Medullary external fixation assisted by double grafting for subtrochanteric femoral nonunions after intramedullary fixation
10.3760/cma.j.cn115530-20200116-00027
- VernacularTitle:髓外固定辅助双植骨治疗股骨转子下骨折髓内固定术后骨不连
- Author:
Liang SUN
1
;
He SUN
;
Hanzhong XUE
;
Zhong LI
;
Yao LU
;
Ming LI
;
Cheng REN
;
Kun ZHANG
Author Information
1. 西安交通大学附属红会医院创伤骨科下肢病区 710054
- From:
Chinese Journal of Orthopaedic Trauma
2020;22(5):384-389
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy and operative techniques of medullary external fixation with proximal femoral plate (PFP) and locking compression plate (LCP) assisted by double grafting (cancellous bone and allograft bone grafting in nail holes plus structural grafting at ununited fracture ends) for subtrochanteric femoral nonunions after intramedullary fixation.Methods:Between January 2018 and December 2008, 21 patients received secondary revision at Department of Orthopedics, Honghui Hospital for subtrochanteric femoral nonunion after intramedullary fixation. All of them obtained full follow-up. They were 15 men and 6 women, with an average age of 52.3 years (from 27 to 65 years). There were 18 cases of atrophic nonunion and 3 ones of ischemic nonunion. The intervals between primary operation and secondary revision averaged 10.3 months (from 9 to 13 months). All the fractures were treated by intramedullary fixation with closed reduction in 10 cases and open reduction in 11 cases (including 8 ones of wire binding). All the nonunions were managed with PFP and LCP assisted by double grafting (cancellous bone and allograft bone grafting in nail holes plus structural grafting at ununited fracture ends). Functional recovery of the hip was evaluated by Harris scoring 12 months after operation.Results:The 21 patients obtained an average follow-up of 11.4 months (from 10 to12 months).All the nonunions got united after an average time of 5.2 months (from 4 to 6 months). Postoperative subcutaneous haematomas occurred in only one patient which was treated by a secondary debridement. The mean hip Harris scores were 85.7 (from 84 to 92).Conclusions:As PFP can effectively correct varus deformity and strengthen fixation, LCP plus structural grafting can provide medial mechanical support, and cancellous bone and allograft bone grafting can increase the bone mass in nail holes, our composite method can greatly increase the healing rate of subtrochanteric femoral nonunions after intramedullary fixation with better functional recovery of the hip joint.
