Journal of Musculoskeletal Trauma

Rare Experience of Bilateral Femoral Neck and Shaft Fractures - A Case Report -: DaeHyun Choe, Jae-Ho Lee, Ki-Chul Park; J Korean Fract Soc 2020;33(3):154-158. Published online July 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.3.154

Abstract PDF: Ipsilateral fractures of the femoral neck and shaft are relatively common injuries and accompany 2% to 9% of all femoral shaft fractures. On the other hand, it is extremely rare for these injuries to occur bilaterally. This paper reports the authors’ experience of a case with bilateral femoral neck and shaft fractures. The patient sustained multiple injuries, including liver laceration with hemoperitoneum, bilateral open fractures of the tibia, and bilateral femoral neck, and shaft fractures caused by a high-speed motor vehicle accident. Under the circumstances, damage-control orthopedic principles were applied, and external fixators were initially placed. After the patient’s general condition showed improvement, both femurs were fixed with a reconstruction nail. Fracture healing was achieved without complications, such as avascular necrosis of the femoral head. Despite the rare occurrence, this paper describes this case because these injuries must be managed with meticulous attention.

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Avulsion of the Femoral Attachment of Anterior Cruciate Ligament Associated with Ipsilateral Femoral Shaft Fracture in Skeletally Mature Patient: A Case Report: Seong Eun Byun, Taesup Kim, Bang Hyun Kim, Jae Hwa Kim, Soo Hong Han, Wonchul Choi; J Korean Fract Soc 2016;29(3):200-205. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.200

Abstract PDF: Avulsion fracture at the femoral attachment of the anterior cruciate ligament (ACL) is very rare and has been reported mostly in skeletally immature patients. Authors experienced a case of avulsion fracture at the femoral attachment of ACL in a skeletally mature, a 21-year-old male associated with ipsilateral femoral shaft fracture. Here, authors report on the case with a literature review. Care should be taken because an avulsion fracture at the femoral attachment of ACL can be accompanied by ipsilateral femoral shaft fracture in skeletally mature patients.

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Treatment of the Femoral Fracture Using Sirus(R) Nail: A Comparison of Complication according to the Entry Potal: Young Yool Chung, Dong Hyuk Choi, Dae Hyun Yoon, Jung Ho Lee, Ji Hun Park; J Korean Fract Soc 2015;28(2):103-109. Published online April 30, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.2.103

Abstract PDF: PURPOSE
The purpose of this study is to analyze the clinical results of fixation using Sirus(R) nail in patients with femoral subtrochanteric and shaft fracture and the difference in the frequency of complications according to the entry portal.
MATERIALS AND METHODS
From July 2006 to August 2013, at least 1-year clinical follow-up, we retrospectively analyzed 36 cases with femoral subtrochanteric (15 cases) and shaft fracture (21 cases) who underwent surgery using Sirus(R) nail. We reviewed the records of operation time, intra-operative amounts of bleeding and complications. At last follow-up, we reviewed clinical results by Ray-Sanders criteria and analyzed the periods of bone union on the radiograph. We also measured changing of the femoral neck-shaft angle in the subtrochanteric fractures and angulation in the shaft fractures, respectively. Considering anatomical variation of the trochanter and fracture position of subtrochanteric and femoral shaft, entry points were divided into subgroups, and the clinical results were compared.
RESULTS
The mean Ray-Sanders score was 27.4, 27 cases (75.0%) were good or excellent. The mean periods of bone union was 21.1 weeks in 31 cases. The mean neck-shaft angles were 135.7o preoperatively, 130.2o postoperatively. The mean angulation of the femur was 24.4o preoperatively, 2.4o postoperatively in patients of femoral shaft fractures. Despite no statistical significance, greater trochanter tip entry point and lateral entry point had a higher rate of frequency than medial entry point, with respect to the occurrence of iatrogenic fracture and malalignment.
CONCLUSION
Using Sirus(R) nail for femoral subtrochanteric and shaft fractures showed good clinical and radiographic results and a high rate of union. Medial entry point yielded slightly better results in the occurrence of iatrogenic fracture and malalignment, compared to greater trochanter tip entry point and lateral entry point.

