Surgical outcomes of minimally invasive cerclage clamping technique using a pointed reduction clamp for reduction of nonisthmal femoral shaft fractures

BackgroundWe modified the general application method of the pointed reduction clamp, focusing on the function of encompassing the fracture site, and applied it to femoral shaft fractures. The purpose of the present study is to describe the minimally invasive cerclage clamping technique (MICC) and compare radiological and clinical results of MICC with that of percutaneous cerclage wiring (PCW).Materials and methodsA retrospective comparative study was performed in two institutions from 2010 to 2019. Patients aged ≥18 years with acute femoral shaft fractures that were treated with intramedullary nailing and reduced using MICC or PCW were included. Patients with open fractures, atypical fractures, and follow-up less than 12 months were excluded. A total of 68 patients were finally included and divided into two groups based on the reduction technique each patient underwent. We then compared radiological and clinical results between the two groups, including coronal and sagittal alignment, time for union, and complications.ResultsThe average time needed for the technique in the MICC group was shorter than that in the PCW group (7.1±4.6 min vs. 11.5±4.8 min, P < 0.001). There was no significant difference in the quality of reduction or alignment between the two groups. The mean union time was not different between the two groups (24.1±8.7 weeks vs. 24.1±8.6 weeks, P = 0.990). The MICC group had one nonunion patient and the PCW group had one postoperative infection patient. There were no cases of major neurovascular injury such as femoral artery injury or sciatic nerve palsy.ConclusionsMICC, using a pointed reduction clamp for nonisthmal femoral shaft fractures, demonstrated satisfactory reduction and favorable surgical outcomes with intramedullary nailing. We believe that MICC can be a reliable and safe reduction method for femoral shaft fractures.     

Technical note and surgical outcomes of percutaneous cable fixation in subtrochanteric fracture: A review of 51 consecutive cases over 4 years in two institutions

Background

The main purpose of this study is to introduce our surgical technique and report surgical outcomes for percutaneous cable fixation in the treatment of subtrochanteric femoral fractures.

Percutaneous cerclage wiring for reduction of periprosthetic and difficult femoral fractures. A technical note

BackgroundCombining closed reduction techniques with minimally invasive plate osteosynthesis (MIPO) or intramedullary nailing is a technically challenging procedure, especially when dealing with complex femoral fractures such as periprosthetic fractures. Cerclage wiring is a well known adjunct for fracture reduction and fixation. However, it is usually performed by open reduction, requiring wide surgical exposures, that results in soft tissue stripping.ObjectivesTo present how a novel cerclage wiring technique, employing a new percutaneous cerclage system, helped reduce a periprosthetic femoral fracture, fixed with MIPO, and a difficult proximal femoral fracture, stabilized with an intramedullary nail.ConclusionPercutaneous wiring is an alternative reduction technique to facilitate the reduction and maintenance of difficult femoral fractures, which reduces the radiation exposure to the surgeon.     

Outcomes of long retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty

Background

The treatment of periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) is challenging because of osteopenia and the limited bone available for distal fixation. The purpose of this study was to report the outcomes of periprosthetic supracondylar femoral fractures treated with long retrograde intramedullary nailing.

Methods

We conducted a retrospective review of 25 patients who were treated with a long retrograde intramedullary nail for periprosthetic supracondylar femoral fractures following TKA. Clinical evaluation included range of motion of knee, Knee Society Score (KSS), Western Ontario and McMaster Universities Arthritis (WOMAC) score, and radiologic evaluation including time to union, coronal and sagittal alignment of femoral component, lower limb alignment, and implant loosening. The mean duration of follow-up after the fracture repair was 39 months (range 12–47).

Results

All 25 fractures were united with a mean time of 12 weeks (range 8–20). At the last follow-up, the mean knee flexion was 111° (range 60°–130°), the mean KSS was 81.5 (range 50–100), and the mean WOMAC score was 30.2 (range 5–55). Four (16 %) of the 25 patients developed malalignment according to Rorabeck and Taylor criteria, but all patients had a knee flexion of more than 90°. Coronal and sagittal alignments of femoral component and lower limb alignment did not differ significantly between before and after the fracture repair. Complications included the loosening or breakage of distal interlocking screws in three patients. No deep infection or prosthesis loosening was detected at the last follow-up.

