A novel reduction device for the minimally invasive treatment of femoral shaft fractures.

Objective: In this study, a new type of reduction device for femoral shaft fractures was developed and designed. The reduction procedure was also standardized and is expected to be useful in clinical practice.

Methods: A bone traction retractor that consisted of a special traction needle, a resistant sleeve, a crossbar and an arc-adjusting bar was designed. Forty-eight patients (32 males and 16 females, mean age 33.21±7.03 years old) with femoral shaft fractures treated in our hospital from January 2016 to December 2017 were selected. According to the AO classification, there were 15 patients with type A, 24 patients with type B and 9 patients with type C fractures. All patients were treated with transverse bone traction for closed reduction of femoral shaft fractures and femoral reconstruction with intramedullary nails for final fixation. The injured side, preoperative delay time, reduction and operative times, operative blood loss, drilling frequency, number of open reduction cases, hospitalization days, fracture healing time, postoperative HSS function score and complications were recorded.

Results: All 48 patients were treated with transverse bone traction using our novel device to obtain reduction. The average time needed for reduction was 19.98±4.66 min. The operating time was 60-100 min, with an average of 78.65±16.81 min, and the average intraoperative blood loss was 131.91±30.22 ml. Open reduction was performed in 8 patients: 1 patient in the experimental group and 7 patients in the control group. The average hospitalization days was 7.78±2.81 days, the fracture healing time was 10 to 15 weeks, with an average of 12.44±2.63 weeks, and the postoperative HSS score was 80-95 points, with an average of 86.52±6.03 points. None of the patients had coxa vara, nonunion, internal fixation failure, infection, nerve injury, limb length discrepancy or other complications.

Conclusion: In this study, the transverse bone traction reduction technique and the design of a proprietary reduction device system were proposed, with high clinical application. The transverse bone traction reduction technique has the advantages of simple operation, reliable reduction and limited intraoperative fluoroscopy in the minimally invasive treatment of femoral shaft fractures.