FORENSIC ASSESSMENT OF ADVERSE OUTCOMES OF ISOLATED DIAPHYSEAL FEMORAL FRACTURES
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Keywords

diaphyseal femoral fracture, surgical treatment, perioperative risk factors, postoperative complications, unsatisfactory outcomes

How to Cite

Sokol, V. (2020). FORENSIC ASSESSMENT OF ADVERSE OUTCOMES OF ISOLATED DIAPHYSEAL FEMORAL FRACTURES. Inter Collegas, 7(1), 26-33. https://doi.org/10.35339/ic.7.1.26-32

Abstract

FORENSIC ASSESSMENT OF ADVERSE OUTCOMES OF ISOLATED DIAPHYSEAL FEMORAL FRACTURES

Sokol V.

Fractures of the diaphysis of the femur are one of the most frequent mechanical injuries of the skeleton, however, the frequency and causes of the development of the complicated post-traumatic period are not well understood. The aim of this research was to study the causes of the development of adverse outcomes of isolated diaphyseal femoral fractures. Object and methods of research. Retrospective analysis of the protocols of clinical and radiological examination of 21 patients with adverse outcomes of a femoral diaphysis fracture, which, according to the results of the initial expert assessment, did not establish the severity of injuries due to the development of complications in the postoperative period. Results. The main cause of fractures in this category of patients is road traffic accidents (90.4% of cases); closed fractures of the femoral diaphysis (85.7%) in the middle third (76.1%) in men (76.2%) prevailed. The following reasons for the unsatisfactory results of surgical treatment of diaphyseal fractures of the femur were revealed: 1) patient-dependent: a combination of overweight and arthrosis of adjacent (hip and knee) joints - 57.1%; violation of the motor regime in the form of physical inactivity (19.0%) and excessive axial load on the operated leg (19.0%); 2) implant-dependent: a mismatch between the dimensions of the device for immersion osteosynthesis and the anatomical sizes of the corresponding segments of the femur in all cases; 3) surgical-dependent causes: unresolved intraoperative displacement of fragments of the femur (23.8%), violation of the technology of radiation diagnostics (14.3%), violation of the terms of postoperative x-ray monitoring (23.8%) and perioperative antibiotic prophylaxis (14.3%). The consequence of this was a violation of the stability of osteosynthesis in 95.2% with a secondary displacement of bone fragments of the femur (47.6%), delayed consolidation of a hip fracture (61.9%), the formation of pseudarthrosis of the femur (38.1%), and post-traumatic femoral deformity bones (71.4%), development of post-traumatic contracture of the knee joint (81.0%), suppuration of the postoperative wound (23.8%), development of post-traumatic osteomyelitis (14.3%), migration of screws from the osseous plate (47.6% ), migration of a distal blocked nail from the intramedullary st rust (4.8%), intramedullary rod migration (4.8%).

Keywords: diaphyseal femoral fracture, surgical treatment, perioperative risk factors, postoperative complications, unsatisfactory outcomes.

 

Резюме.

СУДОВО-МЕДИЧНА ОЦІНКА НЕСПРИЯТЛИВИХ НАСЛІДКІВ ІЗОЛЬОВАНИХДІАФІЗАРНИХ ПЕРЕЛОМІВ СТЕГНОВОЇ КІСТКИ.

Сокол В.К.

Переломи діафіза стегнової кістки є однією з найбільш частих механічних травм скелета, проте частота і причини розвитку ускладненого посттравматичного періоду вивчені недостатньо. Метою даного дослідження стало вивчення причин розвитку несприятливих наслідків ізольованих діафізарних переломів стегнової кістки. Об'єкт і методи досліджень.Ретроспективний аналіз протоколів клініко-рентгенологічного обстеження 21 хворого з несприятливими наслідками перелому діафіза стегнової кістки, яким за підсумками первинної експертної оцінки не була встановлена ​​ступінь тяжкості тілесних ушкоджень у зв'язку з розвитком ускладнень в післяопераційному періоді. Результат досліджень. Основна причина переломів у даній категорії пацієнтів - дорожньо-транспортні пригоди (90,4% випадків); переважали закриті переломи діафіза стегнової кістки (85,7%) в середній третині (76,1%) у чоловіків (76,2%). Виявлено наступні причини незадовільних результатів хірургічного лікування діафізарних переломів стегнової кістки: 1) паціентзалежні: поєднання надмірної ваги і артрозу суміжних (кульшового і колінного) суглобів - 57,1%; порушення рухового режиму у вигляді гіподинамії (19,0%) і надлишкового осьового навантаження на оперовану ногу (19,0%); 2) імплантзалежні: невідповідність розмірів пристрою для погружного остеосинтезу і анатомічних розмірів відповідних сегментів стегнової кістки у всіх випадках; 3) хірургзалежні причини: неусунення інтраопераційно зміщення фрагментів стегнової кістки (23,8%), порушення технології променевої діагностики (14,3%), порушення термінів післяопераційного рентгенконтроля (23,8%) і періопераційної антибіотикопрофілактики (14,3%). Наслідком цього стало порушення стабільності остеосинтезу в 95,2% з вторинним зміщенням кісткових фрагментів стегнової кістки (47,6%), сповільнена консолідація перелому стегна (61,9%), формування псевдоартрозу стегнової кістки (38,1%), посттравматична деформація стегнової кістки (71,4%), розвиток посттравматичної контрактури колінного суглоба (81,0%), нагноєння післяопераційної рани (23,8%), розвиток посттравматичного остеомієліту (14,3%), міграція гвинтів з накісткової пластини (47,6% ), міграція дистального цвяха, що блокує, з інтрамедулярного стрижня (4,8%), міграція інтрамедулярного стрижня (4,8%).

