Complications following comminuted femoral shaft fractures treated with interlocking nail with or without inter fragmentary screw fixation for butterfly fragment: case series
Keywords:Comminuted femur fractures, Interfragmentary screws, Bone grafting
Background: This case series is to highlight the complications following interfragmentary compression screw fixation for butterfly fragment while treating femoral shaft fractures with interlocking nail.
Methods: Twelve cases have been included in this study conducted in institute of orthopaedics and traumatology, MMC & RGGGH, Chennai. All patients had shaft of femur fracture with butterfly fragment for which open reduction and interlocking nailing done. For 6 patients we applied interfragmentary screws for the butterfly fragment and in rest of the patients (6) patients we left the butterfly fragment in situ without disturbing the soft tissue attachment and bone grafting for the bone gap where ever necessary. We followed up the patient at 3 weeks, 6 weeks and 12 weeks, 6 months and 12 months.
Results: All the six patients fixed with inter fragmentary screws had wound infection and went for infected nonunion for which appropriate management was done including revision nailing or LRS application. Union was achieved in 12 to 16 months after various surgical interventions. Remaining six patients in whom interfragmentary screws were not applied and primary bone grafting when and where necessary was done, showed radiological union by three months.
Conclusions: Blood supply to large butterfly fragment is the main key for the healing process not the near normal anatomical reduction using interfragmentary screw for the butterfly fragment. Relative stability is enough for fracture union. In bone defects arising out of comminution primary bone grafting is essential for the bone healing.
Rockwood and green”s fracture in adults. In: Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD (eds). Volume 2. 4th Ed. Philadelphia: Lippincott Raven publishers; 1996: 1827-918.
Bucholz RW, Jones A. Current conceptsreview fracture of the shaft of the femur. J Bone joint Surg. 1991;10(73):1561-6.
Winquist RA, Hansen ST Jr. Comminuted fracture of femoral shaft treated by intramedullary nailing. Orthop Clin North Am. 1980;11:633-48.
Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing, its application to comminuted fractures of the femur. J bone joint Surg. 1985;67(5):709-20.
Johnson KD, Greenberg M. Comminuted femoral shaft fractures. Orthop Clin North Am. 1987;18(1):133-47.
Johnson KD, Johnston DWC, Parker B. Comminuted femoral shaft fracture/treatment by roller traction, cerclage wires and intramedullary nail or an interlocking nail. J Bone Joint Surg. 1984;66:12-22.
Sojbjerg J, Eiskjaer S. Larsen FM. Locked nailing of comminuted and unstable fractures of the femur. J Bone Joint Surg. 1990;72(1):23-5.
Russell TA. Biomechanical concepts of femoral intramedullary nailing (Review paper), Intern Jorthop Trauma. 1991;1(1):36-51.
Christie J, Court- brown C, Kinninmonth AWG, Howie CR. Intramedullary locking nails in the management of femoral shaft fractures. J Bone joint Surg Br. 1988;70:206-10.
Gharehdaghi M, Rahimi H, Bahari M, Afzali J. A prospective study of closed and open reamed intramedullary nailing of 136 femoral shaft fractures in adults. J Res Med Sci. 2007;12:16-20.