Comparison Of Effect Between Intramedullary Nails And Locking Compression Plate In The Treatment Of Femoral Shaft Fracture

The femoral shaft fracture is the clinical common bone fracture,including the fracture from the small swell to the femoral condle above the spot. The Proportion of the femoral shaft fracture in the bone fracture of the whole body is 6%, and the male is more than the female, for 2.8∶1 ,and it mainly occurs in the young adults.There are many methods of treatments,including traditional pulling,external fixation,open reduction and internal fixation, closed reduction and external fixation ,and so on. As the methods of the treatment in the femoral shaft fracture are improved,and fixed materials are improved,the locking compression plate and the interlocking intramedullary nails are known by the people gradually.In the 1990s, Krettek et al proposed the method of MIPO, according to it designing micro locking plate,so locking compression plate is well known,which is known as external fixation in internal fixation,and develops from the point contact fixator and the dynamic comprcssion plate.The principle of LCP in the treatment of bone fracture conforms to the biological fixation, namely indirect reduction as far as possible and the protection of periosteum's integrity maximum, which is advantageous to the union of the bone fracture. The stability of the LCP is the angle stability, and the stability produce through the bolt fixing the Bone fracture end to the anchor on productor. It is no need for the LCP to contact intimately with the bone, therefore its modeling is not necessary precisely. Simultaneously the bolt receives the bending force, so it causes the bone ends to form a certain elastic, which is the advantage of bone callus growing and stimulates bone fracture cicatrisation growth,bone fracture healing. Because the technology of the closed reduction and the internal fixation is highly,my hospatial carries out the technology of opening reduction and inernal fixation. The interlocking intramedullary nails comes out as the intramedullary nails develops to the certain extent. There are the following merits:the main nail is intramedullary,so it is fixed in the center, and the stress shielding small, no bending stress, internal fixation firm, against revolving . The soft tissue and the periosteum peeled around the bone fracture are few,thus it reduces the destruction of the blood which supplies to the bone .The techniques of the interlocking intramedullary nails include two kinds of reamed marrow and no reamed marrow, and they have the advantages and disadvanges respectively.Reamed marrow is easy to cause fat embolism and to increase internal pressure of the medullary cavity, which causes the possibility of the important organ embolism. Simultaneously reamed marrow destroys the blood in the medullary cavity,so it destroys intimal osteogensis. Some experts favor the application of no reamed marrow in the treatment of the femoral shaft fracture. But the intramedullary nails selected is so thin that it is easy to break off, and it may lead to bone fracture once more. Simultaneously reamed marrow is helpful to the bone development, therefore it is not sure of selecting reamed marrow or unreamed marrow .There are two types of the fixation in the intramedullar nails including the power interlocking fixation and the static interlocking fixation. Now the majority of domestic and foreign experts, the scholar think that it is necessary to make use of the power interlocking fixation or the power interlocking fixation after being static interlocking fixation 6-8 weeks in the treatment of the formal shaft fracture. As the interlocking intramedullar nails is widly applied,it is inevitable that there are some complications .The main complication of the interlocking intramedullar nails is that the nail is broken off.In fact, the stress load of the locking screw was significantly affected by the suitable degree between the interlocking intramedullary nail and the size of the marrow,the contact degree between interlocking intramedullary nail and the size of cortical.Objective:Comparison of clinical effect between interlocking intramedullary nails and locking compression plate in the treatment of the femoral shaft fracture.Materials and methods:This study retrospectively analysed 40 patients with femoral shaft fractures treated in the 2nd clinical hospital in Ji lin university over a period of 2 years between november 2007 and july 2009. There were 30 males cases,women 10 cases;They had an average age of 39.5 years;Twenty-five of these cases suffered from tracffic accidents,ten cases had self-fallen;four cases had fallen from a height,one case is caused by the heavy thing; two cases had open fracture,the rest had closed fracture;All of the cases had comminuted fracture,belonging to Class B or C class in AO classification; All of the cases were unstable fractures;fifteen cases were fracture of the left side,and twenty-five were fracture of the right side,there were no both sides;Ten cases were the upper femoral shaft fractures ,the middle nine cases,the lower twenty-one cases.All of the cases were fresh fractures,without important blood vessel and nevers injury ,basic diseases less.twelve cases were multiple fractures.Preoperative time was two hours to five days after fracture.According to the treatment :the treatment group of the interlocking intramedullary nails has twenty–one cases and the treatment group of the locking compression plate has nineteen cases.They were evaluated with an average follow-up of 8 months,and the index measured includes operation time,surgical bleeding,fracture healing time,delayed nunion,postoperative inflection,intenal fixator loosening or fracture,malunion,knee joint dysfunction and so on .Result: All of the 40 cases are followed up,and the average time is 8 months(6~12 months).the 21 cases in the treatment of the interlocking intramedullary nails are use of reamed medullar and static fixation type.All of the the 21 cases are union,and the average healing time is 3.99 mouths, no delayed union( namely bone union has not yet reached beyond the normal healing time or again extending the time of the treatment for generally 8 months after treatment). Due to premature weight-bearing (2.5 months) the distal locking screw of one case was broken,and the fracture was union by limiting his weight-bearing for 5 months. Efficacy Evaluation: excellent in 19 cases,good in 2 cases. 19 cases of the Locking compression plate fixation group were union, and the average healing time was 4.42 months. Efficacy Evaluation: excellent in 17 cases, good in 2 case. After operation locking screw was loosened in 1 patient; the middle of the plate was broken off in 1 patient after operation 2 months, and after 5 months it achieved union by external fixation. Due to severe bone crushing,internal fixation was not reliable in 2 patients, and plaster immobilization was achieved, leading to knee dysfunction. Clinical evaluation of knee function: excellent in 17 cases, 2 cases were good. No postoperative infection, malunion and other issues.Against the treatment group of the locking compression plate fixation,the treatment group of the interlocking intramedullary nails,operation time shorter, the average operation time was about 137.14 minutes,and there was Statistically significant difference ( P<0.05 );less surgical bleeding, the average amount of surgical bleeding was 397.42 ml,and there was Statistically significant difference ( P<0.01 ); In the aspect of delayed union,postoperative inflection,intenal fixator loosening or fracture,malunion,knee joint dysfunction,there were no singinificant diffences(P>0.05).Conclusion: Through the comparison of the methods beween interlocking intramedullary nail and locking compression plate fixation in the treatment of the femoral shaft fracture,we obtained the advantages of the interlocking intramedullary nail Includeing:firstly,operation time short,lost blood less;secondly the healing time short. When Locking compression plate is used by open reduction and internal fixation,there is longer operation time, lost blood much,bone healing time long. At the same time locking screw is fixed in the plate in 90 degrees, which makes bone,screws and plates as a whole.It play the role of external fixation, especially suitable for patients with osteoporosis. There was no significant difference in the postoperative infection, implant loosening and fracture, knee joint dysfunction. Clinically, it is the preferred to use interlocking intramedullary nail for the femoral shaft fracture, while it is also a good option to use locking compression plate for fractures with osteoporosis.