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PubMed2001

[The results of forearm fractures by percutaneous stabilization in children].

Between 1997 and 1999, 332 children (251 boys and 81 girls), aged 1 to 16, with fractures of the forearm bones were treated at the Department of Pediatric Surgery and Oncology in Łódź. In 38 patients (11.4%) percutaneous intramedullary Kirschner wiring of displaced fragments was performed. Proper reduction and good union of the fractured bones was achieved in all cases. Early evaluation performed at 6 months to 2 years after surgery revealed full joint mobility, preserved bone axis and no bone-length differences in comparison with the healthy forearm. Limitation of carpal joint mobility found in 4 cases (10.5%) was treated with prolonged (3 to 6 months) therapeutic rehabilitation. No patient in the analyzed series showed any symptoms of ostitis. The obtained results indicate that percutaneous intramedullary Kirschner wiring is a simple and effective way of treating chosen cases of forearm fractures in children.

Adolescent↗
PubMed1992

Femoral shaft fractures in the elderly treated with Grosse-Kempf slotted locked intramedullary nail.

Thirty-one femoral shaft fractures in patients over 60 years of age were treated with the Grosse-Kempf slotted, locked intramedullary nail and followed for a median of 24 months. The patients tolerated the operation reasonably well and the mortality was not higher than the mortality connected with femoral neck fractures. Three reoperations were performed due to intra- and postoperative complications. The main reason for the less satisfactory result was shortening > 2 cm after unstable dynamical locking. This occurred in 8 of 15 dynamically nailed fractures with locking screw(s) in one end of the nail only. A 9 cm shortening among these was the reason for one of the two poor results in the series. The other poor result was a malalignment of the distal fragment in a statically locked fracture. We conclude that locked intramedullary nailing is a good way to treat femoral shaft fractures in the elderly, the high subtrochanteric, midshaft and infraisthmic fractures.

Aged↗
PubMedDate not supplied

Closing intramedullary nailing for the treatment of diaphyseal forearm fractures in adolescence: a preliminary report.

The results of treatment of 20 unstable diaphyseal fractures of the forearm in adolescent patients by closed intramedullary nailing are presented. All fractures healed within 4-7 weeks. No cross-union, nonunion, pseudarthrosis, or infection occurred. The advantages of this method are (a) maintenance of accurate reduction, (b) reduction of complication rate, (c) negligible cosmetic defect, and (d) removal of the internal fixation device under local anesthesia.

Adolescent↗
PubMedDate not supplied

Ilizarov compression over a nail for aseptic femoral nonunions that have failed exchange nailing: a report of five cases.

OBJECTIVE: To evaluate a new operative treatment of femoral nonunion following failed exchange nailing. DESIGN: Retrospective review, consecutive series. SETTING Office-based orthopaedic practice. PATIENTS: Five consecutive patients (ages 31-67 years) were referred in with a femoral nonunion following exchange nailing an average of 28 months (range 11-55) after the initial traumatic injury. The patients had undergone an average of 5 (range 2-8) previous surgeries on the femur. No patient had signs or history of bone infection or segmental bone loss at presentation. All patients had diaphyseal or diaphyseal-metaphyseal oligotrophic nonunions and had failed an average of 2 (range 1-3) previous exchange nailings. INTERVENTION: Slow compression (0.25 to 0.50 mm per day) of the nonunion site over a new, smaller diameter nail using an Ilizarov external fixator. MAIN OUTCOMES MEASUREMENTS: Clinical and radiographic evidence of bone union, ambulation, pain, residual deformity, or shortening. RESULTS: All nonunions healed without the need for further nonunion surgery. The external fixator was removed at an average of 133 days (range 86-238 days). No deep infections occurred in any patient. All patients experienced some degree of pin site irritation. At the most recent follow-up (average 45 months; range 12-75 months), all patients had improved their functional ambulatory status and had discontinued or decreased the use of assistive devices to walk. All patients were full weight bearing. Average pain, as rated on a 0 to 10 Visual Analogue Scale, decreased from 8 of 10 before treatment to 1 of 10 after treatment. No patient experienced a clinically significant worsening of leg length discrepancy. CONCLUSIONS: Slow compression over an intramedullary nail using external fixation successfully promotes the healing of problematic femoral nonunions that have failed one or more prior exchange nailings.

