ObjectiveTo explore the efficacy and advantages of the lower extremity axial distractor assisted closed reduction and retrograde intramedullary nail internal fixation in the treatment of distal femoral fractures.MethodsThe clinical data of 49 patients with distal femoral fractures treated with retrograde intramedullary nail internal fixation between April 2016 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative reduction, the patients were divided into trial group (29 cases, using lower extremity axial distractor to assist closed reduction) and control group (20 cases, using free-hand retraction reduction). There was no significant difference in general information between the two groups (P>0.05), such as gender, age, side of injury, cause of injury, and fracture classification. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, and callus formation time were recorded and compared between the two groups. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation.ResultsAll patients successfully completed the operation. In the control group, there was 1 case with open reduction and internal fixation, and the rest of the two groups were closed reduction. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups (P>0.05). There was no complication such as vascular or nerve injury and iatrogenic fracture, etc. during and after operation, and the incisions healed by first intention. Except for 2 patients in the trial group who were lost to follow-up at 3 months after operation, the rest of the patients were followed up 12-36 months, with an average of 16.0 months. There was no significant difference in the callus formation time between the two groups (t=2.195, P=0.145). During the follow-up, postoperative knee joint stiffness occurred in 1 case in the control group, which improved by strengthening the knee joint function exercise and removing the internal fixator; the rest were not found to be associated with delayed or nonunion fractures, knee stiffness, and internal fixation complication. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation, the trial group achieved excellent results in 22 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 96.3%; in the control group, the results were excellent in 16 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate was 95.0%; showing no significant difference in the excellent and good rate between the two groups (χ2=0.451, P=0.502).ConclusionThe lower extremity axial distractor assisted closed reduction and retrograde intramedullary nailing for the treatment of distal femoral fractures is convenient, which has satisfactory efficacy.
Objective To compare the effectiveness of lower extremity axial distractor (LEAD) and traction table assisted closed reduction and intramedullary nail fixation in treatment of femoral subtrochanteric fracture. Methods The clinical data of 117 patients with subtrochanteric fracture of femur treated by closed reduction and intramedullary nail fixation between May 2012 and May 2022 who met the selection criteria were retrospectively analyzed. According to the auxiliary reduction tools used during operation, the patients were divided into LEAD group (62 cases with LEAD reduction) and traction table group (55 cases with traction table reduction). There was no significant difference in baseline data, such as gender, age, injured side, cause of injury, fracture Seinsheimer classification, time from injury to operation, and preoperative visual analogue scale (VAS) score, between the two groups (P>0.05). Total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, closed reduction rate, fracture reduction quality, fracture healing time, weight-bearing activity time, and incidence of complications, as well as hip flexion and extension range of motion (ROM), Harris score, and VAS score at 1 month and 6 months after operation and last follow-up were recorded and compared between the two groups. Results There were 14 cases in the LEAD group from closed reduction to limited open reduction, and 43 cases in the traction table group. The incisions in the LEAD group healed by first intention, and no complication such as nerve and vascular injury occurred during operation. In the traction table group, 3 cases had perineal crush injury, which recovered spontaneously in 1 week. The total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, and closed reduction rate in the LEAD group were significantly better than those in the traction table group (P<0.05). There was no significant difference in the quality of fracture reduction between the two groups (P>0.05). Patients in both groups were followed up 12-44 months, with an average of 15.8 months. In the LEAD group, 1 patient had delayed fracture union at 6 months after operation, 1 patient had nonunion at 3 years after operation, and 1 patient had incision sinus pus flow at 10 months after operation. In the traction table group, there was 1 patient with fracture nonunion at 15 months after operation. X-ray films of the other patients in the two groups showed that the internal fixator was fixed firmly without loosening and the fractures healed. There was no significant difference in fracture healing time, weight bearing activity time, incidence of complications, and postoperative hip flexion and extension ROM, Harris score, and VAS score at different time points between the two groups (P>0.05). ConclusionFor femoral subtrochanteric fracture treated by close reduction and intramedullary nail fixation, compared with traction table, LEAD assisted fracture reduction can significantly shorten the operation time, reduce intraoperative blood loss and fluoroscopy frequency, reduce incision length, effectively improve the success rate of closed reduction, and avoid complications related to traction table reduction. It provides a new method for good reduction of femoral subtrochanteric fracture.
Objective To compare the effectiveness of the infrapatellar approach versus the semi-extended parapatellar approach for intramedullary nailing in the treatment of type A tibial shaft fractures. MethodsA retrospective analysis was conducted on 66 patients with type A tibial shaft fractures treated with intramedullary nailing between May 2018 and February 2023. Among them, 23 patients underwent the infrapatellar approach (group A), 22 the semi-extended lateral parapatellar approach (group B), and 21 the semi-extended medial parapatellar approach (group C). There was no significant difference among the three groups in baseline data (P>0.05), including gender, age, cause of injury, time from injury to surgery, presence of concomitant fibular fractures, AO/Orthopaedic Trauma Association (AO/OTA) classification, and preoperative visual analogue scale (VAS) score for pain. The operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, length of hospital stay, fracture healing time, knee range of motion (ROM) at 12 months postoperatively, Lysholm knee score at last follow-up, incidence of postoperative anterior knee pain, and incidence of postoperative skin numbness around the knee were recorded and compared. VAS scores were also evaluated preoperatively and at 4, 8, and 12 weeks postoperatively. Results All patients completed the surgery successfully, with primary incision healing in all cases and no incision infections. There was no significant difference among the three groups in intraoperative blood loss or length of hospital stay (P>0.05). The operation time was significantly shorter in group B compared to groups A and C (P<0.05), and incision length was significantly shorter in groups A and B compared to group C (P<0.05). The intraoperative fluoroscopy frequency, from least to most, was group B, group C, and group A, with significant differences (P<0.05). All patients were followed up 12-24 months, with no delayed union or nonunion. There was no significant difference among the three groups in fracture healing time (P>0.05). At 12 months postoperatively, knee ROM and incidence of postoperative skin numbness around the knee were comparable among groups (P>0.05). Groups B and C showed significantly lower incidence of postoperative anterior knee pain during follow-up and higher Lysholm scores at last follow-up than group A (P<0.05). VAS scores decreased gradually over time in all groups, with significant differences among all time points (P<0.05). At 4, 8, and 12 weeks postoperatively, VAS scores in groups B and C were significantly lower than those in group A (P<0.05). Conclusion Compared with the infrapatellar approach, the semi-extended parapatellar approach offers more accurate nail placement, easier fracture reduction, fewer intraoperative fluoroscopies, better late knee function, and fewer complications in the treatment of type A tibial shaft fractures. Among parapatellar approaches, the lateral approach demonstrates greater clinical advantages, with shorter operation time, fewer fluoroscopies, lower incidence of skin numbness around the knee, and suitability for patients with soft tissue contusions.