Ключові слова: діафізарний перелом стегна, хірургічне лікування, періопераційні фактори ризику, післяопераційні ускладнення, незадовільні наслідки діафізарних переломів стегна.

 

Резюме.

СУДЕБНО-МЕДИЦИНСКАЯ ОЦЕНКА НЕБЛАГОПРИЯТНЫХ ИСХОДОВ ИЗОЛИРОВАННЫХ ДИАФИЗАРНЫХ ПЕРЕЛОМОВ БЕДРЕННОЙ КОСТИ.

Сокол В.К.

Переломы диафиза бедренной кости являются одной из наиболее частых механических травм скелета, однако частота и причины развития осложненного посттравматического периода изучены недостаточно. Целью данного исследования стало изучение причин развития неблагоприятных исходов изолированных диафизарных переломов бедренной кости. Объект и методы исследований. Ретроспективный анализ протоколов клинико-рентгенологического обследования 21 больного с неблагоприятными исходами перелома диафиза бедренной кости,которым по итогам первичной экспертной оценки не была установлена ​​степень тяжести телесных повреждений в связи с развитием осложнений в послеоперационном периоде.Результат исследований. Основная причина переломов у данной категории пациентов - дорожно-транспортные происшествия (90,4% случаев); преобладали закрытые переломы диафиза бедренной кости (85,7%) в средней трети (76,1%) у мужчин (76,2%). Выявлены следующие причины неудовлетворительных результатов хирургического лечения диафизарных переломов бедренной кости: 1) пациентзависимые: сочетание избыточного веса и артроза смежных (тазобедренного и коленного) суставов - 57,1%; нарушение двигательного режима в виде гиподинамии (19,0%) и избыточной осевой нагрузки на оперированную ногу (19,0%); 2) имплантзависимые: несоответствие размеров устройства для погружного остеосинтеза и анатомических размеров соответстующих сегментов бедренной кости во всех случаях; 3)хирургзависимые причины: неустраненное интраоперационно смещение фрагментов бедренной кости (23,8%), нарушение технологии лучевой диагностики (14,3%), нарушение сроков послеоперационного рентгенконтроля (23,8%) и периоперационной антибиотикопрофилактики (14,3%). Следствием этого явилось нарушение стабильности остеосинтеза в 95,2% с вторичным смещением костных фрагментов бедренной кости (47,6%), замедленная консолидация перелома бедра (61,9%), формирование псевдоартроза бедренной кости (38,1%), посттравматическая деформация бедренной кости (71,4%), развитие посттравматической контрактуры коленного сустава (81,0%), нагноение послеоперационной раны (23,8%), развитие посттравматического остеомиелита (14,3%), миграция винтов из накостной пластины (47,6%), миграция дистального блокируемого гвоздя из интрамедуллярного стержня (4,8%),  миграция интрамедуллярного стержня (4,8%).

Ключевые слова: диафизарный перелом бедра, хирургическое лечение, периоперационные факторы риска, послеоперационные осложнения, неудовлетворительные исходы переломов диафиза бедра.

https://doi.org/10.35339/ic.7.1.26-32
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References

Deepak, CD., Chethan, BA. (2019). A study of functional outcome of femoral diaphyseal fractures by closed reduction and internal fixation using intramedullary interlocking nail in adults. International Journal of Orthopedic Science, 5(1),132-138. DOI: https://doi.org/10.22271/ortho.2019.v5.i1c.25.

