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JINJ-5788; No. of Pages 1 Injury, Int. J. Care Injured xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Letter to the Editor The butterfly fragment in comminuted femoral shaft fracture may be movable following intramedullary nail treatment A B S T R A C T
The gap among fracture fragments is an important factor which influences the healing of bone fracture, and it may be changeable during the early phase of bone healing. In this letter, we pointed out our view that the gap between the butterfly fragment, and the shaft in femoral shaft fractures can easily be changed, so it is hard to study the potential correlation between the size of the gap and fracture healing. ß 2014 Elsevier Ltd. All rights reserved.
Dear Editor, Recently, we have interestingly read a paper finished by WeiHsiu Hsu and his colleagues, ‘‘Effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail’’ presented on the 10th issue of volume 44 in 2013. We absolutely agree with this argument that a larger fracture gap has a higher potential to interfere with bone healing; however, the gap between a fragment and the femoral shaft is mainly formed as a result of haematoma expansion, soft tissue interposition and traction of muscles attached on the fragment. So with the absorption of haematoma, necrosis or contraction of muscles and postoperative activities of the patient, the fragments which have not been fixed in intramedullary nail treatment may not be maintained still; their positions can easily be changed especially during the early phase of bone fracture healing. So we think that it may be critical to show a relevant evidence to support the conclusion or give some explanations in the discussion section. Second, in our experience, a larger butterfly fragment tends to form a greater gap. Because a fracture with a larger butterfly fragment is always caused by more powerful axial compression besides a bending stress, the fracture is more unstable in this situation. A larger fragment may have a higher probability to develop haematoma expansion, soft tissue or muscle contraction, so it is easy to be kept away from its original anatomic location to form a greater gap. Furthermore, a few data in this study show
that ‘‘the mean size of fragments in the small- and large-gap groups was 64.7 mm and 78.5 mm, respectively (p = 0.059)’’, the two values of the mean size really shows a relatively significant difference, and the p value is close to 0.05; so we hope that the authors enlarge the sample size to conduct another wonderful study to show clinical researchers more perfect data in future. Lastly, we think that it would be wonderful to show some postoperative radiogram pictures from the last follow-up to elucidate the different fracture healing states of small- and largegap groups. We declare that there is no conflict of interests about our letter.
Qikui Wang1 Junlin Zhou* Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Gong Ren Ti Yu Chang Nan Rd, Chaoyang District, 100020 Beijing, China *Corresponding author. Tel.: +86 13911591377 E-mail addresses: [email protected] (Q. Wang), [email protected], [email protected] (J. Zhou). 1
Tel: +0086 15611357720. Received 16 June 2014
http://dx.doi.org/10.1016/j.injury.2014.06.020 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Wang Q, Zhou J. The butterfly fragment in comminuted femoral shaft fracture may be movable following intramedullary nail treatment. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.06.020
JINJ-5788; No. of Pages 1 Injury, Int. J. Care Injured xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Letter to the Editor The butterfly fragment in comminuted femoral shaft fracture may be movable following intramedullary nail treatment A B S T R A C T
The gap among fracture fragments is an important factor which influences the healing of bone fracture, and it may be changeable during the early phase of bone healing. In this letter, we pointed out our view that the gap between the butterfly fragment, and the shaft in femoral shaft fractures can easily be changed, so it is hard to study the potential correlation between the size of the gap and fracture healing. ß 2014 Elsevier Ltd. All rights reserved.
Dear Editor, Recently, we have interestingly read a paper finished by WeiHsiu Hsu and his colleagues, ‘‘Effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail’’ presented on the 10th issue of volume 44 in 2013. We absolutely agree with this argument that a larger fracture gap has a higher potential to interfere with bone healing; however, the gap between a fragment and the femoral shaft is mainly formed as a result of haematoma expansion, soft tissue interposition and traction of muscles attached on the fragment. So with the absorption of haematoma, necrosis or contraction of muscles and postoperative activities of the patient, the fragments which have not been fixed in intramedullary nail treatment may not be maintained still; their positions can easily be changed especially during the early phase of bone fracture healing. So we think that it may be critical to show a relevant evidence to support the conclusion or give some explanations in the discussion section. Second, in our experience, a larger butterfly fragment tends to form a greater gap. Because a fracture with a larger butterfly fragment is always caused by more powerful axial compression besides a bending stress, the fracture is more unstable in this situation. A larger fragment may have a higher probability to develop haematoma expansion, soft tissue or muscle contraction, so it is easy to be kept away from its original anatomic location to form a greater gap. Furthermore, a few data in this study show
that ‘‘the mean size of fragments in the small- and large-gap groups was 64.7 mm and 78.5 mm, respectively (p = 0.059)’’, the two values of the mean size really shows a relatively significant difference, and the p value is close to 0.05; so we hope that the authors enlarge the sample size to conduct another wonderful study to show clinical researchers more perfect data in future. Lastly, we think that it would be wonderful to show some postoperative radiogram pictures from the last follow-up to elucidate the different fracture healing states of small- and largegap groups. We declare that there is no conflict of interests about our letter.
Qikui Wang1 Junlin Zhou* Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Gong Ren Ti Yu Chang Nan Rd, Chaoyang District, 100020 Beijing, China *Corresponding author. Tel.: +86 13911591377 E-mail addresses: [email protected] (Q. Wang), [email protected], [email protected] (J. Zhou). 1
Tel: +0086 15611357720. Received 16 June 2014
http://dx.doi.org/10.1016/j.injury.2014.06.020 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Wang Q, Zhou J. The butterfly fragment in comminuted femoral shaft fracture may be movable following intramedullary nail treatment. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.06.020
