Background: Pediatric femoral shaft fractures are one of the common fractures that we encounter in the orthopedics outpatient department. These fractures have various treatment options ranging from traction and early hip spica casting to elastic titanium intramedullary nails [titanium elastic nailing system (TENS)] and reamed intramedullary nails. In this study, we are evaluating the functional outcome and results following the use of flexible intramedullary nails and conservative management for femoral shaft fractures in children. Methods: This was a prospective observational study which was carried out in a tertiary care hospital from October 2015 to May 2017 for two groups of children who sustained traumatic femoral shaft fractures. A total of 40 patients were taken into consideration with 20 patients each in two groups. Results: The male-to-female ratio was 2. 6: 1 in our study population. The overall post-operative complication rate was more in the TENS group. Besides, we found that the TENS group of patients had a less limb length discrepancy (LLD) (P = 0. 004) and a lower degree of angular deformity (P = 0. 36). Conclusion: TENS demonstrated advantages including sufficient axial stability, early mobilization, and more rapid return to function than spica cast treatment, however, it had the drawback of possible infection and pin site irritation. Overall, TENS offers a minimally invasive method for treatment of the femoral shaft fractures in children which stands superior to traditio nal spica casting.

Background: Simultaneous knee ligament injury with femoral shaft fracture happens not infrequently. Such injuries may be missed on initial evaluation of the broken limb. In this study we report the prevalence of knee ligament injury in a group of isolated femoral fractures.Materials and Methods: A total of 125 patients with isolated femoral fractures entered to this study and followed for 24 months. After fixation of their fractures, all patients underwent a thorough examination of knee ligaments in the operating room.Results: Among these 123 cases 75.1% were male. Mean age was 26.2 years. There were 39 patients (31.2%) with simultaneous ligamentous injury. The types of ligamentous injury were as follow: medial collateral ligament (18), posterior cruciate ligament (12), lateral collateral ligament (6), and anterior cruciate ligament (3).Conclusion: Based on the above findings, it is recommended to have a high index of suspicion for co-existence of knee injuries in ipsilateral fracture of femoral shaft.

Background: Femoral nonunion is an important complication, which can occur after intramedullary nailing and it requires surgical intervention. Plate augmentation over intramedullary nail is emerging as an acceptable option with satisfactory results for femoral nonunion. Objectives: The aim of the present study was to determine whether plate augmentation over retained intramedullary nail is an effective treatment for nonunion of femoral shaft fracture. Methods: Overall, 35 cases of femoral nonunion, initially treated with intramedullary nailing, were managed with plating augmentation. Patients with oligotrophic or atrophic nonunion also received iliac cancellous auto graft. The outcome was evaluated by the rate and duration of union and complications were recorded. Results: All patients achieved bony union during an average time of 21 weeks ( 3. 94) and no union occurred later than 35 weeks. In plain radiography, evidence of callus formationwasseen atmeantime of 10 weeks. Therewasnostatistically significant difference in union time among different types of nonunion (P: 0. 466) while a significant difference was noticed in the time for callus formation (P < 001). Also, no complications were observed. Conclusions: Plating augmentation is an effective and safe treatment option for nonunion of femoral shaft fractures.

Background: Treatment of femoral shaft fracture in children depends on age and condition of patient, and may consist of Spica casting, traction followed by casting, external fixator, plate fixation and intramedullary nailing. Leg length discrepancy is a common complication after this fracture. Growth stimulation following this fracture has been known for years but precise cause remains unknown. This is a report on leg length discrepancy observed in a group of younger children who had been treated with casing, and an older group who received plate fixation for their femoral shaft fractures.Methods: In a cross sectional study, 233 children under 12 years with femoral shaft fracture who had been treated between years 1993 and 1997 in two hospitals in Ahvaz-Iran, were studied. Patients were studied in two groups of surgery or plate fixation (125 patients) and non-surgery or casting (108 patients). With a mean follow of 49 months (22-82 months) clinical and radiographic evaluation of leg lengths was performed, and possible factors responsible for discrepancy were assessed.Results: The mean leg length discrepancy in plate fixation was 6.6 mm, and with casting was 1.93 mm. Gender or side of fracture had no significant relationship with post treatment leg length discrepancy Conclusion: Leg length discrepancy is more likely to be observed in children’s femoral fractures treated with plate fixation. The discrepancy, however, is not a significant amount.

Background: Femoral shaft fractures regularly occur after major trauma, such as road traffic accidents and falls from a height (1, 2). These fractures usually are associated with concurrent injuries due to the high-energy forces in the trauma (3). In addition, due to osteopenia, this type of fracture is also frequent in the elderly population (1, 4). The AO Foundation/Orthopedic Trauma Association (AO/OTA) has categorized femoral shaft fractures into three subtypes: A, B, and C,they represent the simple fracture, fractures with more than two fragments (with maintained continuity), and complicated with disjoined bone cortex subsequently (5). . .

