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 829 records · Page 46Linked to original sources
PubMed2006

[Research on the systematic inflammatory response syndrome after femoral intramedullary nail].

OBJECTIVE: To investigate the rate of systemic inflammatory response syndrome (SIRS) among patients treated by intramedullary nail (IMN) for femoral shaft fracture right after the operation, the effect of femoral nailing on SIRS and sought to differentiate any differences between reamed and unreamed IMN. METHODS: Three hundred and twenty-four patients presenting with acute femoral fractured from April 1997 to April 2005, divided into 2 group depending on ISS. Group 1 had 179 patients (ISS < 16, AIS < 2) including 64 reamed cases and 115 unreamed cases; group 2 had 145 patients (ISS >or= 16, AIS >or= 2) including 51 reamed patients and 94 unreamed. All patients were treated by close reduction and intramedullary nail for fixation. The heart rate, breath rate, temperatures were recorded every 6 h before and after operation. If any of the life sign was above normal, then venous blood samples were taken at once to make sure whether SIRS occurred or not. All data were crosstabs analysis by SPSS 10.0. RESULTS: One hundred and twenty-four patients suffered from SIRS postoperation. In group 1, 24 reamed and 37 unreamed, in group 2, 27 reamed and 36 unreamed. Among those SIRS, 119 cases healed evenly and 5 patients developed further complication. Between reamed and unreamed patients both in group 1 and group 2, there was no significant difference found. The Chi-Square value were 0.159 and 2.885 respectively, total value was 3.467, which P was 0.325, 0.089 and 0.471, all greater than 0.05. CONCLUSIONS: Although SIRS will result from IMN, there is no significant different effect on the rate of SIRS found between reamed and unreamed nail in both group.

Adult↗
PubMed2005

Forearm fractures in children. Single bone fixation with elastic stable intramedullary nailing in 20 cases.

We present our experience with elastic stable intramedullary nailing (ESIN) used in the single bone fixation of both bones forearm fractures in children. From May 2002 to July 2004, 20 children (14 boys and 6 girls), median age of 10 years (range 6-15 years) were treated with ESIN for 16 closed and 4 grade I open forearm fractures. All patients were reviewed clinically at a median follow-up of 20 months (range 6-30 months). All fractures were radiologically united at a median of 6.7 weeks (6-9 weeks). The median operating time was 35min (range 25-60min). The median hospital stay was 2 days (range 1-3 days). Removal of the nails was undertaken in all 20 children at a median of 19 weeks (range 16-24 weeks) post-operatively. At follow-up, a full range of elbow and wrist movements were found in all cases. There was no clinically significant rotational deformity in any case. ESIN seems to be a safe method in the treatment of single bone fixation of both bones forearm fractures in children between 6 and 15 years of age.

Adolescent↗
PubMed1997

Nonreamed locking intramedullary nailing for open fractures of the tibia.

The use of nonreamed interlocking tibial nails in the management of open fractures of the tibial shaft has gained wide acceptance. This technique has been reported to have reproducible good results with a low incidence of complications in Type I, Type II, and Type IIIA open tibial shaft fractures. The use of nonreamed nails in Type IIIB fractures continues to be a source of controversy. The treatment of 72 open fractures of the tibial shaft with nonreamed interlocking intramedullary nailing is detailed. There were 27 Type I, 22 Type II, 11 Type IIIA, and 12 Type IIIB open tibial shaft fractures. There were three (4.2%) deep infections; one Type II, one Type IIIA, and one Type IIIB. Forty-nine fractures (68%) united by 6 months, all fractures had united by 12 months. The use of nonreamed locking intramedullary nailing in Types I, II, IIIA, and IIIB open fractures of the tibial shaft is supported.

Adolescent↗
PubMed2005

Provisional plating of Type III open tibia fractures prior to intramedullary nailing.

Intramedullary nailing of tibial shaft fractures is the preferred treatment of most displaced, unstable tibial shaft fractures. In open tibia fractures, direct exposure of the fracture segments for irrigation and debridement is required prior to fracture stabilization. We propose a method of provisional stabilization using commonly available implants placed through the associated traumatic open wound prior to intramedullary nailing. This technique, particularly helpful to surgeons operating with limited assistance, employs a temporarily applied 3.5-mm dynamic compression plate or limited contact dynamic compression plate implant secured with unicortical screws, allowing reaming and intramedullary nailing of a reduced, stabilized tibia fracture.

