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Results for “Fracture Fixation, Intramedullary”

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PubMed1997

Informed consent from whom?

To obtain legally safe informed consent requires that the patient has a 'substantial understanding' of the proposed procedure and that the doctor obtaining the informed consent has sufficient knowledge to explain the nature of the procedure to the patient. In this paper we have shown that significant misunderstanding exists among non-specialist junior doctors of certain common orthopaedic procedures and conditions. Junior doctors often lack sufficient technical training to fully inform their patients and thus meet legal requirements. The implications of this are that the onus falls even more on specialists to ensure that their patients receive a more detailed explanation of the proposed intervention.

Arthroscopy↗
PubMed1991

Risk of deep infection with intramedullary nailing following the use of external fixators.

A retrospective review was carried out to assess the incidence of deep infection occurring when intramedullary nailing was performed following the use of an external fixator. Three groups of patients were identified: group 1 in which the external fixator was used in initial fracture management (ten cases, nine patients), group 2 in which the external fixator was used in the management of established non-union (seven cases, seven patients), and group 3 in which the external fixator was used in limb lengthening procedures (eight cases, eight patients). All the 25 cases reviewed had clinical evidence of pin track infection before removal of the external fixator. After removal of the fixator it is our normal policy to wait for the pin sites to become dry before performing intramedullary nailing. In only one case, where there was a history of preceding recrudescent osteomyelitis, was there evidence of deep infection being reactivated following intramedullary nailing. We therefore conclude that pin track infection does not seem to be a contraindication to the subsequent use of an intramedullary nail, providing that underlying active osteomyelitis is not present. A delay of 7 to 14 days after removal of the fixator is recommended. Some problems experienced during nailing are highlighted, and solutions proposed.

Adolescent↗
PubMed1994

[Treatment of femoral trochanteric fracture with intramedullary interlocking nailing: a report of 32 cases].

We improved and made the intramedullary interlocking nail and it's instrument for surgical operation in December 1989 by consulting the reported material of the gamma locking nail. 32 cases of the femoral trochanteric fracture were treated by using this fixation system. The results were satisfactory. The patients could stand up and move about beginning from 6th to 13th day after operation. No mechanical failure of implant, infection and other complications occurred in our series. 29 cases were followed-up for 5 to 19 months and showed all of the fractures were healed. Their hip functions were completely or basically recovered. Coxa vara deformity occurred in two cases and one had a 2.5 cm shortening of the lower limb. We consider that the intramedullary interlocking nail conforms to the principle of human biomechanics and it may be used as an effective surgical treatment with the fracture fixation of superior strength and stability for every type of femoral trochanteric fractures.

Adult↗
PubMed2003

Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial.

BACKGROUND: Intramedullary nailing of the femur without reaming of the medullary canal has been advocated as a method to reduce marrow embolization to the lungs and the rate of infection after open fractures. The use of nailing without reaming, however, has been associated with lower rates of fracture-healing. The purpose of this prospective study was to compare the rate of union of femoral shaft fractures following intramedullary nailing with and without reaming. METHODS: Two hundred and twenty-four patients were enrolled in a multicenter, prospective, randomized clinical trial to compare nailing without reaming and nailing with reaming. One hundred and six patients with 107 femoral shaft fractures were treated with a smaller diameter nail without reaming of the canal, and 118 patients with 121 fractures had reaming of the canal and insertion of a relatively larger diameter nail. Patients were followed at six-week intervals until union occurred or a nonunion was diagnosed. RESULTS: The two groups were comparable with regard to the measured patient and injury characteristics. Eight (7.5%) of the 107 fractures in the group without reaming had a nonunion compared with two (1.7%) of 121 fractures in the group with reaming (p = 0.049). The relative risk of nonunion was 4.5 times greater (95% confidence interval = 1 to 20) without reaming and with use of a relatively small-diameter nail. CONCLUSION: Intramedullary nailing of femoral shaft fractures without reaming results in a significantly higher rate of nonunion compared with intramedullary nailing with reaming.

Adult↗