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Minimally Invasive Plate Osteosynthesis for Femoral Mid-Diaphyseal Fractures: Hyoung Keun Oh, Suk Kyoo Choo, Jong In Kim, Sung Jong Woo; J Korean Fract Soc 2013;26(2):140-146. Published online April 30, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.2.140

Abstract PDF: PURPOSE
To investigate the surgical outcomes of patients with femoral mid-diaphyseal fractures treated with minimally invasive plate osteosynthesis (MIPO), which were difficult to intramedullary nailing.
MATERIALS AND METHODS
We evaluated 11 patients with femoral mid-diaphyseal fractures who were treated with MIPO. There were 7 males and 4 females and the mean age was 47 years (20-85 years). According to AO/OTA classification, there were 1 type of A1, 5 types of A3, 1 of B2 and 4 of B3. The reason of plate fixation instead of intramedullary nailing is as follows: femoral vessel and severe soft tissue injuries-2 cases, polytrauma patients with chest injury-6 cases, and narrow medullary canal diameter-3 cases. Six out of 11 cases were treated with initial external fixation as a damage control orthopedics.
RESULTS
The mean union time of 6 cases was 3.7 months (3-5 months). There were 5 cases (45%) of nonunion, which should be treated with autogenous bone graft. All cases of nonunion resulted from severe soft tissue damage and polytrauma, which needed initial external fixation. There was no case of malalignment and implant-related complication.
CONCLUSION
In cases of difficult intramedullary nailing for the femoral mid-diaphyseal fractures, MIPO could be an alternative surgical option, but concurrent soft tissue injuries and multiple trauma may increase the risk of nonunion in spite of biological fixation.

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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; J Korean Fract Soc 2011;24(4):313-320. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.313

Abstract PDF

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.

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Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef
Augmentative Locking Plate Fixation for the Treatment of Femoral Nonunion after Intramedullary Nailing
Ki-Chul Park, Chul-Woong Kim, Kyu-Tae Hwang, Ye-Soo Park
Journal of the Korean Fracture Society.2013; 26(4): 268. CrossRef

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Clinical Outcome of Surgical Treatment for Fracture of the Femoral Shaft with Ipsilateral Fracture of the Proximal Femur: Hee Gon Park, Jae Sung Yoo; J Korean Fract Soc 2011;24(4):307-312. Published online October 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.4.307

Abstract PDF: PURPOSE
To analyze diagnostic process and clinical data in cases of fracture of the femoral shaft with fracture of the proximal femur.
MATERIALS AND METHODS
We reviewed 24 cases of patient who undergone surgery for fracture of the femoral shaft with ipsilateral fracture of the proximal femur and more than 1 year of examination of follow up was available. Age, sex.location and classification of the fracture, the time of diagnosis and operation, the method of operation, the associated injuries, the time of bony union and complication were investigated, postoperative function was evaluated on Friedman and Wyman criteria.
RESULTS
Bony union showed significant difference in the displacement and comminution of fracture, postoperative function revealed significant difference according to the associated injuries. The 6 cases (25%) out of 24 cases are failed early diagnosis, 4 cases out of 6 cases was detected during operation and 2cases was found after surgery. 21 cases out of 24 cases of femoral shaft fractures showed union, 23 cases out of 24 cases of femoral neck fractures showed union. There were eleven good, eleven fair, and two poor functional result according to Friedman and Wyman criteria.
CONCLUSION
Precious clinical and radiologic examination is needed not to miss the diagnosis of proximal femur fractures in ipsilateral femoral shaft fractures with proximal femur fractures. Anatomical reduction and rigid fixation of proximal femur are important to reduce avascular necrosis of femoral head and nonunion of proximal femoral fractures.