Conclusions

Surgical treatment of periprosthetic supracondylar femoral fractures following TKA with long retrograde intramedullary nailing resulted in high union rates and encouraging functional outcomes.     

Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results

Background

Although intramedullary nailing is an ideal treatment for subtrochanteric femoral fractures, it is technically challenging in fractures extending into the nail entry area and/or involving the lesser trochanter. Although the application of circumferential wire may facilitate reduction in these situations, its use remains controversial due to possible blood supply disturbances to underlying bone. In the present study, we evaluated complex subtrochanteric fractures treated by percutaneous cerclage wiring followed by intramedullary (IM) nailing for anatomical fracture reduction and union.

Methods

Twelve patients (mean age 48.3 years) with an unstable subtrochanteric fracture were prospectively treated. Indications of percutaneous cerclage wiring followed by IM nailing were a fracture extending proximally into the nail entry area deemed difficult to treat by anatomical reconstruction by IM nailing or a fracture with long oblique or spiral component. One or two cerclage wires were percutaneously applied for the temporary reduction of main fragments, and then, a cephalo-medullary or a reconstruction nail was fixed. We assessed radiologic results (union time, alignment), functional results, and complications.

Results

All 12 cases healed, without a bone graft, at an average of 19.1 weeks after surgery (range 16–24). In 11 cases, acceptable alignment was achieved (mean, valgus 0.3° extension 0.6°) with minimal leg-length discrepancy; the other exhibited 1 cm of shortening. All patients were able to return to pre-injury activity levels, and median Merle d’Aubigne score was 16.9 (15–18). No infection or implant-related complication was encountered to latest follow-up (minimum 12 months postoperatively).

Conclusion

Temporary reduction by percutaneous wiring offers a means of satisfactory nailing in difficult subtrochanteric femoral fractures, and affords anatomical reconstruction and favorable bony union.     

Percutaneous retrograde intramedullary single wire fixation for metacarpal shaft fracture of the little finger

This study aimed to evaluate the anatomic and functional outcome of retrograde intramedullary single wire fixation for metacarpal shaft fractures of the little finger. Forty consecutive patients with closed metacarpal shaft fractures of the little finger who have been treated with retrograde intramedullary single wire fixation were evaluated. Fracture union and angulation were analyzed radiologically, and clinical evaluations were performed including the percentage of total active motion (%TAM), disabilities of the arm, shoulder and hand (DASH) score, and complications. Fracture union was achieved in all cases, and callus formation was obvious at 42 days postoperatively. The average angulation of the fracture site was 2.7° in the coronal plane and 1.0° in the sagittal plane at the last follow-up, and no measurable metacarpal shortening was observed. Mean %TAM was 92.0 ± 6.2 % (range, 84.6–100 %), and DASH score was 2.8 ± 1.2 (range, 0–6). There were two cases of pin migration as intermediate complications. A closed reduction with subsequent percutaneous retrograde K-wire fixation produced good radiological and functional results. We recommend this minimally invasive technique which provides adequate fixation of displaced little finger metacarpal shaft fractures with good functional results and low morbidity.     

Open reduction and intramedullary stabilisation of subtrochanteric femur fractures: A retrospective study of 56 cases

Subtrochanteric femur fractures commonly present with predictable displacement because of the deforming muscle forces acting upon the proximal femur. For this reason, successful closed reduction and femoral nailing can be a technically demanding procedure. Open reduction prior to nail placement has been advocated to improve and maintain anatomic fracture alignment. The purpose of this study was to evaluate the results of patients with closed subtrochanteric femur fractures treated with open reduction and a reamed antegrade statically locked intramedullary nail. An initial query of our database identified 154 patients who had sustained a subtrochanteric femur fracture over the defined study period. Ninety-six patients had adequate radiographic and clinical follow-up. Fifty-six (58%) patients were treated with open reduction and nail placement. There were no wound complications or infections and all patients went on to successful osseous union. There was no loss of reduction and a final coronal and sagittal plane deformity of <5 degrees in 55 of 56 (98%) patients. Open reduction of closed subtrochanteric femur fractures followed by intramedullary nailing leads to high union rates with rare complications.     

Antegrade Versus Retrograde Locked Intramedullary Nailing for Femoral Fractures: Which Is Better?

