Leg length discrepancies in adult femoral shaft fractures treated with intramedullary nailing

BACKGROUND
To evaluate the leg length discrepancy (LLD) retrospectively in adult femoral shaft fractures treated with intramedullary nailing (IMN).
METHODS
Sixty-three patients (58 male, 5 female; mean age 29.9±12.4; range 15 to 77 years) were included in the study. Fractures were identified according to the Winquist-Hansen (W) system and AO classification. 16 W0, 18 WI, 16 WII, 7 WIII, and 6 WIV fractures and 35 type A, 22 type B, and 6 type C fractures were repaired. Thirty-one (49.2%) patients had multiple injuries. Fourteen patients sustained an open fracture. LLDs were measured on physical examination and using orthoroentgenography.
RESULTS
The mean follow-up was 90.2±29.9 (39-193) months. The mean LLD was 12.3±15.2 [12-(-60)] mm using orthoroentgenography and 12.9±13.7 [10-(-60)] mm according to manual measurement. In seven cases, no LLD was observed. Twenty-seven shortenings and one lengthening were observed in the 28 femurs with a discrepancy greater than 10 mm (44.4%). There was no statistical correlation between LLD and open or closed fracture (r=0.02, p=0.86), polytrauma (r=-0.09, p=0.47), or delayed surgery (p=0.31), but there was a tendency to a greater discrepancy in comminuted fractures (WIII, IV) (r=0.33, p=0.007).
CONCLUSION
LLD may be seen in high rates in adult femoral shaft fracture cases treated with IMN. Static IMN following absolute restoration of the length may prevent this problem in femoral diaphysis fractures, especially comminuted WIII and IV types.

Ýntramedüller çivileme uygulanan eriþkin femur diafiz kýrýklý olgularda ekstremite uzunluk eþitsizliði

AMAÇ
Ýntramedüller çivileme uygulanan eriþkin femur diafiz kýrýklý olgularda ekstremite uzunluk eþitsizliði (EUE) geriye dönük olarak deðerlendirildi.
GEREÇ VE YÖNTEM
Altmýþ üç hasta (58 erkek, 5 kadýn; ort. yaþ 29,9±12,4; daðýlým 15-77) çalýþma grubunu oluþturdu. Kýrýklar Winquist-Hansen (W) ve AO sýnýflamalarýna göre tanýmlandý. 16 W0, 18 WI, 16 WII, 7 WIII, 6 WIV ve 35 tip A, 22 tip B, 6 tip C kýrýk tedavi edildi. Olgularýn 30’una konvansiyonel, 18’ine distal kilitli, 12’sine statik ve 3’üne proksimal kilitli çivileme uygulandý. Ekstremite uzunluk eþitsizliði fiziksel inceleme ve ortoröntgenografi ile deðerlendirildi.
BULGULAR
Ortalama izlem süresi 90,2±29,9 (daðýlým 39-193) ay, ortalama EUE ortoröntgenografi ile 12,3±15,2 [12-(-60)] mm, fiziksel inceleme ile 12,9±13,7 [10-(-60)] mm bulundu. Yalnýz yedi olguda EUE saptanmadý. 10 mm’den fazla uzunluk eþitsizliði tespit edilen 28 femurda 27 kýsalýk ve 1 uzunluk vardý (%44,4). Açýk ve kapalý kýrýklar (r=0,02, p=0,86), politravma (r= -0,09, p=0,47) ve geç cerrahiye alýnma süresi (p=0,31) ile uzunluk eþitsizliði arasýnda anlamlý iliþki saptanmadý. Bununla birlikte, parçalý kýrýklar (WIII, IV) (r=0,33, p=0,007) ile anlamlý iliþki saptandý.
SONUÇ
Ýntramedüller çivileme uygulanan eriþkin femur diafiz kýrýklý olgularda EUE yüksek oranda görülebilmektedir. Özellikle parçalý (WIII, IV) femur diafiz kýrýklarýnda mutlak kemik uzunluðunun saðlanmasýndan sonra yapýlacak statik intramedüller çivileme uygulamasý bu sorunun önüne geçebilir.