Highlights
- •Immediate application of retrograde IMN is a reliable treatment of choice in combat related injuries regardless of time.
- •Largest series about combat-related Gustilo type III supracondylar femoral fractures treated with retrograde IMN.
- •Immediate application of definitive treatment gives chance for faster recovery and psychologic relief to adapt life.
Abstract
Introduction
Femur fractures due to bomb explosions and gunshots in battlefield require osseous
stabilization as quickly as possible to expedite emergent conditions. İmmediate external
fixation is the initial procedure as usual with planned early conversion to definitive
treatment. The purpose of the current study is to determine the results of the early
retrograde intramedullary nailing in combat-related injuries.
Material and methods
Eighteen patients with comminuted supracondylar femur fractures, initially treated
with external fixation followed by planned conversion to retrograde intramedullary
nailing in a one-stage procedure, were evaluated in a retrospective review to gather
demographic, injury, management, and fracture-healing data for analysis.
Results
According to the system of Gustilo Anderson and Orthopedic Trauma Association, all
fractures were open type III and 33-A3, respectively. The mean follow-up, operation
time and union time were 1.8 years (range, 6 months to 2,6 years), 75 min (range,
60–100), and 3 months (range, 1.5–4), respectively. There was one complication of
acute osteomyelitis which was successfully treated with antibiotic-load beams and
aggressive bone debridement. No septic arthritis was observed.
Conclusions
We concluded that immediate retrograde intramedullary nailing in combat-related supracondylar
femur fractures regardless of contamination even in Gustilo type III is a safe and
reliable treatment method.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A review of orthopaedic injuries in three recent US military conflicts.Mil Med. 2000; 165: 463-465
- Improvised skeletal traction in the management of ballistic femoral fractures.J R Army Med Corps. 2009; 155: 194-196
- Outcome, following significant delays in initial surgery, of ballistic femoral fractures managed without internal or external fixation.J Bone Joint Surg Br. 2009; 91: 97-101
- Retrograde versus antegrade intramedullary nailing of gunshot diaphyseal femur fractures.Clin Orthop Relat Res. 2013; 471: 3974-3980
- Unreamed retrograde intramedullary nailing of fractures of the femoral shaft.J Orthop Trauma. 1998; 12: 334-342
- The role and efficacy of retrograding nailing for the treatment of diaphyseal and distal femoral fractures: a systematic review of the literature.Injury. 2005; 36: 813-822
- Analysis of postoperative knee sepsis after retrograde nail insertion of open femoral shaft fractures.J Orthop Trauma. 2010; 24: 677-682
- Retrograde intramedullary nailing of femoral diaphyseal fractures.J Orthop Trauma. 1998; 12: 464-468
- No evidence of infection after retrograde nailing of supracondylar femur fracture in gunshot wounds.J Trauma. 2010; 68: 970-974
- Skeletal Trauma Research Education Consortium (STReC). Infection reduces return-to-duty rates for soldiers with Type III open tibia fractures.J Trauma Acute Care Surg. 2014; 77: S194-7
- Retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots.Orthopedics. 2009; 32: 162
- Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures.J Orthop Surg Res. 2012; 17: 7
- Retrograde nailing of the femoral shaft.J Am Acad Orthop Surg. 1999; 7: 209-216
- Gunshot injuries to the extremities: experience of a U.K. Trauma centre.Injury. 2005; 36: 407-411
- Ballistics and gunshot wounds: effects on musculoskeletal tissues.J Am Acad Orthop Surg. 2000; 8: 21-36
- Clinical update: gunshot wound ballistics.Clin Orthop Relat Res. 2003; 408: 28-57
- The retrograde nail for distal femoral fractures in the elderly: high failure rate of the condyle screw and nut.Injury. 2006; 37: 1004-1010
- Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System): a prospective study of 30 fractures with a follow up of 20 months.Acta Orthop Scand. 2004; 75: 56-60
- Management of distal femoral fractures in elderly patients using retrograde titanium supracondylar nails.Injury. 2000; 31: 169-173
- Retrograde interlocking nailing of distal femoral fractures with the intramedullary supracondylar nail.Chirurg. 1996; 67: 1135-1140
- Retrograde femoral nailing: a focus on the knee.Am J Knee Surg. 2001; 14: 109-118
- Nailing versus plating for comminuted fractures of the distal femur: a comparative biomechanical in vitro study of three implants.Eur J Trauma Emerg Surg. 2013; 39: 139-146
- Surgical management of complex fractures of the distal femur.Clin Orthop. 1989; 240: 77-86
- Surgical treatment of displaced, comminuted fractures of the distal end of the femur.J Bone Joint Surg Am. 1982; 64 (871—9)
- Retrograde intramedullary nailing in distal femoral fractures—results in a series of 46 consecutive operations.Injury. 2004; 35 (517—22)
- Mid-to long-term clinical findings in nailing of distal femoral fractures.J Surg Orthop Adv. 2003; 12 (218—24)
- External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft.J Am Acad Orthop Surg. 2006; 14: S131-5
- Evaluation of results of interlocking nail in the treatment of open fracture shaft femur due to high energy trauma.J Indian Med Assoc. 2012; 110 (821-2, 8)
- Intramedullary nailing for open fractures of the femoral shaft: evaluation of contributing factors on deep infection and nonunion using multivariate analysis.Injury. 2005; 36: 1085-1093
- External fixation of femoral fractures: experience with 15 cases.J Orthop Trauma. 1990; 4: 70-74
- Committee for coding and classification: fracture and dislocation compendium.J Orthop Trauma. 1996; 10
Article info
Publication history
Published online: January 14, 2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