Adult↗
PubMed2000

Osteosynthesis of metastatic lesions of the proximal femur with a solid femoral nail and interlocking spiral blade inserted without reaming.

OBJECTIVES: To evaluate the efficiency of a solid femoral nail and interlocking spiral-blade, inserted without reaming (UFN/ spiral blade, Synthes-Stratec, Oberdorf, Switzerland), for the fixation of pathologic and impending pathologic fractures of the proximal femur, particularly those involving the subtrochanteric area. DESIGN: Retrospective, consecutive series. SETTING AND PATIENTS: All patients treated for pathologic and impending pathologic fractures of the trochanteric or subtrochanteric area, stabilized using a UFN/spiral blade, inserted without reaming, from June 1994 to June 1997. INTERVENTION: Femoral intramedullary nailing was performed without reaming on a radiolucent operating room table. The nail was inserted through a five-centimeter supratrochanteric approach, and the interlocking spiral-blade device was introduced percutaneously. METHODS: The following parameters were assessed: pathology reports, location of bone lesions, patient survival, pain relief, ambulation, hardware failure on successive radiographs, and intraoperative complications. RESULTS: Twelve pathologic and impending pathologic fractures were stabilized in ten patients. Two patients required bilateral nailing that was staged with intervals of two and three weeks, respectively. The average postsurgical survival was six and one-half months. No implant failure was noted, and no surgical revision was performed. One intraoperative death occurred during surgery and was documented on autopsy as massive pulmonary fat embolization. Neither patient with bilateral nailing suffered from fat embolism syndrome. CONCLUSIONS: Femoral nail insertion without reaming using an interlocking spiral blade provides appropriate stabilization of the proximal femur in case of metastatic lesions, even with extensive subtrochanteric involvement. Although the nails were inserted without reaming, this did not avoid the risk of fat embolization syndrome. This study only addressed results in patients with short-term survival.

Activities of Daily Living↗
PubMed2007

[Treatment of bilateral distal tibial nonunions. Use of an intramedullary compression nail and a modified locking compression plate osteosynthesis].

Operative treatment of distal tibial fractures remains a challenge for the surgeon even today. The soft tissues demand atraumatic operative techniques, although an anatomical reduction of the articular fracture component is mandatory. The nonunion rate increases with disturbed local blood supply, widened fracture gap, unstable fixation. If a nonunion occurs, an individual treatment concept is required, so that even difficult situations can be successfully managed, as described in our case with bilateral tibial nonunions.

Adult↗
PubMed2005

The role and efficacy of retrograding nailing for the treatment of diaphyseal and distal femoral fractures: a systematic review of the literature.

The aim of this analysis has been to evaluate the efficacy of retrograde nailing in the treatment of distal femur and femoral shaft fractures. Articles were extracted from the Pubmed database and the retrieved reports were included in the study only if pre-specified eligibility criteria were fulfilled. Moreover, a constructed questionnaire was administered, aimed at assessing the quality of the outcomes. Twenty-four articles were eligible for the final analysis, reviewing a total of 914 patients (mean age of 48.8 years) who sustained 963 distal and diaphyseal femoral fractures. The overall mortality rate was 5.3%. The incidence of infection was 1.1% and for septic arthritis of the knee was 0.18%. In patients with distal femoral fractures, the mean time to union and rate to union were 3.4 months and 96.9%, respectively. The mean range of knee motion was 104.6 degrees . The rates of knee pain, malunion and re-operations were 16.5, 5.2 and 17%, respectively. Patients with femoral shaft fractures had a mean time to union 3.2 months, whilst the rate of union was 94.2%. The mean range of knee motion was 127.6 degrees . The rates of knee pain, malunion and re-operations were 24.5, 7.4 and 17.7%, respectively. We concluded that retrograde intramedullary nailing appears to be a reliable treatment option, mainly for distal femoral fractures. However, in the management of diaphyseal fractures, retrograde intramedullary nailing is associated with high rates of knee pain and lower rates of fracture union.

Bone Nails↗
PubMed2005

[Comparison of two different operations on comminuted intercondylar fracture].