Background: Fat embolism syndrome symptoms is due to the presence of free fat globules originates from bone marrow and deposit in parenchyma of the lung, brain, and other organs and in most cases is particularly due to long bones, or pelvic fractures and can be accompanied by considerable complications and mortality. The aim of this research is to evaluate effect of early fixation of femoral fractures on preventing of fat emboli.Materials and Methods: In a double blind nonrandomized clinical trial study 174 patients with femoral fractures enrolled in four groups and in the first 12 hours after fracture occurrence were treated as below Group I: included 53 patients were treated by means of open reduction and internal fixation with screws and plate. Group II: included 46 patients were treated by means of skeletal traction. Group III: included 33 patients that were not treated by means of any methods of fracture fixation. Group IV: included 42 patients were treated by means of interlocking intramedullary nailing. With use of Chi-square, ANOVA and Tukey post hoc test there were significant differences among groups (p=0.003).Results: 11 patients in all groups and in Group A, any patients, in Group B, four patients (7.8%) in group three, six patients (18.1 %) in group four, one patient had fat embolism syndrome (4.2%).Conclusion: The main point in the prevention of fat embolism syndrome is stabilization of fracture site of long bones as soon as possible.

Background: Stabilization of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults; however, to ream or not to ream is still being debated.Objectives: The primary objective of this study was to determine clinical results following unreamed versus ream intramedullary nailing of femoral fractures.Patients and Methods: Between January 2008 and August 2009, 50 patients with femoral shaft fractures were treated with unreamed or reamed femoral nails in our clinic. From this prospective single centre study, 16 patients were excluded due to insufficient follow-up data. According to the AO classification, fractures in this study were either type A or B. Dynamic proximal locking was performed in all cases. The remaining 34 patients were divided into two groups of 17 with ream or unream nailing. During and after the operation, we evaluated some variables in whole series.Results: After statistical analyzes, we found that there were no differences in radiologic union time (P=1) or full weight bearing time (P=0.73) between ream and unream nailing. Nail breakage or iatrogenic fractures during nail insertion did not occur and we did not have any fat emboli in both groups but one secondary loss of reduction occurred in the unream group. Superficial infection after the operation was seen in one case which was treated successfully with antibiotics. In the ream group surgical time was about thirty minutes longer and differences were significant (P=0.000). Patients had to pay more for ream nailing but the difference was not significant. We found no statistical difference between union time with or without reaming; on the other hand, there was significant increased operation length, blood loss and systemic changes in BP or So2 in the ream group versus the unream group.Conclusions: We advocate that unream nailing in traumatic femoral shaft fractures is a simple, safe and effective procedure with significant advantages, especially in multitrauma patients.

Introduction & Objective: Closed intramedullary nailing has become the standard treatment for femoral shaft fractures, but because the existing closed reduction methods are difficult and demanding, in the most trauma centers these fractures usually are treated by open reduction method. Our objective was close reduction of these difficult fractures by a simple but effective method using Schanz screws for manipulating fracture fragments on a radiolucent table.Materials & Methods: In this prospective study, 30 patients whose femoral shaft fractures required reduction were operated on a radiolucent table in the lateral position and their fractures reduced closed by SchaZ pins and fixed with IM Rod. The patients were followed up 1 year.Results: We obtained reduction in 93% of patients. Average time of reduction in the first 48 hours was 9.23minutes and after 48 hours it was 19.7minutes (p<0.05). Also time to reduction was dependent on amount of preoperative traction. When the amount of preoperative traction was 5kg, that time was 19.16minutesbut in maximal amount of traction it was 10.29minutes. Time to reduction also was shorter in Winquist-Hansen type In and IV fractures than in type I and n fractures. There was 13% valgus deformity (5-10 °), 33% external malrotation (5-15°) and 37% shortening (up to 1-3 cm). But we had no infection and no need for blood transfusion or bone grafting.Conclusion: Schanz screws provide a very effective method for close reduction of femoral shaft fractures. Complications of this method are the same or even in some parts are less than other close reduction methods. The method is more successful if performed in the first 48 hours, or if the weight of preoperative skeletal traction is near to the maximum (15% of body weight).

Background and Objective: Femoral shaft traumatic fracture is one of the major causes of mortality and morbidity. Nowadays, the standard treatment method in adult is reduction with femoral interlocking intramedullary nailing. This study was performed to compare the open and closed methods femoral interlocking intramedullary nailingin femoral shaft fractures treatment.Materials and Methods: This clinical trial study was done on 40 18-50 year old patients (33 men and 7 women with mean age of 26.3 years) with femoral shaft closed fracture who were referred to the Shahid Kamyab hospital of Mashhad, Iran during 2007-08. Patients were divided into two 20 membered groups of open and close femoral interlocking intramedullary nailing treatment. Subjects were followed for one year and the union time, infection and non-union level were measured. Clinical and radiological findings were analyzed using SPSS-13, Student’s t-test and Fisher's exact test.Results: 97.5% of union was obtained within six months in both groups. Full weight bearing was determined 6-12 weeks (mean of 9.3 weeks) in close and 12-16 weeks (mean of 13.25 weeks) in open reduction. Complications included non-union in open (one patient, 5%), infection in open (one patient, 5%), shortening in both (one patientin, 5%), limited range of movement in both (one patient, 5%) and malrotation in close (one patient, 5%) groups. Close reduction group showed higher rate of radiologic callus formation and earlier full weight bearing than open reduction group (P<0.005), but union rate was not significant.Conclusion: This study showed that there is no difference between final union rate of open and close reduction by interlocking intramedullary nailing in femoral shaft fractures.