Adolescent↗
PubMed1994

[Reducing the risk of infection by use of an unreamed intramedullary nail in open tibial fractures].

An intramedullary stabilisation with an unreamed tibial nail (UTN) was carried out in 75 patients suffering from first (n = 45) and second (n = 30) degree open fractures. In 23 cases (8 of which had a second degree and 15 a third degree open fracture) the treatment regime was changed from external fixation (EF) to an UTN. The results were compared with 112 patients with first degree open tibial fractures treated with a reamed tibial nail (RTN). A change from EF to RTN was carried out in 93 cases (21 patients had a first degree, 55 a second degree and 17 patients a third degree open fracture). The rate of infection seen in open fractures was reduced by using an UTN for the tibia (4.5% using RTN versus 1.3% using UTN in primary implantation; 6.5% versus 4.3% in case of changing from EF to tibial nailing). The UTN does not disturb the healing of the fracture and there is no increased risk of axis deviation.

Adolescent↗
PubMed2006

Comparative study on the effect of reamed and nonreamed intramedullary nails on treating open tibial fractures.

OBJECTIVE: To compare the clinical effect of reamed and nonreamed intramedullary interlocking nails on treating open tibial fractures. METHODS: From February 2002 to February 2004, 92 cases of open tibial fractures (86 patients) were treated with intramedullary interlocking nails. Of the 86 patients, 65 were male and 21 were female. Their age ranged from 18 to 68 years (36.5 on average). Of the 92 cases, 54 were in the reamed group and 38 in the nonreamed group. Patients moved with the support of crutch after their wounds were healed. RESULTS: All patients were followed up regularly for 6 to 24 months. Infection rate in the reamed group and nonreamed group was 20.3% and 5.3% respectively, and there was significant difference between them (P < 0.05). The average healing time of the fractures was 22.5 weeks in reamed group and 19 weeks in nonreamed group, and there was no significant difference between them (P > 0.05). Delayed unions occurred in 8 cases and 3 cases in reamed group and nonreamed group respectively. CONCLUSION: Compared with reamed group, nonreamed intramedullary interlocking nails have lower infection rate and fewer delayed unions and unions.

Adolescent↗
PubMed1995

Tibial intercalary allograft incorporation: comparison of fixation with locked intramedullary nail and dynamic compression plate.

The healing and incorporation of intercalary cortical bone allografts stabilized with locked intramedullary nails was compared with that of allografts fixed with compression plates in a sheep model. Both techniques achieved healing of the allograft to host tibia, and there was no measurable difference in the area of callus or the quality of union histologically. Incorporation of the allograft as measured by fluorescent labeling was not different in the two groups.

Animals↗
PubMedDate not supplied

In vivo evaluation of intramedullary interlocking nail fixation of transverse femoral osteotomies in foals.

OBJECTIVE: To evaluate an intramedullary interlocking nail for stabilization of transverse femoral osteotomies in foals. STUDY DESIGN: A transverse osteotomy and restabilization with an intramedullary interlocking nail was performed on the right femur in three foals and the left femur in three foals. ANIMALS: Six foals weighing 149 to 207 kg. METHODS: The femur was destabilized with a transverse middiaphyseal osteotomy and repaired with a 0.5-in (12.7 mm) interlocking nail. The implanted femurs were radiographed monthly until completion of the study 6 months after surgery. At the completion of the study, all foals were observed for evidence of lameness, gluteal thickness was determined by ultrasonographic measurement, and a necropsy was performed. RESULTS: Healing was satisfactory in all foals. Five of the six had osseous bridging of the osteotomy apparent radiographically by 3 to 4 months. The sixth foal had postoperative infection but was healed radiographically in 5 months. There was a mean decrease in gluteal muscle thickness of 6.6 mm (P = .04) in the operated limb of the five foals that healed without complication. Two foals were lame at the completion of the project; one foal with varus deformities of the contralateral limb was mechanically lame, and another was grade 2/5 lame on the operated limb. On necropsy, there was circumferential enlargement of the diaphysis of all operated limbs with the majority of the callus at the cranial and medial aspects of the cortex. All nails were solid within the medullary cavity. CONCLUSIONS: The intramedullary interlocking nail provided adequate stabilization for repair of the transverse osteotomy. CLINICAL RELEVANCE: Further investigation is warranted before use for stabilization of spontaneously occurring fracture configurations.

