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The Fate of Large Butterfly Fragments in Femoral Shaft Comminuted Fractures Treated withClosed Interlocking Intramedullary Nailing
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Keun Bae Lee, Jae Yoon Chung, Eun Sun Moon, Eun Kyoo Song, Kwang Cheul Jeong
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J Korean Soc Fract 2002;15(4):504-510. Published online October 31, 2002
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DOI: https://doi.org/10.12671/jksf.2002.15.4.504
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Abstract
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To evaluate the radiographic changes and union of large butterfly fragments after closed interlocking IM nailing for femoral shaft comminuted fractures. MATERIALS AND METHODS The objects of this study were 23 cases(15 males, 8 females) of femoral shaft comminuted fractures with butterfly fragments larger than 5cm and with the follow up period of 12 months or more from June 1995 to June 2000. We assessed the size, the degrees of displacement and angulation of the large butterfly fragments at preoperatively, one day, one month and three month postoperatively and evaluated the union at four month and six month postoperatively. RESULTS The size of the fragments was 8.4cm (5.0-13.0) in average. The distance between the fragment and shaft was 15.9cm preoperatively and 10.1, 7.7, 6.8cm at one day, one month and three month postoperatively. In 13 cases of angulation over 5 degrees, it changed from 19.6 degrees preoperatively to 13.9 degrees , 8.4 degrees , 5 . 9 degrees at one day, one month and three month postoperatively. There is no increase in angulation.The union was completed at 4 months in 13 cases (56.5%) and at 6 months in all except one case of delayed union, in which we did not do any further procedure until the union was achieved. CONCLUSION In femoral shaft comminuted fractures with displaced large butterfly fragments treated with closed interlocking IM nailing, the distance and angulation of fragments decreased gradually and even the fragments were inverted or largely displaced and angulated the fragments were united. So the caution must be given not to displace the fragments intraoperatively and to keep anatomical position of the fragments by active exercise and hydrostatic pressure of the muscles of thigh postoperatively. Then the open reduction and internal fixations of the fragments will not be necessary.
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Usefulness of Interlocking Compression Nail in Treatment of Femoral Shaft Stable Fracture
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Keun Bae Lee, Sung Taek Jung, Eun Sun Moon, Eun Kyoo Song, Kwang Cheul Jeong
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J Korean Soc Fract 2001;14(4):601-608. Published online October 31, 2001
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DOI: https://doi.org/10.12671/jksf.2001.14.4.601
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Abstract
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The goal of our study was to evaluate the usefulness and results of the Interlocking Compression Nail in femoral shaft stable fractures. MATERIALS AND METHODS The 87 patients, 88 cases, who were underwent internal fixations with interlocking compression nail for the stable fracture of the femoral shaft were evaluated. The majority of the causes of injury was traffic accident and the majority of location of the fractures was middle one thirds. The classification of the fracture using Winquist-Hansen classification showed that grade 0 were 23 cases(26.1%), grade 1, 47 cases(53.4%) and grade 2, 18 cases(20.5%). We used ICnail(Osteo, Switzerland) that can actively compress the fracture gap, maximum 10mm. RESULTS We used active compression in 63 cases(71.6%) and the mean length of compression was 2.3mm(range 1-5mm). The bone union was seen in 63 cases(71.6%) at postoperative 4 months and in 87 cases(98.9%) at postoperative 6 months. There was one case of delayed union, but there were no nonunion, infection, leg length discrepancy, and angular or rotational deformity, disturbing the daily activity. CONCLUSION The interlocking compression nail can reduce the fracture gap easily and effectively using compression screw by active interfragmentary compression. Thereby promote fracture healing and postoperative stability at the fracture site can be obtained, so early weight bearing is possible. Especially, this is recommendable useful method for femoral shaft stable fracture.
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