Management of Ipsilateral Fractures of Shaft of Femur and Both Bones Leg through a Single Percutaneous Incision

Mohammed Younus, M (2008) Management of Ipsilateral Fractures of Shaft of Femur and Both Bones Leg through a Single Percutaneous Incision. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Ipsilateral fractures and shaft of femur and both bones leg is an unique combination of injuries. It was described by the term “floating knee” by Blake and McBryde way back in 1974. This usually results from high energy trauma particularly motor vehicle accidents. It is frequently associated with other life threatening injuries in as high as 74% of patients. It is also associated with significant mortality rates (5-15%). In about 59-67% of cases either one or both fracture were found to be compound. There is a need for amputation in about 20-30% of cases because of associated neurovascular injury. In these patients once the initial concern of preservation of life is fulfilled, focus should change towards early management and rehabilitation of the patient. This is most commonly achieved via intramedullary nailing of the femur and either external fixation or intramedullary nailing of the tibia. AIM: The purpose of this study is to analyze the efficacy of management of ipsilateral fractures of shaft of femur and both bones leg using retrograde femoral interlocking nailing and antegrade tibial interlocking nailing through a single percutaneous incision. MATERIALS AND METHODS: 24 patients with ipsilateral fractures of shaft of femur and both bones leg / tibial shaft were included in the study. 18 were males and 6 were females. The age of the patients ranged from 19 to 55 years. The period of study was from May 2004 to December 2007. All patients were followed up regularly at least up to the fracture union. Mean follow up period was 25 months. Inclusion and Exclusion Criteria: Patients with significant intraarticular extension of the fracture or with significant neurovascular deficit or with wound status precluding intramedullary nailing in compound fractures were excluded from the study. We operated 27 patients fulfilling the above criteria. Of them only 24 were included for the final analysis. Of the excluded patients one had fat embolism preoperatively and an alternate method of fixation was undertaken, one had segmental bone loss while attempting open reduction of femur shaft fracture which was later plated, one underwent regular antegrade nailing of both fractures because the patient did not consent for retrograde femoral nailing. All the other patients underwent retrograde found femoral nailing and antegrade tibial nailing through a single percutaneous incision. Patients with other associated injuries requiring surgery underwent the same on the same operating table in a single sitting. RESULTS: The operating time was calculated from the start of the surgical incision to wound closure. It was found be on an average of 112 min ± 17 min. The blood loss was calculated according to the number of surgical pads soaked and was found to be on the average of 143 ml ± 44 ml. The mean duration of image intensifier usage was found to be 51 sec ± 19 seconds. All cases were followed at least up to fracture union. The various definitions used for union were • Clinical union - the ability to perform a single leg stance on the injured limb without pain or instability • Radiographic union - three bridging cortices seen on the combined antero-posterior (AP) and lateral radiographs. Union was considered to be delayed if the fracture line is still visible or if there is failure of progression at 24 weeks. All fractures went in for uneventful union. The mean time to union was 19.6±7.1 weeks for femoral shaft fractures and 21±6.9 weeks for tibial shaft fractures. We experienced 3 cases of superficial wound infection which was managed with I.V antibiotics and debridement. There was a single case of deep wound infection which necessitated metal exit and the end of fracture union. CONCLUSION: In conclusion, based on this group of patients, treatment of the floating knee lesion with the technique of retrograde nailing of the femoral fracture and ante grade nailing of the tibial fracture yields results at least as good as other methods of stabilization. In addition, it offers the practical advantages of a simple and efficient technique for these often multiply injured patients. Neither significant irritation nor interference with knee function was encountered. However, this study did have several shortcomings. The length of follow-up was short for some patients, and no specific functional outcome assessment tool was used. These problems notwithstanding, the results of this technique seem good enough to justify further evaluation with a well-designed, prospective, randomized evaluation with standardized functional outcome assessment.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Management ; Ipsilateral Fractures ; Shaft of Femur ; Bones Leg ; Single Percutaneous Incision.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:29
Last Modified: 17 Sep 2017 05:29

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