Complex Surgical Treatment of Non-United Fractures and False Joints of the Femur
Keywords:
Femur fractures, revision surgery
Abstract
Despite greater understanding of biomechanics and improvements in implant design, nonunion of femoral shaft fractures continues to be a major challenge in the treatment of such injuries (Bishop JA, Palanca AA). Femoral nonunion presents a challenge for the surgeon and entails significant personal and economic burden for the patient. In most cases of femoral fractures treated with intramedullary osteosynthesis, the incidence of this complication is estimated at approximately 1% (Zura et al., 2016; Santolini et al., 2015). Recent reports suggest an increase in this incidence due to advances in trauma medicine, resulting in increased survival of patients with severe trauma and expanded indications for the use of intramedullary nails. Although the treatment of femoral shaft fractures is well described in the orthopedic literature, information on the treatment of nonunions of this part of the bone is limited and controversial, due to the small number of cases in most of the reported series. Despite this, a careful analysis of the existing literature provides some answers regarding the choice between conservative and surgical treatment. The gold standard in the treatment of nonunions of the femoral diaphysis remains surgical intervention in the form of intramedullary osteosynthesis with closed reaming or exchange osteosynthesis. However, several alternative techniques have been noted, including the use of electromagnetic fields, low-intensity ultrasound, extracorporeal shock wave therapy, external fixators, and exchange or indirect plate osteosynthesis techniques. This article provides a comprehensive review of current treatments for aseptic midshaft nonunion, preceded by a brief review of the incidence, definition, classification, and risk factors of this complication.
References
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27. Yamshchikov O.N. Treatment of femoral fractures in patients with multiple trauma and traumatic shock // Vestnik Tambov. un-ta. Series: Natural and technical sciences. - 2015. - T. 20, No. 4. - P. 817-820.
28. A finite element model to simulate femoral fractures in calves: testing different polymers for intramedullary interlocking nails / L.B. Rodrigues [et al.] // Vet. Surg. - 2022. - Vol. 41, No. 7. - P. 838–844.
29. A three-dimensional comparison of intramedullary nail constructs for osteopenic supracondylar femur fractures / Paller D.J. // J Orthop Trauma. - 2013. - 27, 2. - P. 93-99.
30. Antegrade femoralintramedullarynailing in a lateral position / J. Friederichs, C. von Rüden, C. Hierholzer, V. Bühren // Unfallchirurg. - 2019. - 118, 4. - P. 295-301.
31. Assessment of compromised fracture healing / J.A. Bishop, A.A. Palanca, M. J. Bellino, D.W. Lowenberg // J. Am Acad Orthop Surg. - 2012. - 20, 5. - P. 273-282.
32. Bell A., Templeman D., Weinlein J.C. Nonunion of the Femur and Tibia: An Update // Orthop. Clin. North. Am. - 2016. - Vol. 47, N 2. - P. 365-375.
33. Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study / S. Samiezadeh, P. Tavakkoli Avval, Z. Fawaz, H. Bougherara // Clin Biomech. - 2019. - 29, 7. - P. 803-810.
2. Froelke J.P.M., Patka P. Definition and classification of fracture nonunions. Wound. 2007; 38(Suppl 2): S19–S22. doi: 10.1016/S0020-1383(07)80005-2.
3. Ferreira N., Marais L., Aldous K. Problems and controversies in the definition and classification of tibial nonunions. S.A. Orthop J 2014; 13:52–56.
4. Schmahl H, Brix M, Bue M, Ekman A, Ferreira N, Gottlieb H, et al. Nonunion - consensus of the 4th annual meeting of the Danish Society of Orthopedic Traumatology. EFORT Open, version 2020; 5:46–57. doi: 10.1302/2058-5241.5.190037.
5. Panagiotis M. Classification of nonunions. Wound. 2005; 36: S30–S37. doi: 10.1016/j.injury.2005.10.008.
6. Zeki K. Aseptic nonunion of the femoral and tibial shafts in healthy patients - an analysis of health-related quality of life and socio-economic outcomes. Open Orthop J 2011; 5: 193–197. doi: 10.2174/1874325001105010193.
7. Huck DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, Simpson H, Alt W. Delayed union and nonunion: epidemiology, clinical issues and financial Aspects. Wound. 2014; 45:S3–S7. doi: 10.1016/j.injury.2014.04.002.
8. Bauer T.V., Mushler G.F. Materials for bone grafting. Klin Orthop Relat Res. 2000; 371:10–27. doi: 10.1097/00003086-200002000-00003.
9. O'Connell B., Wragg N.M., Wilson S.L. Use of PRP injections in the treatment of knee osteoarthritis. Cellular tissue Res. 2019; 376: 143–152. doi:10.1007/s00441-019-02996-x.
10. Menon R.S., Wragg N.M., Wilson S.L. Rotator cuff augmentation using osteoinductive growth factors. SN Compr Clin Med. 2019; 1:267–276. doi: 10.1007/s42399-019-0041-z.
11. Gardner M.J., Evans J.M. Failure of osteosynthesis with plates // Osteosynthesis. - 2011. - No. 1 (14). - P. 15-23.
12. Gilev Y.Kh., Milyukov A.Yu., Koltanyuk D.G. Intramedullary osteosynthesis with pins with blocking in patients with polytrauma // X Congress of Russian Traumatologists and Orthopedists: materials. M., 2014. P. 94.