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Retrograde Intamedullary Nailing for Femoral Fracture: Kyung Won Song, Seung Yong Lee, Sung Il Shin, Jin Young Lee, Gab Lae Kim, Dae Eun Choi, Young Suk Ko, Hyung Suk Oh; J Korean Fract Soc 2006;19(3):314-318. Published online July 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.3.314

Abstract

PURPOSE
To evaluate the effectiveness. analyze the result after retrograde intramedullary (IM) nailing in femoral shaft fracture MATERIALS AND METHODS: Thirty-four femoral shaft fracture (32 patients) were operated with retrograde IM nail and followed the result for more than 18 month from march 2001 to march 2003. There were 6 of femoral mid shaft fractures and 28 of distal femur fractures. According to AO classification, there were 1 of A1, 1 of A2, 2 of A3, 2 of C1 in femoral mid shaft fracture and 11 of A1, 7 of A2, 7 of A3, 1 of B1, 2 of C1 in distal femur fracture. They included 5 open fracrures. By Gustilo classification there were 3 of type I, 2 of type II. Through radiologic study we evaluated the time of union, nonunion, malunion. And in clinical evaluation we checked knee function in 18 month after operation.
RESULTS
It took 16 weeks (range 12~20 weeks) for average bone uion period. 30 cases out of 34 cases had the bone union but 4 cases showed nonunion. There were not any complication except 3 cases of screw migration. Full rage of motion was gained in 29 cases. However knee stiffness occurred in 5 cases. The knee function through knee score was assessed by showing 28 of excellent, 1 of good, 5 of poor.
CONCLUSION
Even though the retrograde intramedullary nailing may have some defect to be able to damage to knee joint in operating, It can be useful surgical technique for femoral shaft fracture in such as ipsilateral fracture or multiple fracture, poor general condition, and so on.

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

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Reamed versus Unreamed Interlocking Intramedullary Nailing in the Treatment of Femoral and Tibial Shaft Fracture: Sung Soo Kim, Chul Hong Kim, Myung Jin Lee, Jin Hun Kang; J Korean Fract Soc 2006;19(2):141-146. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.141

Abstract: PURPOSE
To comparative analysis of clincal difference between reamed and unreamed interlocking intramedullary nailing in the treatment of femoral and tibial shaft fractures.
MATERIALS AND METHODS
We reviewed femoral and tibial shaft fracture who were treated with reamed or unreamed nail. They were followed for a minimum of 16 months. Winquist-Hansen and Johner-Wruhs criteria were applied for the classification of the fractures. Retrospectively we evaluated the duration of operation, the amount of bleeding, the first time of callus formation, union time, the time of partial weight bearing, isthmic ratio, complications.
RESULTS
The average duration of operation for femoral fractures with reamed and unreamed nail were 104 minutes, 95 minutes, respectively. And those for tibial fractures were 96 minutes, 87 minutes, and the difference was statistically significant (p<0.05). The amount of bleeding in femoral fractures with reamed and unreamed nail were 360 ml, 223 ml, respectively. And those in tibial fractures were 280 ml, 205 ml, respectively, and the difference was statistically significant (p<0.001). The isthmic ratio in femoral fracture with reamed and unreamed nail were 105.5%, 87.0%, respectively and those in tibial fracture were 106.3%, 85.3%, respectively. There were 2 delayed unions in femoral fractures and 1 delayed union in tibial fracture with unreamed nail, and 1 metal failure in tibial fracture with unreamed nail.
CONCLUSION
Unreamed femoral intramedullary nailing involves fewer steps and less intraoperative blood loss than reamed nailing. There was no statistical difference the first time of callus formation, union time, the time of partial weight bearing. It must be consider that delayed union and metal failure in the unreamed intramedullary nailing due to high grade fracture, lower isthmic ratio, combined with multiple trauma.

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A Skeletal Traction on the Radiolucent Table in Closed Intramedullary nailing of Femoral Fracture: Eun Woo Lee, Han Jun Lee, Kee Hyun Lee, Ho Sun Jin; J Korean Fract Soc 2005;18(3):244-249. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.244

