| Objective: Femur is the strongest long bone in the human body. However, along with the development of modern transportation and the change of production method and life style, more and more femoral fractures occur due to high-energy lesion. Because of the special anatomical relationship, femoral fractures often cause bone nonunion. Although modern medical level enhances unceasingly, femoral bone nonunion is still a great challenge for orthopedic surgeons. In this study, we analyzed the cases of bone nonunion after femoral fracture surgery by retrospective analysis. The causes of bone nonunion and the therapeutic effects of the fixation and bone graft method have been explored, attempting to make certain theoretical guidance to this common and tough issue for orthopedic surgeons.Methods: The cases are collected from hospitalized patients with femoral bone nonunion of Department of Trauma Orthopedics, Xijing Hospital, the Fourth Military Medical University since January 2010 to January 2015. 45 patients were involved in this study, among whom 3 people were lost to follow-up. Of the 42 available cases,34 were male,while 8 were female. The average age was 42.19±13.57, ranging from 20 to 75. The average time span from the first operation to visiting our department was 21.5 months, ranging from9 months to 8 years. Times for operation before hospitalizing: 31 cases for once, 2 cases for twice, 2 cases for more than 3 times. Initial injury: 37 cases for closed injury, 5 cases for open injury. The original fixed method: 11 cases for intramedullary nail fix, 25 cases for steel screws fix, 5 cases for external fix. 1 case for plaster fixation. Bone nonunion type: Hyperplasia type bone nonunion 21 cases, malnutrition type bone nonunion 12 cases, atrophic type bone nonunion 9 cases, Bone nonunion site: 10 cases for femoral upper segment, 26 cases for femoral middle segment, 6 cases for femoral lower-middle segment. Initial cause: Initial cause: 26 cases for car accident, 4cases for bruise injury caused by heavy object, 5 cases for falling down, 7 cases for tumble.Initial fractures AO type: type A in 18 cases, 13 cases for B type, type C in 11 cases. Treatment in our hospital: intramedullary nail in 27 cases(interlocking intramedullary nails in 15 cases, 12 cases for expandable intramedullary nail), locking compression plate in 15 cases, 13 cases were treated with RBX graft. 18 Autogenous bone graft,6 cases treated by PRP combine with allogeneic bone graftingResults: All 42 cases received follow-up, ranging from 9 to 60 months, an average of 23 months. The total healing rate was 92.8%(39/42), postoperative function excellent and good rate was 90.5%(38/42), interlocking intramedullary nail with expandable intramedullary nailing with locking compression plate in the treatment of femoral bone nonunion in postoperative healing rate and postoperative function was no statistical significance.Conclusion: Violent damage, improper operation and the choice of internal fixation, and iatrogenic factors such as improper postoperative functional exercise are the main reasons for nfective femoral bone nonunion.Treatment should focus on to ensure strong fixation fracture end, avoid stress shelter, broken side clean-up completely, close pressure convolution, protect the blood supply, prevent infection, the effective bone graft, bone nonunion is broken end, reasonable postoperative function exercise., fixed choice, should according to patients’ condition, the types of fracture, bone nonunion, the main cause of don’t heal and physicians choose personal habits. |
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