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PubMed2004

Antegrade interlocking nailing of humeral shaft fractures.

The results of 39 humeral shaft fractures (37 patients) treated with antegrade locked nailing using a Russell-Taylor nail were reviewed. There were 30 acute fractures, 6 fractures malaligned in a hanging cast or brace, and 3 pathological fractures. Patient age ranged from 26 to 80 years (average, 59.7 years) and average follow-up was 25.7 months (range, 6-48 months). Fracture union was achieved in 92.3% of our cases, while shoulder function was excellent or good in 87.2% of cases. Antegrade locked nailing offers a dependable solution for the treatment of humeral shaft fractures, especially in polytrauma patients and cases of segmental or pathological fractures. Far less satisfactory results were obtained in comminuted fractures of the proximal third in the humerus, especially in osteoporotic patients, and we therefore advocate caution with the use of intramedullary nailing in this type of fracture. Certain technical aspects such as avoiding nailing the fracture in distraction, properly countersinking the tip of the nail, and achieving adequate fixation stability have been found to be of paramount importance to reduce the incidence of delayed union/non-union rate and to obtain better functional results from the shoulder joint.

Adult↗
PubMed1986

A new approach to the treatment of ankle fractures. The Inyo nail.

The Inyo nail is a new intramedullary device for the treatment of fractures of the distal fibula. It is a tapered V-shaped nail made of malleable stainless steel, which provides rigid fracture fixation. Torsional stress is resisted because of its triflanged shape. It may be introduced closed, using the image intensifier. Two groups of patients were evaluated: Group I was treated with the Inyo nail and Group II was treated by the Association For the Study of Internal Fixation (ASIF) technique. Eighty-five percent of the patients in Group I were rated as good, compared with 63% in Group II. There was significantly less morbidity and complications in Group I. Several factors must be observed in the treatment of ankle fractures. Stress radiographs must be obtained intraoperative. Surgery may be indicated in unstable supination lateral rotation Type II injuries, if these occur in patients with high physical demands. Anatomic reduction of the lateral malleolus must be obtained. Early weight-bearing and motion produces the best result. Late reconstruction of malunions can be accomplished using the Inyo nail.

Adult↗
PubMed2003

Management of femur shaft fracture with close locked intramedullary nailing: comparison of Variwall and predrilled Kuntscher nail.

A prospective and comparative study of 44 cases of close locked static intramedullary (IM) nailing of Femur shaft fracture with two nailing systems was done. Comparing the cheap predrilled Kuntscher nail with standard but expensive Variwall nail of Biomet Company England, we found almost equal result in both groups regarding complications and healing of the fracture. Average healing time in Variwall and Kuntscher nailing were 16.4 and 16.1 weeks respectively, P value being in-significant. In Variwall nailing, stable fractures healed at the average of 13.5 weeks and unstable fractures at 17.2 weeks; open fractures at 18.4 weeks and close ones at 14.2 weeks; fractures due to Road Traffic Accident (RTA) at 16.3 weeks, gunshot injury at 18.6 weeks and fractures due to fall at 14 weeks. Similarly in Kuntscher nailing these figures were 14 and 16.7 weeks; 19.6 and 14.5 weeks; 16.6, 22 and 13 weeks respectively. Pre-drilled Kuntscher nail with good quality cortical screws for interlocking is recommended for any variety of femoral shaft fracture. It is cost effective, at the same time gives acceptable result as compared to standard interlocking intramedullary nail.

Adult↗
PubMed1993

Rush rods versus plate osteosyntheses for unstable ankle fractures in the elderly.

Fifty patients with unstable fibular fracture were randomized into two groups. Twenty-five were treated with Rush rods and 25 with AO plates. Eighty-eight percent of patients treated with intramedullary rods had good or fair functional results, compared with 76% of patients undergoing plate and screw fixation. Full weight bearing was possible 6 weeks earlier with Rush rods than with AO plates, and there was less morbidity in the intramedullary group than in the AO group. This study indicates that Rush rods are a useful tool in elderly patients with soft bone, who are at risk for complications with plate and screw fixation.

Aged↗
PubMed2002

[The BEHAC nail--a new intramedullary implant for managing 2-stage fractures of the humerus].

The BEHAC-nail is a new implant for the treatment of complex humeral fractures, particularly for segmental fractures. It is an elastic intramedullary implant that is inserted retrograde into the distal humerus. The special feature of this nail is its proximal "loop design" which reduces the implant penetration at the proximal fixation site in the subchondral area of the humeral head in comparison to implants with tips such as Rush pins or Hackethal's nails. Thus, the risk of nail migration and perforation of the humeral head is less with the BEHAC-nail than with other nails. Another advantage of the "loop design" is that the humeral head fragment can be fixed adequately. Even short proximal fragments can be stabilized with this design. In contrast a short humeral head fragment cannot be held with implants like the UHN, HVN or Seidel's nail. The BEHAC-nail is a useful implant for segmental fractures of the humerus.

