Analysis On The Healing And Related Impact Factors Of Femoral Shaft Fracture Following Surgical Treatment

Objectives To investigate the fracture union and related impact factors after operation of femoral shaft fracture through a retrospective study of the clinical and follow-up data from femoral shaft fracture cases in our hospital, and to provide test basis and thereby guide the clinical treatment for femoral shaft fracture.Methods A retrospective study was performed on all cases with femoral shaft fracture after surgical treatment in our hospital from January 2004 to December 2013, screened by review of medical record, phone contact and outpatient follow up, excluding those with dual femoral shaft fracture, or history of fracture at same femur, or bone motablism, or taking glucocorticoid medicine for a long period and those with insufficient follow up data. The data including age, gender, side of fracture, fracture type and classification, concomitant diseases, operation manner, time from operation to weight bearing were collected and recorded. Those starting weight bearing later than 12 weeks after surgery was defined as delayed weight bearing. Nonunion was defined as a clinically and radiographically unhealed fracture including ossification of fractured ends, closed medullary cavity and formation of false joint and needed secondary operation. Fisher’s exact test was used to evaluate the significance of the independent variables including age, gender, side of fracture, fracture type and classification, concomitant diseases, operation manner, time from operation to weight bearing. Logistic regression analysis was performed on the significant factors screened out by the Fisher’s exact test. A P value <0.05 was considered significant.Results 1 A total of 167 femoral shaft fracture cases were included in this study, of which 145 were male and 22 were female, aged from 17 to 68 years. Ninety eight cases were with left side femoral fracture, while 69 cases at right side. Thirty five patients were open fracture, 132 cases were closed fracture. Eighty eight cases were simple fracture, 36 cases were wedge and 43 were complicated cases. Fixation by intramedullary nailing and nail-plate system were 132 and 35 cased separately.2 Fracture union: One hundred and fifty six of all the successfully follow up cases achieved primary fracture healing, and the other 11 were nonunion cases, the union rate and nonunion rate were 93.4% and 6.6% respectively.3 Univariate analysis of risk factors for nonunion: Fisher’s exact test results indicated the fracture type, classification and time from operation to weight bearing were significantly impact the fracture union rate(P<0.05). Case with open fracture, complicated fracture or delayed weight bearing had lower fracture union rate. No significant result was found in regard of the other factors including age, gender, side of fracture, concomitant diseases and operation manner.4 Logistic regression analysis of multiple factors for fracture nonunion: Logistic regression analysis confirmed open fracture and delayed weight bearing were independently associated with nonunion(P<0.05). After adjustment of other factors, the risk of fracture nonunion in open femoral shaft fracture case is 3.853 times of that in closed case, the risk of fracture nonunion in delayed weight bearing case in 4.127 times of that in early weight bearing case. Complicated fracture had no significant impact on fracture union.(P>0.05)Conclusion Open fracture and delayed weight bearing are factors markedly influencing the fracture healing in femoral shaft fracture following surgical treatment, further studywas needed to confirm the association between complicated fracture and fracture nonunion.