Abstract Background: Locked intramedullary nailing or interlocking nailing (ILN) is a proven mode of treatment for femoral shaft fractures. It can be inserted via the antegrade or retrograde approach. Retrograde approach is technically less demanding especially if the patient is overweight. But there are concerns with regard to the violation of the knee and its effect on subsequent knee function. Methods: We studied consecutive cases of femoral shaft fractures treated with locked intramedullary nailing at the Penang General Hospital, from 1st June 2004 to 1st June 2005. We looked at radiological and clinical union rates, union of fractures, alignment of the operated limb, and the knee function, using the Thoresen scoring system. Results: There were a total of 77 cases of femoral interlocking nails during the study period. Forty-two cases were antegrade nails and 35 cases were retrograde nails. Both groups of patients eventually achieved union of the fracture and retrograde nailing group showed significantly earlier union rate (p = 0.032). There is no significant difference between both groups, in regards to knee pain, swelling, and range of motion as well as postnailing femoral alignment. Conclusions: Both methods of nailing achieved excellent union rates with good alignment of the limb. Contrary to popular belief, we found that retrograde nailing does not give rise to a higher rate of knee complications. Therefore, we strongly recommend this approach of nailing as it is technically less demanding.     

Subtrochanteric fractures after retrograde femoral nailing

Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.     

Outcome of intramedullary nail for fixation of osteoporotic femoral shaft fractures in the elderly above 60

IntroductionIntramedullary nailing is an acceptable treatment option for femoral shaft fracture in young patients but not extensively studied in the elderly with osteoporotic fractures. Plate fixation for osteoporotic femoral shaft fractures have a high rate of complications and delayed healing time, and the most acceptable treatment is intramedullary nailing. This study evaluated the healing time and incidence of complications in osteoporotic femoral shaft fractures after intramedullary nailing.Patients &MethodsThis was a retrospective study that included 16 patients above 60 years old with osteoporotic femoral shaft fractures operated between January 2015 and December 2018. Patients with metastatic fractures or with atypical fractures were excluded. Thirteen patients had low-energy injuries such as a simple fall from standing height or lower and twisting injuries. The remaining 3 patients sustained high-energy-mechanism of injury. No patient received bisphosphonate except 2 patients received oral bisphosphonate for a period of 6 and 8 months, respectively.ResultsSixteen patients (12 females and 4 males) with mean age 69.5 ± 3.7 presented with femoral shaft fracture were operated with intramedullary nail, 10 patients were fixed with trochanteric entry nails with proximal neck screws, and 6 patients were fixed with piriformis entry nails. In 9 patients, closed reduction of fracture was achieved while 7 patients required open reduction, of which 5 fracture required cerclage wire addition. The mean bone healing time was 5.35±1.2 months. Intraoperative extension of femoral fractures during intramedullary nail insertion was observed in two cases that required open reduction and addition of cerclage wires around the fracture. The overall incidence of complications was 18.7%.ConclusionsIntramedullary nailing for osteoporotic femoral shaft fracture is a good acceptable option in elderly patients with reasonable healing time with no major complications.     

微创手术治疗浮膝31例

目的 探讨微创手术方法治疗浮膝的临床意义。方法 对31例股骨中下段骨折合并同侧胫骨中上段骨折患者采用闭合复位股骨及胫骨交锁髓内钉内固定治疗。结果 31例随访8～20个月,仅1例出现胫骨延迟愈合,HSS膝关节功能评分优23例,良7例。结论 髓内钉对骨折的固定稳定牢靠,采取闭合复位的微创手术对骨折端的血循环影响较小,对于浮膝病例是其适应证。     

股骨重建髓内钉内固定治疗股骨干多节段骨折合并髋部骨折

目的探讨小切口复位股骨重建髓内钉内固定治疗股骨干多节段骨折合并同侧髋部骨折的疗效。方法对54例股骨干多节段骨折合并同侧髋部骨折行小切口复位骨折段及粉碎的股骨干,然后采用股骨重建髓内钉内固定。股骨干骨折合并股骨颈骨折37例,股骨干骨折合并股骨粗隆间骨折17例。结果54例均获得3～6个月的随访,平均4个月。骨折均一期愈合,发生髋内翻1例,股骨头切割2例。末次随访时髋关节功能Harris评分平均（92．22±2．17）分。结论小切口复位股骨干骨折同时采用股骨重建髓内钉内固定治疗股骨干骨折合并同侧股骨颈或股骨粗隆间骨折,具有手术时间短、出血少且固定牢靠等优点,是预防髋内翻发生和促进骨折愈合的有效术式。     