13. Dynamics of injury rates depending on the mechanism of injury among residents of Stavropol injured in road accidents / M.I. Ulyanchenko [and others] // Kuban. scientific honey. messenger - 2019. - No. 5 (140). - pp. 180-184.
14. Emanov A.A., Mitrofanov A.I., Borzunov D.Yu. Replacement of pseudoarthrosis defects in long bones under conditions of combined osteosynthesis (experimental study) // Genius of Orthopedics. - 2019. - No. 3. - P. 43-47.
15. Ivanov D.V., Barabash A.P., Barabash Yu.A. A new type of intramedullary rod for osteosynthesis of diaphyseal femoral fractures // Ros. Journal of Biomechanics. - 2019. - No. 1. - P. 1005-1012.
16. Ivanov P.A., Kalensky V.O. Methods for treating post-traumatic defects of long bones of the extremities // Kremlin Medicine. Clinical Bulletin - 2013.- No. 2.- P. 113-118.
17. Intramedullary blocking osteosynthesis - modern technique, new difficulties, complications / V.V. Dergachev [and others] // Trauma. - 2021. - No. 4. - P. 26-29.
18. History of development and current state of the problem of treating limb injuries using transosseous osteosynthesis (literature review) / N.V. 124 Tyulyaev, T.N. Vorontsova, L.N. Solomin, P.V. Skomoroshko // Traumatology and Orthopedics of Russia. - 2021. - No. 2 (60). - pp. 179-190.
19. Kaplan A.V., Pozharisky V.F., Lirtsman V.M. Multiple and combined injuries of the musculoskeletal system. Main problems // Proceedings of the III All-Union Congress of Orthopedic Traumatologists. - M.: CITO, 1976. - P. 29-37.
20. Kaplunov O.A. Transosseous osteosynthesis according to Ilizarov in traumatology and orthopedics. - M.: Publishing house. house "GEOTAR-MED", 2012. - 237 p.
21. Klishin D.V., Atamanov M.T. Prevention of domestic injuries // Sat. abstract IX Congress of Traumatology and Orthopedists of Russia: in 3 volumes - Saratov: Scientific. book, 2020. - T. I. - P. 42.
22. Combined and sequential use of transosseous and locked intramedullary types of osteosynthesis in the treatment of patients with false joints, defects and deformities: medical technology / Federal State Institution "RNIITO im. R.R. Vreden Rosmedtekhnologii", Federal State Institution "UNITO named after. V.D. Chaklina Rosmedtekhnoloii"; author: L.N. Solomin [and others]. - M., 2017. - 27 p.
23. Solomin L.N., Sabirov F.K. Complications associated with the use of extracortical fixators with the combined and sequential use of transosseous osteosynthesis and internal fixation of the femur // Traumatology and Orthopedics of Russia. - 2015. - No. 4 (78). - P. 103-110.
24. State of injury and orthopedic morbidity among the adult population of St. Petersburg in 2019-2021. and the work of the city’s traumatology and orthopedic service / R.M. Tikhilov, T.N. Vorontsova, A.Zh. Cherny, S.S. Luchaninov // Traumatology and Orthopedics of Russia. - 2022. - No. 4 (66). - pp. 110-119.
25. The state of traumatological and orthopedic care to the population of Russia / S.P. Mironov [etc.] // X Congress of Traumatology and Orthopedists of Russia: materials. - M., 2019. - P. 3.
26. Chernavsky V.A. Hip fractures and their treatment. M.: Medgiz, 1958. - 112 p. 71. Shastov A.L. Analysis of the effectiveness of mechanical action on the area of pseudarthrosis of the femur // Genius of Orthopedics. - 2019. - No. 3. - P. 97-98.
27. Yamshchikov O.N. Treatment of femoral fractures in patients with multiple trauma and traumatic shock // Vestnik Tambov. un-ta. Series: Natural and technical sciences. - 2015. - T. 20, No. 4. - P. 817-820.
28. A finite element model to simulate femoral fractures in calves: testing different polymers for intramedullary interlocking nails / L.B. Rodrigues [et al.] // Vet. Surg. - 2022. - Vol. 41, No. 7. - P. 838–844.
29. A three-dimensional comparison of intramedullary nail constructs for osteopenic supracondylar femur fractures / Paller D.J. // J Orthop Trauma. - 2013. - 27, 2. - P. 93-99.
30. Antegrade femoralintramedullarynailing in a lateral position / J. Friederichs, C. von Rüden, C. Hierholzer, V. Bühren // Unfallchirurg. - 2019. - 118, 4. - P. 295-301.
31. Assessment of compromised fracture healing / J.A. Bishop, A.A. Palanca, M. J. Bellino, D.W. Lowenberg // J. Am Acad Orthop Surg. - 2012. - 20, 5. - P. 273-282.
32. Bell A., Templeman D., Weinlein J.C. Nonunion of the Femur and Tibia: An Update // Orthop. Clin. North. Am. - 2016. - Vol. 47, N 2. - P. 365-375.
33. Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study / S. Samiezadeh, P. Tavakkoli Avval, Z. Fawaz, H. Bougherara // Clin Biomech. - 2019. - 29, 7. - P. 803-810.
Published
2023-12-16
How to Cite
Alimov, A. P., & Turaev, S. K. (2023). Complex Surgical Treatment of Non-United Fractures and False Joints of the Femur. Central Asian Journal of Medical and Natural Science, 4(6), 1053-1064. Retrieved from https://www.cajmns.centralasianstudies.org/index.php/CAJMNS/article/view/2186
Section
Articles
