Sep 2026· journal of Health Research and Development· 0 citations· 26 references
TL;DR
The findings of the present study indicated that potential complications such as delayed union, nonunion, and osteomyelitis in the intramedullary nailing method are approximately comparable to those of the external fixator method.
Abstract
Background: Various statistics have reported the prevalence of nonunion following intramedullary nailing to be between 0.9% and 1.1%. Femoral shaft fractures typically should achieve union within three to six months after intramedullary nailing. This study aimed to determine the prevalence of nonunion in patients with femoral shaft fractures treated with intramedullary nailing at Fatemi Hospital, Ardabil. Methods: This descriptive-analytical study was conducted on 70 patients who presented to the orthopedic clinic of Fatemi Hospital, Ardabil, with a diagnosis of femoral shaft fracture and underwent intramedullary nailing surgery in 2023 (1402 Persian calendar). Using anteroposterior femoral radiographs, patients were categorized into one of five groups (0 to 4) according to the Winquist-Hansen classification. Additionally, data on fracture type and fracture line, as well as demographic variables including age and sex, were collected. Data were analyzed using SPSS 22 software with descriptive statistics, chi-square test, Fisher's exact test, and independent t-test. The significance level was set at 0.05. Results: In the present study, 70 patients with femoral shaft fractures with a mean age of 36.06 ± 13.5 years who underwent IM nailing surgery at Fatemi Hospital, Ardabil, participated. The prevalence of nonunion complication in femoral shaft fracture patients was 18.6%. A significant relationship was observed between fracture grade and nonunion complication. Conclusion: The findings of the present study indicated that potential complications such as delayed union, nonunion, and osteomyelitis in the intramedullary nailing method are approximately comparable to those of the external fixator method. On the other hand, the duration of hospitalization, time to union, and other complications were lower in the intramedullary nailing method.
Introduction: The primary purpose of this study was to report the indications for and the rate of polyethylene exchange (PE) during retrograde intramedullary nailing (rIMN) in periprosthetic distal femur fractures. This study also explores the role of polyethylene-related etiologies of patients experiencing prefracture TKA instability. Methods: Retrospective review was done on patients older than 18 years treated with rIMN or nail-plate combination (NPC) for periprosthetic fracture (PPFx) of the femur above a total knee arthroplasty with well-fixed components from 2013 to 2023. Patient demographic, perioperative, and surgical data were collected. Descriptive data were reported as means ± standard deviation (SD) for continuous data or counts (%) for categorical data. Results: Twenty-six patients met inclusion criteria and were included for analysis. Seven patients (26.9%) had reports of instability before fracture. Of these, 5 (71.4%) reported catching, 1 (14.2%) presented with antecedent pain, and 1 (14.2%) experienced giving out. The incidence of PE was 34.6% (9/26). Indications for exchange were flexion instability in 33.3% (3/26), damaged polyethylene in 22.2% (2/26), blocked nail entry in 22.2% (2/26), flexion instability with internal rotation deformity in 11.1% (2/26), and polyethylene wear in 11.1% (2/26). Conclusion: This pilot study demonstrates a higher incidence of PE than previously reported in the literature. Indications for PE in distal femur PPFx around a TKA in this cohort include postfixation flexion instability, intraoperative polyethylene damage, blocked nail entry, and polyethylene wear. With larger, prospective studies, an increased understanding of the role for PE may lead to improved patient outcomes and limit morbidity associated with recurrent and new TKA instability postoperatively.
Joseph G. Miceli, Nikki A Doerr, Nicholas T Andriani et al.· Journal of the American Acad...· 0 citations
INTRODUCTION
In the geriatric age group, intertrochanteric hip fractures are a major public health concern. Definitive management is desired, considering age and associated comorbidities. This study was conducted to assess the functional outcome of unstable intertrochanteric femur fractures treated with proximal femoral nail antirotation II (PFNA-II) in the elderly population.
OBJECTIVE
To assess the functional outcome of fracture fixation using PFNA-II in elderly patients with unstable intertrochanteric fractures in a tertiary care center and study the complications associated with it.
METHODOLOGY
In this study, 64 patients fulfilling the criteria were included. The study setting was at the government medical college in Thiruvananthapuram. After admission according to the protocol, preoperative examination with detailed history taking was done. Then they were watched for any intraoperative complications and immediate postoperative complications, after 2 weeks in the outpatient department (OPD). Then, 3 months in OPD visit, the Harris Hip Score (HHS) was calculated, and finally, an average of the HHS was calculated as the final outcome, and a list of complications was also made.
