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Results for “Fracture Fixation, Intramedullary”

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PubMed1997

Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing.

Seventeen femoral nonunions after intramedullary nail internal fixation were treated with augmentative plate internal fixation. Six of them were initially managed with a Küntscher nail internal fixation; the other 11 fractures were managed with a locked nail internal fixation. All the femoral nonunions were caused by insecure fixation of the intramedullary nailing, in which a rotational instability of the fracture site was verified in all cases during operation. Leaving the intramedullary nail in situ, an augmentative plate fixation was applied to the fracture site to counter the rotational instability. A simultaneous bone grafting was performed in seven of them to repair the bony defect. All these patients walked bearing full weight on the extremity without aching at the fracture site within 3 months and all these 17 fractures obtained a bony union within an average of 7 months after this treatment. From our experience, we have found this method is a useful treatment for the nonunion of the femoral shaft fracture after an intramedullary nail internal fixation. The technique is simple and does not require any special instrument. It facilitates an early weight bearing and gives a quick recovery from nonunion.

Adolescent↗
PubMed2005

State-of-the-art treatment of forearm shaft fractures.

As the treatment of pediatric forearm shaft fractures has changed extensively over the past 30 years, it is worth discussing the current treatment modalities in these fractures. The recommendations are based on an ongoing evaluation of treatment procedures, problems, complications, and final results going back to 1976. Between 1976 and 1985, the 95.9% of fractures that were treated conservatively were tainted with bad functional results because a significant proportion healed with malalignment. The introduction of elastic-stable intramedullary nailing (ESIN) initiated a definitive change and the opportunity to stabilize unstable fractures with a less invasive method. Apart from some technical problems, the functional results of ESIN are very satisfactory. The external fixator is a good treatment for open, comminuted, or special distal dia-metaphyseal fractures in older children and adolescents. Therefore, we currently have a variety of methods to treat forearm shaft fractures in children using primary definitive fracture care (PDFC). The differentiated use of conservative and surgical measures should minimize final functional sequelae. A well-tried algorithm for this fracture region is outlined.

Adolescent↗
PubMed2006

Bending stiffness and pull-out strength of tapered, variable pitch screws, and 6.5-mm cancellous screws in acute Jones fractures.

BACKGROUND: Stabilization of fifth metatarsal Jones fractures with intramedullary screws is popular, particularly in athletes, because nonoperative treatment involves prolonged casting and a distinct risk of nonunion or delayed union. Conventional lag screws of various diameters are routinely used for Jones fracture fixation. More recently, tapered, headless, variable pitch screws have become available as an option. These screws have the advantage of not having a protruding screw head, but information regarding their performance in Jones fracture fixation is limited. To determine whether differences exist in the mechanical integrity of fifth metatarsals fixed with each type of screw, this study was designed to compare Jones fracture fixation with 6.5-mm partially-threaded lag screws and headless, tapered, variable pitch compression screws with a 4-mm leading-thread diameter and 5-mm trailing-thread diameter. METHODS: Simulated Jones fractures were created in 20 matched pairs of fresh-frozen fifth metatarsals. One bone from each pair was stabilized with a tapered, variable pitch screw, and the contralateral with a 6.5-mm partially-threaded cancellous lag screw. The stiffness in lateral-to-medial bending of the resulting constructs and the resistance of the screws to pulling out of the distal fragment were quantified. RESULTS: There was no demonstrable difference in bending stiffness between metatarsals fixed with the two types of screws (p = 0.688). The 6.5-mm screw provided significantly higher resistance to pull-out (p = 0.001). CONCLUSIONS: Headless, tapered, variable pitch compression screws of the size tested are not entirely comparable to 6.5-mm lag screws in this application. They are effective in resisting bending but do not offer equivalent resistance to thread pull-out.

Aged↗
PubMed1993

Intramedullary nailing of the cortical bone osteotomies in rabbits with self-reinforced poly-L-lactide rods manufactured by the fibrillation method.

Right femoral, cortical bone osteotomies of 42 rabbits were fixed with fibrillated, self-reinforced (SR) poly-L-lactide (PLLA) rods, 4.5 mm in diameter. Follow-up times were from 3 to 48 wk. None of the rods broke during this period. There was one non-union at three weeks and one non-union at 12 weeks. Radiographic, histologic, microradiographic and oxytetracyclic fluorescence studies showed normal healing. Shear load carrying capacity of the osteotomy plane was measured from 30 bone samples; the shear force at breaking increased during the follow-up time to 450 N, while the mean shear force of intact, left-side control femurs was 440 N. Before shear tests of the bones, the SR-PLLA rods were taken away from the medullary cavities of the femurs. The rods were also tested mechanically. About 25% of the initial 136 MPa shear-strength of the rods was left after 24 wk. The results show that fibrillated SR-PLLA rods are strong enough to be used in intramedullary nailing of femoral cortical bone osteotomies in rabbits.

Animals↗
PubMed1993

[Intramedullary nailing of fractures during the growth period with a new implant].

Intramedullary nailing with flexible titan pins is a simple and safe method for the treatment of fractures in children. Avoiding the epiphysis two pins are introduced into the medullary space in a double-crossing way to stabilise diaphysial fractures of bigger bones such as femur, tibia or humerus. Forearm fractures are splinted with a single pin each to radius and ulna. The method is also practicable in proximal fractures of the radius, reduction and stabilisation can be achieved with an intramedullary pin in one step avoiding arthrotomy.

Adolescent↗
PubMed1986

Treatment of failures after plating of tibial fractures.

Eighteen patients with tibial fractures treated by plating that had failed were treated by intramedullary nailing. Nine patients had a broken plate or screw that had pulled out. In seven, the plate and screws were intact but no healing was evident, and in two patients the plate was intact but one or more screws were broken. The plate and screws were removed from all patients and immediate limited open intramedullary nailing was done with a Küntscher nail after the bone was reamed. In one patient the method failed, while in fifteen patients the fracture united and in the two remaining patients who could not be contacted union was thought to be in process when they were last seen, five and ten months postoperatively. Two bone grafts were used in one patient. Six fibular osteotomies were performed in conjunction with the intramedullary nailing.

Adult↗
PubMed1985

[Treatment of diaphyseal fractures of the crural bones].

Results of the treatment of 878 diaphyseal fractures of the shin are analyzed according to the severity of fractures and methods of treatment. The immobilization method was shown to be preferred for light fractures, closed intramedullary osteosynthesis for fractures of the moderate severity, extrafocal osteosynthesis--for critical fractures. Skeletal traction is expedient for fractures of the moderate severity, whose biomechanical characteristics are not suitable for intramedullary osteosynthesis.

Adolescent↗
PubMed1995

Nonreamed interlocked intramedullary tibial nailing. One community's experience.

Forty-nine acute displaced tibial fractures (31 closed, 18 open: 5 Grade I, 7 Grade II, 4 Grade IIIA, and 2 Grade IIIB) were treated in 1 community with a standard operative protocol using a distractor without a fracture table, and an unreamed interlocked tibial nail. Forty-six fractures healed (94%). Complications included 3 nonunions (6%), 2 deep infections (4%), 9 delayed unions (18%), 4 angular malunions (8%), 2 rotatory malunions (4%), and 12 interlocking screws bent or broke (24%). Twenty-eight patients (57%) required at least 1 additional operation to obtain union, most commonly dynamization of a statically locked nail. The authors conclude that unreamed tibial nails provide adequate stabilization of displaced tibial fractures and can be used in the management of most open or closed tibial fractures. However, static locking is required in axially unstable fractures. Early dynamization or exchange nailing and bone grafting should be considered to hasten union and avoid screw failure. The distractor is an excellent adjunctive technique for reduction and alignment of tibial shaft fractures during intramedullary nailing.