McLaughlin, MA, Orosz, GM, Magaziner, J, HannanEL, McGinn, T, Morrison, RS, Hochman T, & Koval K. (2006). Preoperative status and risk of complications in patients with hip fracture. Journal of General Internal Medicine, 21(3),219-225.

Giannoudis, PV. (2003). Surgical priorities in damage control in polytrauma. Journal of Bone Surgery (Br), 85,478-83.

Plotnikov, IV, Bondarenko, AV. (2012). Oslozhneniya intramedulluarnogo blokiruemogo osteosynteza diafizarnyh perelomov bedra u patsientov s polytravmoy (Complications of intramedular lockable osteosynthesis of femur shaft fracture in patients with politrauma). New medical technologies, 1,15 - 37.

Koyuncu, S, Altay, T, Kayalı, C, Ozan, F, &Yamak, K. (2015). Mechanical failures after fixation with proximal femoral nail and risk factors. Clinical interventions in aging, 10, 1959-1965.

M. Ehlinger, M, Adam, P, Arlettaz, Y, Moor, BK, DiMarco, A, Brinkert, D, & Bonnomet, F. (2011). Minimally-invasive fixation of distal extra-articular femur fractures with locking plates: Limitations and failures. Orthopaedics & Traumatology: Surgery & Research, 97,674—680.

Bentley, G, (ed.). (2014). European Surgical Orthopaedics and Traumatology. The EFORT Textbook. Springer, 2014.

Enninghorst, N, McDougall, D, Evans, JA, &, Balogh, ZJ. (2013). Population-based epidemiology of femur shaft fractures. Trauma Acute Care Surgery, 74(6),1516-520. doi: 10.1097/TA.0b013e31828c3dc9.

Enninghorst, N, McDougall, D, Sisak, K, & Balogh, ZL. (2018). The epidemiology of femoral shaft fractures in an inclusive trauma system. Orthopaedic Proceedings, 94-B. Retrieved from https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.94BSUPP_XLI.AOA-NZOA2011-132.

Asplund, CA, & Mezzanotte, TJ. (2019). Midshaft femur fractures in adults. UpToDay. Retrieved from. https://www.uptodate.com/contents/midshaft-femur-fractures-in-adults#H14.

Deepak, MK, Jain, K, Rajamanya, KA, Gandhi, PR, Rupakumar, CS, & Ravishankar, R. (2012). Functional outcome of diaphyseal fractures of femur managed by closed intramedullary interlocking nailing in adults. Annals of African Medicine, 11 (1),52-57. DOI: 10.4103/1596-3519.91025

Adnan, RM, Zia, MI, & Amin, Jl. (2012). Frequency of femoral fractures; comparison in patients less than and more than 40 years of age. Professional Medical Journal, 19,11.

Zhang, Y. (2016). Clinical epidemiology of orthopaedic trauma (2nd ed.). New York, USA: Thieme.

Anderson, SR, Nelson, SC, & Morrison, MJ. (2017).Unstable pediatric femur fractures: combined intramedullary flexible nails and external fixation. Journal of Orthopedic Case Report, 7,32.

Fajar, JK, Taufan, T, Syarif, M, & Azharuddin, A. (2018). Hip geometry and femoral neck fractures: A meta-analysis (review article). Journal of Orthopaedic Translation, 13,1-6.

Medda, S, & Halvorson, J. (2019). Diaphyseal femur fractures. StatPearls Publishing LLC.[Internet].

Augatab, P, Rüdenabc, C. (2018). Evolution of fracture treatment with bone plates. Injury, 49(suppl 1), S2-S7. doi: https://doi.org/10.1016/S0020-1383(18)30294-8

Sultanbaev, TTz, Alchogaev, SS, & Tusupov DM. (2016). Oshibki oslozhneniya pri lechenyi perelomov bedra (Errors aand complications in the treatment of hip fractures). Vestnik KazNMU, 3(1),309-311.

Korzh, NA, Gerasimenko, SI, Klimovitskyi, VG, Loskutov, AE, Romanenko, KK, Gerasimenko, AS, & Kolomiets, EN. (2011) Rasprostranennost' perelomov kosteĭ i rezul'taty ikh lecheniya v Ukraine (kliniko-epidemiologicheskoye issledovaniye) (The prevalence of bone fractures and the results of their treatment in the Ukraine (clinical and epidemiological study)). Medical news, 7, 37-44.

Bel, J-C (2019). Pitfalls and limits of locking plates. Orthopaedics & Traumatology: Surgery & Research, 105 (1, suppl.), S103-S109.

