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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 April;59(2):81-6
Unreamed intramedullary nailing for the treatment of femoral shaft fractures
Rosario L., Salvatore L., Palmisciano G., Rapisarda S. A.
Unità Operativa di Ortopedia e Traumatologia Azienda Ospedaliera S. Giovanni di Dio Agrigento, Agrigento, Italia
Aim. The aim of this article was to report Authors’ clinical experience on surgical treatment of femoral fractures using the unreamed intramedullary nailing.
Methods. Between January 2003 and February 2005, 52 femoral shaft and both proximal and distal femoral metaphisis fractures have been treated (36 men, 16 women, with average age of 26 years); surgical treatment was performed within 12 h by the trauma. Fourty-four patients presented closed fractures while eight had a 1st or 2nd grade exposition according to Gustilo. Endomidollar unreamed femoral nails were used.
Results. The complete consolidation of the fracture was reached in15-20 weeks, except in one case of bilateral fracture that after six months was successfully treated with active ultrasounds; three patients suffered from venous thromboembolism. In four cases the fractured limb was shortened of 1 cm and in five cases <1 cm.
Conclusion. This study demonstrates that unreamed intramedullary nailing, when indicated, is the best treatment choice for femoral fractures; this method, besides a higher respect for the biology, reduces the risk of hemorrhages, infections, venous thromboembolism and guarantees early hospital discharge. Moreover, emergency surgery, along with endomidollary nailing, may reduce anemia risk; in average two red cells concentrates were used after surgery, with a hemoglobin average levels of 8.1 mg/dL. The 25% of patients did not need any transfusion.