Evaluation of the effect of eccentric nailing on femoral diaphyseal union delay

Ozgur Erdogan; Emre Kaya; Mert Maraşlı; Levent Adiyeke; Hakan Serhat Yanik; İsmail Emre Ketenci; Serkan Tuna

doi:10.52312/jdrs.2025.2256

Ozgur Erdogan¹, Emre Kaya², Mert Maraşlı³, Levent Adiyeke⁴, Hakan Serhat Yanik⁵, İsmail Emre Ketenci⁵, Serkan Tuna⁵

¹Department of Orthopedics and Traumatology, Private Clinic, İstanbul, Türkiye
²Department of Orthopedics and Traumatology, İstanbul Kent University, İstanbul, Türkiye
³Department of Orthopedics and Traumatology, Gebze Fatih State Hospital, Kocaeli, Türkiye
⁴Department of Orthopedics and Traumatology, Şişli Kolan Hospital, İstanbul, Türkiye
⁵Department of Orthopedics and Traumatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Türkiye

Keywords: Bone and bones, femur, femoral fixtion, femoral fracture, injuries.

Abstract

Objectives: In this study, we aimed to investigate whether there was a relationship between deformity at the fracture line/eccentric placement of the nail, and union time (UT) in isthmal diaphyseal femoral fractures treated with intramedullary nails.

Patients and methods: Between September 2017 and December 2020, a total of 61 patients (38 males, 23 females; median age: 47 years; range, 23 to 62 years) with closed femoral shaft fractures who underwent antegrade nailing were retrospectively analyzed. The following parameters were examined: (i) amount of angulation in the fracture line (AFL), (ii) varus/valgus of the fracture line (VAFL), (iii) amount of deviation of the distal tip of the nail from the femoral notch (DDT), (iv) medial lateral orientation of the distal nail relative to the notch (MLON), (v) number of fracture parts (NFP), and (vi) UT.

Results: The causes of injury were high-velocity traffic accidents in 42 patients and falls in 19 patients. The median surgical delay was 4.5 (range, 2 to 8 days). The median follow-up time was 37 (range, 12 to 57) months. There was a moderate, statistically significant and positive correlation between UT and AFL, DDT, and NFP (r=0.486, p<0.001). The difference in UT according to MLON (p=0.002) was statistically significant.

Conclusion: Our study results suggest that impaired weight-bearing force and translational force may cause impaired healing. Thus, angulation of the fracture line and eccentric nail placement may delay fracture union. We recommend using bold screws to ensure that there is no deformity in the fracture line and to fully center the nail inside the distal bone.

Citation: Erdogan O, Kaya E, Maraşlı M, Adiyeke L, Yanik HS, Ketenci İE, et al. Evaluation of the effect of eccentric nailing on femoral diaphyseal union delay. Jt Dis Relat Surg 2025;36(3):724-731. doi: 10.52312/jdrs.2025.2256.