Influence of femoral shaft fracture extension into subtrochanteric or supracondylar region on operation and fluoroscopy time in dynamic extramedullary fixation

Introduction/Objective. Although femoral shaft fractures are mostly treated by intramedullary fixation today, certain situations indicate extramedullary fixation for these fractures. The aim of this study was to evaluate the influence of femoral shaft fracture extension into the subtrochanteric or supracondylar region on operation time and intraoperative fluoroscopy time while performing dynamic extramedullary fixation. Method. Ninety cases of femoral shaft fractures treated using Selfdynamizable Internal Fixator (SIF) were analyzed. Patients were divided into three groups according to the applied implant type: SIF-troch, SIF-shaft, and SIF-cond, depending on whether the fracture was confined to the shaft region or extended proximally or distally. Results. The shortest mean operation time was observed in the SIF-shaft group, while the longest was recorded in fractures extending into the supracondylar region (SIF-cond group). The shortest average fluoroscopy time occurred in the SIF-shaft group, while the longest in the group with the fracture extension into the subtrochanteric region (SIF-troch group). Operation time was mainly influenced by the technique of lag screws and locking screws insertion and by the fracture reduction maintenance in the subtrochanteric and supracondylar regions. Conclusion. Extension of femoral shaft fractures into the subtrochanteric or supracondylar region is associated with increased operation and fluoroscopy times. Selfdynamizable Internal Fixator allows for dynamic extramedullary fixation, but also provides a relatively simple and fast performing surgical technique for femoral shaft fractures fixation, especially when the fracture does not extend beyond the shaft area.