RESULTS
The study included 64 patients with unstable intertrochanteric fractures who fulfilled the inclusion criteria. More than 75% of patients were with age more than 65 years, throwing light on to the fact that the incidence of fracture increase with old age. More than 70% of patients were female, and in about 89%, the mode of injury was fall at home. Among the 64 patients, 56 had a 31A2 type of injury according to the AO classification. Patients were treated depending on hospital protocols and were followed up on 2 weeks and after 3 months. They were functionally evaluated using the HHS, and complications were analyzed.
CONCLUSION
The study conducted at Government Medical College, Thiruvananthapuram, involving 64 patients with intertrochanteric fractures treated with PFNA-II, demonstrated a good functional outcome.
George Sonu, Gokul Gopan, Jeeva George et al.· Annals of African medicine· 0 citations
Background: Intertrochanteric femoral fractures are among the most common fragility fractures in elderly patients and are associated with significant morbidity. Early surgical fixation allows rapid mobilization and minimizes complications related to prolonged immobilization. Short Proximal Femoral Nail (PFN) has gained popularity because of its biomechanical advantages and minimally invasive nature.
Objectives: To evaluate the functional and radiological outcomes of intertrochanteric femoral fractures treated with Short PFN and to assess its advantages and complications.
Materials and Methods: A prospective observational study was conducted on 40 adult patients with intertrochanteric femoral fractures treated with Short PFN between March 2023 and March 2025 at Chigateri General Hospital and Bapuji Hospital, attached to JJM Medical College, Davangere. Patients were followed for six months with clinical and radiological assessment. Functional outcome was evaluated using the Modified Harris Hip Score.
Results: Forty patients were included, comprising 25 males (62.5%) and 15 females (37.5%). The majority of patients were aged 71–80 years. Boyd and Griffin Type II fractures were the most common (65%). Most fractures united satisfactorily with good functional recovery. The procedure was associated with minimal blood loss, shorter operative time, and a low complication rate. Functional outcome assessed using the Modified Harris Hip Score was predominantly good to excellent.
Conclusion: Short Proximal Femoral Nail provides stable fixation for both stable and unstable intertrochanteric femoral fractures. It offers excellent functional recovery, reliable fracture union, reduced surgical trauma, and facilitates early mobilization with acceptable complication rates.
Dr Shrivatsa G K, Dr Naveena H M, Dr Raghavendra KR et al.· PAIN, JOINTS, SPINE· 0 citations
Background: Distal tibial fractures are among the most commonly encountered long bone injuries. A variety of treatment approaches have been explored for the management of displaced fractures in this region. The two commonly used methods include plate fixation and intramedullary nailing. The aim of our research was to assess and compare the effectiveness of intramedullary nailing and plate fixation in the treatment of distal tibial fractures. Materials and Methods: This prospective comparative study included 60 patients aged >18 years with extra-articular distal tibial fractures who underwent surgical fixation with either intramedullary nailing or plate fixation at Eastern Medical College Hospital, Cumilla, Bangladesh, from January to December 2025. Patients were divided into two groups: intramedullary nailing (n=30) and plate fixation (n=30). After obtaining informed written consent, data were collected through face-to-face interviews using a pretested structured questionnaire that included sociodemographic data, clinical findings, and pre- and postoperative outcomes. Follow-up assessments were performed at 4, 8, 12, and 24 weeks postoperatively, and complications were recorded each visit. Data was analyzed using SPSS version 25.0. Ethical approval was obtained from the Review Board of Eastern Medical College. Results: Most patients were in the 31-50 years age group in both the nail fixation (53.3%) and plate fixation (60%) groups, with comparable mean ages (38.59±12.7 vs 37.86±11.2 years). Males were slightly more common in both groups. Motorcycle accidents were the most frequent cause of injury, and AO Type A fractures were the predominant fracture pattern. Nail fixation showed significantly faster fracture union (20.1 vs 22.8 weeks, p=0.01) and earlier weight-bearing (15.1 vs 16.3 weeks, p=0.01) compared to plate fixation. The overall complication rate was higher in the plate fixation group (46.7%) than in the nail fixation group (23.3%), with infections occurring only in the plate fixation group. Conclusion: The findings of this study suggest that both intramedullary nailing and plate fixation are safe and effective for the treatment of distal tibial fractures. However, intramedullary nailing may be considered a preferable option due to its shorter operative time, reduced hospital stays, earlier full weight-bearing, and lower infection rate.
