OTA 2007 Posters

Scientific Poster #13 Femur OTA-2007

What Intraoperative Factors May Influence Postoperative Femoral Fracture Reduction and Rotation: A Clinical Evaluation

Tobias Hüfner, MD1 (n); Musa Citak, MD1 (n); Gil R. Ortega, MD; MPH2 (n);
Daniel Kendoff, MD1 (n); Mustafa Citak, MD1 (n); Christian Krettek, MD1 (n);
1Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany;
2Sonoran Orthopaedic Trauma Surgeons, Scottsdale Healthcare, Scottsdale, Arizona, USA

Purpose: During femoral shaft fracture reduction and intramedullary nailing, there may be a high incidence of errors regarding femoral fracture reduction axis and length. In our review of the literature, it appears that there may be a wide spectrum of abnormalities concerning femoral shaft fracture reduction and deviations in femoral axis and length. The purpose of our study was to investigate the deviations in femoral diaphysis fracture axis rotation and length abnormalities while analyzing factors that may commonly influence femoral fracture reduction.

Methods: Using a retrospective data analysis, we found 82 patients at our institution who suffered a femoral shaft fracture and were treated with reduction and intramedullary nail fixation. All patients were analyzed in different comparison groups while using different measurement parameters. The groups were separated by fracture pattern, open versus closed reduction, surgeon (resident or attending), surgical approach (antegrade or retrograde), and the influence of the time when the patient was operated on (12 am-8 am and 8 am-12 am. Parameters were difference of postoperative femoral axis, postoperative length of femur, fluoroscopy time, and the operating time.

Results: Complex fractures showed a significantly higher error rate in the femoral axis angle deviation when compared to simple fracture patterns (19.43° vs 8.98°; P <0.05). When measuring the four parameters, there was no significant difference whether the fracture was reduced by open or closed reduction techniques, if the procedure was done by resident or attending, or if the approach was antegrade or retrograde. The operations done between 12 am and 8 am had a higher femoral axis deviation angle (15.24°) than those cases done between 8 am and 12 am (10.28°; P >0.05). There were no significant differences in the mean values for operative time, x-ray time, and leg length (P >0.05).

Conclusion/Significance: Our study shows that fixation of complex femoral shaft fractures have a higher rate of femoral axis deviations when compared to simple fracture patterns. Also, fractures fixed between 12 am and 8 am had a higher femoral axis deviation (15.24°) than those cases done between 8 am and 12 am (10.28°) (P >0.05). Therefore, we believe that complex femoral fractures may benefit from careful evaluation of the femoral axis deviation with reduction and fixation with a potential benefit in using a peak work time for treatment.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing.