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PubMed2002

[Use of the elastic stable intramedullary nailing technique in non-typical pediatric fractures].

PURPOSE OF THE STUDY: The "Elastic Stable Intramedullary Nailing" (E.S.I.N.) of French authors as a method of treatment of children's diaphyseal long bone fractures is well known from nineties of the last century. After we got familiar with the technique we wanted to introduce it in other indications, especially some metaphyseal long bone fractures and injuries of metacarpals, meta-tarsals and phalangeal bones in the growing skeleton. MATERIAL: During two last years, i.e. 1999-2000, ESIN procedure in 97 children was performed in our Regional Pediatric Trauma Centre. That was 39% of all osteosyntheses and 3.05% of all children's fractures treated during this period. Children treated by ESIN procedure were divided into three groups (see in Methods), 52 being in group one, 28 in group two and 17 in group three. METHODS: In our series of patients managed with the use of ESIN procedure according to the type of fractured bone and physical behavior of the implants three groups were formed. In the first group called "Classic ESIN Procedure" were children with diaphyseal long bone fracture (femur, tibia, humerus and forearm bones), in the second group "Non-typical ESIN Procedure" metaphyseal long bone fractures (humerus, radius, tibia) and in the third group, "ESIN-like Procedure" patients with metacarpal and phalangeal digital fractures were included. In all children the technique was very similar to original French (Nancy) description. Supraphyseal trepanation of the bone and introduction of usually two prebent elastic nails intramedullary. RESULTS: All 97 children healed good. In four children we saw little problems. In one patient it was necessary to change the ESIN osteosynthesis of open tibia fracture to external fixation. In the other boy we saw delayed union of forearm bones and in the third a 2 centimeter overgrowth of the affected tibia was recorded. In the last boy where non-typical ESIN procedure was performed for proximal radial fracture separation the angulation of radial head, overgrowth and subluxation occurred. However, we were surprised by simplicity, short time of the procedure and good results in two new groups of patients with metaphyseal and metacarpal resp. phalangeal fractures. DISCUSSION: Though in metaphyseal long-bone fractures (Non-typical ESIN Procedure) and metacarpal and phalangeal digital fractures (ESIN-like Procedure) the technique does not respect original physical suggestions of three point fragment fixation it works very well. Already the French authors from Nancy mention the indication of the ESIN technique for some metaphyseal fractures (supracondylar humeral and proximal radial). We do not use the method in supracondylar fractures but found it excellent in earlier problematic proximal humeral and radial fractures and especially phalangeal digital fractures. Also we were able to establish three main indication groups for this procedure. CONCLUSIONS: The ESIN technique can be used in three groups of children's fractures. "Classic ESIN Procedure" in diaphyseal long bone fractures, "Non-typical ESIN Procedure" in metaphyseal long bone fractures and "ESIN-like Procedure" in metacarpal and phalangeal digital fractures.

Bones of Upper Extremity↗
PubMed1997

Supracondylar femur fracture above a mature knee fusion treated with a long locked intramedullary rod.

Fracture around a mature knee fusion has been reported in the orthopedic literature, but little has been written regarding treatment options. Closed long anterograde rodding with interlocking screws offers distinct advantages over other methods of reduction and fixation. The closed nature of the procedure avoids excessive soft-tissue stripping. In comparison with a short unlocked rod or plate, the long locked rod imparts more stability and prevents shortening and rotation. We present a case of a supracondylar femur fracture above a mature knee fusion treated in this manner. The literature on this injury is also reviewed.

Arthrodesis↗
PubMed1998

[Measurement of interfragmentary micromovement induced by mechanical vibration with accelerometers in vitro].

The interfragmentary micromovement induced by mechanical vibration was measured in vitro in seven preserved adult cadaveric femurs by using accelerometers. Accuracy analysis of this method indicated that it can detect relative interfragmentary micromovement as small as 0.1 mm or below under certain range of frequency. Also, the results have shown that the mechanical vibration can induce interfragmentary micromovement under intramedullary nailing, but it can not do so under plate fixation.

Adult↗
PubMedDate not supplied

Treatment strategies for acute fractures and nonunions of the proximal fifth metatarsal.

There are at least three distinct fracture patterns that occur in the proximal fifth metatarsal: tuberosity avulsion fractures, acute Jones fractures, and diaphyseal stress fractures. Each of these fracture patterns has its own mechanism of injury, location, treatment options, and prognosis regarding delayed union and nonunion. Tuberosity avulsion fractures are the most common in this region of the foot. The majority heal with symptomatic care in a hard-soled shoe. The true Jones fracture is an acute injury involving the fourth-fifth intermetatarsal facet. These injuries are best treated with non-weight-bearing cast immobilization for 6 to 8 weeks. The rate of successful union with this treatment has been reported to be between 72% and 93%. For the high-performance athlete with an acute Jones fracture, early intramedullary-screw fixation is an accepted treatment option. Nonacute diaphyseal stress fractures of the proximal fifth metatarsal and Jones fractures that develop into delayed unions and nonunions can both be managed with operative fixation with either closed axial intramedullary-screw fixation or autogenous corticocancellous grafting. Early results with the use of electrical stimulation are promising; however, prospective studies are needed to better define the role of this modality in managing these injuries.

Casts, Surgical↗
PubMed1997

[Intramedullary nailing in forearm shaft fractures--an 18 year retrospective study of a patient sample].