Abstract PDF: PURPOSE
To evaluate the clinical results of femoral shaft fracture treated by Intramedullary (IM) nailing through skeletal traction compared with manual traction on a radiolucent table.
MATERIALS AND METHODS
Thirty cases with femoral shaft fracture treated with closed IM nailing from January 2000 to June 2002 were divided into two groups; fifteen fractures reduced by manual traction (Group A) and fifteen fractures reduced by skeletal traction (Group B) on a radiolucent table. The number of people participated in the operations, operation and radiation exposure time, and post-operative complications were evaluated.
RESULTS
The number of people participated in the operations was five in Group A and four in Group B. The average operation time was 116 minutes and 82 minutes (p<0.001). The radiation exposure time was 2.8 minutes and 1.2 minutes (p<0.001). However, there was no significant difference in the post-operative complications such as shortening or lengthening of bone between two groups.
CONCLUSION
There was no significant difference in the operative outcome between two groups. However, skeletal traction has positive effects of reducing the operation time, radiation exposure time, and number of people participating in the operations. Also, regarding the consistent traction power, skeletal traction is the better treatment modality in maintaining the alignment and length of femoral bone than manual traction.

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Instability of Knee Associated with Ipsilateral Femoral and Tibial Shaft Fractures: Whan Yong Chung, Woo Suk Lee, Woo Sik Kim, Yong Chan Kim, Taek Soo Jeon, Sun Hong Kim, Ji Hyuk Lim, Young Su Lim; J Korean Fract Soc 2005;18(2):136-143. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.136

Abstract PDF: PURPOSE
To establish the incidence, type and significance of knee instability in patients with ipsilateral femoral and tibial shaft fracture, comparing with the patients with femoral shaft or tibial shaft fracture alone.
MATERIALS AND METHODS
Two hundreds and seventy-nine consecutive patients were retrospectively reviewed from February 2000 to April 2004. They were composed of 80 patients with femoral shaft fracture alone, 176 patients with tibial shaft fracture alone and 23 patient with ipsilateral femoral and tibial shaft fracture. We evaluate the instability of knee based on physical examinations, plain stress films and MRI. We analyze incidence and period to diagnosis of instability, period to complete bony union and Hospital for Special Surgery (HSS) knee score respectively.
RESULTS
There were 6.3% of knee instability in femoral shaft fracture alone, 9.7% in tibial shaft fracture alone and 30.4% in ipsilateral femoral and tibial shaft fracture. The average period to diagnosis of instability, average period to complete bony union and average HSS knee score were 9.2 months, 4.7 months and 65 points in femoral shaft fracture alone, 9.1 months, 4.2 months and 69 points in tibial shaft fracture alone, 8.7 months, 5.3 months (femur), 4.7 months (tibia) and 57 points in ipsilateral femoral and tibial shaft fracture respectively.
CONCLUSION
We should consider MRI to evaluate the knee instability in patient with ipsilateral femoral and tibial shaft fracture at the time of injury and make a plan early about the treatment of knee instability.

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Flexible Intramedullary Nail Fixation of Pediatric Femoral Shaft Fracture: Suk Kyu Choo, Byung Jik Kim, Hyun Wook Chung; J Korean Fract Soc 2005;18(1):60-64. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.60

Abstract PDF: PURPOSE
To traditional treatment of pediatric femoral shaft fracture has been a traction and spica cast application. But flexible intramedullary nail fixation has been introduced as an alternative to other treatment modalities. With this in mind, we analyzed the clinical and radiologic results of flexible intramedullary nail fixation of pediatric femoral shaft fractures.
MATERIALS AND METHODS
We analyzed 12 patients (13 cases) who were treated with flexible intramedullary nail and followed up for at least 6 months at the department of Orthopedic Surgery, Inje University Ilsan Paik Hospital since May, 2002.
RESULTS
In all 12 patients (13 cases) involving 1 case with reoperation because of reduction failure, average duration of bone union was 12.6 weeks. There were no considerable complications except mild post-op knee pain and limitation of motion.
CONCLUSION
In spite of relatively short term study, a flexible intramedullary nail fixation seems to be a useful method without serious complications on pediatric femoral shaft fracture. However, in big or older pediatric patients, interlocking intramedullary nail fixation may be a better choice rather than a flexible nail fixation because of it's insufficient stability.

