J Korean Fract Soc.  2012 Jan;25(1):46-51. 10.12671/jkfs.2012.25.1.46.

The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing

• An KC
• Kim YJ
• Choi JS
• Seo SS
• Gwak HC
• Jung DW
• Jeong DW

• KMID: 1434110
• DOI: http://doi.org/10.12671/jkfs.2012.25.1.46

Abstract

PURPOSE
For conservative treatment of shaft fractures, the butterfly fragments that were somewhat larger in the closed intra-medullary (IM) nailing. The results of treatment were monitored using radiography separately for the weight-bearing femur and non-weight-bearing humerus.
MATERIALS AND METHODS
27 from Group I and 31 from Group II. In the two groups, the displacement and angulation changes in the fragments, and the degree of improvement of these two factors, were compared using follow-up radiography.
RESULTS
The mean angulation of fragments in Groups I and II were 9.2degrees and 9.6degrees, and the mean degree of displacement of the fragments in Groups I and II were 16.7 mm and 21.2 mm, respectively. Follow-up radiography showed that the above factors improved in both groups. The degree of displacement was significantly lower in the normal cases than in the complicated cases (p=0.001).
CONCLUSION
Displacement and angulation gradually improved in both groups. It was found that the degree of displacement after the initial reduction is more important than the influence of anatomical position or weight bearing. This indicates that care should be taken when inserting IM nails to prevent displacement or angulation.

Keyword

Femur shaft fracture; Humerus shaft fracture; Intramedullary nailing; Weight bearing; Butterfly fragments

MeSH Terms

Butterflies
Displacement (Psychology)
Extremities
Femur
Follow-Up Studies
Fracture Fixation, Intramedullary
Fractures, Comminuted
Nails
Weight-Bearing

Figure

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  Fig. 1 The degree of displacement of butterfly fragments were measured by longer pependicualr distance between shaft cortex parallel line and mid-point of fragment cortex parallel line.

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  Fig. 2 The degree of angulation of butterfly fragments were measured by angle between parallel line of shaft cortex and main fragment cortex on AP or Lateral radiograph.

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  Fig. 3 The fracture gap of main fragments were measured by distance between proximal and distal main fragment on AP or Lateral radiograph.

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  Fig. 4 (A) Complicated case Lateral radiograph showing initial post-op finding with large amount of displacement. (B) Complicated case Lateral radiograph showing no union evidence with remnanat displacement. (C) Immediate post-operative Lateral radiograph showing bone graft status using mini-open procedure. (D) Three months later follow-up Lateral raidograph showing radiologic union.

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