Between 1976 and 1993 we have operated 253 patients with 350 fractures of the radius-and/or ulna. 180 fractures were stabilized with a plate (ASIF) or external fixation. In 100 patients with 170 fractures Hackethal's bundle nailing was performed, including 23 times nailing of one bone and external fixation or plating of the other bone. Our indications for Hackethal's bundle nailing of forearm fractures are closed and 1 degree open A and B-fractures of the 2. to 5. sixth of the radius and/or the ulna. 83 of 100 patients, stabilized with bundle nailing, were followed up clinically and radiologically after a mean of 6.8 years. For evaluating follow-up results, the score by Oestern and Tscherne was employed. Very good and good results were found in 74.7%, satisfying and poor results in 25.2% of the cases. Injuries of the same extremity, e.g. fractures of the humerus, arterial- or nerve lesions interfered with the results. We found a low complication rate after bundle nailing: 1 osteomyelitis (0.59%), 3 non-unions (1.76%), 1 refracture (0.59%), 5 synostoses (4.12%, incl. 2 patients (1.18%) with a combination of bundle nailing and plate osteosynthesis or external fixation). In the mentioned indications the stabilization of forearm fractures by Hackethal's bundle nailing is a low-risk method with fast bone healing and short operation time.

Adult↗
PubMed2003

[Intramedullary stabilisation of metastatic fractures of long bones].

UNLABELLED: Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept. PATIENTS AND METHODS: From 01.01.1995 to 30.08.2001 36 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n=11), femoral neck (n=6), per- and subtrochanteric region (n=12), femoral shaft (n=10) and tibia (n=2). Most of them were malignancies of the kidneys (n=13), bronchi (n=7) and breast (n=6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery. RESULTS: No intraoperative complications occurred. 63 % of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95 % CI 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n=1), soft tissue infection (n=1), dislocation of the nail (n=2), loosening of the distal locking screw (n=1), proceeding osteolysis with high fracture risk (n=1). CONCLUSION: Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure is less invasive and allows early weight bearing.

Adult↗
PubMed2004

[Primary non-Hodgkin's lymphoma of bone].

Primary lymphoma of bone is a rare condition that has been described as a malignant neoplasm formed of lymphoid and myelopoetic tissues. Morphologic substrate is formed of lymphoid cells of different evolutional stages. Primary lymphoma of bone occurs predominantly in males; a male to female ratio is 1.8:1. It may occur at any age. The sites commonly affected are the long bones. In Lithuania 400 new cases of lymphoma are diagnosed every year. About 75% of them are non-Hodgkin's lymphoma. Many histological types and subtypes of lymphoma exist. This variation leads to difficulties when reviewing the literature and comparing prognoses, treatment and oncologic outcomes. Treatment options for primary bone lymphoma historically have included local therapy with radiation or surgery with or without systemic therapy. The aim of surgery is prophylactic fixation of impending fractures or treatment of pathological fractures. We present a clinical case report of 40-year-old male who developed primary lymphoma of bone with pathological fracture of femur. The systemic chemotherapy was applied during the time of treatment. The choice of surgical treatment was intramedullary nailing without using of methylmethacrylate, because regeneration of bone was visible on roentgenograms. After twelve-month follow-up the patient is full weight bearing without external support.

Adult↗
PubMed2002

Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly.

We report a randomised, prospective study comparing a standard sliding hip screw and the intramedullary hip screw for the treatment of unstable intertrochanteric fractures in the elderly. One hundred and two patients were randomised on admission to two treatment groups. Fifty-two patients were treated with a compression hip screw (CHS), and fifty had intramedullary fixation with an intramedullary hip screw (IMHS). Patients were followed for 1 year and had a clinical and radiological review at 3, 6 and 12 months. The mean duration of operation and fluoroscopy screening time was significantly greater for insertion of the intramedullary hip screw. There was no difference between the groups with regard to transfusion requirements or time to mobilise after surgery. There were two technical complications in the CHS group and three in the IMHS group. There was no significant difference between the two groups in radiological or functional outcome at 12 months. It remains to be shown whether the theoretical advantages of intramedullary fixation of extracapsular hip fractures bring a significant improvement in eventual outcome.

Aged↗
PubMedDate not supplied

Congenital pseudarthrosis of the tibia: treatment with free vascularized fibular grafts.

We used free vascularized fibula transfers to treat 12 patients with congenital pseudarthrosis of the tibia. The mean age at surgery was 6.5 years, and the average follow-up was 3.4 years. Only one patient had persistent nonunion at the time of last follow-up, but he had 2.2 operations after the initial vascularized procedure. Problems included delayed union at the distal anastomosis and refracture. Union can be achieved in most patients, but attention to technical detail is very important. All angulation must be corrected and, at the first sign of delayed union, the site should be regrafted and intramedullary fixation should be used.

Adolescent↗
PubMed2002

[Retrograde tibial intramedullary nailing with the Flex Nail--treatment of tibial fracture in an unusual case].

We report a case by a 75 year old female patient suffering a third-degree open fracture of the shinbone with a severe damage of the soft tissue. Primary operation was a temporary fixation with a fixateur externe and a radical debridement of the soft tissue with vacuum-sealing. Ten days later we did the definitive surgery. Osteosynthesis was done by a retrograd nailing with the flexible unreamed humerus nail (Flex-Nail) through the medial ankle. The defect of the soft tissue was treated by a muscle flap and meshgraft transplantation. Healing of the soft tissue and beginning consolidation of the fracture comes after 4 months. In our opinion the retrograd inserted Flex-Nail is a good option for treatment of compound fractures of the lower leg in special cases.

Aged↗