جاانداري بسته و تثبيت شكستگي هاي تنه استخوان ران با استفاده از پيچهاي شانز

Shanz Screws for Closed Reduction of Femoral Shaft Fractures during Intramedullary Nailing

Introduction & Objective: Closed intramedullary nailing has become the standard treatment for femoral shaft fractures, but because the existing closed reduction methods are difficult and demanding, in the most trauma centers these fractures usually are treated by open reduction method. Our objective was close reduction of these difficult fractures by a simple but effective method using Schanz screws for manipulating fracture fragments on a radiolucent table. Materials & Methods: In this prospective study, 30 patients whose femoral shaft fractures required reduction were operated on a radiolucent table in the lateral position and their fractures reduced closed by Schanz pins and fixed with IM Rod. The patients were followed-up 1 year. Results: We obtained reduction in 93% of patients. Average time of reduction in the first 48 hours was 9.23minutes and after 48 hours it was 19.7minutes (p<0.05). Also time to reduction was dependent on amount of preoperative traction .When the amount of preoperative traction was 5kg, that time was 19.16minutes but in maximal amount of traction it was 10.29minutes. Time to reduction also was shorter in Winquist -Hansen type III and IV fractures than in type I and II fractures. There was 13% valgus deformity (5-10 33% external malrotation (5-15 °) and 37% shortening (up to 1-3 cm). But we had no infection and no need for blood transfusion or bone grafting. Conclusion: Schanz screws provide a very effective method for close reduction of femoral shaft fractures. Complications of this method are the same or even in some parts are less than other close reduction methods. The method is more successful if performed in the first 48 hours, or if the weight of preoperative skeletal traction is near to the maximum (15% of body weight).