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首页> 外文期刊>Injury >Open intramedullary nailing in neglected femoral diaphyseal fractures.
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Open intramedullary nailing in neglected femoral diaphyseal fractures.

机译：开放式髓内钉治疗被忽视的股骨干骨骨折。

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INTRODUCTION: Neglected femoral diaphyseal fractures are not uncommon in developing nations however there is a paucity of literature in this regard. Due to lack of effective traction, reduction or immobilisation these fractures are invariably associated with shortening and adjacent joint stiffness, presenting a challenging problem to the treating surgeon. The socioeconomic constraints in our society which result in patients seeking non-medical forms of treatment in the first place also warrant the need for an economically viable, simple effective form of treatment which can be carried out in a less advanced setup, gives reliable outcomes and allows early return to work. METHODS: Eleven patients with neglected or late presenting femoral diaphyseal fractures were considered for the study. All patients underwent open intramedullary nailing, bone grafting and manipulation of the knee under anaesthesia. Iliac crest graft was harvested when local callus did not suffice. All patients received a supervised regimen of physiotherapy. Patients were followed up clinically and with plain radiographs at 6 weeks and 3 months to assess union and at monthly intervals thereafter. RESULTS: The mean patient age was 28.8 years (15-48). The mean delay in presentation was 14 weeks (3-32 weeks). The mean shortening was 3.8 cm with four fractures showing signs of malunion. Five patients were given preoperative traction and bone resection was performed in only one patient. The mean hospital stay was 11 days (5-25 days). One patient was lost to follow up, of the remaining 10 patients all united at a mean of 11.9 weeks with 7 patients regaining full range of motion. The mean knee range of motion was 142.5 degrees . There were no wound related or neurological complications. One patient had a patellar tendon rupture which was repaired and another required dynamisation and bone marrow injection for delayed union. CONCLUSION: We conclude that the treatment of neglected femoral diaphyseal fractures with open intramedullary nailing and bone grafting followed by manipulation of the knee with preoperative traction in selected cases is a satisfactory method of treatment showing reliable bony union however knee mobilisation should be undertaken with caution.
机译：简介：被忽视的股骨干骨骨折在发展中国家并不少见，但是在这方面文献很少。由于缺乏有效的牵引，减少或固定，这些骨折总是与缩短和邻近的关节僵硬相关，这给治疗的外科医生提出了挑战性的问题。首先，导致患者寻求非医学形式治疗的社会经济制约因素也保证了经济可行，简单有效的治疗形式的需要，这种形式可以在较不先进的环境中进行，获得可靠的结果，并且允许及早恢复工作。方法：11例被忽视或晚期出现股骨干phy端骨折的患者被纳入研究范围。所有患者均在麻醉状态下进行开放式髓内钉，植骨和膝关节操作。当局部愈伤组织不足时，收获lia骨移植物。所有患者均接受了物理疗法的监督治疗。对患者进行临床随访，并在6周和3个月进行X线平片检查，以评估合并情况，此后每月间隔一次。结果：平均患者年龄为28.8岁（15-48岁）。呈现的平均延迟为14周（3-32周）。平均缩短为3.8 cm，其中四个骨折均显示畸形迹象。 5例患者接受了术前牵引，只有1例患者进行了骨切除术。平均住院时间为11天（5-25天）。一名患者失去随访，其余10例患者平均平均11.9周团结在一起，其中7例患者恢复了全部运动。平均膝关节活动范围为142.5度。没有伤口相关或神经系统并发症。一名患者的a骨肌腱断裂得以修复，另一名患者需要进行动力检查和骨髓注射以延迟愈合。结论：我们得出结论，在选定的病例中，采用开放式髓内钉和植骨术，然后在术前牵引下操作膝关节，治疗被忽视的股骨干phy端骨折是一种显示出可靠的骨结合的令人满意的治疗方法，但应谨慎进行膝关节动员。

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