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At least 217 records · Page 12Linked to original sources
PubMed2004

Implant breakage, a rare complication with the Gamma nail. A review of 843 fractures of the proximal femur treated with a Gamma nail.

Internal fixation with a Gamma nail, in its short and long versions, is an excellent surgical technique for intertrochanteric and subtrochanteric fractures of the femur. A stable osteosynthesis is obtained which allows early mobilisation and promotes healing of the fracture. However, it is not free from complications; many of them are due to poor surgical technique and/or inadequate monitoring. Breakage due to fatigue of the material is an exceptional complication. A review of 843 cases operated in our department between 1990 and 2002 was made. Five cases of implant breakage were found. Non-union of the fracture appears to be the primary cause. The weakest point of the Gamma nail is the opening for the cervical screw. The optimal treatment will depend on each particular case. The possibility of dynamisation of the construct should be considered when delayed healing is suspected.

Adult↗
PubMed1991

[Does covered tibial intramedullary nailing promote formation of a compartment syndrome? Perioperative and intraoperative continuous monitoring of compartmental pressure in covered tibial intramedullary nailing].

Between October 1988 and October 1989 we performed a continuously pressure monitoring with the infusion technique in the tibialis anterior and deep posterior compartment of the lower leg during the nailing of the tibia in complete fractures of the lower leg in 16 patients. We set up 2 groups of patients because of different pathophysiological conditions: patients, who were operated on a few days after trauma (Group A) and patients operated on months after the trauma (Group B) because of non-union of the tibia. The effects of the preoperative, intraoperative, and postoperative manipulations were recorded. In no case we saw a beginning compartmental syndrome, although very high pressures of 100 mmHg in Group A and 55 mmHg in Group B in the deep posterior compartment during reduction of the fracture were registrated. The registrated pressures correlated very well with the manipulations during the operation and were absolutely reversible after the ending of these manipulations. In our observation the closed tibia nailing does not favorize the development of a compartmental syndrome, if not done during the vulnerable phase after the first days after trauma, in blunt multiple trauma patients and during bleeding complications.

Adult↗
PubMed1991

[A simple, rapid and economical method of distal interlocking nailing in upper and lower leg intramedullary nailing].

Distal interlocking of intramedullary nails is associated with a relatively high radiation exposure. For the reduction of fluoroscopy time and surgeon's hands irradiation, many devices have been developed so far. In this paper, a simple free-hand-technique is presented. The mean fluoroscopy time in 30 femur and 10 tibia interlocking intramedullary nailing procedures was one minute. The technique avoid the central beam of the fluoroscope and does not require specific instruments. The technique is based on the axial placement of a 2 mm K-wire in the interlocking screw holes. A centrally perforated 4.5 mm drill is placed over the K-wire. Therefore in this technique a perfect centrally placement of the K-wire is not necessary. The drill is guided by the K-wire thereby avoiding complications such as drill failure or deviation of the drill direction.

Bone Wires↗
PubMed1987

[Lezius nailing under controversy? Experiences with Lezius-Herzer curved nailing in 1,062 pertrochanteric femoral fractures].

Curved nailing according to Lezius and Herzer was applied to 700 of 1,062 cases of pertrochanteric fractures of the femur at the Surgical Department of the "Carl Gustav Carus" Medical Academy, Dresden, between 1964 and 1985. Complications are described, and results are generally compared with other surgical techniques used to handle pertrochanteric fractures of the femur. Lezius nailing, when compared to other methods, has proved to be a simple and reliable approach, primarily under the aspect of geriatric traumatology, and should be used on a much wider scale.

Female↗
PubMed1984

The best dressing for a nail bed is the nail itself.

The replacement of a surgically avulsed nail as a splint and dressing with "Superglue" is reported. It provides a painless cover for the sterile matrix and facilitates the dressing of finger tip injuries.

Adhesives↗
PubMedDate not supplied

Unreamed nailing of tibial fractures--a prospective study of the routine use of the unreamed tibial nail.

We prospectively studied 44 patients treated with the AO Unreamed Tibial Nail (UTN) at two orthopaedic trauma units. There were 15 open fractures: eight type I, four type II, one type IIIA, and two IIIB (Gustilo). The mean follow-up time was 13 months (range 6-24 months). There were 14 type A, 26 type B and four type C fractures (AO classification, Muller). All patients with the open fractures had surgery within eight hours of injury. Closed fractures were treated on the next available trauma list. The mean time to fracture union was 15.3 weeks (range 10-26). In the closed fracture group (n = 29), the mean time to union was 14.9 weeks compared to 18.6 weeks for the open fracture group. There were no non-unions and no infections. One patient had a malunion and breakage of locking bolts occurred in two cases. Our results indicate that the UTN provides excellent results in the treatment of both closed and open fractures of the tibial shaft, with union times comparable to reamed techniques.

Adolescent↗
PubMed2006

Finite element study of the proximal femur with retained trochanteric gamma nail and after removal of nail.

This study aims to evaluate the stress and strain distributions in the healed proximal femur after fixation with a trochanteric gamma nail (TGN) and after TGN removal, using the finite element method. The stress distributions in the proximal femur with retained TGN and after TGN removal were very similar. The strain and the strain energy density in the femoral neck region with retained TGN were much higher than in the lag screw hole at the subtrochanter and the distal locking screw hole at the proximal femur, and even higher after TGN removal. Stair climbing resulted in higher strain and higher strain energy density at the femoral neck than normal walking. The conclusion can be drawn that removal of the TGN may result in high risk of femoral neck fracture.

Bone Nails↗
PubMed2006

Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures.

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.

Aged↗
PubMed2002

Pseudoaneurysm of the superficial femoral artery after closed hip nailing with a Gamma nail: report of a case.

Pseudoaneurysm of the femoral artery after internal fixation of a trochanteric fracture is caused primarily by overpenetration of the drill bit or screws. We report a case of pseudoaneurysm of the superficial femoral artery after insertion of a Gamma nail. A probable cause for this injury is adduction and internal rotation of the involved limb. During the distal interlocking procedure, this maneuver endangers the superficial femoral artery by abutment of the femoral vessels to the femur. It is recommended that the limb be placed in a neutral position during preparation of the interlocking hole.

Aged↗
PubMed1991

Intramedullary locking femoral nails. Experience with the AO nail.

The AO interlocking nail was introduced to the Ulster Hospital, Dundonald in 1988 and since then has been used in over 50 patients with femoral shaft fractures. We have reviewed 45 patients with 46 femoral shaft fractures treated between June 1988 and April 1990. These included four compound fractures and 13 comminuted fractures. The results compare favourably with other series. The union rate was 98% and there were no instances of deep infection. The alternative treatment methods available are discussed along with a review of the relevant literature.

Adult↗
PubMedDate not supplied

Surgical management of diaphyseal humeral nonunion after intramedullary nailing: Wave-plate fixation and autologous bone grafting without nail removal.

Six patients with a nonunion of the humeral diaphysis after intramedullary nailing were treated with a wave plate and autologous bone graft but without removal of the intramedullary implant. The mean duration of the nonunion was 19 months (range, 6-36 months). At a mean follow-up of 12 months (range, 6-18 months), all six nonunions had healed, and patient satisfaction was high. Five patients had regained full shoulder function. One patient, who was treated for a rotator cuff tear before the humeral fracture, had a satisfactory functional outcome. Elbow motion was full in all but one patient. One patient had a postoperative radial nerve palsy, which recovered partially but did not require further surgery. This report suggests that healing of humeral nonunions can be achieved in the presence of intramedullary hardware.

Adult↗
PubMedDate not supplied

Structural properties of interlocking nails, canine femora, and femur-interlocking nail constructs.

Using standard material testing techniques (bending stiffness, torsional stiffness, and maximum torque to failure or yield torque), the structural properties of interlocking nails (IN), canine femora, and IN/femur constructs were determined. Specimens that were tested included: 6 and 8 mm diameter IN with 5 to 10 screw holes (n = 18), and intact canine femora (n = 10), which also, with an IN inserted, formed the intact construct (IC) group, (n = 10). Specimens in the IC group were first tested with an 8 mm diameter IN with zero screws, followed by one and two screws (4.5 mm diameter) in the proximal and distal femur. A fracture model construct (FMC), (n = 14), consisting of a transverse femoral osteotomy with a 3 mm gap, was used with either 6 mm or 8 mm IN. In the 6 mm FMC, one and two 3.5 mm screws were used sequentially in the proximal and distal femoral segment. In the 8 mm FMC, one and two 3.5 mm screws and one and two 4.5 diameter screws were used similarly. When bending forces were applied parallel to IN screw holes, mean IN stiffness was 20% less than with forces perpendicular to the holes (n = 18), (P < .05). Eight-millimeter IN were 220% stiffer in torsion and 270% stiffer in bending than 6 mm IN (P < .05). Six-millimeter IN had approximately 32% of the bending stiffness and torsional stiffness of intact femurs (P < .05). Eight-millimeter IN had 93% and 79% of the bending stiffness and torsional stiffness, respectively, of intact femurs. Intact femur constructs (8 mm IN with four, 4.5 mm screws) had 147% of the bending stiffness (P < .05), and similar torsional stiffness and maximum torque, as intact femora (P > .05). The mean values of 6 mm FMC with four screws (3.5 mm) were 21% and 33% in torsional stiffness and bending stiffness, respectively, of intact femora values. When tested in torsion, 8 mm FMC failed by bone fracture; 6 mm FMC, in contrast, underwent plastic deformation. In comparing FMC stabilized with an 8 mm IN with two screws (4.5 mm diameter) in each bone segment, to intact femurs, the maximum torque was similar, FMC torsional stiffness was 40% (P < .05), and FMC bending stiffness was 65% (P < .05). These 8 mm FMC percentages are comparable to human IN fracture model construct values, indicating that the 8 mm IN/four screw construct should provide adequate stabilization for many canine diaphyseal femoral fractures.

Animals↗
PubMed1998

[The Richard classic nail (intramedullary hip screw, IMHS) as unreamed intramedullary nail in osteosynthesis treatment of pertrochanteric fractures].

The treatment of 85 patients with pertrochanteric femoral fractures (average age 82.3 years) with the Richards classic nail allowed full weight-bearing in 94.1% and unreamed implantation in 91.8%. In the follow-up period (11.2 months post-operatively) few complications (1.2% infections, 1.2% cutting out) could be documented. The Sanders and Regazzoni score revealed that 66% of the patients reached their preoperative status again. Statistical analysis showed a negative influence of patient age and fracture type on the postoperative walking ability.

Aged↗