The Design of an "H" Joystick for Closed Reduction and Its Application in Segmental and Comminuted Femoral Shaft Fractures: an Innovative Technique

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2020 Aug 28

PMID 32847603

Citations 1

Authors

Zhaofeng Jia

Shijin Wang

Tinghui Xiao

Wei Jiang

Tianjian Zhou

Qisong Liu

Guangheng Li

Xinjia Hu

Affiliations

Soon will be listed here.

Abstract

Background: Closed reduction and locked intramedullary nailing has become a common surgical method in the treatment of femoral shaft fractures. Overlap and rotation displacements can usually be corrected through the use of an orthopedic traction table. However, lateral displacement and angulation persist.

Methods: In this paper, we describe a joystick that can be used in the closed reduction of a fracture. It can correct lateral displacement and angulation, and has the advantage of multi-direction reduction. The device described in this paper includes two parallel horizontal joysticks, one vertical main joystick and four assistant rods. Moreover, there are many specific spacing holes in the two parallel horizontal joysticks and a groove structure in the vertical main joystick. When the main "H" joystick is pressed, it can adjust lateral displacements and angulation because of the lever principle. The distance between parallel horizontal joysticks and assistant rods can be adjusted to the fracture position and body mass index of different patients.

Results: The study participants consisted of 11 males and 5 females with a mean age of 31.0 years. All participants had good closed reduction and achieved bony union without any complications such as infection, nerve injury, non-union, malunion, and limb length discrepancy. By using an "H" joystick, closed femoral shaft fracture reduction and locked intramedullary nailing becomes simpler and faster.

Conclusion: Based on the use of this instrument, we can easily and conveniently obtain the correct reduction situation, which leads to better surgical results. This device can be applied in the reduction of clinical femoral fractures and gradually extended to the reduction of other fractures.

Citing Articles

Incidence of complications and functional outcomes following segmental femoral shaft fractures: a critical review of the literature.

Vasilopoulou A, Karampitianis S, Chloros G, Giannoudis P Eur J Orthop Surg Traumatol. 2024; 34(6):2891-2902.

PMID: 39150553 PMC: 11377483. DOI: 10.1007/s00590-024-04065-8.

References

Patterson B, Routt Jr M, Benirschke S, Hansen Jr S . Retrograde nailing of femoral shaft fractures. J Trauma. 1995; 38(1):38-43. DOI: 10.1097/00005373-199501000-00012. View

Wolinsky P, Tejwani N, Richmond J, Koval K, Egol K, Stephen D . Controversies in intramedullary nailing of femoral shaft fractures. Instr Course Lect. 2002; 51:291-303. View

Yamaji T, Ando K, Nakamura T, Washimi O, Terada N, Yamada H . Femoral shaft fracture callus formation after intramedullary nailing: a comparison of interlocking and Ender nailing. J Orthop Sci. 2002; 7(4):472-6. DOI: 10.1007/s007760200082. View

Tang P, Gates C, Hawes J, Vogt M, Prayson M . Does open reduction increase the chance of infection during intramedullary nailing of closed tibial shaft fractures?. J Orthop Trauma. 2006; 20(5):317-22. DOI: 10.1097/00005131-200605000-00004. View

Georgiadis G, Burgar A . Percutaneous skeletal joysticks for closed reduction of femoral shaft fractures during intramedullary nailing. J Orthop Trauma. 2001; 15(8):570-1. DOI: 10.1097/00005131-200111000-00007. View

Gheraibeh P, Vaidya R, Hudson I, Meehan R, Tonnos F, Sethi A . Minimizing Leg Length Discrepancy After Intramedullary Nailing of Comminuted Femoral Shaft Fractures: A Quality Improvement Initiative Using the Scout Computed Tomography Scanogram. J Orthop Trauma. 2018; 32(5):256-262. DOI: 10.1097/BOT.0000000000001135. View

Morihara T, Arai Y, Tokugawa S, Fujita S, Chatani K, Kubo T . Proximal femoral nail for treatment of trochanteric femoral fractures. J Orthop Surg (Hong Kong). 2007; 15(3):273-7. DOI: 10.1177/230949900701500305. View

Cheng T, Xia R, Dong S, Yan X, Luo C . Interlocking Intramedullary Nailing Versus Locked Dual-Plating Fixation for Femoral Shaft Fractures in Patients with Multiple Injuries: A Retrospective Comparative Study. J Invest Surg. 2017; 32(3):245-254. DOI: 10.1080/08941939.2017.1400131. View

Helmy N, Jando V, Lu T, Chan H, OBrien P . Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral shaft fractures. J Orthop Trauma. 2008; 22(1):10-5. DOI: 10.1097/BOT.0b013e31815f5357. View

10.

Park Y, Song H, Zheng X, Yang K . Intramedullary Nailing for Atypical Femoral Fracture with Excessive Anterolateral Bowing. J Bone Joint Surg Am. 2017; 99(9):726-735. DOI: 10.2106/JBJS.16.00760. View

11.

Parekh A, Smith W, Silva S, Agudelo J, Williams A, Hak D . Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation. J Trauma. 2008; 64(3):736-9. DOI: 10.1097/TA.0b013e31804d492b. View

12.

Kempf I, Grosse A, Beck G . Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am. 1985; 67(5):709-20. View

13.

Fitzpatrick C, Rothwell A . Proceedings: The treatment of fractures of the shaft of the femur by closed intramedullary nailing. J Bone Joint Surg Br. 1975; 57(2):255. View

14.

Matsubara H, Yasutake H, Matsuda E, Uehara K, Niwada M, Tanzawa Y . Treatment of femoral shaft fractures in children using intramedullary Kirschner wire pinning. J Orthop Sci. 2005; 10(2):187-91. DOI: 10.1007/s00776-004-0882-4. View

15.

Hooper G, Lyon D . Closed unlocked nailing for comminuted femoral fractures. J Bone Joint Surg Br. 1988; 70(4):619-21. DOI: 10.1302/0301-620X.70B4.3403610. View

16.

Garnavos C, Lasanianos N . The management of complex fractures of the proximal tibia with minimal intra-articular impaction in fragility patients using intramedullary nailing and compression bolts. Injury. 2011; 42(10):1066-72. DOI: 10.1016/j.injury.2011.03.024. View

17.

El-Menyar A, Muneer M, Samson D, Al-Thani H, Alobaidi A, Mussleman P . Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis. J Orthop Surg Res. 2018; 13(1):160. PMC: 6022515. DOI: 10.1186/s13018-018-0856-4. View

18.

Fine N, Sexton S, Williams D . The learning curve with a new cephalomedullary femoral nail. Injury. 2017; 48(7):1575-1578. DOI: 10.1016/j.injury.2017.05.030. View

19.

Harris I, Hatfield A, Donald G, Walton J . Outcome after intramedullary nailing of femoral shaft fractures. ANZ J Surg. 2003; 73(6):387-9. DOI: 10.1046/j.1445-2197.2003.t01-1-02655.x. View

20.

Yoshino O, Brady J, Young K, Hardy B, Matthys R, Buxton T . Reamed locked intramedullary nailing for studying femur fracture and its complications. Eur Cell Mater. 2017; 34:99-107. DOI: 10.22203/eCM.v034a07. View