title: Less invasive percutaneous wave plating of simple femur shaft fractures: A prospective series.
abstract: In developing nations, fixation of femoral shaft fractures with intramedullary (IM) nails can pose significant challenges. Use of IM implants is commonly limited by availability, funds or patient's physique. Conversely, traditional compression plates are usually readily available at a much lower cost, making bridge plating of femur fractures a frequently used surgical technique. We hypothesised that less invasive percutaneous plate osteosynthesis (MIPPO) of femoral shaft fractures has a similar outcome compared to IM nailing. The study is designed as a prospective case series at a Level 1 university trauma centre. Fifty-seven patients with simple femur shaft fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type A) were enrolled between April 2001 and December 2005 and followed up for a minimum of 1 year or until fracture union. Primary outcome measures included union rate and time to union. Secondary outcome parameters were hardware failure, malalignment, infection and need for revision surgery. The mean age of the study cohort was 24.7 years. Fifty-four patients sustained associated systems injury. Primary union occurred in 54 patients in an average time of 13 weeks. Two patients presented with implant failure, and one patient displayed signs of delayed union. Six patients developed valgus deformities, whereas five patients displayed external rotation malalignment. One patient developed a superficial wound infection, and another presented with a deep infection. Bridge wave plating represents a safe and efficacious treatment alternative to IM nailing for simple femoral shaft fractures in countries where IM nails are limited by availability, costs and patient's physical characteristics.
authors.affiliation: Department of Orthopedics and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), P.O. Box 6111, 13070-170 Campinas, São Paulo, Brazil.
authors.forename: Alessandro Janson
authors.initials: AJ
authors.lastname: Angelini
authors.forename: Bruno
authors.initials: B
authors.lastname: Livani
authors.forename: Michael A
authors.initials: MA
authors.lastname: Flierl
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Morgan
authors.forename: William Dias
authors.initials: WD
authors.lastname: Belangero
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails / Q000191:economics; D001860:Bone Plates / Q000191:economics; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D017759:Fractures, Malunited / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D013530:Surgical Wound Infection / Q000453:epidemiology; D014143:Traction; D016896:Treatment Outcome; D055815:Young Adult