Small residual fracture gaps delay time to union in length stable femur fractures treated with intrameduallary fixation

The purpose of this study was to investigate whether residual fracture gapping and translation at time of intramedullary nail (IMN) fixation for diaphyseal femur fractures were associated with delayed healing or nonunion. Retrospective cohort study Level 1 trauma hospital, quaternary referral center...

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Bibliographic Details
Published in:Injury 2023-02, Vol.54 (2), p.687-693
Main Authors: Chang, Peter S., Bechtold, Daniel, Kazarian, Gregory S., Tian, Andrea, Miller, Anna N., McAndrew, Christopher M., Inclan, Paul M., Berkes, Marschall B.
Format: Article
Language:English
Subjects:
Bone Nails
Femoral Fractures - complications
Femoral Fractures - diagnostic imaging
Femoral Fractures - surgery
Femoral shaft fracture
Femur
Femur fracture
Femur nonunion
Fracture Fixation, Intramedullary
Fracture Healing
Humans
Intramedullary nail
Orthopedic trauma
Retrospective Studies
Trauma
Treatment Outcome
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Summary:The purpose of this study was to investigate whether residual fracture gapping and translation at time of intramedullary nail (IMN) fixation for diaphyseal femur fractures were associated with delayed healing or nonunion. Retrospective cohort study Level 1 trauma hospital, quaternary referral center Length stable Winquist type 1 and 2 diaphyseal femur fractures treated with IMN at a single Level I trauma center were retrospectively reviewed. The largest fracture gap and translation were evaluated on immediate anteroposterior (AP) and lateral postoperative radiographs. Radiographic healing was assessed using Radiographic Union Score in Femur (RUSF) scores at each follow-up. Radiographic union was defined as a RUSF score ≥8 and consolidation of at least 3 cortices. ANOVA and student's t-tests were used to evaluate the influence of fracture gap parameters on time to union (TTU) and nonunion rate. Patients were stratified to measured average gap and translation distances 3mm for portions of the analysis. Sixty-six patients who underwent IMN with adequate follow-up were identified. A total of 93.9% of patients achieved union at an average of 2.8 months. Fractures with average AP/lateral gaps of 3mm had an average TTU of 70.1, 91.7, and 111.9 days respectively; fractures with larger residual gap sizes had a significantly longer TTU (p=0.009). Fractures with an average gap of 1-2.9mm and >3 mm had a significantly higher nonunion rate (1.5% and 4.5% respectively) compared to 0% nonunion in the
ISSN:0020-1383
1879-0267
DOI:10.1016/j.injury.2022.11.006