Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fracture Fixation, Intramedullary”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 775 records · Page 43Linked to original sources
PubMed2000

Displaced tibial shaft fractures: a prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients.

Of 53 patients with unilateral, displaced and closed or grade 1 open tibial shaft fractures, 27 patients (group I) were randomized to treatment with an intramedullary nail and 26 patients (group II) to treatment with a plaster cast. 12 fractures in the latter group were considered stable enough for treatment with only a cast (group IIa), while 14 fractures in group II showed redisplacement during reduction under anesthesia or at 1 week follow-up. Therefore, these fractures were stabilized with cerclage or screws (group IIb), which was a prerequisite for continuing cast treatment. The mean time-to-union was 19 weeks for group I, and 25 weeks for group II. 6 patients in group I and 16 in group II had delayed union. The Nottingham Health Profile index scores on physical mobility, social isolation, work ability, and sexual life were significantly better in group I than in group II at 3 months after injury. Delayed union, malunion, and restricted range of motion at the ankle joint were common complications when these fractures were treated with a cast. We recommend intramedullary nailing for these fractures.

Activities of Daily Living↗
PubMed2006

Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study.

The aim of this study was to compare the results of the humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of the humerus. Forty-seven patients with diaphyseal fracture of the shaft of the humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were grade 1 or 2a compound fractures, polytrauma, early failure of conservative treatment and unstable fractures. The patients with pathological fractures, grade 3 open fractures, refractures and old neglected fractures of the humerus were excluded from the study. Twenty-three patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach. The outcome was assessed in terms of the union time, union rate, functional outcome and the incidence of complications. Functional outcome was assessed using the American Shoulder and Elbow Surgeons' Score (ASES). On comparing the results by independent samples t test, there was no significant difference in ASES scores between the two groups (P>0.05). The average union time was found to be significantly lower for IMN as compared to DCP (P<0.05). The union rate was found to be similar in both groups. Complications such as infection were found to be higher with DCP as compared to IMN, while shortening of the arm (1.5-4 cm) and restriction of shoulder movements due to impingement by the nail were found to be higher with IMN as compared to DCP. However, this improved in all patients following the removal of the nail once the fracture had healed. This study proves that IMN can be considered a better surgical option for the management of diaphyseal fractures of the humerus as it offers a short union time and lower incidence of serious complications like infection. However, there appears to be no difference between the two groups in terms of the rate of union and functional outcome.

Adult↗
PubMed2003

Fine wire frame-assisted intramedullary nailing of the tibia.

Intramedullary nailing is accepted as the technique of choice for treatment of unstable tibial diaphyseal fractures. Indirect closed reduction must first be obtained to allow passage of the guide wire and reamers. We describe the use of a simple frame that allows precise reduction, control of rotation and easy imaging access, without increasing operating or screening time.

Bone Nails↗
PubMed1998

Interlocked intramedullary nailing for treatment of open femoral shaft fractures.

Twenty-eight patients with open femoral shaft fractures treated by reamed intramedullary nailing were reviewed retrospectively. Nine patients had Gustilo Grade I injuries; 14, Grade II; and five, Grade IIIA. Twenty cases had static locking, two cases had dynamic locking, and six cases were not locked. Average time to union was 20 weeks. The infection and nonunion rates were 0%. The data suggest that interlocked reamed intramedullary nailing is a safe treatment option for treating open femoral shaft fractures.

Adolescent↗
PubMed2006

Does open reduction increase the chance of infection during intramedullary nailing of closed tibial shaft fractures?

