| Objective To explore the clinical efficacy and related indications of combined fixation with intramedullary nail and plate for the treatment of unstable non-isthmus femoral fractures with butterfly bone fragment, providing reference for the selection of clinical surgical schemes.Methods A retrospective study was conducted on 62 patients with non-isthmus femoral fractures accompanied by butterfly bone fragment, who were admitted to Taicang Hospital Affiliated to Suzhou University from June 2017 to June 2020. They were divided into simple intramedullary nail group (37 cases) and combined fixation with intramedullary nail and plate group (25 cases), according to the inclusion and exclusion criteria. The simple intramedullary nail group was fixed with intramedullary nails alone, while the combined fixation group was fixed with intramedullary nails combined with plates. The surgical time, intraoperative bleeding, time for first straight leg lift after surgery, VAS pain score on the first day and one week after surgery, knee joint flexion at one week and one year after surgery, and fracture healing time, PPMS functional score and incidence of healing related adverse events at 1 year after surgery were observed in both groups. Changes in the rotation angle of the affected limb, angular deformity of the coronal position of the affected limb, degree of displacement of the butterfly bone fragment, and the RUST score of fracture healing one year after surgery was dynamically observed to evaluate stability.Results The patients were followed up for an average of 24-35 months, with an average of (28.18±3.02) months. There was no statistically significant difference in surgical time between the two groups (P>0.05). The intraoperative bleeding volume in the intramedullary nail group was significantly lower than combined fixation group, and fracture healing time in the intramedullary nail group was significantly longer than combined fixation group (P<0.05). There was no statistical difference between the two groups in first straight leg elevation time and postoperative VAS score (P>0.05). The flexion angle in the intramedullary nail group was significantly better than combined fixation group at 1 week post operation (P<0.05), but there was no statistically significant difference at 1 year post operation (P>0.05). There was no significant difference in PPMS score at 1 year post operation between the two groups (P>0.05). Four cases of bone non union occurred in the simple intramedullary nail group, of which 1 case also experienced nail breakage. The incidence of healing related adverse events was 10.8% (4/37). There was 1 case of bone nonunion in the nail plate combined fixation group, with an overall incidence of adverse events of 4% (1/25) (P>0.05). The incidence of femoral rotation deformity angle ≥10°in the simple intramedullary nail group was significantly higher than that in combined fixation group at 1 week and 1 year post-operation, and the difference was statistically significant (P<0.05). There was no statistically significant difference (P>0.05) between the two groups with a coronary deformity angle of ≥5°1 week post-operation, but the coronary deformity angle of ≥5°in the simple intramedullary nail group was much higher than that in combined fixation group 1 year post-operation, and the difference was statistically significant (P<0.05). The average displacement distance of the butterfly bone fragment before surgery in the intramedullary nail group was (16.51±3.48) mm, while in the combined fixation group it was (15.52±4.16) mm (P>0.05), but the distance was (14.35±3.99) mm in the intramedullary nail group and (5.08±2.14) mm in the combined fixation group one week post operation (P<0.05).Conclusion For unstable non-isthmus femoral fractures with butterfly bone fragment, combined fixation with intramedullary nail and plate can improve reduction quality and increase postoperative stability. Moreover, the incidence of adverse events related to fracture healing is lower than that of simple intramedullary nail fixation. |