Adolescent↗
PubMed2001

Loads acting in an intramedullary nail during fracture healing in the human femur.

The form and function of the musculo-skeletal system is closely related to the forces acting in its components. Significant forces are present in the long bones, but their magnitudes have so far only been estimated from mathematical models. Fracture fixation by means of metal implants provides an opportunity to measure the implant-born forces and to estimate the long bone forces before healing occurs. The load changes during fracture healing may provide additional information. Therefore, a telemetrized, interlocking femoral nail for wireless transmission of forces and moments acting across the fracture site was developed. The design was based on the geometry and material of a 16 mm AO nail with a circular, closed cross-section allowing full protection of the electronic circuits from the body fluids. After careful testing, it was implanted in a 33-year-old patient who had sustained a multifragmentary fracture of the left femur. Measurements at a rate of approx. 0.4 Hz were performed in different patient postures between the 2nd and 26th postoperative week. Significant axial forces and bending moments were measured during several activities such as sitting, unsupported leg elevation and partial weight bearing in a standing position. Forces orthogonal to the nail axis remained small. The reductions of the implant loads due to fracture consolidation were in the order of 50%. Dynamization of the nail did not change the forces. Even though the telemetry system did not allow for dynamic measurements and the results presented here provide data from one subject only, the new information will be useful with respect to implant design, biomechanics of fracture fixation and evaluation of healing progression.

Adult↗
PubMed1983

[Intramedullary nailing as secondary intervention following prior use of external fixation].

The external fixation has its clear indications. In some cases, however, healing up of the bone fails to appear. This is caused partly by the gravity of the primary injury, partly by biomechanical reasons. The failure of a perfect fracture healing can require a change of the osteosynthesis procedure. Under certain conditions nailing provides good success. By means of 13 own cases conditions, indications and results of secondary nailing after prior external fixation osteosynthesis will be discussed.

Adult↗
PubMedDate not supplied

Operative treatment of clavicle fractures in children: a review of 21 years.

Between 1980 and 2000, 15 children (14 boys and 1 girl) underwent surgical treatment of a fractured clavicle at the authors' hospital. Eight patients were treated for midshaft fracture, two had medial fractures, and five had fractures to the lateral end, one of which occurred in combination with true disruption of the acromioclavicular joint. The indications for operative treatment of clavicle fractures are rare, in some cases debatable, and surgery is usually necessary only in older children. If surgically treated, the results are satisfactory without major complications. In the authors' experience intramedullary stabilization with elastic nails is the method of choice in most cases.

Adolescent↗
PubMed1994

Acute lengthening of shortened lower extremities after malunion or non-union of a fracture.

Forty-nine skeletally mature patients who had either a non-union or a malunion of a fracture of the tibia or the femur had correction of the deformity and acute axial lengthening of the fractured bone. Distraction was provided by the short AO/ASIF fracture distractor applied directly to the site of the osteotomy or non-union. At an average of sixty-three months (range, twenty-six to 105 months), the average increase in the tibial and femoral length was 1.7 and 3.2 centimeters, respectively. There were no compartment syndromes or ischemia secondary to any of the procedures. One patient had a transient sensory-nerve loss. Fatigue fractures were seen in two tibial plates, two femoral plates, and one femoral intramedullary nail used for osteosynthesis. A non-union developed after four other femoral intramedullary nailing procedures. One infection developed after lengthening of a tibia. Restoration of normal length by acute lengthening and internal fixation was achieved in twenty-seven patients. One patient had overlengthening of one centimeter. Fifteen patients had residual shortening of approximately one centimeter, three had shortening of more than one to 2.5 centimeters, and three patients had more than 2.5 centimeters of shortening. The patients in this series had acute restoration of limb length after traumatic shortening with a low prevalence of complications of neurovascular compromise. Three of the thirty tibial lengthenings and seven of the nineteen femoral lengthenings had to be followed by at least one additional procedure to obtain union.

Adult↗