Frequency of Nonunion in Ipsi Lateral Femur and Tibia Fracture Treatment
Keywords:Floating knee, Interlocking nail, Ipsi-lateral fractures, Non union.
Objective: The objective of our study is to determine the frequency of non union in ipsilateral femur and tibia fractures treatment.
Methods: This descriptive study included 30 patients having ipsilateral femur and tibia fractures in District Headquarter Hospital(DHQ)Teaching hospital Dera Ismail Khan( DI khan) from January 2016 to December 2018.Adult patients of either gender having ipsi lateral femur and tibia fractures fulfilling the inclusion criteria and treated surgically were included in this study. Postoperatively all the patients were seen at 2 weeks, and then every month till union is achieved.
Results: In our study male were 27(90%) and female 3(10%).The mean age of our patients were 43±4SD. Femur interlocking nailing was done in 23(76.6%) cases and platting in 7(23.3%) cases, while tibia platting was done in 25(83.3%) cases and interlocking in only 5(16.6%) patients. A total of 11(36.6%) patients had non union. In 7(23.3%) patients femur alone went to non union while in 4(13.3%) patients femur non union was accompanied with tibia. Femur fractures treated with plating had a non union percentage of 20%(6 patients) while 5(16.6%) patients with interlocking nail reported non union.Among patients of tibial non union, 2(6.6%) had interlocking nail and 2(6.6%) had plating. All femur plates were replaced with interlocking nails and exchange nailing was done in all six interlocking femur nonunion cases. In all four tibial nonunion only bone grafting was added at nonunion site after refreshing the area.
Conclusion: The frequency of non union in ipsilateral femur and tibia treatment is higher in femur than in tibia. Patients treated with femur platting had more chances of non union than with interlocking nail.
1. Puri P, Goel S, Gupta KA,Verma P.Management of polytrauma patient in emergency department: An experience of a tertiary care health institution of northern India. World J Emerg Med 2013;4 (1):15-19.
2. Stewart RM, Mayer JG, Dent DT,Ermis P,Gray GA, Villarreal R. Seven hundred and fifty three consecutive deaths in a level 1 trauma center:The argument for injury prevention.J Trauma 2003 ;4:66-71.
3. Matar ZS.The clinical profile of polytrauma and management of abdominal trauma in a general hospital in the central region of Saudi Arabia. The Internet J Surg 2008;14:11.
4. Tscherme H,Regel G,Pape HC,Pohlemann T, Krettek C. Internal fixation of multiple fractures in patients with polytrauma. Clin Orthop Relat Res 1998 ;(347):62-78.
5. Hussmann B, Lendemans S. Pre hospital and early in hospital management of severe injuries :Changes and Trends. Injury 2014;3(45).39-42
6. Graff I,Ghamari S, Schacher S, Glien P, Fimmers R,Baehner T,Kim SC. Improvement of polytrauma management –quality inspection of a newly introduced course concept. J Eval Clin Pract 2017;120-124.
7. Schiedts D, Mukisi M, Bouger D, Bastaraud H. Ipsilateral fracture of femoral and tibial diaphysis. Rev Chir Orthop Reparatrice Appat Mot 1996;82(6):535-40.
8. Lundy DW, Johnson KD. Floating knee injuries: Ipsilaterel fractures of femur and tibia. J Am Acad Orthop Surg 2001 :9(4);238-45.
9. Anan JB,Neuwirth AL, Horn BD, Baldwin KD. Ipsilaterel femur and tibia fractures in pediatrics patients: Asystematic review. World J Orthop 2017;8(8):638-643.
10. Della RGJ. External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of femoral and tibial shafts. J Am Acad Orthop Surg 2006;14:131-5.
11. Malik ZU, Hanif MS, Safdar A, Masood T. Planned external fixation to locked intramedullary nailing conversion for open fractures of shaft of femur and tibia.J Coll Physicians Surg Pak 2005;15(3):133-6.
12. Collinge CA, Hymes R,Archdeacon M.Unstable proximal femur fractures treated with proximal femoral locking plates :A Retrospective, Multicenter study of 111 cases. J Orthop Trauma 2016;(9)489-95.
13. Verma R, Sharma P, Ghaur S. Augmentation plating in management of failed femoral nailing. Injury 2007 ; 48 (2):45-50
14. Yokoyama K, Tsukamolo T. Evaluation of functional outcome of the floating knee injury using multivariate analysis. Arch Orthop Trauma Surg 2002 Nov;122 (8):432-5.
15. Alaa MH. Surgical management of ipsilateral fracture of femur and tibia in adults (the floating knee): postoperative clinical, radiological and functional outcomes. Clin Ortop Surg 2011;3(2)133-139.
16. Schmeling GJ, Schwab JP. Polytrauma care: The effect of head injuries and timing of skeletal fixation. Clin Orthop Relat Res 1995 ;(318):106-16.
17. Kroupa J. Indications for primary osteosynthesis in patient with fractures of long bones of extremities with special regard to multiple and associated fracture of femur diaphysis. Czech Med 1986;9(4):218-32.
18. Anari JB, Neuwirth AL, Horn BD, Baldwin KD. Ipsilaterel femur and tibia fractures in pediatric patients: A systemic review. World J Orthop 2017 18;(8):638-643.
19. Arsalan HI,Kapukaya A, Kesemenli CC,Necmioglu M.Coban V. The floating knee injuries in adults: Twenty –four cases of ipsilaterel fracture of femur and tibia. Acta Orthop Traumatol Turc 2003;37(2): 197-12.
20. Alexander A, Sitnik, Alexander V, Beletsky. Minimally Invasive Percutaneous Plate fixation of tibia fractures : Results in 80 patients. Clin Orthop Relat Res 2013 ; 471(9): 2783-2789.
21. Babst R,Khong K.Minimally invasive surgery. AO Principles of fracture managent. Thieme 2007 :199-212.
22. Borg T, Larsson S, Lindsjo U. Percutaneous plating of distal tibia fracture.Preliminary results in 21 patients. Injury 2004;35:608-614.
23. Hasenbochler E, Rikh D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphysial and dital tibial fractures: a retrospective study of 32 patients. Injury 2007;38:365-370.
24. Chavda AG,Lil NA,Patel PR. An approach to floating knee injury in Indian Population: An analysis of 52 patients. Indian J Orthop 2018;52:631-7