OBJECTIVE: To evaluate whether an open technique used to obtain reduction during intramedullary nailing of closed tibial shaft fractures increases the risk of infection, compared to closed reduction and nailing. SETTING: University level 1 trauma center. DESIGN: Retrospective database analysis. PATIENTS/PARTICIPANTS: One hundred seventeen patients with 119 fractures from our trauma database who had sufficient follow-up and met study criteria. The patients were grouped by open versus closed reduction. Only OTA fracture types 42 A to C were included in this study. INTERVENTION: Locked reamed intramedullary nailing for closed tibial shaft fractures accomplished through either open or closed reduction. MAIN OUTCOME MEASUREMENT: The presence or absence of infection as determined by the clinical presentation (erythema, warmth, purulent drainage, fevers, chills, increased pain at the fracture site), indicative laboratory work (complete blood count, erythrocyte sedimentation rate, C-reactive protein), and/or positive culture. RESULTS: There were 85 males and 32 females. The average age was 35.7 years; the average follow-up was 14.3 months. Of the 119 fractures, 79 had closed reduction whereas 40 had open reduction. The open reductions consisted of 13 with a formal incision (>1 cm in length), 22 with percutaneous incisions, and 5 with fasciotomies. There were no infections in the closed reduction group and 2 infections (5%) in the open reduction group. This difference was not statistically significant (P=0.1). The average time to union was 7.0 months in closed reductions and 7.3 months in open reductions. By latest follow-up, 107 fractures had reached union (89.9%), 1 had not (0.8%), and 11 were lost to final follow-up (9.2%). CONCLUSIONS: Limited open techniques can greatly facilitate the reduction of closed tibial shaft fractures but raise concern for infection through exposure of the fracture site. This study found that the rate of infection for open versus closed reductions was higher but not statistically different. Judicious use of open reduction techniques during intramedullary nailing of closed tibia fractures seems to have a minimal risk of infection.

Adult↗
PubMed2003

Intramedullary stabilization of distal-third femur fractures in octogenarians.

Management of distal-third femoral fractures is challenging, especially in the elderly population, where the associated complication rate has been reported to be as high as 40%. This study reviews the techniques and safety of intramedullary stabilization for displaced and unstable fractures involving the distal third of the femur in patients who were at least 80 years old, with the use of Ender nails. A retrospective study of 12 patients with 14 femur fractures underwent closed fixation of their fracture(s) with Ender nails performed within 24 hours of the injury. There were 10 females and 2 males, whose average age was 88 years (range, 82-103 years). The average length of follow-up was 3 years. Twelve fractures (86%) healed uneventfully. There were two nonunions (14%) with no other major or minor complications. No patients were lost to follow-up evaluation. All patients eventually returned to their preinjury level of function. This technique is particularly applicable to elderly patients with severe osteopenia and preexisting medical problems, as it minimizes blood loss and other associated complications, while providing stability for immediate mobilization.

Age Factors↗
PubMed2002

["Biorigid" interlocking after unreamed intramedullary nailing of tibial shaft fractures].

Between April 1996 and December 1999, 76 tibial shaft fractures were treated at the Department of Trauma Surgery of the Justus-Liebig-University in Giessen, Germany and the Department of Orthopedic Surgery of the University of Louisville, USA with a newly developed, unreamed, solid, small diameter tibial nail interlocked "biorigidly" with screws in grooves of the nail. 69 Patients were reviewed with a minimal follow-up period of 16 months. In 65 patients, the fractures united without exchange nailing, although four of these fractures showed a delay of healing. In further four cases, non-union occurred, one of which was associated with the only break of a nail located at a distal interlocking groove of the nail. In one patient, a late medullary infection so far has not recurred following treatment. In 358 implanted interlocking screws, no implant failure was observed. First clinical experience suggests that, especially due to the low rate of material fatigue, the biorigid nail is an alternative to other implants for unreamed intramedullary nailing of the tibia.

Adolescent↗
PubMed1997

The effects of femoral intramedullary reaming on pulmonary function in a sheep lung model.

Two methods of intramedullary fixation of fractures of the middle of the femoral shaft were evaluated in a sheep model to determine the effect of femoral reaming on pulmonary function. The effect of a modified reamer was also studied. A second experiment with the same model was performed to evaluate the relationship between embolization and pulmonary dysfunction. This experiment involved two groups of sheep--those with normal lungs and those with contused lungs--divided into subgroups--those that had nailing with reaming and those that had nailing without reaming. Intracardiac ultrasound was used to measure the magnitude and duration of transvenous particulate embolization during the operations. Both experiments involved hemodynamic monitoring during and after the nailing. The pulmonary tissue was examined histologically after the animals were killed. The hemodynamic monitoring revealed only a transient increase in pulmonary vascular resistance in the animals that had femoral nailing with reaming in both experiments. The modified reamer had no effect on the pulmonary response. Histological analysis of pulmonary tissue demonstrated a significant increase in the number of fat emboli in both the animals that had nailing with reaming and the animals that had nailing without reaming compared with the control animals. Intravascular ultrasound revealed that the operative maneuver associated with the greatest number of emboli was opening of the intramedullary canal with the awl. The first two passes of the reamer produced more emboli and embolism of longer duration than did the later passes. Pulmonary confusion did not increase the risk of pulmonary dysfunction due to intramedullary nailing in this model.

Animals↗
PubMed2004

Exchange reamed nailing for aseptic nonunion of the tibia.

