus when radiological signs of healing were delayed.

In Distal Third group, poller screws were used in conjugation with reamed exchange nailing with a 2 mm larger diameter nail and interlocking screws in different planes.

Out of the 50 patients, 48 were men and 2 women. Their mean post-surgical procedure period at presentation of non-union was 11.60 months.

Results: Out of a total 55, 5 were lost to follow up- all from isthmus group. In isthmus group, healing was observed in 25 out of 29 patients with union achieved in a mean of 7.60 months. Delayed union was seen in 3 patients and addressed with dynamisation of distal screws leading to union in all cases in a mean of 13 months without further intervention.1 patient had superficial infection which resolved with debridement at 4 months. 1 patient required additional bone grafting for persistent non-union and healed at 18 months. Non-union was encountered in 3 patients who refused further treatment and accepted functional limitations. Harris Hip Score for this group was 87.40.

In Distal Third group, all 21 patients achieved union in a mean time of 10.30 months.

No patients required further revisions however 4 patients had superficial infection which was treated with antibiotics and debridement. No further complications were encountered in this group of patients and bony union was uneventful otherwise. Harris Hip Score of this group was 92.40.

Conclusion: Using exchange nailing for isthmus and poller screw augmentation for Distal Third Shaft Femur Non-union yields excellent clinical, functional and radiological outcome. Exchange nailing with or without poller screw augmentation is a less invasive method to treat aseptic non-union of shaft femur fractures without additional complications.

Keywords: Nonunion; Exchange Nailing; Poller Screw; Femoral Non-Union; Aseptic Non-Union

×

References

1. Taitsman LA., et al. “Risk factors for femoral nonunion after femoral shaft fracture”. The Journal of Trauma 67.6 (2009): 1389-1392. 2. Canadian Orthopaedic Trauma Society. “Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial”. The Journal of Bone and Joint Surgery American Volume 85.11 (2003): 2093-2096. 3. Wolinsky PR., et al. “Reamed intramedullary nailing of the femur: 551 cases”. The Journal of Trauma 46.3 (1999): 392-399. 4. Zickel RE. “Nonunions of fractures of the proximal and distal thirds of the shaft of the femur”. Instructional Course Lectures 37 (1988): 173-179. 5. Yang KH., et al. “Nonisthmus femoral shaft nonunion as a risk factor for exchange nailing failure”. The Journal of Trauma and Acute Care Surgery 72.2 (2012): E60-E64. 6. Pihlajamaki HK., et al. “The treatment of nonunions following intramedullary nailing of femoral shaft fractures”. Journal of Orthopaedic Trauma 16.6 (2002): 394-402. 7. Shroeder JE., et al. “The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions”. Journal of Orthopaedic Trauma 23.9 (2009): 653-657. 8. Danckwardt-Lilliestrom G. “Reaming of the medullary cavity and its effect on diaphyseal bone. A fluorochromic, microangiographic and histologic study on the rabbit tibia and dog femur”. Acta Orthopaedica Scandinavica Supplementum 128 (1969): 1-153. 9. Grundnes O and Reikeras O. “Acute effects of intramedullary reaming on bone blood flow in rats”. Acta Orthopaedica Scandinavica 64.2 (1993): 203-206. 10. Reichert IL., et al. “The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia”. The Journal of Bone and Joint Surgery British Volume 77.3 (1995): 490-493. 11. Russell TA., et al. “Mechanical characterization of femoral interlocking intramedullary nailing systems”. Journal of Orthopaedic Trauma 5.3 (1991): 332-340. 12. Utvag SE., et al. “Graded exchange reaming and nailing of non-unions. Strength and mineralisation in rat femoral bone”. Archives of Orthopaedic and Trauma Surgery 118.1-2 (1998): 1-6. 13. Weresh MJ., et al. “Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures”. Journal of Orthopaedic Trauma 14.5 (2000): 335-338. 14. Banaszkiewicz PA., et al. “Femoral exchange nailing for aseptic non-union: not the end to all problems”. Injury 34.5 (2003): 349-356. 15. Cleveland KB. “Delayed union and nonunion of fractures”. In Canale and Beaty: Campbell’s Operative Orthopaedics, Volume III. 12th edition. Edited by Canale ST, Beaty JH. Philadelphia: Mosby, Chapter 59 (2013). 16. Heckman JD., et al. “Acceleration of tibial fracture-healing by non-invasive, low-intensity pulsed ultrasound”. The Journal of Bone and Joint Surgery American Volume 76.1 (1994): 26-34. 17. Kessler SB., et al. “The effects of reaming and intramedullary nailing on fracture healing”. Clinical Orthopaedics and Related Research 212 (1986): 18-25. 18. Brumback RJ. “The rationales of interlocking nailing of the femur, tibia, and humerus”. Clinical Orthopaedics and Related Research 324 (1996): 292-320. 19. Niedzwiedzki T., et al. “Treatment of femoral shaft union disturbances with intramedullary nailing. Treatment failure”. Ortopedia, Traumatologia, Rehabilitacja 9.4 (2007): 377-383. 20. Brinker MR and O’Connor DP. “Nonunions: evaluation and treatment”. In: Browner BD, Jupiter JB, Levine AM., et al. eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. Philadelphia, PA: W.B. Saunders (2009): 615-707. 21. Frolke JP., et al. “Viable osteoblastic potential of cortical reamings from intramedullary nailing”. Journal of Orthopaedic Research 22.6 (2004): 1271-1275. 22. Wenisch S., et al. “Human reaming debris: a source of multipotent stem cells”. Bone 36.1 (2005): 74-83. 23. Gelalis ID., et al. “Diagnostic and treatment modalities in nonunions of the femoral shaft: a review”. Injury 43.7 (2012): 980-988. 24. Zhang X., et al. “Treatment of distal femoral nonunion and delayed union by using a retrograde intramedullary interlocking nail”. Chinese Journal of Traumatology = Zhonghua Chuang Shang Za Zhi 4.3 (2001): 180-184. 25. Ueng SW., et al. “Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing”. The Journal of Trauma 43.4 (1997): 640-644. 26. Krettek C., et al. “The mechanical effect of blocking screws ("Poller screws") in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails”. Journal of Orthopaedic Trauma 13.8 (1999): 550-553.
×

Citation

Citation: Supreet N Bajwa., et al. “Reamed Intramedullary Exchange Nailing for Aseptic Non-Union of Isthmus and Enhanced Distal Fixation Exchange Nailing for Non- Union of Distal Third Shaft Femur Fractures". Acta Scientific Orthopaedics 3.7 (2020): 13-19.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US