2008•Zhōnghuá gǔkē yīxué zázhìRequires access
Intramedullary Nailing for the Treatment of Isolated Femoral Shaft Fractures-Experience in a Regional Hospital
Chun-Yang Chen, Lih‐Yuann Shih, Chao‐Yu Chen, Mel S. Lee, Wen‐Ling Yeh, Chung-I Shen, Chin-Chou Hsu
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Abstract
Purpose: Closed intramedullary nail placement is the current standard of treatment for femoral shaft fractures. Nevertheless, open surgery for nail placement is sometimes advocated by orthopedists because of the lack of availability of a fluoroscopic image intensifier and/or concern about the potential disadvantages of closed reduction techniques. There are only a few reports in which closed and open nailing techniques for the treatment of femoral shaft fractures are compared and their conclusions are discordant. The purpose of this retrospective study was to compare the results of closed and open nailing techniques for the treatment of femoral shaft fractures in a regional hospital. Methods: Between July 2003 and June 2005, a total of 32 patients with femoral shaft fractures were treated in our hospital. Fifteen patients underwent closed intramedullary nail placement and 17 underwent open nailing. The clinical data and results were compared retrospectively. Results: There were no significant differences between the two groups regarding patient demographics, fracture patterns, preoperative hemoglobin level, and operation time. Duration of hospital stay and time to bone union were shorter in the closed nailing group. The estimated amount of intraoperative blood loss, blood transfusion requirements, and the number of patients requiring blood transfusions were significantly greater in the open nailing group. Intraoperative splitting fractures of the femur occurred in two closed nailing patients. Postoperative morbidities (infection, refracture, and nail failure) requiring a second operation occurred in three open nailing patients. Conclusions: Open nailing increases blood loss and transfusion requirements without shortening the operation time. A static interlocking nail inserted using the closed technique remains the treatment of choice for femoral shaft fracture and it produces a relatively shorter hospital stay and time to bone union.