BACKGROUND: Exchange reamed nailing of the tibia is a common procedure in the treatment of an aseptic tibial nonunion. However, reports in the literature supporting this technique are limited. METHODS: Forty patients with a tibial nonunion after initial unreamed intramedullary nailing were retrospectively assessed after an exchange reamed nailing. The main outcome measurements included radiographic and clinical union as well as time from exchange reamed nailing to union. RESULTS: Thirty-eight patients achieved union of their fracture (95%). The average time from exchange nailing to union was 29 +/- 21 weeks. Complications included one deep vein thrombosis (2.5%) and two hardware failures (5%). CONCLUSION: Exchange reamed nailing for nonunions of the tibia results in a high union rate and is associated with a low complication rate. This technique is recommended as a standard procedure for aseptic tibial nonunions after initial unreamed intramedullary nailing.

Adolescent↗
PubMed1998

[Surgical treatment of fractures of long bones in a patient with multiple injuries].

The authors recommend application of the intramedullary and extracortical osteosynthesis methods while the trauma severity constituting less than 25 marks according to the ISS scale, the extracortical one--in 25-40 marks, and the external one--in more than 40 marks. Three patients died after the early conduction of osteosynthesis and 15--after the postponed one of the whole 315 operated injured persons with polytrauma. The miniinvasive extracortical osteosynthesis using the minimal contact plates, the intramedullary osteosynthesis using the rods with the hightened rotational stability and the external osteosynthesis using pivotal apparatuses were applied for the long bones fractures treatment.

Fracture Fixation, Internal↗
PubMed2005

Retrograde intramedullary nailing for nonunions of supracondylar femur fracture of osteoporotic bones.

Nonunion of supracondylar femur fracture remains a challenging problem because of limited treatment options. The situation is more complex when it occurs in elderly patients with osteoporotic bones. We report the treatment of 3 elderly patients with supracondylar femur fracture nonunion after open reduction and internal fixation with various plate-screw internal fixation systems. Two of these patients had traumatic fractures and the third had a periprosthetic fracture after primary total knee arthroplasty (TKA). After revision surgeries using retrograde nailing techniques, all fractures united eventually. When combined with indirect reduction, these techniques provide superior biomechanical properties and reduce the need for soft tissue dissection.

Aged↗
PubMed1986

Intramedullary stabilization of humeral shaft fractures in patients with multiple trauma.

Sixty-one patients with multiple injuries, which included sixty-three fractures of the humeral diaphysis, were treated by intramedullary stabilization of the fracture with Rush rods or Ender nails. Portals of entry allowing antegrade or retrograde insertion or insertion at the epicondyles were used. For most of the patients, closed intramedullary fixation of the fracture was performed within twenty-four hours of the injury. Adequate follow-up studies were obtained for fifty-six patients (fifty-eight fractures). Stabilization by antegrade insertion gave excellent results if the portal of entry did not violate the rotator cuff. Symptoms of impingement in the shoulder and pain associated with an incorrect position of the portal for antegrade insertion required early removal of the device. Each fracture that was treated with fixation through the epicondylar portal had a poor result, and this technique is not recommended. Retrograde insertion, with the portal of entry located proximal to the olecranon fossa, yielded excellent results. Care must be taken to prevent encroachment on the olecranon fossa, which can result in a block to extension of the elbow. The surgical technique of closed fixation by retrograde insertion is presented. Immediate closed intramedullary stabilization of the fractured humeral shaft resulted in a 94 per cent rate of union and a 62 per cent rate of excellent clinical results. This technique is particularly applicable to patients with multiple trauma, as it minimizes loss of blood and the risk to neurovascular structures while providing stability for mobilization and aggressive pulmonary physiotherapy. In our opinion, however, isolated fractures of the humeral shaft should be treated by non-operative methods.

Bone Nails↗
PubMed1991

Tips of the trade #34. Removal of broken rush pins.

Reported rates of nonunion with the nonoperative treatment of isolated humeral shaft fractures (nonpathologic bone) are low. Higher rates (13%) in open fractures are reported; open intramedullary nails may contribute to this nonunion rate. In this situation, when we identify a fractured pin, an anterolateral approach is used. The proximal pin is removed and the nonunion site is identified. The fibrous nonunion or pseudoarthrosis is excised and the distal pin fragment is identified in the intramedullary canal. A drill bit is used to remove the rod. Bone grafting is also generally utilized.

Bone Nails↗