OBJECTIVE: To compare the effect of two different operations on treating severely comminuted intercondylar fracture. METHODS: From December 2001 to October 2003, 20 cases of severely comminuted intercondylar fracture were operated. Of the 20 cases, 7 (group 1) were treated with closed reduction and retrograde intramedullary nailing through arthroscope, 13 (group 2) were treated with open reduction and retrograde intramedullary nailing without arthroscope. Follow-ups were conducted after operation. RESULTS: All cases of fracture were recovered. Swelling in group 1 was alleviated more obviously than that in group 2. In group 1, all knees could flex to 120 degrees during 6th to 9th weeks after the operation. In group 2, only 4 could flex 110 degrees. CONCLUSION: Retrograde intramedullary nailing through arthroscope proves to be less invasive and more effective in treating heavily comminuted intercondylar fracture.

Adult↗
PubMed2004

Surgical Implant Generation Network (SIGN) intramedullary nailing of open fractures of the tibia.

We treated 36 open tibial fractures (32 patients) by primary intramedullary nailing and debridement and treatment of open wounds. There were 13 grade I, 14 grade II and 9 grade III according to Gustilo-Anderson classification. After a minimum follow-up of 8 months, there were two cases of superficial infection and one of deep infection. Thirty-one fractures united within 6 months with a mean period to union of 22 weeks. There were four delayed unions and one non-union. There was a longer union time and a higher rate of delayed or non-union in the complex and/or comminuted grade IIIB fractures. Intramedullary nailing, with appropriate soft-tissue treatment, gives good results in the treatment of open tibial fractures.

Adolescent↗
PubMed1992

Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures.

Thirty-five displaced tibial shaft fractures, treated with functional bracing were compared with 43 similar fractures, treated with locked intramedullary nailing. There were 22 excellent/good results in the brace group and 38 in the nail group. There was one infection in the brace group and three in the nailed group. There were five delayed unions and two nonunions in the brace group and one delayed union in the nail group. The functional results in the nailed group were better than the braced group but locked intramedullary nailing of tibial shaft fractures require special resources and training. Locked intramedullary nailing fullfils all the functional criteria for acceptable fracture care.

Adolescent↗
PubMed1987

Closed nailing of the humerus--from down under.

Closed intramedullary nailing of the humerus using a curved clover-leaf nail (Pohl nail) is a relatively minor operative procedure and is associated with few complications. The technique of the operation when performed from below (29 cases) and also from above (7 cases) is that as described initially by Kuntscher and his colleagues. This paper presents the technique and the experience from 1978 to 1985 with 36 cases (20 for metastatic bone deposits, four in multiple injury patients, three in patients with a severe head injury, four in patients with multiple fractures in the same limb and five in other patients particularly elderly women with osteoporotic bones). This review demonstrates the efficacy of closed intramedullary nailing of the humerus particularly when the nail is inserted into the humerus from below just proximal to the olecranon fossa.

Aged↗
PubMed1994

Effects of graded reaming on fracture healing. Blood flow and healing studied in rat femurs.

In 30 rats, closed bilateral fractures of the femur were produced. On the left side intramedullary reaming was performed to 1.6 mm, and the fracture fixed-with a steel pin with a diameter of 1.6 mm. On the right side the femoral canal was reamed to 2.0 mm and a hollow steel tube with a diameter of 2.0 mm was used for fixation. An additional 8 rats were used to obtain mechanical, dimensional and flow data on intact femurs, and another 10 rats were used to study the acute flow changes caused by fracture and different degrees of reaming and fracture. Fracture and reaming reduced total bone and cortical bone blood flows to about one third of normal flow, with no differences between the 1.6-mm and the 2.0-mm reamed bones. At 4 weeks, total bone flow was about double and cortical bone flow about 4 times increased in the 1.6-mm group. In the 2.0-mm reamed bones increases of approximately 5 times in total bone flow and of about 7 times in cortical flow were found. Callus flow was about twice the size of the respective cortical flow in both groups. Both total and cortical flows gradually subsided, without differences between the 2 groups. At 12 weeks, the callus area in the 2.0-mm group was greater than in the 1.6-mm group, while bone dimensions were greater in the 2.0-mm group at 4 and 12 weeks. Bending moment and rigidity were greater in the 1.6-mm group than in the 2.0-mm one at every time interval; no differences were found in fracture energy.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Monitoring and healing analysis of 100 tibial shaft fractures.

