Management of third fragment in femoral shaft fractures: a personal algorithm

Salvatore Bonfiglio¹*, Giancarlo Salvo³, Giuseppe Caff², Sebiano Pitronaci⁴ and Alessandro Famoso¹

¹Department of Othopedic Surgery, Garibaldi Nesima - Catania, Italy
²Department of Orthopedic Surgery, Garibaldi Centro - Catania, Italy
³Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, Catania, Italy
⁴Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Azienda Ospedaliero Universitaria Policlinico G Rodolico-San Marco, Catania, Italy

*Corresponding Author: Salvatore Bonfiglio, Department of Othopedic Surgery, Garibaldi Nesima - Catania, Italy.

Received: April 26, 2023; Published: June 16, 2023

Abstract

Background and Aim of the Work:Third fragment is often referred as cause of non-union or delayed healing in high-energy femoral shaft fractures. The purpose of this paper is to assess how third fragment features, such as fragment size, his angulation and displacement degree or a reverse fragment, can affect fracture healing, as well as the surgical technique applied, and to develop a decisional algorithm.

Research Design and Methods: From January 2005 to December 2022, the authors report their own experience above a total of 70 femoral shaft fractures with third fragment treated with both close and open reduction approach, analysing two cases with different approach and comparing it to literature.

Results: A total of 70 patients with presence of third fragment with a mean follow-up of 16.9 months (range 6–33 months) met the inclusion criteria. Patients were divided in four group (1A, 1B, 2A, 2B) according to dimension of third fragment and displacement and surgical approach.

The best fracture healing was recorded in fractures with fragment shorter than 5 cm and displaced less than 1 cm (group 1A-1B), while the poorest one was recorded in fracture with fragment longer than 5 cm and with displacement > 2 cm and/or reverse fragment (Group 2A-2B). Among Group 2’s patients the best outcome was in patients with open reduction approach.

Conclusion: Third fragment in femoral shaft fracture is still an unsolved challenge daily facing orthopaedic surgeon. Far from settling a specific approach, literature begins to define the usefulness of the open reduction for the third fragment management. Many Authors proved that in general management of a third fragment having specific characteristics performing an open reduction would improve the outcome in terms of fracture healing with a reduced risk of consolidation defects. However, currently there are still no univocal guidelines or appropriate decision-making algorithms. For that reason, we propose a new algorithm about management of femoral shaft fractures with a third fragment based on its characteristics.

Keywords:Third Fragment; Non-Union; Femoral Shaft Fracture; New Algorithm

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Citation

Citation: Salvatore Bonfiglio., et al. “Management of Third Fragment in Femoral Shaft Fractures: A Personal Algorithm”.Acta Scientific Orthopaedics 6.7 (2023): 23-29.

Copyright

Copyright: © 2023 Salvatore Bonfiglio., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.