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Flexible Intramedullary Nailing in Children's Femoral Shaft Fractures: Yeo Hon Yun, Chang Ho Choi, Jae Hak Jung; J Korean Soc Fract 2003;16(3):385-391. Published online July 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.3.385

Abstract PDF

PURPOSE
We report a treatment result and the pros-cons of the flexible intramedullary nailing for femoral shaft fractures in children between the ages of 4 and 11 years.
MATERIALS AND METHODS
During the recent three years, 28 femoral shaft fractures in 27 consecutive pediatric patients were treated with flexible intramedullary nailing. We retrospectively reviewed their clinical and radiological records, followed-up for at least one year, in respects to the recovery of knee joint motion; time of weight bearing; time of fracture union; period of admission and rehabilitation; angular deformity and leg length discrepancy; and other complications.
RESULTS
In all children, the knee joint motion was rapidly recovered to near normal range within 2~4 weeks. Partial weight bearing with wearing functional brace was possible within 2~4 weeks, while full weight bearing without brace was started until 6~12 (average 8.4) weeks after the nailing. In the last follow-up radiographs, five cases (18%) showed an angular deformity in any direction of more than 5 degrees. Two children represented leg length discrepancy of more than 1 cm. Other complications were one fixation failure, and one deep soft tissue infection at the entry point of the nail.
CONCLUSION
We strongly recommend the flexible intramedullary nailing in this injury because the fixation is strong enough to permit early knee motion and weight bearing in orthosis, the fracture healing was so rapid without any case of delayed or nonunion, and the incidences of residual angular deformity and leg length discrepancy were significantly less than the nonoperative treatment.

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Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures
Do-Young Kim, Sung-Ryong Shin, Un-Seob Jeong, Yong-Wook Park, Sang-Soo Lee, Keun-Min Park
The Journal of the Korean Orthopaedic Association.2008; 43(1): 30. CrossRef

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Treatment of Femoral Shaft Nonunions with Dynamic Compression using Interlocking-Compression (IC) Nail: Youn Soo Park, Young Wan Moon, Ki Sun Sung; J Korean Soc Fract 2003;16(2):155-162. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.155

Abstract PDF: PURPOSE
To evaluate the effectiveness of a specially designed Interlocking-Compression Nail (IC Nail(R), Osteo, Switzerland) which allows compression force across the nonunion site for the treatment of femoral shaft nonunions.
MATERIALS AND METHODS
Between Nov. 1998 and June 2002, twenty one nonunions of femoral shaft fractures in twenty patients were treated with reamed IC nails of larger diameters without bone grafting in 9 men and 11 women, 8 to 45 months after initial operations. Seventeen cases were hypervascular nonunions, 3 avascular, and 1 infected. For initial operation, 10 closed nailing, 10 open nailing and 1 plate fixation were performed. One or more additional procedures had been done in 17 cases prior to IC nailing.
RESULTS
The nonunion gap was considerably narrowed from 7.4 mm to 3.1 mm with IC nailing and bony unions were achieved in all but one case. The time for radiographic union was 4 to 15 months posteoperatively with an average of 7.4.
CONCLUSION
Reamed IC Nail(R) with a larger diameter is an effective procedure for femoral shaft fracture nonunion regardless of initial treatment modalities and even in 3 avascular nonunions, 2 have shown radiographic union without bone grafting. Additional procedures are to be considered in failed surgery of avascular nonunions.

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Treatment of Femoral Shaft Fracture with External Fixator in Children: Phil Hyun Chung, Suk Gang, Dong Ju Chae, Jong Pil Kim, Sung Pock Park; J Korean Soc Fract 2002;15(3):421-426. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.421

