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Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation

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Abstract

Purpose

Traction table-based intrameduallary (IM) nail fixation is an accepted treatment method for displaced femoral shaft fractures in adults. However, some complications have been described. To avoid complications associated with the use of a traction table, a rapid reductor was invented. This study aims to assess the outcomes of displaced femoral shaft fractures treated by a novel minimally invasive technique that employs a rapid reductor to reduce fracture and facilitate IM nail fixation.

Methods

Between November 2012 and March 2013, 22 cases of displaced femoral shaft fractures were enrolled into this study. The patients included 13 males and nine females who were between 21 and 42 years old (average, 31.3 years). All the fractures were unilateral and comprised four cases of type 32-A, 13 cases of type 32-B, and five case of type 32-C according to AO/OTA classification of fracture. During the operation, the displaced femoral shaft fractures were firstly reduced by skeletal traction with the use of a rapid reductor, and the residual antero-posterior or lateral displacement were then corrected percutaneously by using a Kirschner wire or Schantz pin with a “joy stick” technique. The fracture reduction was maintained with the rapid reductor and an IM nail was inserted to fix the fracture. The operation time, reduction time, fluoroscopy time, and intra-operative blood loss were recorded. Follow-up was conducted to assess the healing of the fractures and the functional recovery of the injured limbs.

Results

Anatomical or nearly anatomical fracture reduction was achieved in all 22 cases and open reduction was not required in any case. The average operative time, fracture reduction time, fluoroscopy time and blood loss were 58 minutes (range, 43–95 minutes), 9.1 min (range, 6–15 minutes), 13.2 seconds (range, 4.5-41.0 seconds) and 87 mL (range, 60–150 mL), respectively. During the operation, no incident of reductor-induced neurovascular injury or Schantz pin-induced ilium splitting occurred. Twenty-two patients were followed up for an average of 20.3 months (range, 18–22 months). All fractures healed well on an average of six months. No limb length discrepancy was noted.

Conclusions

The rapid reductor can be applied to effectively achieve and maintain the reduction of displaced femoral shaft fractures in a minimally invasive fashion, which is conducive for IM nailing fixation. The patients exhibited excellent functional recovery.

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Conflict of interests

This study was supported by the National Natural Science Foundation of China (Grant No. 81401789 ). No other conflicts of interest declared.

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    Authors and Affiliations

    1. Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, People’s Republic of China

      Wei Chen, Tao Zhang, Juan Wang, Bo Liu, Zhiyong Hou & Yingze Zhang

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    1. Wei Chen
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    2. Tao Zhang
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    3. Juan Wang
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    4. Bo Liu
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    5. Zhiyong Hou
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    6. Yingze Zhang
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    Corresponding author

    Correspondence to Yingze Zhang.

    Additional information

    Wei Chen and Tao Zhang contributed equally to this work.

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    Chen, W., Zhang, T., Wang, J. et al. Minimally invasive treatment of displaced femoral shaft fractures with a rapid reductor and intramedullary nail fixation. International Orthopaedics (SICOT) 40, 167–172 (2016). https://doi.org/10.1007/s00264-015-2829-0

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    • DOI: https://doi.org/10.1007/s00264-015-2829-0

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