Eastern Med Coll J. January 2026 Vol.11 No.1 : 60-65
Mohammad Khaza Ahamed, M. M. Rahman, G. Sarwar et al.· Eastern Medical College jour...· 0 citations
Femur intertrochanteric fractures are frequent injuries, especially in the elderly group of people, which is linked to high morbidity and functional impairment. DHS and Proximal Femur Nail (PFN) are common fixation techniques but the most effective modality of treatment is still under debate. The study aims to compare the results of the operative treatment of Trochanteric Hip Fractures (THF) performed with the help of DHS and PFN concerning the length of operation, period to fracture union and functional outcome. Between March 2024 and March 2026, the Department of Orthopaedics at Sree Balaji Medical College and Hospital in Chennai conducted a prospective comparative study. Thirty intertrochanteric fractured patients were selected and randomly assigned to either DHS (n=15) or PFN (n=15) fixation. Patients were monitored clinically and radiologically at six weeks, twelve weeks, and six months. The outcome measures were the duration of operation, time of fracture union, postoperative complications, pain, mobility, shortening of the limb, range of motion, and functional outcome. PFN fixation recorded shorter operative time, shorter incision, reduced postoperative pain, improved mobility recovery, less limb shortening and greater hip flexion than DHS fixation (p < 0.05). Fluoroscopy exposure time was significantly higher in the PFN group (p < 0.001). Fracture union time was comparable between the two groups (p = 0.83). Although functional outcomes favored PFN, the difference was not statistically substantial. Both DHS and PFN provided satisfactory fracture union and functional recovery. However, PFN offered compensations in operative efficiency and postoperative rehabilitation, suggesting its potential benefit for facilitating earlier functional recovery following intertrochanteric fracture fixation.
Vasanthkumar Chandrakumar, Yogeshwar Agharkar, S. K et al.· PAIN, JOINTS, SPINE· 0 citations
Background/Objectives: This study aimed to compare the incidence, extent, and time to diagnosis of osteonecrosis of the femoral head (ONFH) between Femoral Neck System (FNS) and multiple cannulated screw (CS) fixation in patients with femoral neck fractures (FNFs) at a minimum follow-up of 24 months, as well as to identify factors associated with ONFH after FNS fixation. Methods: A retrospective cohort study was conducted at a single university hospital involving patients aged ≥18 years with isolated FNFs treated by closed reduction and internal fixation using either FNS or multiple CS. Reduction quality, fracture union, incidence and extent of ONFH (measured by Kerboul angle), and revision surgery due to ONFH or other causes were assessed as outcome measures. Logistic regression analyses were conducted to identify factors associated with ONFH after FNS fixation. Results: Eighty-seven patients were included, comprising 48 in the FNS group and 39 in the CS group. No significant differences were found between the groups in reduction quality, union rate, or time to union (p > 0.05 for all). The incidence of ONFH did not differ significantly between the FNS and CS groups (p = 0.314). However, the FNS group showed a significantly greater extent of ONFH (p = 0.031) and longer mean time to ONFH diagnosis (p = 0.001). No significant differences were observed in revision surgery rates due to ONFH (p = 1.000) or other causes (p = 0.624). Multivariate analysis identified fracture displacement (Garden classification stages III and IV) and poor reduction quality (“Broken S” by Lowell’s criteria) as significant predictors of ONFH after FNS fixation. Conclusions: ONFH following FNS fixation tended to exhibit a larger necrotic area and a delayed radiographic onset compared to CS fixation; however, the overall incidence and revision rates were comparable between implants. These differences may be due to initial fracture displacement and baseline severity, rather than the FNS implant itself. In the FNS group, the mean time to radiographic diagnosis of ONFH was 13.1 months, and initial fracture displacement and reduction quality were identified as risk factors for the development of ONFH following FNS fixation. Therefore, long-term and vigilant follow-up is essential after FNS fixation, particularly in patients with displaced fractures. Achieving optimal reduction quality and anatomical femoral neck alignment remains paramount to mitigating the risk of ONFH after FNS fixation.
Incheol Kook, Sihoon Choi, Soo-young Jeong et al.· Journal of Clinical Medicine· 0 citations
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