Primary Clinical Application Of Fast Traction Reductor For Femoral Shaft Fractures

Objective: Femoral shaft fracture is one of the most common fractures inthe orthopaedic clinic(12.7%). Due to the role of muscle pulling direction,femoral shaft fractures often occurs shortening, angular deformity, andtherefore the reduction of femoral shaft fractures usually requires traction.There are various treatment methods for femoral shaft fractures, it is accordingto type of fracture and conditions of patients to select the appropriatetreatment metohd. At present, fixed in orthopedics traction bed, closed tractionreduction and intramedullary fixation is the most common surgical proceduresfor treatment of adult femoral shaft fractures. But as the universal applicationof the surgical, orthopedics traction bed for traction reduction have broughtsome problems gradually, such as crush injury of perineum, pudendal nerveinjury. Study on the design of a new reduction device in femoral shaft fractureoperation is necessary for clinical.To develop a fast traction reductor for the reduction of femoral shaftfractures during the minimally invasive surgery and explore its safety andefficacy.Methods:From January2013to December2013，interlocking intramedullarynailing internal-fixation were conducted in60patients with fracture of femoralshaft，underwent reduction by self-designed fast traction reductor for femoralshaft fracture in the surgery. They were45males and15females. Their agesranged from18to79years, with an average of35.2years. By AOclassification, there were18cases of A type,28cases of B type,14cases of Ctype. Team A patients are supine with hip underlaying pads, and thecontralateral lower extremity fixed in lithotomy position. Get a0.5cm incisionin the ipsilateral anterior superior iliac spine and drill single-layer cortex of anterior superior iliac spine. In30degrees to the horizontal direction, we turna special5mm Schanz screws into the anterior superior iliac spine, and thenfix the screw to the end of traction shaft which attached to front crossbar ofreset bracket. The reset bracket ride across on the shank. Makingsupracondylar traction, and attach traction bow to the rotating bracket screw.Confirm reset part is securely connected. Taking C-arm to observe the overlapdegree of femoral shaft fracture, and then we reduce the fracture through fasttraction redactor. We correct the anteroposterior displacement using pinthrough the vertical hole in the traction shaft and lateral displacement throughlateral unit. The rotational deformity can be corrected by rotating the tractionbow. Then we choose appropriate type intramedullary to fix the fractures.Team B patients are reduced by the orthopaedics traction bed, and chooseappropriate type intramedullary to fix the fractures. The operative time,reduction duration, limited open exposure or not in operation wererecorded．The complications such as swelling, numbness in perineal area andanterior superior iliac spine bone splitting after surgery were recorded.Results:The operative time of A team patients ranged from50to95min (mean,65min)；reduction duration was12.5min(range：8to20min)；2patient (6.7%)reduction procedure assist with limited open exposure; No patient has anteriorsuperior iliac spine bone splitting fracture. The operative time of B teampatients is60-100min (mean,75min)；reduction duration was15.5min(range:10to25min)；5patients (16.7%) reduction procedure assist with limited openexposure;3female patients (10%) have complications such as swelling,numbness in perineal area after surgery.Conclusion:The fast traction reductor for femoral shaft fractures has obviousadvantages, which will not only support the clinical doctors to receive aperfect reduction effect of femoral shaft fracture, and also remain femoralshaft fracture steady in place during the fixation procedure. The fast tractionreductor can avoid complications such as genital tissue and nerve damage, foot injury associated with tracton. The merits of the fast reducter is directreduction, reasonable price, small size, suitable for promoting, and thedemerits is unsuited to obese patients and whose fracture line approaching tothe distal femur. The fast traction redactor has a risk to lead to bone splittingof anterior superior iliac spine.