Ahtyamov, IF, Shakirov, FV, Gatina, EB, Manirambona, ZhK, & Aliev EI. (2015). Morfologicheskoye issledovaniye lokal'nogo vliyaniya implantatov s pokrytiyami na osnove sverkhtverdykh soyedineniĭ na kostnuyu tkan' v usloviyakh indutsirovannoĭ travmy (Morphological study of the local effect of implants with coatings based on superhard compounds on bone tissue under conditions of induced trauma). Journal of Clinical and Experimental Orthopedics named G.A. Ilizarov, 1,65-70.

Volotovskyi, PA, Sytnik, AA, & Beletskyi, AV. (2018). Infektsionnyye oslozhneniya posle osteosinteza dlinnykh trubchatykh kostey: etiologiya, klassifikatsiya i diagnostika. (Infectious complications after osteosynthesis of long tubular bones: etiology, classification and diagnosis). Military medicine, 1,83-89.

Elmi, A, Rohani, AR, Tabrizi, A, Esmaili, SM. (2014). Comparison of outcome of femoral shaft fracture fixation with intramedullary nail in elderly patient and patients younger than 60 years old. Archive Bone Joint Surgery, 2(2),103-105.

Kobbe, P, Klemm, R, Reilmann, H, & Hockertz, TJ. (2008). Less invasive stabilisation system (LISS) for the treatment of periprosthetic femoral fractures: a 3-year follow-up. Injury, 39,472–479.

Li, YL, Guo, WP, Jiang, WT, Wang, QY, & Fan, YB. (2013). Biomechanical study on the influence of shaping amplitude on material strenght of titanium implant. Applied Mechanics and Materials, 275,38-43. doi: https://doi.org/10.4028/www.scientific.net/AMM.275-277.38

Hung, L-W, Chao, C-K, Huang, J-R, Lin, J. (2018). Screw head plugs increase the fatigue strength of stainless steel, but not of titanium, locking plates. Bone Journal Research, 7(12),629-635. doi: 10.1302/2046-3758.712.BJR-2018 -0083.R1

Sadic, S, Custovic, S, Smajic, N, Fazlic, M, Vujadinovic, A, Hrustic, A, & Jasarevic, M. (2014). Complications and functional recovery in treatment of femoral shaft fractures with unreamed intramedullary nailing. Medical Archives, 68(1),30-33.

Gueorguieva, B, Lenzb, M. (2018). Why and how do locking plates fail? Injury, 49(suppl 1),S56-S60. doi: https://doi.org/10.1016/S0020-1383(18)30305-X.

Ehlinger, M, Adam, P, Di Marco, A, Arlettaz, Y, Moor, B-K, & Bonnomet, F. (2011). Periprosthetic femoral fractures treated by locked plating: Feasibility assessment of the mini-invasivesurgical option. A prospective series of 36 fractures. Orthopaedics & Traumatology: Surgery & Research, 97(6),622-628.

Akinoola, L, Orekha, O, & Odunsi, A. (2011). Open intramedullary nailing of neglected femoral shaft fractures: indications and outcome. Acta Orthopedica Belgica, 77,73-77.

AlTurki, AA, AlAqeely, KS, AlMugren, TS, & AlZimami, IS. (2019). Analysis of femoral fracture post motor vehicle accidents. Saudi Medical Journal, 40(1),41–44. doi: 10.15537/smj.2019.1.21547

Berry, DJ. (2002). Management of periprosthetic fractures: the hip. Journal of Arthroplasty,17,11–13.

Xing, W, Pan, Z, Sun, L, Zhang, C, Zhang, Z, Feng, W, & Liu, C. (2019). Sliding bone graft combined with double locking plate fixation for the treatment of femoral shaft nonunion. Journal of International Medical Research, 47(5),2034–2044. DOI: 10.1177/0300060519835334.

Dim, EM, Ugwoegbulem, OA, & Ugbeye, ME. (2012). Adult traumatic femoral shaft fractures. A review of the literature. Ibom Medical Journal, 5(1),26-38.

Bottlang, M., Doornink, J., Byrd, G.D., Fitzpatrick, D.C., & Madey, S.M. (2009). A nonlocking end screw can decrease fracture risk caused by locked plating in the osteoporotic diaphysis. Journal of Bone and Joint Surgery (Am.), 91,620–627.

Ehlinger, M, Ducrot, G, Adam, P, & Bonnomet, F. (2013). Distal femur fractures. Surgical techniques and a review of the literature. Orthopaedics & Traumatology: Surgery & Research, 99, 353—360.

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