DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20213682

Clinical evaluation of diaphyseal femoral fractures operated in lateral decubitus position with interlocking nail

Syed S. M. Haque, Alaf A. Pathan, Ansari M. A. Aziz, Ayesha Saba

Abstract


Background: The diaphyseal fractures of femur in adults are conventionally treated in supine position on traction table, which carries risk of compartment syndrome, pudendal nerve palsy, whereas in lateral decubitus position these complications can be avoided with additional advantage of easy access to greater trochanter particularly in obese patients. The aim of this study is to evaluate outcomes of femur diaphyseal fractures treated with intramedullary interlocking nail in lateral decubitus position.

Methods: In this study 40 patients with femur diaphysea fractures were treated with intramedullary interlocking nail in lateral decubitus position, were studied for a period of 9 months from September 2019 to May 2020.

Results: At the end of our study of 40 patients, outcome is graded according Thoresen’s criteria where 22 (55%) patients had excellent results with full, pain-free, function of the extremity and 11 (27.5%) patients had good result; 10 patients had range of motion 1200 and shortening of femur by 1.5 was observed in 1 patient. There were 6 (15%) patients with fair result; with range of motion 900 and 1 poor result (2.5%) had non-union with range of motion <900.

Conclusions: Fixation of femur diaphyseal fracture in lateral decubitus position leads to easy access to the proximal femur making it easy to establish an entry point for an intramedullary device and it significantly eliminates the complications caused by other conventionally used methods.


Keywords


Lateral decubitus position, Femur shaft fracture, Interlocking nail

Full Text:

PDF

References


Arpacioğlu MO, Akmaz I, Mahiroğullari M, Kiral A, Rodop O. Treatment of femoral shaft fractures by interlocking intramedullary nailing in adults. Acta Orthop Traumatol Turc. 2003;37(3):203-12.

Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984;66:529-39.

Weil YA, Gardner MJ, Helfet DL, Pearle AD. Computer navigation allows for accurate reduction of femoral fractures. Clin Orthop Relat Res. 2007;460:185-91

Anglen J, Banovetz J. Compartment syndrome in the well leg resulting from fracture table positioning. Clin Orthop Relat Res. 1994;301:239-42.

Brumback RJ, Ellison TS. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am. 1992;74(10):1450-55.

Callanan I, Choudhry V, Smith H. Perineal sloughing as a result of pressure necrosis from the traction post during prolonged bilateral femoral nailing. Injury. 1994;25(7):472.

Aiyer S, Jagiasi J, Argekar H, Sharan S, Dasgupta B. Closed antegrade interlocked nailing of femoral shaft fractures operated up to 2 weeks post injury in the absence of a fracture table or c-arm. J Trauma. 2006;61:457-60.

Liu HT, Wang IC, Yu CM, Huang JW, Wang KC, Chen CH, Ueng SW. Closed femoral nailing in lateral decubitus position without a fracture table: a preliminary report of fifteen patients. Chang Gung Med J. 2005;28(9):629-35.

McFerran MA, Johnson KD. Intramedullary nailing of acute femoral shaft fractures using manual traction without a fracture table. J Orthop Trauma. 1995;9:57-62.

Liao JC, Hsieh PH. Mini open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table. Chang Gung Med J. 2003;26(9):660-8.

Stephen DJ, Kreder HJ, Schemitsch EH, Conlan LB, Wild L, McKee MD. Femoral intramedullary nailing: comparison of fracture-table and manual traction. a prospective, randomized study. J Bone Joint Surg Am. 2002;84(9):1514-21.

Tornetta P, Ritz G, Kantor A. Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma. 1995;38:213-9.

Johnson KD, Greenberg M. Comminuted femoral shaft fractures. Orthop Clin North Am. 1987;18(1):133-47.

Deepak MK, Jain K, Rajamanya KA, Gandhi PR, Rupakumar CS, Ravishankar R. Functional outcome of diaphyseal fractures of femur managed by closed intramedullary interlocking nailing in adults. Ann Afr Med. 2012;11(1):52-7.

Klemm KW, Borner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res. 1986;212:89-100.

White GM, Healy WL, Brumback RJ, Burgess AR, Brooker AF. The treatment of fractures of the femoral shaft with the Brooker-Wills distal locking intramedullary nail. J Bone Joint Surg Am. 1986;68(6):865-76.

Ha SH, Kim WH, Lee GC. Results of intramedullary nailing of femoral shaft fracture trochanteric entry portal versus piriformis entry portal (M/DN nail). J Korean Fract Soc. 2014;27(1):50-7.

Blumberg KD, Foster WC, Blumberg JF. A comparison of Brooker Wills &Russel Taylor nails for treatment of fracture femoral shaft. J Bone Joint Surg Am. 1990;72A:1019-24.

Thoresen BO, Alho A, Ekeland A, Strømsøe K, Follerås G, Haukebø A. Interlocking intramedullary nailing in femoral shaft fractures. A report of forty-eight cases. J Bone Joint Surg Am. 1985;67(9):1313-20.