Comparative study between the use ofbridge-plate and the use of interlocking intramedullary nail in comminuted shaft fractures of the femur
Keywords:
femoral fractures, surgery operative, postoperative complicationsAbstract
Fourteen patients (15 fractures) with comminuted shaft fractures of the femur who were operated between April, 1995 and August, 1996, were assessed. The patients were treated by the biological fixation method and they were divided in two groups: one group with 8 fractures treated with [he Bridge-Plate and a second group with 7fonurfractures treated using the fracture table. This study aimed to verify if the internal stabilization technique with Bridge-Plate for the surgical treatment of comminuted shaft fractures of the femur is a good as the internal stabilization using the Interlocking Intramedullary Nail without using the technologic devices such as the image intensifier. The results observed were that all the fractures have evoluted to consolidation within an average of 119 days in the group of patients treated with the Bridge-Plate and an average of 136 days for those who were treated by the Interlocking Intramedullary Nail. The mean time of the duration of the surgery with the Bridge-Plate method was 2 hours and 25 minutes and the average time with the Interlocking Intramedullary Nail was 3 hours and 4 minutes. Two complications were observed in the group of patients Treated with Bridge-Plate: breaking of the synthesis material due to premature weight-bearing, that however evoluted io consolidation after replacement. In another patient a shortening of 4 cm was noticed on the operated limb. With the patients treated with the Interlocking Intramedullary Nail, one of them showed a deep infection in the fracture focus and another one had a consolidation delay, however both of them evoluted for consolidation after an adequate treatment. As a conclusion, the authors considered the Bridge-Plate method very valuable in the treatment of this kind of fractures, because it showed as good as results the Interlocking Intramedullary Nail method, and yet, it doesn't need the use of the image intensifier.
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References
ALLGOWER, M., SPIEGE, P. Internai fixation of fractures: evolution of concepts. Clin Orthop, Philadelphia, v. 138, 1126-29, jan./Feb.,1979.
ANDERSON, R.L. Conservative treatment fractures of the femur. J Bone Joint Surg Am, Boston, v.49, p. 1371-1375, Oct. 1967.
CARVALHO, J.J. ELIAS, N., GALVÃO, S. Participação do periósteo na consolidação da fratura. Rev Bras Ortop, Rio de Janeiro, v.26, n.7, p.251-254, 1991,
CHRISTIE, J., COURT-BROWN, C., KINNINMONTH, W, G, Intramedullary locking nails in the management of femoral shaft fractures. J Bone Joint Surg Br, London, v.70, p.206-210, Mar, 1988.
ELIAS, N. , CARVALHO, LJ., OLIVEIRA, L.P. Participação do hematoma na consolidação da fratura, Rev Bras Ortop, Rio de Janeiro, v.27, n.7, p. 529-533, 1992.
FALA VINHA, R.S. Fixação biológica das fraturas multifragmentárias do fêmur, Rev Bras Ortop, Rio de janeiro, v.31, n.6, p. 449-455, 1996.
GEBER, J.W.M., GRASS, R. Biological internai fixation of fractures. Arch Orthop Trauma Surg, Berlin, v. 109, 1990.
GUSTILO, R.B., MERkOW,R.L., TEMPLEMAN, Current concepts review: the management of open fractures. J Bone Joinr Surg A m, Boston, v. 72, n.2, p.299-304, 1990.
HEITEMEYER,U., KEMPER, F., HIERHOLZER, G. Severely comminuted femoral shaft fractures: treatment by bridgint-plate osteosynthesis. Arch Orthop Trauma surg, Berlin, v. 106, p.327-330, 1987.
HUNGRIA NETO, J.S. Fraturas diafisárias do fêmur: ainda há indicações para uso de placas? Rev Bras Ortop, Rio de Janeiro, v. 31, n.6, p. 444-448, 1996.
KEMPF, 1., GROSSE, A., BECK, G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am, Boston, v.67, 11.6, p.709-720, 1985.
KÜNTSCHER, G. Intramedullary surgical technique and its place in orthopaedic surgery. My present concept.] Bone Joint Surg Am, Boston, v.47, n.4, p. 809-818, 1965.
MOONEY, V., CLAUDI, B.F. Fractures in the femur shaft. In: ROCKWOOD, G. Fractures in adults. Philadelphia: JB Lippincott, 1984. v.2: p. 1357-1427.
MULLER, M.E et al. H. Manual of internal fixation. Berlin: Springer-Verlag, 1979. p. 1-5.
NAZARIAN, S., KOCH, Pi The comprehensive classification of fracture of long bones. New York: Springer-Verlag, 1990. p. 16-26.
NICHOLS, P.J.R. Rehabilitation after fractures of the shaft of the femur, J Bone Joint Surg Br, London, v.45, p.96-102, Jan./Feb., 1963.
OSORIO, L, OSORIO, E.G., AMARAL, F.G. Tratamento das fraturas cominutivas do fémur pelo método da placa em ponte. Rev Bras Ortop, Rio de Janeiro, v.29, n. 11/12, p.855-860, 1994.
THORENSEN, B.O. et al. Interlocking intramedullary nailing in femoral shaft fractures: a report of fortyeight cases. J Bone Joint Surg Am, Boston, v.67, p.1313-1320, Dec. 1985.
WINQUIST, R.A., HANSEN JR., S.T., CLAWSON, D.K. Closed intramedullary nail of femoral fractures. A report of five hundred and twenty cases. J Bone Joint surg Ant, Boston, v. 66, p.529-539, Apr. 1984.
