PubMed · 13998860
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O C WARD. 1963. Two pins.. https://pubmed.ncbi.nlm.nih.gov/13998860/
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The choice between dynamic screw-intramedullary nail (DSIN) devices and dynamic screw-plate (DSP) devices for the fixation of unstable trochanteric fractures remains controversial. This study presents a meta-analysis of fixation failures in unstable trochanteric femoral fractures using DSP devices or DSIN devices. Two independent assessors selected randomised controlled trials using a range of electronic databases, as well as reference lists of selected articles. A study quality checklist was used. The occurrence of fixation failure, in particular cut-out, was the primary subject of analysis using descriptive statistics and random-effect meta-analyses. Seventeen trials were identified. Meta-analyses showed no significant difference in the frequency of implant-related complications between the two types of devices. Iatrogenic femoral fractures associated with the use of DSIN devices represent a rare, but persistent, risk. There was a tendency for less frequent cut-out with intramedullary devices compared with DSP devices.
Distraction osteogenesis has been widely utilized to treat leg length discrepancy, deformity, nonunion, osteomyelitis, and bone loss. It has been found that most difficult conditions can be resolved with this method. This paper introduces the usefulness of distraction osteogenesis for the treatment of nonunion and bone loss after tumor excision. The procedure was found to be extremely effective for the treatment of nonunion accompanied by bone loss and infected nonunion. In particular, the Ilizarov method offers a simultaneous solution for several problems related to nonunion, such as instability, infection, deformity, bone loss, joint contracture, limb length discrepancy, and skin defects. In addition, distraction osteogenesis is safe, useful, and efficient for the treatment of bone loss even after tumor excision. Joint preservation and reconstruction by means of distraction osteogenesis is the most conservative limb-saving surgery available at present. Furthermore, distraction osteogenesis can provide natural limb regeneration.
We describe a novel technique to aid the removal of a proximally inserted femoral nail by using a guide wire and the starter reamer. By reaming through the scar tissue, a cylindrical track is created and the threaded top end of the nail is exposed. The soft tissue dissection is therefore limited to the absolute minimum with no further damage to the hip abductors.