Comparative Study Of Locking Plate And Intramedullary Nail For Comminuted Femoral Shaft Fracture In Adults

Objective:Through the study of locking plate and intramedullary nail in the treatment of comminuted fractures of adult femoral shaft,to explore the effective treatment of femoral shaft comminuted fractures and precautions of operative treatment for the fracture.Methods:A total of 54 patients with femoral shaft comminuted fractures diagnosed and treated at the Second Affiliated Hospital of Dalian Medical University from October 2015 to July 2017 were selected as study subjects.Twenty-six patients were treated with intramedullary nails and 28 patients were treated with locking plates.The patient’s operative time,blood loss,and hemoglobin decrease at 1 day after surgery(If the patient is transfused before surgery,the hemoglobin value after the last transfusion will be used;if the patient is transfused after surgery,the last blood hemoglobin after the transfusion will be used.),fracture healing rate,fracture healing time,incidence of adverse complications,and knee joint mobility at 1,2,3,and 4months after surgery,were treated as evaluation criteria for surgical outcomes.Kolmert function assessment was used to analyze the excellent and good rate of knee joint function at 2,3,4 and 5 months after operation betwwen the two groups.SPSS19.0statistical software was used to weigh the differences of operation time,blood loss,hemoglobin decrease 1 day after operation,fracture healing time,adverse complication rate,fracture healing rate,and motion of knee joint at 1,2,3,and 4 months after operation,excellent and good rate of knee joint function at 2,3,4 and 5 months after operation betwwen the two groups,P<0.05 was considered statistically significant.Result:A total of 54 cases of femoral comminuted fractures,26 cases ofintramedullary nail group and 28 cases of locked plate group were studied.Follow-up patients were followed up for 6-10 months.There were no statistical differences in age,gender distribution,fracture AO classification,affected side and injury mechanism between the two groups(P>0.05).There were no significant differences in the operation time,fracture healing time,and hemoglobin decrease 1 day after operation between the intramedullary nail group and locking plate group(P>0.05).The fracture healing rate of the nail group was better than that of the locking plate group,and the difference was statistically significant(P<0.05).The blood loss of operation and complication rate after operation in the intramedullary nail group were lower than those in the locking plate group,and the difference was statistically significant(P < 0.05).The degree of motion of the knee joints in the intramedullary nail group was better than the locking plate group in the first and second month after operation(P<0.05).There was no statistical difference in knee joint motion 3 and 4 months after operation beween the two groups(P>0.05).The excellent and good rate of Kolmert function evaluation in the intramedullary nail group was better than that in the locking plate group at 2,3,4 and 5months after operation.The difference between the two groups was statistically significant(P<0.05).Conclusion:This study believes that intramedullary nail treatment for adult comminuted femoral shaft fractures is overall better than the locking plate,but there is no difference among surgical time,fracture healing time after operation,the actual amount of intraoperative bleeding between them.