Equipment Design↗
PubMed1996

Accuracy of intramedullary templates in femoral and tibial radiographs.

The accuracy of templates used for the preoperative planning of the fixation of intramedullary fractures depends on radiological magnification. To study the accuracy of these templates, we randomly selected 100 femoral and 100 tibial radiographs taken after stabilisation by an intramedullary nail using a standard technique. We then compared the known nail length with the corresponding measurements on the radiographs. The mean magnification factor for the femur was 9% and for the tibia 7%; these differ considerably from the range of magnification of the manufacturers' templates (femur, 15% to 17%; tibia 10% to 15%). We conclude that templates are unreliable for the selection of implant length and that this should be done by intraoperative measurements.

Bone Nails↗
PubMed1996

Analysis of failed surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity: the Jones fracture.

Failure of surgical management of fractures of the base of the fifth metatarsal distal to the tuberosity is uncommon. Only one such failure has been reported in the literature to date. The purpose of this article is to present the clinical course of 11 patients with failure of surgically managed jones fractures reviewed by the senior author (J.S.T.). Surgical management was complicated by delayed union in three patients, refracture in seven patients, and nonunion in one patient. The 11 procedures were divided between two established techniques: (1) intramedullary screw fixation (N = 6) and (2) inlaid corticocancellous bone graft (N = 5). In the six intramedullary fixation procedures, using other than a 4.5-mm ASIF malleolar screw for internal fixation correlated with failure. In the five inlaid bone graft procedures, undersized corticocancellous grafts and incomplete reaming of the medullary canal correlated with failure. Also, after both procedures, early return to vigorous physical activity is believed to have played a role in delayed union and refracture.

Adolescent↗
PubMed1994

The prevention of infection in open fractures: an experimental study of the effect of fracture stability.

An experimental model of a contaminated open fracture has been developed. This model has been used to test the hypothesis that stable fixation of a contaminated open fracture will reduce its susceptibility to infection. The tibiae of male New Zealand white rabbits were fractured and then fixed with either a dynamic compression plate (stable group) or a loose-fitting intramedullary rod (unstable group). The fracture site was then inoculated with a standard inoculum of Staphylococcus aureus. There were 20 rabbits in the stable group and osteomyelitis developed in seven (35 per cent); in the unstable group 15 (71 per cent) out of 21 animals developed osteomyelitis. This difference in infection rates was statistically significant (P < 0.02). This experimental study supports the concept of stabilization of open fractures in man.

Animals↗
PubMed2003

[The prosthesis nail -- a new stable fixation device for periprosthetic fractures and critical fractures of the proximal femur].

Increasing numbers of total hip arthroplasties in combination with increasing age and growing daily activities of the elderly lead to increasing numbers of periprosthetic fractures and revision arthroplasties in osteoporotic bone. The prosthesis nail is a hybrid of a hip prosthesis and an intramedullary nail allowing immediate full weight bearing and early rehabilitation. The prosthesis nail consists of three self-locking components: a distally locked intramedullary nail, different lengthening modules, and a hip prosthesis module. From 1992 to 1999, 28 prosthesis nails were implanted in 26 patients (40-88 years, mean age: 71 years). The indications were 21 peri- and subprosthetic fractures caused by trauma, 2 fractures of the proximal femur in combination with a fracture of the femoral head or severe degenerative arthritis, and 4 revision arthroplasties associated with poor bone quality. A combination of the prosthesis nail and bone cement was used in one patient suffering from a pathological fracture of the distal femur. Patients were additionally treated with wire cerclage (six patients) and autogenous bone grafting (ten patients). All patients-except those who received a reconstruction of the acetabulum in the same session (four patients)-were mobilized with full weight bearing on the operated side as soon as wound pain diminished. Bone healing was observed in all periprosthetic fractures. In three patients the prosthesis nail had to be revised: one patient suffered from recurrent dislocations and in one patient weighing 350 pounds limb shortening occurred after the distal locking screw broke. Intramedullary infection was observed once after treatment of a periprosthetic fracture. When bone union was achieved the prosthesis nail was removed and the patient was mobilized with a girdlestone situation. The idea of the prosthesis nail is based on the logical consequence of treating femur fractures with the most efficient procedure, which is intramedullary nailing. The prosthesis nail can be applied according to the requirements of the fracture as a reamed or unreamed nail and immediate full weight bearing is possible. Considering the high average age of the patients, low morbidity, short rehabilitation time, and low costs are the major advantages of this new device. Taking into account the unfavorable preoperative conditions associated with elderly and multimorbid patients, the rate of complications is relatively low.

Acetabulum↗