Abstract PDF: PURPOSE
Children with femoral shaft fractures in association with other injuries such as head injuries, abdominal injuries, open fractures, multiple fractures, or unstable displaced fractures require operative treatment rather than being treated in conservative methods. In this study, we compare the surgical result of femoral shaft fracture using external fixator in children, and evaluate the complications and the related factors as well as the advantage over the other management described in the literature.
MATERIALS AND METHODS
We reviewed 15 cases of femoral shaft fractures in children admitted between May, 1995 and May, 2000. The mean age was 8 years and 2months old (range: 6-12 year-old, 9 boys, 6 girls). All the evaluations were based on the postoperative radiologic studying and clinical findings. In the radiologic evaluations, bony union time, angular deformity, and leg length discrepancy in both sagittal and coronal plane were evaluated, and in the clinical evaluations, we analyzed the duration of external fixation, hospital day, range of motion in both hip and knee joint, and post-operative complications.
RESULTS
The average bony union time based on the radiologic studying was 10.9 weeks (ranging from 7 to 24 weeks). Angular deformity at the fracture site was less than 5 degrees and no rotational deformity was found in all 15 cases. The average length of overriding fracture fragment was 11.7 mm (ranging from 10 to 15 mm) and average leg length discrepancy was 2.1 mm (ranging from -3 to +10mm). Duration of external fixation averaged 12.1 weeks (ranging from 9 to 24 weeks) and average hospital day was 29.4 day (ranging from 21 to 48 day). None of the patient had limitation in hip or knee joint movement. There were 1 case of refracture (case of pathologic fracture) and 4 cases of pin tract infection(superficial infection).
CONCLUSION
At our institution, we observed average overgrowth of 2.1 mm and no severe complications excepts in 1 case of refracture due to pathologic fracture. Thus we concluded that closed reduction and external fixation is effective in treating open, or unstable displaced fracture of femoral shaft with other associated injuries in pediatric population, and it is also believed to be effective means in treating closed femoral fractures.

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Breakage of Interlocking Screw after Intramedullary Nailing of Femoral Shaft Fracture: Gun Il Im, Cheol Won Hyun, Joo Ho Shin, Do Young Kim, Won Ho Cho; J Korean Soc Fract 2000;13(3):463-469. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.463

Abstract PDF: PURPOSE
We analysed risk factors for failure of interlocking screws after femoral intramedullary nailing, and introduce tips for removing broken screw.
MATERIALS AND METHODS
Seventy-two closed femoral shaft fractures were treated with interlocking nail. We compared 7 patients in whom interlocking screw breakage occurred (Group I) with 65 patients without breakage of interlocking screw (Group II). Analytic parameters were age, weight, level of fracture, degree of comminution, nail diameter. We used Mann-Whitney U test & Chi-sqare test for statistical analysis.
RESULT
Upper one of distal interlocking screws was broken in 6 patients, both of distal screws were broken in one patient. All of the patients with broken screws had associated delayed union. The mean age of patients were 20 years in group I, 31 years in group II. The mean weight were 69.6 Kg in group I, 62.02kg in group II. Three patients had fractures in proximal half and four patients had fractures in distal half in group I. In group II, there were 25 proximal fractures and 40 distal fractures. There were 2 type I, 2 type II, 1 type III, 2 type IV fractures in group I, and 16 type I, 31 type II, 17 type III, 1 type IV fractures according to Winquist and Hansen classification. Nail diameters were 10mm in 4 patients, 11mm in 2 patients, 12mm in 1 patient for group I and 10mm in 8 patients, 11mm in 13 patients, 12mm in 25 patients, 13mm in 13 patients, and 14mm in 6 patients for group II. Age, weight, degree of comminution, nail diameter had statistically significant relation to the breakage of interlocking screw(p<0.05), but the level of fracture didn't(p>0.05). Broken screws were easily removed by advancing screw to medial compartment with S-pin and making short medial incision.
CONCLUSION
It is suggested from our study that combination of parameters may have contributed to the failure of interlocking screw ; narrower diameter nail for comminuted fracture in young, active patients with more body weight. Inserting two screws have advantage over one screw.

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Nonunion after Intramedullary Nailing of Femoral Shaft Fracture: Woo Suk Lee, Kyoo Ho Shin, Kyung Su Lim; J Korean Soc Fract 1999;12(3):577-593. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.577