BACKGROUND: We assessed the value of measuring biomechanical stiffness by assessing the fixator's external deformation as an objective means for monitoring fracture healing and determining the postoperative treatment regime, as compared to clinical and radiographic means of evaluation. PATIENTS AND METHODS: One hundred patients with tibial shaft fractures managed by unilateral external fixation had their fracture stiffness monitored. Stiffness was measured and clinical and radiological examinations were performed every 3-4 weeks. RESULTS: The time required for healing as indicated by stiffness measurement was an average of 2.5 weeks earlier than by radiological assessment. Eighty-two patients healed within 19 weeks (12.1+/-3.3 weeks) and ten patients in the following 6 weeks (24+/-4.3 weeks). Eight patients did not show an increase in fracture stiffness and received intramedullary nailing at a second operation. The average healing time was 11.3+/-4 weeks for type A, 13.1+/-3.6 weeks for type B fractures, and 15.1+/-5.9 weeks for type C fractures. The healing time for closed fractures was 11.3+/-3.2 weeks and for open fractures 14+/-4.9 weeks. CONCLUSIONS: The measurement of fracture stiffness allows the detection of patients at risk for nonunions. The healing time increased with increasing fracture gap size and was less in patients with younger age, less complex fractures, and lesser degrees of soft tissue damage.

Adolescent↗
PubMed1997

[Correcting torsion after intramedullary nailing osteosynthesis of the lower extremity].

Intraoperative control of torsion is delicate in intramedullary nailing of femur and tibia fractures. Post-traumatic torsional deformities cause clinical problems if the rotational 0-position, according to the neutral-0-method, cannot be attained or exceeded. The necessary precondition for every indication and planning of corrective osteotomies is conscientious analysis of the geometry of the lower extremities by clinical means, radiography and computed tomography. Operative procedures and techniques of corrective osteotomies in case of torsional deformities after intramedullary nailing are presented. Preoperatively, the intraindividual torsional differences in 15 patients with maltorsions of the femur were 33 degrees (-37/+50) and in 7 patients with maltorsions of the tibia 23 degrees (-21/+29). Positive signs indicate external and negative signs of internal maltorsions. Postoperatively, the intraindividual torsional differences were 6 degrees (-3/+14) in the femora and 7 degrees (+3/+12) in the tibiae. Therefore, the physiological torsional tolerance of 15 degrees was respected in all 22 patients. Additionally, limb lengthening was realized in 4 patients with shortening after intramedullary nailing of the femur. In 3 patients a one-step procedures with interposition of allogeneic cancellous bone in the osteotomy gap was performed and in one patient continuous callus distraction by external fixation.

Adult↗
PubMedDate not supplied

Our first experiences with the Unreamed Femoral Nail (UFN).

The Unreamed Femoral Nail (UFN) has been used in Belgium since April 1995. Compared with the Reamed Femoral Nail (RFN) the new device had some advantages: it can also be used for subtrochanteric fractures and ipsilateral fractures of the femoral neck, there is less iatrogenic damage to the vascularization of the bone, the risk of fat embolism syndrome and ARDS is reduced, the operation is a less time consuming procedure, associated with less blood loss. During a 9 months period, 36 patients have been treated with the UFN: 10 patients with metastatic disease, 12 patients with a subtrochanteric fracture, 14 patients with a diaphyseal fracture. In 4 cases however, previous reaming was necessary. No fat embolism syndrome, nor ARDS were ever observed. The two mechanical complications were not due to the implant itself. Two old patients with a subtrochanteric fracture died within six months after the treatment. In the ten others, no healing problems were observed. In twelve patients with a diaphyseal fracture, the evolution was uneventful. In two open fractures delayed union was observed. Once, the UFN had to be replaced by a RFN with adjacent bone grafts. The average blood loss was 140 ml, average operating time 70 minutes. We conclude that the UFN is an easy and safe procedure, which has enlarged the indications of intramedullary nailing also as a primary treatment in polytrauma patients.

Adolescent↗