Animals↗
PubMed2000

[Risks and results after simultaneous intramedullary nailing in bilateral femoral fractures: a retrospective study of 40 cases].

PURPOSE OF THE STUDY: A retrospective series of 40 patients who underwent simultaneous intramedullary nailings for bilateral femoral shaft fractures was analyzed. The aim of our study was to verify that simultaneous nailing without reaming does not increased risk of fat embolism and to assess clinical and radiological outcome. MATERIAL AND METHOD: This series included 27 men and 13 women, mean age 27.8 years, who underwent first intention intramedullary nailing between 1986 and February 1999. Thirty-two patients had multiple fractures. Mean ISS was 23 (range 9 to 59). Among the 80 femoral shaft fractures, 15 were open fractures, 3 were associated with sciatic paralysis, and 4 were complicated by an interruption of the femoral vessels. The AO classification was: type A=44; type B=25; type C=11. Mean delay to simultaneous centromedullary nailing was 3. 8 days: surgery was performed on the day of arrival for 25 patients. General anesthesia was used in all cases with respiratory assistance (FIO(2) =50 to 100 p. 100). Mean nail diameter was 11.6 (range 10-14). Gurd criteria and PaO(2) were followed to assess pulmonary function. Clinical and radiological outcome was assessed using the modified Thorensen criteria. RESULTS: Preoperatively, PaO(2) was< 87 mmHg in 8 patients. Four of these patients showed a discrete drop off and three improved well above the normal level. Only one patient experienced an important decrease but did not develop respiratory distress. Among the 32 patients with a normal level preoperatively, PaO(2) remained in the normal range in 18, fell to a limit level but below 87 mmHg in 4, and showed a substantial drop off of 46 to 172 mmHg in 10. Two of these 10 patients developed respiratory distress due to fat embolism which was fatal in one case. One other patient died in the immediate postoperative period of an undetermined cause. All of the other patients recovered normal gas levels within a few hours or days. There were four cases of phlebitis, including one with pulmonary embolism, one case of respiratory distress by pulmonary superinfection, and one case of septicemia. Both femoral fracture sites became infected in one patient. Malunion occurred in two cases. Two vascular repairs of the femoropopliteal axis were unsuccessful, leading to above knee amputations. Thirty-four patients have been examined after a minimal 12 months follow-up (mean 30 months). Outcome was excellent for 48 femurs, good for 10 and fair for 10. DISCUSSION: This continuous series of simultaneous bilateral femoral shaft intramedullary nailings appears to be the only such report to date. The clinical and radiological outcomes were comparable with those achieved in one-side femoral fractures. The risk of fat embolism is inevitable after long bone fractures. Many factors favoring the risk are recognized, the most important being delay to fixation. Reaming creates excessive pressure in the medullary canal and could thus contribute to the risk. The presence of an associated chest trauma is not a formal contraindication if effective hematosis is preserved as evidenced by the blood gases. CONCLUSION: Simultaneous nailing of bilateral femoral shaft fractures can be performed if blood gases remain acceptable and minimal reaming is used.

Adolescent↗
PubMed1990

Closed intramedullary tibial nailing. Its use in closed and type I open fractures.

We present the results of using the Grosse-Kempf interlocking nail in the management of 125 closed and type I open tibial fractures. The mean time to union was 16.7 weeks and no fracture required bone grafting. Mobilisation of the patient and the range of joint movement were better than with other methods of treating tibial fractures. There was a 1.6% incidence of infection; 40.8% of patients had knee pain and 26.4% needed to have the nail removed. Other complaints were minor. We suggest that closed intramedullary nailing with an interlocking nail system is an excellent method of treating closed and type I open tibial fractures.

