Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult

Yong-Woon Shin; Yerl-Bo Sung; Jeong Yoon Choi; Minkyu Kim

doi:10.12671/jkfs.2011.24.4.313

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Shin, Sung, Choi, and Kim: Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(4): 313-320.

Published online: 30 October 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.4.313

Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult

Yong-Woon Shin, M.D., Yerl-Bo Sung, M.D., Jeong Yoon Choi, M.D., Minkyu Kim, M.D.

Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea.

Address reprint requests to: Yerl-Bo Sung, M.D. Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, 761-1, Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea. Tel: 82-2-950-1032, Fax: 82-2-934-6342, ybs58@paik.ac.kr

Received 4 May 2011 Revised 24 May 2011 Accepted 5 September 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the union time and nonunion rate after intramedullary nailing of femoral shaft fracture in adult, we would like to analysis the operation techniques, comminution, contact surface and displacement.

Materials and Methods

We reviewed retrospectively 53 patients undergoing femoral intramedullary nailing at least 2 years postoperatively and analysised the union time and nonunion rate by operation techniques, comminution, contact surface and displacement. Patients were operated by either antegrade or retrograde intramedullary nailing.

Results

There were no differences in nonunion rate, the duration of bony union between antegrade and retrograde intramedullary nail groups. Significant differences were found in the duration of bony union between the Winquist and Hansen type I, II and the type III, IV (p<0.05). There were significant differences in the duration of bony union among simple, comminuted, and segmental fracture groups (p<0.05).

Conclusion

The union time is affected by not operation techniques and fracture displacement, but Winquist-Hansen classification and number of fracture fragments in intramedullary nailing of adult femoral shaft fracture.

Keywords: Femoral shaft fracture, Union time, Nonunion rate, Intramedullary nailing

Figures and Tables

Fig. 1

23 year-old female who sustained right femoral shaft fracture was treated by retrograde intramedullary nailing.

Fig. 2

67 year-old female who sustained left femoral shaft fracture was treated by antegrade intramedullary nailing.

Fig. 3

Graph showing duration of bony union according to type of Winquist and Hansen classification. Significant differences were found in the duration of bony union between the Winquist and Hansen type I, II and the type III, IV.

Fig. 4

Graph showing duration of bony union according to the number of Fracture fragments. There were significant differences in the duration of bony union both between the simple and comminuted fracture groups, simple and segmental fracture.

Table 1

Patients characteristics and the differences of duration of bony union between 2 groups

Table 2

Associated fractures

Table 3

The differences of duration of bony union and non-union rate among Type I, Type II, Type III, and Type IV base on Winquist and Hansen classification (Results of a Kruskal-Wallis test and the Conover multiple comparison test as a post hoc analysis for comparison of Mean duration of bony union with the four groups)

The values are given as the mean and the standard deviation. ^*Significant at p<0.05, ^†The differences in between the Winquist and Hansen type I, II and the type III, IV were significant (p<0.05).

Table 4

Average duration for union of femoral shaft fracture and patient characteristics between Winquist and Hansen Type I, II and Type III, IV

The values are given as the mean and the standard deviation. ^*Significant at p<0.05.

Table 5

The differences of duration of bony union according to the degree of preoperative displacement

The values are given as the mean and the standard deviation.

Table 6

The differences of duration of bony union and non-union rate among simple, comminuted, and segmental fracture (Results of a Kruskal-Wallis test and the Conover multiple comparison test as a post hoc analysis for comparison of Mean duration of bony union with the three groups)

The values are given as the mean and the standard deviation. ^*Significant at p<0.05, ^†The differences in both between the simple and comminuted fracture groups, simple and segmental fracture groups were significant (p<0.05).

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