Interlocking intramedullary nailing in femoral shaft fractures: the effect of open or closed reduction on the results
Levent Çelebi, Ertuğrul Akşahin, Hasan Hilmi Muratlı, Onur Hapa, H. Yalçın Yüksel, Ali Biçimoğlu
Ankara Numune Eğitim ve Araştırma Hastanesi 3. Ortopedi ve Travmatoloji Kliniği
Keywords: Bone nails; femoral fractures/surgery/radiography; fracture fixation, intramedullary.
Objectives: We compared the results of interlocking intramedullary nailing after closed or open reduction of femoral shaft fractures.
Patients and methods: The study included 179 femoral shaft fractures of 170 patients (98 males, 72 females; mean age 37 years; range 18 to 82 years). The fractures were classified according to the Winquist-Hansen classification. All the patients underwent reamed interlocking intramedullary nailing after closed (n=101) or open (n=78) reduction. The two groups were compared with regard to operation time, amount of bleeding, union time, delayed union and nonunion rates, infections, and functional results.
Results: The mean operation time (137±21 min) and the mean amount of bleeding (421±50 ml) were significantly increased in the open reduction group, which were 115±36 min and 296±44 ml in the closed reduction group (p<0.001). Union was achieved in 172 fractures (96.1%) after a mean of 21.3±5.5 weeks, being 19.6±5.0 weeks and 23.6±5.6 weeks with closed and open reductions, respectively (p<0.001). Delayed union was observed in nine (8.9%) and 15 (19.2%) fractures with closed and open reductions, respectively (p<0.05). Nonunion rates were similar, with two fractures (2%) in closed reduction, and five fractures (5%) in open reduction (p>0.05). Infection rates were (3.0%) with three superficial infections after closed reduction, and (10.3%) with six superficial and two deep infections after open reduction (p<0.05).
Conclusion: Open reduction of femoral shaft fractures treated with intramedullary nailing is associated with prolonged operation time, increased bleeding, a higher rate of secondary operations due to increased delayed union, and a higher infection rate.