Abstract PDF

From January 1992 to June 1997, we reviewed retrospectively eighteen femoral shaft nonunions after intramedullary nailing and followed for an average of 31(18-53)months. We investigated causes of nonunion and analyzed the results according to operative method. Nonunion was divided into infected(4 cases) or noninfected types(14 cases). The causes of noninfected nonunion were insufficient stability(7 cases) and bone defects(4 cases). In insufficient stability, there were loosening of locked screw in four, absence of locked screw in two, and breakage of locked screw in one. There was a correlation between severe comminuted fracture with an early weight bearing and screw failure(p<0.05). Seven cases of nonunion were treated with compression plate and cancellous bone grafting, four cases only bone grafting, three cases Ilizarov external fixations, three cases dynamization, and one case renailing. The clinical and roentgenographic healing processes were recorded. All achieved solid unions within an average period of 11.7(2.5-41)months. An average time to union was 5.2(3-7)months after dynamization, 7.3(7-8)months after bone grafting, 12 months after renailing, 12.9(4-25)months after compression plate and cancellous bone grafting, and 21.3(11-41)months after Ilizarov external fixation. The union period with noninfected nonunion was significantly shorter than infected nonunion(9.2 months vs. 20.3 months; p<0.05).

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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
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef
Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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Nonunion of the Fracture of Distal One-third of Femoral Shaft treated by Interlocking Intramedullary Nailing: Su Chan Lee, Min Ho Song; J Korean Soc Fract 1999;12(2):259-266. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.259

Abstract PDF

The twelve nonunions of distal one-third fracture of femoral shaft after interlocking intramedullary nailing were teated with reaming and exchange nailing with a larger-sized nail, or reaming and exchange nailing with a larger-sized nail added with poller screw fixation. All the femoral nonunion were caused by insecure fixation of the intramedullary nailing, in which a instability of the fracture sites was verified in all cases during operation. The six of them were treated with reaming and exchange nailing. A simultaneous bone graft was performed in one of them to repair the bony defect. The other six of them were treated with reaming and exchange nailing added with poller screw fixation. The result were as follows: 1. In six cases that treated with reaming and exchange nailing, patients walked bearing full weight on the extremity with mild aching at the fracture site within 3 months and not obtained a bony union until a 12 months. 2. In one case that treated with reaming and exchange nailing added with poller screw fixation, patient walked bearing full weight on the extremity with mild aching at the fracture site within 3 months and not obtained a bony union until a 12 months. 3. In five cases that treated with reaming and exchange nailing added with poller screw fixation, patient walked bearing full weight on the extremity without aching at the fracture site within 3 months and obtained a bony union within a average of 7 months. From our experience, etiology of nonunions of distal one-third fractures of femoral shaft is thought insecure fixation of the intramedullary nailing due to wide intramedullary canal. We have found reaming and exchange nailing with poller screw fixation is more helpful treatment that reaming exchange nailing as treatment for those fractures.

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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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Closed Interlocked Nailing in Comminuted Femoral Shaft Fractures: Jung Jae Kim, Chang Won Lee, Key Yong Kim; J Korean Soc Fract 1997;10(1):8-15. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.8

Abstract PDF: Intramedullary nailing is one of the most popular method of treatment in femoral shaft fractures,which provides relatively stable fixation and preservation of blood supply and early mobilization. But whether open reduction, cerclage wiring and/or bone graft is necessary for the displaced comminuted fragment is still a subject of controversy. To clarify such debate we compared the results of IM nailing between simple, minimal displaced fractures and displaced, comminuted ones treated with closed method. We analyzed 36 cases of the fresh closed fractures of femoral shaft treated by closed intramedullary nailing from December 1992 to January 1996. There were 24 cases of minimal displaced fractures and 12 cases of displaced ones more than 1 cm during operation. The average follow-up period was 12 months(5-48 months). Clinical and radiological fracture union occurred in 97% of cases(35/36). Radiological callus was noticed just around 3 weeks postoperatively in both groups and the average time to radiological union was 23 weeks in minimal displaced group and 24.8 weeks in displaced one. Because there was no significant difference in bone healing time, closed interlocking intramedullary nailing is thought to be also the good method of treatment in femoral fractures regardless of fracture pattern or displacement of fragments.

