BACKGROUND Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate.In the case of delayed union after antegrade or retrograde intrame...BACKGROUND Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate.In the case of delayed union after antegrade or retrograde intramedullary nail fixation,fracture dynamization is often attempted first.Nonunion after dynamization has been shown to occur due to infection and other aseptic etiologies.We present a unique case of diaphyseal femoral shaft fracture nonunion after dynamization due to intramedullary cortical bone pedestal formation at the distal tip of the nail.CASE SUMMARY A 37-year-old male experienced a high-energy trauma to his left thigh after coming down hard during a motocross jump.Evaluation was consistent with an isolated,closed,left mid-shaft femur fracture.He was initially managed with reamed antegrade intramedullary nail fixation but had continued thigh pain.Radiographs at four months demonstrated no evidence of fracture union and failure of the distal locking screw,and dynamization by distal locking screw removal was performed.The patient continued to have pain eight months after the initial procedure and 4 mo after dynamization with serial radiographs continuing to demonstrate no evidence of fracture healing.The decision was made to proceed with exchange nailing for aseptic fracture nonunion.During the exchange procedure,an obstruction was encountered at the distal tip of the failed nail and was confirmed on magnified fluoroscopy to be a pedestal of cortical bone in the canal.The obstruction required further distal reaming.A longer and larger diameter exchange nail was placed without difficulty and without a distal locking screw to allow for dynamization at the fracture site.Post-operative radiographs showed proper fracture and hardware alignment.There was subsequently radiographic evidence of callus formation at one year with subsequent fracture consolidation and resolution of thigh pain at eighteen months.CONCLUSION The risk of fracture nonunion caused by intramedullary bone pedestal formation can be mitigated with the use of maximum length and diameter nails and close follow up.展开更多
Background:Femoral interlocking intramedullary(IM)nailing fixation is an effective method for the treatment of femoral shaft fractures.Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon.Currently,...Background:Femoral interlocking intramedullary(IM)nailing fixation is an effective method for the treatment of femoral shaft fractures.Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon.Currently,the treatment for aseptic femoral shaft nonunion is controversial.The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure.Methods:A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019.All patients were treated by leaving the nail in situ,debridement of nonunionsites,decortication,autogenous iliac bone grafting,and augmentative antirotational plating fixation.The time to fracture union and complications were recorded.Results:All patients were followed up for 12–18 months.The union rate after revision surgery was 100%.The average union time was 5.5months(range,4-10).Subjective pain symptoms had disappeared in all patients.There were no incision infections or internal fixator fatigue fractures.Average scores of the physical function and bodily pain components of the SF-36 were 95.5(range,91-98)and 94.1(range,90-97),respectively.No other obvious complications occurred postoperatively.Conclusion:Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing;this approach has an overall high union rate and few complications.展开更多
文摘BACKGROUND Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate.In the case of delayed union after antegrade or retrograde intramedullary nail fixation,fracture dynamization is often attempted first.Nonunion after dynamization has been shown to occur due to infection and other aseptic etiologies.We present a unique case of diaphyseal femoral shaft fracture nonunion after dynamization due to intramedullary cortical bone pedestal formation at the distal tip of the nail.CASE SUMMARY A 37-year-old male experienced a high-energy trauma to his left thigh after coming down hard during a motocross jump.Evaluation was consistent with an isolated,closed,left mid-shaft femur fracture.He was initially managed with reamed antegrade intramedullary nail fixation but had continued thigh pain.Radiographs at four months demonstrated no evidence of fracture union and failure of the distal locking screw,and dynamization by distal locking screw removal was performed.The patient continued to have pain eight months after the initial procedure and 4 mo after dynamization with serial radiographs continuing to demonstrate no evidence of fracture healing.The decision was made to proceed with exchange nailing for aseptic fracture nonunion.During the exchange procedure,an obstruction was encountered at the distal tip of the failed nail and was confirmed on magnified fluoroscopy to be a pedestal of cortical bone in the canal.The obstruction required further distal reaming.A longer and larger diameter exchange nail was placed without difficulty and without a distal locking screw to allow for dynamization at the fracture site.Post-operative radiographs showed proper fracture and hardware alignment.There was subsequently radiographic evidence of callus formation at one year with subsequent fracture consolidation and resolution of thigh pain at eighteen months.CONCLUSION The risk of fracture nonunion caused by intramedullary bone pedestal formation can be mitigated with the use of maximum length and diameter nails and close follow up.
文摘Background:Femoral interlocking intramedullary(IM)nailing fixation is an effective method for the treatment of femoral shaft fractures.Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon.Currently,the treatment for aseptic femoral shaft nonunion is controversial.The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure.Methods:A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019.All patients were treated by leaving the nail in situ,debridement of nonunionsites,decortication,autogenous iliac bone grafting,and augmentative antirotational plating fixation.The time to fracture union and complications were recorded.Results:All patients were followed up for 12–18 months.The union rate after revision surgery was 100%.The average union time was 5.5months(range,4-10).Subjective pain symptoms had disappeared in all patients.There were no incision infections or internal fixator fatigue fractures.Average scores of the physical function and bodily pain components of the SF-36 were 95.5(range,91-98)and 94.1(range,90-97),respectively.No other obvious complications occurred postoperatively.Conclusion:Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing;this approach has an overall high union rate and few complications.
