Effect of postoperative fracture gap on bone union : A retrospective cohort analysis of simple femoral shaft fractures
Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved..
BACKGROUND: Intramedullary nailing (IMN) is considered the gold-standard treatment for femoral shaft fractures. The post operative fracture gap is commonly recognized as a risk factor for nonunion. However, no evaluation standard for measuring the fracture gap size has yet been established. In addition, the clinical implications of the fracture gap size have also not been determined so far. This study aims to clarify how we should evaluate fracture gaps when assessing simple femoral shaft fractures with radiographs and to determine the acceptable cut-off value of the fracture gap size in simple femoral shaft fractures.
METHOD: A retrospective observational study with a consecutive cohort was conducted at the trauma center of a university hospital. We investigated the fracture gap using postoperative radiography and the postoperative bone union of transverse and short oblique femoral shaft fractures fixed by IMN. The receiver operating characteristic curve analysis was conducted to obtain the fracture gap's mean, minimum, and maximum cut-off values. Fisher's exact test was used at the cut-off value of the most accurate parameter.
RESULTS: In the four nonunions among the 30 cases, the analysis using ROC curves revealed that the maximum value had the highest accuracy among the maximum, minimum, and mean values of fracture-gap size. The cut-off value was determined to be 4.14 mm with high accuracy. Fisher's exact test showed that the incidence of nonunion was higher in the group with a maximum fracture gap of 4.14 mm or greater (risk ratio = not applicable, risk difference = 0.57, P = 0.001).
CONCLUSION: In simple transverse and short oblique femoral shaft fractures fixed with IMN, the fracture gap on radiographs should be evaluated by the maximum gap in the AP and lateral views. The remaining maximum fracture gap of ≥4.14 mm would be a risk factor for nonunion.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
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| Enthalten in: |
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association - 29(2024), 2 vom: 28. März, Seite 632-636 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nakagawa, Tomoo [VerfasserIn] |
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| Links: |
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| Themen: |
Delayed union |
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| Anmerkungen: |
Date Completed 08.03.2024 Date Revised 08.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jos.2023.02.012 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM354200720 |
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| 100 | 1 | |a Nakagawa, Tomoo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effect of postoperative fracture gap on bone union |b A retrospective cohort analysis of simple femoral shaft fractures |
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| 500 | |a Date Revised 08.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved. | ||
| 520 | |a BACKGROUND: Intramedullary nailing (IMN) is considered the gold-standard treatment for femoral shaft fractures. The post operative fracture gap is commonly recognized as a risk factor for nonunion. However, no evaluation standard for measuring the fracture gap size has yet been established. In addition, the clinical implications of the fracture gap size have also not been determined so far. This study aims to clarify how we should evaluate fracture gaps when assessing simple femoral shaft fractures with radiographs and to determine the acceptable cut-off value of the fracture gap size in simple femoral shaft fractures | ||
| 520 | |a METHOD: A retrospective observational study with a consecutive cohort was conducted at the trauma center of a university hospital. We investigated the fracture gap using postoperative radiography and the postoperative bone union of transverse and short oblique femoral shaft fractures fixed by IMN. The receiver operating characteristic curve analysis was conducted to obtain the fracture gap's mean, minimum, and maximum cut-off values. Fisher's exact test was used at the cut-off value of the most accurate parameter | ||
| 520 | |a RESULTS: In the four nonunions among the 30 cases, the analysis using ROC curves revealed that the maximum value had the highest accuracy among the maximum, minimum, and mean values of fracture-gap size. The cut-off value was determined to be 4.14 mm with high accuracy. Fisher's exact test showed that the incidence of nonunion was higher in the group with a maximum fracture gap of 4.14 mm or greater (risk ratio = not applicable, risk difference = 0.57, P = 0.001) | ||
| 520 | |a CONCLUSION: In simple transverse and short oblique femoral shaft fractures fixed with IMN, the fracture gap on radiographs should be evaluated by the maximum gap in the AP and lateral views. The remaining maximum fracture gap of ≥4.14 mm would be a risk factor for nonunion | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Delayed union | |
| 650 | 4 | |a Femoral shaft fracture | |
| 650 | 4 | |a Fracture gap | |
| 650 | 4 | |a Nonunion | |
| 700 | 1 | |a Inui, Takahiro |e verfasserin |4 aut | |
| 700 | 1 | |a Matsui, Kentaro |e verfasserin |4 aut | |
| 700 | 1 | |a Ishii, Keisuke |e verfasserin |4 aut | |
| 700 | 1 | |a Suzuki, Takashi |e verfasserin |4 aut | |
| 700 | 1 | |a Kurozumi, Taketo |e verfasserin |4 aut | |
| 700 | 1 | |a Kawano, Hirotaka |e verfasserin |4 aut | |
| 700 | 1 | |a Watanabe, Yoshinobu |e verfasserin |4 aut | |
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