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Fracture of Femur Neck Associated with Technical Errors in Closed Intramedullary Nailing of the Femur: Yong Hoon Kim, Ki Chan Ahn, Sung Suk Seo, Young Chang Kim, Jang Suk Choi, Young Gu Lee; J Korean Soc Fract 1997;10(1):73-78. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.73

Abstract PDF: Closed intramedullary nailing has become increasingly popular in the management of fracture of the femur because of a high rate of union and a low rate of complications. Since the development, it has been widely used in more applicable level of femoral shaft fracture. Therefore, complications of intramedullary nailing was rarely seen, especially rare in case of fractures of the femoral neck associated with technical errors. The three cases of femoral neck fracture with technical errors during intramedullary nailing for treatment of femoral shaft fracture in Paik Hospital, Pusan from April 1994 to July 1995 are reported herein to document that this complication can occur. Three cases of the femoral neck fracture were treated by closed reduction and internal fixation with Knowles pin.

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Interlocking Intramedullary Nailing of Femoral Shaft Fractures in Adolescents: Chil Soo Kwon, Jong Kuk Ahn, Jin Hyok Kim, Byung Hyun Jung, Yerl Bo Sung, Hyung Jin Jung, Jong Deuk Rha, Woo Chun Lee, Hyun Soo Park, Myung Ho Lee, Bu Maan Kim; J Korean Soc Fract 1996;9(4):914-920. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.914

Abstract PDF: Although treatment of femoral shaft fractures by traction and casting satisfactory in young children, it is less useful in obtaining and maintaining satisfactory alignment in adolescent patients. Residual angulation, malrotation. and leg length inequality is well documented. The options for surgical treatment of femoral shaft fractures in adolescents include extemal fixation, plate fixation, and intramedullary nailing. Surgical treatments carry the-risks of growth plate damage and infection, but these risks are very low. Recently, it is generally anepted that adolescent femoral shaft fractures are preferably treated by intramedullary nailing with care taken to avoid damaging the distal femoral physis. The authors experienced 9 femoral shaft fractures in 8 patients treated with interlocking intramedullary nails from August 1989 to May 1994, and followed up for more than 18 months(range from 18 to 45 months). The results were as follows: 1. There were 6 cases in male, 2 cases in female. Average age at the time of injury was 13 years(range, 11-14). 2. All fractures were united, and the nails were removed at an average 13.3 months after operation: no refracture or femoral neck fracture has since occured. 3. None had angular or rotational malunions, infection and avascular necrosis of femoral head. The average leg-length discrepancy at the last follow-up was 0.5cm(range, 0-1.0cm) and all were clinically acceptable. Coxa valga due to premature closure of trochanteric apophysis was not found. The average femoral neck-shaft angle was 133(130~138) at the last follow-up. So, interlocking intramedullary nailing is a reasonable alternative for the treatment of femoral shaft fracture in adolescents.

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Problems and complication after Interlocking Intramedullar Nailing for Femoral Shaft Fracture: In Suk Oh, Do Hyun Moon, Jin Hong Ko, Ki Dong Kang, Si Hwan Kim; J Korean Soc Fract 1996;9(3):547-556. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.547

Abstract PDF

Fracture of the femoral shaft, is among most common fractures in orthopaedics, with its aspect becomming more complex. Since the introduction of Kuncher Nail, closed rodding techinque and locking nail system were followed with additional feature of preventing shortening and rotation as well as allowing early weight bearing and joint motion. With their wide application, we met many problems during the operative procedure due to delicient concept and technique. We have checked the possible problems during and after the procedure of interlocking nailing for the femoral fractures in 65 cases. 1. With poor selection of implant, long, short and small nail were used in 5, 3 & 2 cases, respectively. 2. In the process of operation, inlet error, angular & rotational deformity, femoral neck fracture, failure (or loossening) of distal screws were 2,10, 1, and 4 cases, respectively. 3. A New fragment was made in 7 cases(11%) durinbg surgery, especially medial side and distal to the fracture line. 4. Post-operative deep infection were developed in 2 cases. 5. Post-operative metal failure and delayed(or non) union was 1 and 7(11%) cases, delayed union (or nonunion) occured in 3 cases(20%) after open reduction while following closed reduction in 4 cases(8%).

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Iatrogenic Femur Proximal Shaft Fracture during Nailing Using Lateral Entry Portal on Femur Shaft Fracture
Hong Moon Sohn, Gwang Chul Lee, Chae Won Lim
Journal of the Korean Orthopaedic Association.2014; 49(4): 272. CrossRef

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