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.
Testa G, Aloj D, Ghirri A, Petruccelli E, Pavone V, Massé A. Treatment of femoral shaft fractures with monoaxial external fixation in polytrauma patients. F1000Res. 2017;1333.
2.
Enninghorst N, Mcdougall D, Evans J, Sisak K, Balogh Z. Population-based epidemiology of femur shaft fractures. J Trauma Acute Care Surg. 2013;1516–20.
3.
Gänsslen A, Gösling T, Hildebrand F, Pape H, Oestern H. Femoral shaft fractures in adults: treatment options and controversies. Acta Chir Orthop Traumatol Cech. 2014;108–17.
4.
D’alleyrand J, Toole O, R. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care. Orthop Clin North Am. 2013;499–507.
5.
Jiang M, Li C, Yi C, Tang S. Early intramedullary nailing of femoral shaft fracture on outcomes in patients with severe chest injury: a meta-analysis. Sci Rep. 2016;30566.
6.
Apivatthakakul T, Chiewcharntanakit S. Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop. 2009;1119–26.
7.
Garnavos C, Kanakaris N, Lasanianos N, Tzortzi P, West R. New classification system for long-bone fractures supplementing the AO/OTA classification. Orthopedics. 2012;709–19.
8.
Carsen S, Park S, Simon D, Feibel R. Treatment With the SIGN nail in closed diaphyseal femur fractures results in acceptable radiographic alignment. Clin Orthop Relat Res. 2015;2394–401.
9.
Calori G, Colombo M, Mazza E, Mazzola S, Malagoli E, Marelli N, et al. Validation of the Non-Union Scoring System in 300 long bone nonunions. Injury. 2014;(Suppl 6):93–7.
10.
Maiettini D, Bisaccia M, Caraffa A, Rinonapoli G, Piscitelli L, Bisaccia O, et al. Feasibility and value of Radiographic Union Score Hip fracture after treatment with intramedullary nail of stable hip fractures. Acta Inform Med. 2016;394–6.
11.
Dettoni F, Pellegrino P, Russa L, Bonasia M, Blonna D, Bruzzone D, et al. Validation and cross cultural adaptation of the Italian version of the Harris Hip Score. Hip Int. 2015;91–7.
12.
Acharya K, Rao M. Retrograde nailing for distal third femoral shaft fractures: a prospective study. J Orthop Surg (Hong Kong). 2006;253–8.
13.
Litrenta J, Tornetta P 3rd, Mehta S, Jones C, Oʼtoole R, Bhandari M, et al. Determination of radiographic healing: an assessment of consistency using RUST and modified RUST in metadiaphyseal fractures. J Orthop Trauma. 2015;516–20.
14.
Saleeb H, Tosounidis T, Papakostidis C, Giannoudis P. Incidence of deep infection, union and malunion for open diaphyseal femoral shaft fractures treated with IM nailing: a systematic review. Surgeon. 2019;257–69.
15.
El-Menyar A, Muneer M, Samson D, Al-Thani H, Alobaidi A, Mussleman P, et al. Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis. J Orthop Surg Res. 2018;182.
16.
Bucholz R, Jones A. Fractures of the shaft of the femur. J Bone Joint Surg Am. 1991;1561–6.
17.
Li A, Zhang W, Guo W, Wang X, Jin H, Zhao Y. Reamed versus undreamed intramedullary nailing for the treatment of femoral fractures: A meta-analysis of prospective randomized controlled trials. Medicine (Baltimore). 2016;4248.
18.
Madey S, Tsai S, Fitzpatrick D, Earley K, Lutsch M, Bottlang M. Dynamic fixation of humeral shaft fractures using active locking plates: a prospective observational study. Iowa Orthop J. 2017;1–10.
19.
Coquim J, Clemenzi J, Salahi M, Sherif A, Avval T, Shah P, et al. Biomechanical analysis using FEA and experiments of metal plate and bone strut repair of a femur midshaft segmental defect. Biomed Res Int. 2018;4650308.
20.
Andalib A, Sheikhbahaei E, Andalib Z, Tahririan M. Effectiveness of minimally invasive plate osteosynthesis (MIPO) on comminuted tibial or femoral fractures. Arch Bone Jt Surg. 2017;290–5.
21.
Link B, Apivatthakakul T, Hill B, Cole P, Babst R. Minimally invasive plate osteosynthesis (MIPO) of periprosthetic femoral fractures with percutaneous cerclage wiring for fracture reduction: tips and technique. JBJS Essent Surg Tech. 2014;13.
22.
Carta S, Fortina M, Riva A, Meccariello L, Manzi E, Giovanni D, et al. The biological metallic versus metallic solution in treating periprosthetic femoral fractures: outcome assessment. Adv Med. 2016;2918735.
23.
Ehlinger M, Bonnomet F, Adam P. Periprosthetic femoral fractures: the minimally invasive fixation option. Orthop Traumatol Surg Res. 2010;304–9.
24.
Rollo G, Tartaglia N, Falzarano G, Pichierri P, Stasi A, Medici A, et al. The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut. Eur J Trauma Emerg Surg. 2017;853–61.
25.
Alam Q, Alam M, Reza M, Roy M, Kamruzzaman M, Sayed K, et al. Evaluation of outcome of exchange nailing with autogenous bone graft for treating aseptic nonunion of femoral shaft fracture. Mymensingh Med J. 2019;378–81.
26.
Wenda K, Runkel M, Degreif J, Rudig L. Minimally invasive plate fixation in femoral shaft fractures. Injury. 1997;(Suppl 1):13–9.
27.
Rollo G, Pichierri P, Marsilio A, Filipponi M, Bisaccia M, Meccariello L. The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem? Clin Cases Miner Bone Metab. 2017;372–8.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
