| BackgroundAchieve anatomical reduction and strong internal fixation of fractures for primary healing was once the mainstream idea,however,with the discovery of the secondary healing method,the idea of functional reduction to protect the blood supply of fractured ends has gradually been recognized by people[1].Femoral shaft fracture is a common traumatic orthopedic disease,and its incidence accounts for 6%of systemic fractures[1].With the gradual improvement and development of biological fixation theory,intramedullary nail internal fixation has become the current mainstream method for the treatment of femoral shaft fractures due to the advantages of less trauma,less intraoperative blood loss,and fast recovery[2].Fracture healing and good postoperative function are the main goals of fracture treatment,but the failure and nonunion rate of intramedullary nail treatment is 6.3%-12.5%[3].Damage mechanisms with different directions and strengths have resulted in different types of fractures.The principles of individualized treatment are adopted for different types of fractures.The adaptive surgical method is selected from closed reduction and limited open reduction to promote fracture healing and reduce fracture nonunion events.Most studies use closed reduction and open reduction as the dependent variable analysis description,and did not specifically analyze the differences of different types of fractures.This study analyzes various types of fractures from intraoperative conditions,postoperative complications,fracture healing,and postoperative knee joint function.The advantages and disadvantages of closed reduction and limited incision,in order to provide a suitable surgical plan for the surgical treatment of different types of femoral shaft fractures.ObjectiveCompare and analyze the clinical effects of closed reduction and limited open reduction with intramedullary nails for different types of femoral shaft fractures,and explore the choice of different types of fractures between good reduction and blood supply protection and the corresponding surgical methods.MethodsA review of 98 patients with femoral shaft fractures treated with interlocking intramedullary nails with closed reduction and limited open reduction,including 26 cases of transverse fractures,20 cases of closed reduction,and 6 cases of limited open reduction;Among 46 cases of oblique and spiral fractures,19 cases were closed reduction and 27cases were limited open reduction.Among 26 cases of comminuted fractures,15 cases were closed reduction and 11 cases were limited open reduction.Comparative analysis of the operation time,intraoperative blood loss,intraoperative X-ray use time,postoperative infection,rotation deformity,delay and nonunion,healing time,median healing time,and knee joint 12 months’HSS score after surgery for different types and different surgical methods.Results1.The closed reduction and limited open reduction of transverse fractures were statistically significant in terms of operating time and intraoperative blood loss in the two groups（P<0.05）.Closed reduction can reduce the length of operation and blood loss during the operation.At the same time,there is no statistical difference in the length of operation of X-ray,infection,delay and nonunion,healing time,median healing time,and HSS score.2.The closed reduction and limited open reduction of oblique fractures are statistically significant in the operation time,intraoperative blood loss,and intraoperative X-ray use time（P<0.05）.Open reduction can reduce the length of surgery and the length of X-ray use during surgery,but it will increase blood loss during surgery,reduce postoperative healing time and median healing time（P<0.05）,accelerate postoperative recovery,and enhance postoperative knee joint function（P<0.05）.There were no statistically significant differences in postoperative infection,rotation deformity,delay,and nonunion（P>0.05）.3.Closed reduction and limited open reduction of comminuted fractures were statistically significant in terms of operating time,intraoperative blood loss,and intraoperative X-ray use time（P<0.05）.Closed reduction has a shorter operation time and less intraoperative blood loss,but intraoperative X-rays are used for a relatively long time.There was no statistical difference in postoperative infection,rotational deformity,delay and nonunion（P>0.05）.Closed reduction can accelerate fracture rehabilitation and enhance postoperative knee joint function,but the median healing time was not statistically different（P>0.05）.4.Intramedullary nail treatment of different types of femoral shaft fractures after closed reduction and limited open reduction,the median healing time is different.The median healing time of transverse fractures is the shortest after closed reduction,which is12 weeks,while the median healing time of comminuted fractures is the longest after limited open reduction,which is 32 weeks.5.After closed reduction and limited open reduction with intramedullary nail treatment of transverse,oblique and comminuted femoral shaft fractures,there was no significant difference in the excellent and good rate of the knee HSS score at 12 months after the operation（P<0.05）.Conclusion1.For transverse and comminuted fractures,choose closed reduction as much as possible.Closed reduction can reduce the length of operation,intraoperative blood loss and difficulty of operation.Especially for comminuted fractures,Closed reduction can protect the blood supply of the fracture to the greatest extent.At the same time,a large amount of reamed bone debris can fill the fracture and play the role of bone grafting,which is conducive to the healing of the fracture and the recovery of postoperative limb function as soon as possible2.Oblique and spiral fractures can choose limited open reduction,although limited open reduction will increase intraoperative blood loss,but it can reduce the operation time and the use time of intraoperative X-rays,and also achieve good fracture reduction and stronger fixation to facilitate fracture healing and limb function recovery. |
PDF Full Text Request