Effect Of Small Splint On Reduction Of Bone Fragments In Comminuted Femoral Fractures After Internal Fixation With Intramedullary Nailing

Objective In this study,we studied the reduction effect of bone fragments after internal fixation with intramedullary nails for comminuted femoral fractures with small splints,and discussed the advantages of external fixation with small splints,so as to provide reliable clinical basis for clinical selection of small splints.Method Based on the previous study,a randomized controlled study was conducted to investigate the patients admitted to the orthopedics department of our hospital from September 2016 to October 2018,who were diagnosed as femoral shaft comminuted fracture and underwent minimally invasive intramedullary nail internal fixation in our hospital.The postoperative free distance of bone fragments was greater than 2cm and there was no soft tissue incarceration.Seventy-four patients who met the inclusion criteria were randomly divided into two groups.The treatment group was treated with small splint external fixation on the third day after the internal fixation of intramedullary nails,and the control group was only treated with the basic treatment of internal fixation of intramedullary nails.The distance between free bone fragments and medial femoral axis was compared before and after adding small splints in the treatment group.After the treatment group was treated with small splint external fixation,the differences of pain degree(NRS score),anxiety degree(SAS score),knee joint mobility,fracture healing time and complications between the two groups were compared,and the safety of small splint external fixation was evaluated.Finally,we sorted out clinical data,established a database,and conducted statistical analysis with IBM SPSS Statistics21 software.Result1.There was no significant difference in baseline data of sex,age,height,weight and disease between the two groups(P > 0.05).2.In the treatment group,before and after the use of small splints,there was a significant difference in the distance between the free fragments and the femoral medial axis between the two groups(P < 0.05),indicating that external fixation with small splints had a reduction effect on the free fragments of comminuted femoral fractures.3.There was no significant difference in NRS score and SAS score between the two groups before external fixation with small splints(P > 0.05).There were significant differences in NRS score,SAS score,range of motion of knee joint,healing time of fracture between the two groups after external fixation with small splints in the treatment group(P < 0.05),indicating that the use of small splint on the basis of minimally invasive intramedullary nail fixation can alleviate limb pain,alleviate anxiety,promote functional recovery of knee joint and fracture healing.4.Safety assessment:During the treatment,there were no significant changes in peripheral circulation,sensation and skin color of affected limbs in the treatment group,and no adverse events such as severe tension blisters,pressure ulcer,compression injury of nerves and vessels,osteofascial compartment syndrome,etc.At the same time,it shows that the external fixation of small splint is safe.Conclusion1.On the basis of internal fixation with minimally invasive intramedullary nails,small splints have a certain reduction effect on free bone fragments,which can alleviate pain,alleviate anxiety,promote functional recovery of knee joint,clinical healing of fracture.2.It has certain advantages in treating comminuted femoral fractures with free bone fragments after internal fixation with minimally invasive intramedullary nails plus small splints,which is worthy of clinical application.