Surgical outcomes of retrograde nailing enhanced with minimally invasive cerclage cable fixation for infra-isthmal femoral fracture |
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| Institution: | 1. Department of Orthopaedic Surgery, Chungbuk National University Hospital, Chungbuk National University, Cheongju, Republic of Korea;2. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;3. Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-Do, Republic of Korea;1. Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea;2. Department of Orthopedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea;3. Department of Orthopedic Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, Republic of Korea;4. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul, Republic of Korea;1. Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan;2. Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan;3. Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan;4. Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan;5. Department of Orthopedic Surgery, Keio University, School of Medicine, Tokyo, Japan;6. Department of Orthopedic Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan;7. Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan;8. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan;9. Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan;10. Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan;11. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;12. Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan;13. Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan;14. Department of Orthopedics, Jichi Medical University, Jichi, Japan;15. Department of Orthopedic Surgery, University of Yamanashi, Yamanashi, Japan;p. Department of Orthopedic Surgery, Surgical Science, Tokai University School of Medicine, Tokai, Japan;q. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan;r. Department of Orthopaedic Surgery, Tohoku Medical and Pharmaceutical University, Tohoku, Japan;s. Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan;t. Japanese Organization of the Study for Ossification of Spinal Ligament (JOSL), Tokyo, Japan;1. Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan;2. Department of Bone and Joint Biomaterial Research, Tokyo Medical University, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan;3. Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo, 125-8585, Japan;1. Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima 770-0812, Japan;2. Takamatsu Municipal Hospital, 847-1 Busshozan-Ko, Takamatsu 761-8538, Japan;3. Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-5 Kuramoto, Tokushima 770-8503, Japan;1. The Joint Surgical Center, Chenzhou No. 1 People''s Hospital, Chenzhou, Hunan, 423000, PR China;2. Pediatric Intensive Care Unit, Chenzhou No. 1 People''s Hospital, Chenzhou, Hunan, 423000, PR China |
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| Abstract: | BackgroundInfra-isthmal femoral fracture has been known as one of the risk factors for femoral nonunion. Retrograde intramedullary nailing can provide reliable stability of the distal fragment in infra-isthmal femoral fracture, but adequate reduction is required to achieve a successful outcome. This study aimed to evaluate the surgical outcomes of retrograde nailing enhanced with minimally invasive cerclage cable fixation for infra-isthmal femoral fracture.MethodsBetween March 2013 and July 2017, 15 patients with infra-isthmal fractures treated with retrograde nailing and minimally invasive cerclage cable fixation were included in this study. Cerclage cable was applied for reduction aid (reduction cable) or prevention of further displacement in non-displaced extension of the distal spiral fracture (prevention cable). Number and function of cerclage cables, operation time, additional surgery, and complications were assessed. Further displacement of the wedge after nailing, coronal and sagittal alignment, displacement of the main fragment, and time from injury to union were evaluated as radiologic outcomes.ResultsOf the 15 patients in this study, 14 were treated with reduction cables. Average postoperative coronal and sagittal angulation was 1.7° (1° varus to 4° valgus) and 1.6° (2° flexion to 11° extension). Mean displacement between the main fragments was 3.5 mm (range 0–22 mm). Four of the 14 cases used additional prevention cables combined with reduction cable. Only one case was treated solely with a prevention cable. A total of five prevention cables were maintained without further displacement. All patients achieved bone union, and the average time to union was 22.7 weeks (range 9–44 weeks). There were no complications as a result of surgery, such as infection or major neurovascular injury.ConclusionsThe minimally invasive cerclage cable technique could be a useful and safe enhancement in retrograde nailing for infra-isthmal femoral fracture in order to prevent further displacement and to reduce the main fracture. |
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