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Review paper

Surgical treatment of multifragmentary segmental femur shaft fractures with ORIF and bone graft versus MIPO: a prospective control-group study

By
Giuseppe Rollo Orcid logo ,
Giuseppe Rollo
Contact Giuseppe Rollo

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

Mario Ronga ,
Mario Ronga

Department of Medicine and Health Sciences 'Vincenzo Tiberio' , University of Molise, Campobasso, Italy

Enrico Maria Bonura ,
Enrico Maria Bonura

Department of Orthopaedics and Traumatology, Poliambulanza Foundation Hospital, Brescia, Italy

Rocco Erasmo ,
Rocco Erasmo

Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Pescara, Italy

Michele Bisaccia ,
Michele Bisaccia

Department of Orthopaedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy

Paolo Pichierri ,
Paolo Pichierri

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

Antonio Marsilio ,
Antonio Marsilio

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

Andrea Pasquino ,
Andrea Pasquino

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

David Gomez Garrido ,
David Gomez Garrido

Orthopaedics and Traumatology Unit, Hospital General de Villalba, Madrid, Spain

Raffaele Franzese ,
Raffaele Franzese

Orthopaedics and Traumatology Unit, Villa del Sole Hospital, Casereta, Italy

Andrea Schiavone ,
Andrea Schiavone

Department of Orthopaedics and Traumatology, Maggiore Hospital, Lodi, Italy

Luigi Meccariello
Luigi Meccariello
Contact Luigi Meccariello

Department of Orthopaedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy

Abstract

Aim
Multifragmentary segmental femoral shaft fracture is a high energy injury frequently associated with life-threatening conditions. The aim of this study was to compare the use of bio metallic open reduction internal fixation (ORIF) (plate with allograft bone strut) with minimally invasive plate osteosynthesis (MIPO) fixation for the treatment of multi-segmental femoral shaft fracture in terms of outcomes, bone healing and complications.
Methods
Forty patients with segmental femoral shaft fractures were included and divided into two groups: 20 patients treated with ORIF+, 20 with MIPO. All fractures were classified according to AO (Arbeitsgemeinschaft für Osteosynthesefragen) and Winquist and Hansen Classification. Evaluation criteria were: duration of follow up and surgery, Non-Union Scoring System, Pain Visual Analogic Scale (VAS), objective quality of life and hip function, subjective quality of life and knee function, quality of life the Short Form-12 Survey Questionnaires (SF-12), bone healing and femoral alignment (radiographs), Radiographic Union Score for Hip (RUSH).
Results
Better results of ORIF in terms of complication rate, RUSH, VAS, regression between RUSH and VAS, average correlation clinical-radiographic results and patients' outcomes (Cohen k) were obtained, and similar results for the length of follow up, surgery duration, perioperative blood transfusion, wound healing. No statistical difference for Harris Hip Score (HHS), Knee Society Score (KSS), quality of life (SF-12).
Conclusions
The ORIF and bone strut allograft technique had better results compared to the MIPO technique with regards to complication rate, RUSH, VAS, regression between RUSH and VAS, and average correlation clinical-radiographic results and patients' outcomes (Cohen k) in the surgical treatment of multifragmentary segmental femoral shaft fractures.

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