髓内钉结合空心钉治疗股骨髁部骨折

目的 :观察逆行髓内钉结合空心钉治疗股骨髁部骨折的临床疗效。方法 :回顾性分析2009年6月至2015年6月收治的股骨髁部粉碎性骨折患者13例,均使用逆行髓内钉结合空心钉治疗,男6例,女7例;年龄19~76岁,平均46.1岁。闭合性骨折10例,开放性骨折3例;骨折按AO分型:C1型4例,C2型7例,C3型2例。术后观察骨折复位及膝关节功能恢复情况。结果:13例全部获得随访,时间12~36个月,平均24个月。X线复查示骨折愈合时间为18~24周,平均21周,无内固定物松动、断裂及再骨折病例。手术后1年膝关节HSS评分90.07±4.99。结论:股骨逆行髓内钉结合空心螺钉治疗股骨髁间骨折临床疗效优良,能提高股骨髁部骨折的解剖复位率,减少并发症发生,促进膝关节功能恢复。     

Optimal entry point for retrograde femoral nailing

OBJECTIVE: The purpose of this study is to identify the optimum entry point for retrograde femoral nailing, defined as that point which will provide adequate fracture alignment while minimizing soft-tissue and articular cartilage injury. DESIGN: Cadaveric study. SETTING: Biomechanics laboratory. MAIN OUTCOME MEASURE: Anatomic relationships and fracture reduction.METHODS Eleven cadaveric femori with attached knee joints underwent retrograde femoral nailing with a Synthes femoral nail (Synthes, Paoli, PA, U.S.A.). After placement of the nail, the specimens underwent an osteotomy 3 inches proximal to the articular surface. Multiple entry points were tested to determine fracture alignment and extent of articular cartilage injury. Medial-lateral and anterior-posterior displacements, in addition to any soft-tissue or articular surface trauma, were recorded for these various points of entry. RESULTS: An entry point of 1.2 cm anterior to the femoral origin of the posterior cruciate ligament resulted in the least anterior-posterior displacement of the femoral shaft following fracture. In the coronal plane, an entry point at the midpoint of the intercondylar sulcus was identified as minimizing the displacement following fracture. This ideal position allows for proper seating of the nail within the intercondylar sulcus, resulting in minimal damage to the articular cartilage and posterior cruciate ligament and minimal disruption of the patella femoral joint. CONCLUSION: Retrograde femoral nailing should be used cautiously in select patients, when conventional antegrade nailing cannot be used, due to the unavoidable injury to the knee articular surface associated with this technique. The optimum entry point of 1.2 cm anterior to the femoral posterior cruciate ligament origin and centered in the intercondylar sulcus provides the optimal balance of fracture reduction and knee joint sparing. It may be difficult to target this site with a percutaneous technique and may require direct visualization of the intercondylar sulcus for ideal nail placement.     

Periprosthetic distal femur fractures treated by retrograde intramedullary nails with a 10-degree distal bend achieve significantly better post-operative radiographic alignment when compared to conventional retrograde nails

IntroductionPeriprosthetic distal femur fractures (PPDFFs) are a common complication after total knee arthroplasty (TKA). In the setting of well-fixed TKA components, treatment options include retrograde intramedullary nailing (rIMN) or lateral locked plating. Treatment with rIMN has historically been associated with potential for extension deformity when using conventional nails. We hypothesized that the PPDFFs treated with an intramedullary nail with a specifically designed 10-degree distal bend for periprosthetic fractures would result in improved post-operative sagittal alignment compared to conventional intramedullary nails.Materials and methodsThe study was conducted at a level-1 trauma center over a 12-year period (2010 - 2022). Patients over the age of 18 who sustained a PPDFF treated with rIMN were identified. The primary outcomes of the study were post-operative coronal and sagittal alignment determined by reviewing post-operative radiographs.ResultsA total of 50 patients were included. Twenty-three patients were treated with a rIMN with a 10° distal bend. Twenty-seven patients were treated with a rIMN with distal bend of 5° The mean aPDFA for the 10° distal bend group was 81.7° compared to 92.8° in the 5° distal bend group (p<0.001). There were 3/23 (13%) significant sagittal plane deformities the 10° distal bend group compared to 11/27 (41%) in the 5° distal bend group (p = 0.03). There was one patient with a post-operative extension deformity in the 10° distal bend group compared to 11 patients in the 5° distal bend group (p = 0.02).ConclusionRetrograde intramedullary nailing of PPDFF with a 10° distal bend results in significantly better alignment in the sagittal plane when compared to a conventional 5° nail. The use of a 5° nail resulted in an extension deformity significantly more frequently. We therefore recommend the utilization of a rIMN with a 10° distal bend when treating PPDFFs.SummaryPeriprosthetic distal femur fractures are a common complication following total knee arthroplasty. While several studies report on the use of retrograde intramedullary nails in the treatment of periprosthetic distal femur fractures, there are limited reports of the use of a novel retrograde intramedullary nail with a 10° distal bend in the treatment of these injuries. Herein we present a radiographic study comparing coronal and sagittal postoperative alignment following treatment with retrograde intramedullary nails with a 10° distal bend versus conventional retrograde nails with a 5° distal bend.     

