Clinical Research Of Treat Femoral Fractures With Intramedullary Nail Fixed Postoperative Nonunion By Auyxiliary Fixing Plate And Bone Graft Around The Ends

Objective: Femoral shaft fractures are more common in clinical practice,accounting for6%of the body fractures. Most of the violence caused by thestrong direct, such as extrusion, impact, etc., frequently caused transverse orfractures. Clinical treatment of femoral shaft fractures with surgery, the use ofplate fixation methods traditionally, but some patients still require prolongedbed rest, limb braking, functional exercise began late. With the continuousdevelopment of new internal fixation devices, clinical has gradually started touse interlocking intramedullary nailing replace steel as part of the surgicaltreatment of internal fixation material of femoral shaft fractures. Advantagesof interlocking intramedullary nail is by crossing the femoral cortex comparedwith nail embedded, so that the entire femoral intramedullary nail to form awhole, which has high stability, and can limit the rotation of the femur ends,shift, patients can begin limb functional exercise relatively early. However,with the increase in the number of surgical cases, due to surgery to adapt toimproper selection or improper during surgery operations, early out of bedload and other reasons, but the incidence of nonunion patients usinginterlocking intramedullary nailing for femoral shaft fractures the number isgradually increasing, there are also many reports in the literature. The methodis often used clinically by interlocking intramedullary nail surgically removed,to replace the internal fixation and bone fracture fragments in the approach totreatment. However, this method of longer duration surgery, trauma, bleedingmore. Since January2007, the patient in the clinic for16cases of femoralshaft fractures with interlocking intramedullary nail fixation of nonunionexploration and research auyxiliary fixing plate and bone graft around the endsthis surgical procedure, postoperative recovery was observed case analysis, discussion and evaluation clinical efficacy of femoral fractures withintramedullary nail fixed postoperative nonunion by auyxiliary fixing plateand bone graft around the ends.Methods: For16cases of femoral shaft fractures in patients withinterlocking intramedullary nail fixation nonunion, using methods for treatingby intramedullary fixation to retain the original, local clean-up ends, theauxiliary plate fixation bone around the stump. Detailed preoperative physicalexamination and imaging studies, to exclude pathologic changes andphysiological metabolism of cases, the strict control of surgical indications.Inclusion criteria: femoral shaft fracture with interlocking intramedullary nailfixation nonunion; erythrocyte sedimentation rate, C-reactive protein, bonemetabolism and related endocrine system examination was normal patients.Patients given epidural anesthesia, supine position during surgery, along theoutside of the thigh into the original surgical scar. Blunt separate vastuslateralis, revealing the fracture site to check the stability of the stump, thisgroup of patients, the fracture fragments have unusual activity, stump sclerosis,bone stump varying degrees of bone resorption, bone defect. After exposure tothe fracture site to curette, electric knife thoroughly cleaned of soft tissuearound the fracture site and to bite than rongeur or chisel ends and thesurrounding bone sclerosis, and ends at the top with a bone chisel around andthe outer cortical bone freshly carved multiple scaly rough surface. Optional6-8hole locking compression plate fixed on the outside of the anterolateralfemoral or screwed into a single cortical screw fixation can also be careful toavoid the intramedullary nail, staggered fixed in bilateral cortex. Fully plantedremoved from the patient’s own iliac cancellous bone and ends around inbetween the ends. Conventional anti-inflammatory treatment given to patientsafter surgery, the wound drainage strip pull within24hours.3,6,12monthsafter the above-mentioned cases were followed up, and review the limb femurlateral X-ray films, drawn postoperative fracture healing and the degree ofrecovery of limb function, thereby evaluate clinical efficacy of treat femoral fractures with intramedullary nail fixed postoperative nonunion by auyxiliaryfixing plate and bone graft around the ends.Results: Of these16patients, surgery time:1hour30minutes to3hours00minutes, an average of1hour50minutes. Amount of bleeding:200ml~800ml, average340ml.16patients were followed up for observation, reviewlimb lateral X-ray films up for5-13months, an average of9months.According to the standard determination of fracture healing: None verticalpercussion pain, X-ray showed a fracture line of continuity through thetrabecular bone, limb completely load two weeks without obviousabnormalities,16patients met the healing fracture criteria The healing time is3to7months, an average of4months. Healing rate:100%. Review of16patients with knee flexion and extension activities, straight: reached0°,flexion:90°~120°, good functional recovery.16patients had no woundinfection, osteomyelitis, no plate and screw breakage.Conclusion: Treat femoral fractures with intramedullary nail fixedpostoperative nonunion by auyxiliary fixing plate and bone graft around theends, method is simple, effective and reliable, and has a shorter operative time,less trauma, less bleeding, help patients with fracture healing, help knee earlyexercise, reducing the advantages of knee adhesion, venous thrombosis, andtherefore can be used as an effective treatment applied interlockingintramedullary nailing of femoral shaft fracture fixation nonunion patients.