Abstract
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.
Keywords
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Article info
Publication history
Published online: March 11, 2023
Accepted:
February 17,
2023
Received in revised form:
February 14,
2023
Received:
March 14,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