The Butterfly Fragment in Wedge‐Shaped Femoral Shaft Fracture: Comparison of Two Different Surgical Methods

ObjectiveOur study compared the results of wedge‐shaped femoral shaft fracture following intramedullary (IM) nailing with or without fixation of the third fragment.MethodsWe retrospectively reviewed patients presenting with femoral shaft fracture with AO/OTA type 32‐B from 2011 to 2016. Patients were divided into two groups: closed reduction without touching the third fragment and open reduction with fixation of the third fragment. The fragment ratio, fragment length, nail size, dynamization or not, mRUST scores, union rate, and union time were compared between the two groups. Risk factors of non‐union were also investigated, including sex, age, fracture pattern, fracture location, dynamization, nail size, fragment ratio, fragment size, and postoperative fragment displacement.ResultsA total of 80 patients met inclusion criteria, 20 patients with wedge‐shaped shaft femoral fracture were managed with IM nailing and open reduction with fixation of the third fragment. Sixty patients were treated with IM nail without touching the third fragment. The union rate for the fixation and non‐fixation groups were 60.0% and 81.7%, respectively. The mean union time for the fixation group was 19 months vs 14 months for the non‐fixation group. Multi‐regression analysis showed larger nail size (odds ratio: 2.26) and fixation of the third fragment (odds ratio: 0.18) influenced fracture healing.ConclusionsFixation of the third fragment in wedge‐shaped shaft femoral fracture results in a longer union time and lower union rate. In the management of femoral fracture with a third fragment, a larger nail size is recommended and fixation should be performed in a closed manner. Fixation of the fragment may achieve better fracture reduction. However, disruption of the vasculature and surrounding structures may further result in nonunion of the fracture site.     

Percutaneous Cerclage Wiring Combined with Cephalomedullary Nailing for Irreducible Subtrochanteric Fractures

ObjectiveTo explore the surgical method, operation essentials and the clinical effect of the treatment of irreducible subtrochanteric femoral fractures by percutaneous cerclage wiring and Cephalomedullary nail.MethodFrom February 2016 to October 2019, 17 cases of irreducible subtrochanteric femoral fractures (SFFs) treated via a minimally invasive wire system and intramedullary nail fixation were reviewed retrospectively. Ten male and seven female patients were involved. The average age was 59.88 ± 16.13 years, ranging from 41 to 94 years. Among the patients, seven were injured in traffic accidents, five fell from a standing height, and five injured themselves from falling. The cases were classified based on the Seinsheimer classification. Specifically, five cases were type IIIA, five cases were type IIIB, one case was type IV, and six cases were type V. According to the AO/OTA classification, 10 cases were 32B3, and seven cases were 32C3. During surgery, the patients were placed on a traction bed andattempted closed reduction. For those patients whose closed reduction failed confirmed by fluoroscopy, we performed a small anterolateral incision through which a self‐made minimally invasive percutaneous wire introducer (passer; patent Z: 2016 2 1002800.8) was employed for temporary fixation with a wire. A double‐stranded steel wire was introduced into a self‐made wire traction and lifting device (patent ZL 2020 2 0205658.7), the wire was pulled vertically and firmly fixed. Then an long InterTan nail was used for the fixation. The following information was recorded: (i) length of the invasive incision, (ii) blood loss on the third day after surgery, (iii) operation time; and (iv) maximum displacement and angulation of the fracture ends of the x‐rayed front and side fractures before and after surgery and the maximum displacement and formation of the three‐dimensional CT‐scanned fracture ends in the coronal plane, sagittal plane, and cross section before and after surgery.ResultA total of 15 of the 17 patients were followed for 12 to 24 months. The 15 patients recovered, but one died from pulmonary infection 1 year after surgery. In the postoperative X‐ray and three‐dimensional CT observation reduction treatment, fracture displacement was less than 5 mm, each plane angle was less than 10 degrees, and postoperative fracture healing time was 3 to 14 months, with an average of 4.19 ± 4.04 months. The postoperative Harris hip function score ranged from 66 to 95 points, with an average of 80.81 ± 9.67 points. In terms of clinical outcomes, 11 cases were excellent, four cases were satisfactory, and one case was fair.ConclusionFor refractory subtrochanteric fractures, percutaneous wiring combined with Cephalomedullary nail fixation is a minimally invasive, rapid, and effective method, which can achieve satisfactory results in clinical practice and is worth promoting.     

Percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO): a percutaneous reduction technique in the treatment of Vancouver type B1 periprosthetic femoral shaft fractures

Background

Periprosthetic femoral fractures (PPFs) associated at or near a well-fixed femoral prostheses (Vancouver type-B1) present a clinical challenge due to the quality of the bone stock and instability of the fracture.

Objectives

The purpose of this study was to present a novel reduction technique and analyze clinical and radiographic outcome in patients with Vancouver type-B1 fractures treated with percutaneous cerclage wiring for fracture reduction and maintenance of reduction with minimally invasive plate osteosynthesis (MIPO) utilizing a locking compression plate (LCP).

Methods

Between March 2007 and December 2008, ten consecutive patients with spiral, oblique or wedge Vancouver type-B1 were treated with closed percutaneous cerclage wiring using a new cerclage passer instrument (Synthes^?) through small 2–3?cm incisions for reduction and maintenance of reduction. Internal fixation with MIPO was obtained utilizing a long LCP Synthes^? bridging the fracture. The reduction time, fixation time and operative time were recorded. The rehabilitation protocol consisted of partial weight bearing as tolerated. Clinical and radiographic outcomes included evidence of union, return to pre-injury mobility, and surgical complications were recorded.

Results

There were three men and seven women with an average age of 74?years (range 47–84?years) at the time the fracture occured. The average follow-up was 13.2?months. One patient died 2?months after surgery due to cardiovascular problems and was excluded. The average reduction time with percutaneous cerclage wiring was 24.4?min (range 7–45?min). The average fixation time was 79?min (range 53–100?min). The average operative time was 103?min (range 75–140?min). Blood loss was minimal and only two patients needed a blood transfusion. All fractures healed with a mean time to union of 18?weeks (range 16–20?weeks). There was one implant which bent 10° in the post-operative period but went on to heal uneventfully within 16?weeks. There was no evidence of loosening of any implants. Seven patients returned to their previous level of mobility. Two patients required a walker. There were no implant failures, wound complications or infections.

Conclusions

Percutaneous reduction of spiral, oblique or wedge-type B1 PPFs with percutaneous cerclage wiring combined with minimally invasive locking plate osteosynthesis provided satisfactory reduction, adequate stability and healing in nine patients. Our early results suggest that this reduction technique and fixation may be a useful solution for this growing challenge in orthopaedics. The authors caution that this technique must be done carefully to avoid serious complications, e.g., vascular injury.     

逆行交锁髓内钉治疗股骨髁间粉碎性骨折12例

目的探讨股骨逆行交锁髓内钉治疗股骨髁间粉碎性骨折的效果。方法应用股骨逆行交锁髓内钉治疗12例股骨髁间粉碎型骨折,随访全部病例并进行临床效果评定。结果经6~20个月随访,12例骨愈合良好。结论股骨逆行交锁髓内钉具有操作简便、固定牢靠等优点,是治疗股骨髁间粉碎性骨折较理想的内固定器械。     

Cerclage wiring in the management of comminuted fractures of the femoral shaft

A retrospective series of 20 patients is presented, comprising 21 fractures of the femoral shaft treated by open reduction and internal fixation (usually by medullary nailing) combined with cerclage wiring. Most of the patients were young with comminuted fractures of the femoral shaft, many with multiple injuries. The aims of stable reduction and early sound union of the fracture in anatomical position were achieved in all cases and that of early mobilization of the knee to a good ultimate range of flexion in almost all cases.