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Treatment of humeral fractures by closed reduction and retrograde intramedullary Ender nails.

A retrospective review of 94 humeral shaft fractures stabilized with retrograde Ender nails was performed to determine the safety and efficacy of this technique. Follow-up averaged 71 weeks. Eighty-six (91.5%) healed with no additional intervention (average: 14 weeks). There were eight (8.5%) nonunions. The functional results were good in 74 (81%), fair in 12 (13%), and poor in 5 (6%). There was one radial nerve palsy secondary to the operative procedure. The reoperation rate, including the repair of nonunions, was 19%. We conclude that intramedullary Ender nail fixation is a relatively simple and quick procedure, especially for the multiply injured patient, that adequately stabilizes most humeral fractures, yielding overall good results.

Adolescent↗

Using flexible nails to improve stabilization of proximal femur fractures in adolescents.

Intramedullary fixation as a treatment for adolescent femur fractures has increased in popularity. We investigated the varus stability of 3 fixation techniques--the standard 2-nail configuration (2 retrograde nails), a 3-nail configuration (standard 2-nail configuration plus 1 antegrade nail), and a retrograde/antegrade 2-nail configuration--in synthetic femurs with 2 simulated fracture patterns (transverse, butterfly). A varus moment was applied to the specimens until 20 degrees of varus angulation was obtained. The varus angular stiffness of the construct defined varus stability. The 3-nail configuration had the most varus angular stiffness with both fracture patterns. The varus stability of the 3-nail configuration was statistically higher than that of the standard 2-nail configuration with the transverse fracture pattern only. Adding 1 antegrade nail to 2 retrograde nails significantly increased resistance to varus deformity of reduced proximal-third transverse femur fractures in the synthetic femur model.

Adolescent↗

Fracture fixation in patients having multiple injuries.

The concept of early surgical stabilization of long-bone fractures in patients with multiple injuries became firmly established in the 1970s and 1980s. During the 1990s questions were raised about the early total care of all long-bone fractures in these patients. In particular, it was pointed out that patients with severe chest injuries and those with severe head injuries require special consideration. Although patients in those circumstances do require careful attention, most of the literature suggests that continued early surgical stabilization of these fractures, in particular femoral neck fractures, is important for patients who suffer polytrauma. The concept of early temporary surgical stabilization (damage control orthopedic surgery) has recently been suggested. In the majority of cases, femoral shaft fractures can be treated with interlocked intramedullary nailing.

Craniocerebral Trauma↗

Knee laxity associated with a proximal diaphyseal tibial and fibular fracture.

If operative treatment of a proximal diaphyseal tibial and fibular fracture is required, in most cases, it involves reduction and stabilization of only the tibial fracture. In this case report, after stabilization of the tibial fracture with an intramedullary nail, the patient continued to demonstrate significant varus knee laxity, despite an intact proximal tibiofibular joint and undisplaced fibular head. The stability of the knee was achieved only with internal fixation of the segmental fibular fracture. This case shows the importance of assessing knee laxity in all cases of proximal tibial and fibular fractures.

Adult↗

Biomechanical and clinical evaluation of the expandable intramedullary fixation device.

The use of an expandable intramedullary device for internal fixation of metacarpal or phalangeal bones is described. The device is applicable to transverse fractures, short oblique fractures, or transverse osteotomies. The device consists of a cylindrical apparatus made of titanium that allows collapse in the circumferential diameter. It is introduced into the medullary canal in its collapsed state, and on release expands to its normal diameter in the canal with the fracture reduced over it. A biomechanical evaluation compared the stability of this device with other commonly employed fixation methods. A retrospective review is presented of the first 43 patients in whom the device was implanted.

Adult↗