Adolescent↗
PubMed1988

Closed unlocked nailing for comminuted femoral fractures.

Fifty consecutive comminuted fractures of the femoral shaft were treated by closed unlocked intramedullary nailing. Twelve unstable fractures also had cast-bracing. There were no cases of infection or non-union, and satisfactory results were achieved in 38 fractures (76%). More severe comminution led to a higher incidence of unsatisfactory results, but malrotation deformity was seen more often in less comminuted fractures and appeared to be due to poor operative reduction. Shortening in severe comminution was the main complication and was not controlled by supplementary cast-bracing. Closed unlocked intramedullary nailing is effective for lesser grades of comminution, but fractures with no cortical continuity at reduction should be treated with a locking nail.

Female↗
PubMed2003

Locked intramedullary nailing for difficult nonunions of the humeral diaphysis.

Antegrade intramedullary nailing and bone grafting was carried out for 27 patients with resistant atrophic nonunion of the humeral diaphysis. The initial fracture was open in 12 cases and closed in 15. There were ten proximal humeral fractures, 13 mid-shaft fractures and four distal humeral shaft fractures. Most had previous attempts at internal fixation with bone grafting. Fifteen cases united, but 12 remained ununited necessitating further surgical treatment. The failures were all in the more complex cases. Lack of rigidity and compression may be the problem.

Adolescent↗
PubMed1998

Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture.

As the number of patients with anterior cruciate ligament reconstructions continues to grow, a subpopulation of patients with displaced tibia-fibula fractures will emerge who have had prior anterior cruciate ligament reconstructions. Previous cruciate ligament surgery can complicate the operative treatment of tibia-fibula fractures by intramedullary nailing. Technical complications arise because the tibial tunnel-graft-screw is in the path of insertion of the intramedullary implant. We present a case in which we traced the path of the patellar tendon autograft, adjusted our entry point for the tibial intramedullary canal, and removed the interference screw to facilitate the fracture surgery. This technical note provides an approach to planning intramedullary nailing of the tibia in patients with prior anterior cruciate ligament surgery.

Adult↗
PubMed2005

Outcomes and complications of elastic stable intramedullary nailing for forearm fractures in children.

This prospective study investigated medium-term outcomes for 51 children treated from 1997 to 2001 for displaced diaphyseal forearm fractures with elastic stable intramedullary nailing. Forty-three patients included achieved excellent/good functional results at an average follow-up of 38 months. Four patients required open fracture-manipulation at surgery. Complications included eight cases of soft-tissue irritation at nail-insertion site (three required shortening procedures), two temporary radial nerve branch injuries, four minimal rotational mobility deficits, one 10 degrees elbow extension deficit after splinting, and five small keloid scars. All patients were pain-free, without limitations in activities for daily life or sport/play activities by 12 months after hardware removal. Elastic stable intramedullary nailing is appropriate therapy for these injuries.

Adolescent↗
PubMed1996

[Intramedullary nailing of lower leg fractures with minimal soft tissue injuries].

The importance of intramedullary nailing (IM) for closed and type I tibial shaft fractures is evaluated on the basis of a review of the recent literature (1991-1996) and the data on 61 patients that underwent a reamed (RTN; n = 31) or an unreamed (UTN; n = 26) procedure. There was no difference between the two groups in age, fracture type or localization. Soft tissue trauma prevailed with 38% type I open fractures in the UTN group (RTN group, 3%). Both groups showed about the same proportion of good and very good results (criteria of Johner and Wruhs; 89% RTN and 88% UTN), which corresponds to the results of other authors (83%-96% RTN; 79%-96% UTN). The rate of nonunions is about the same with 6% (RTN) and 4% (UTN), respectively, and there were no infections. In accordance with the literature, we found earlier osseous reunion after unreamed nailing (RTN = 18 weeks vs UTN = 12 weeks). This corresponds to early, painless, full weight-bearing after an average of 10.3 as opposed to 13.8 weeks in the RTN group. Except for earlier osseous reunion reamed and unreamed TN proved to be equivalent procedures. As a precondition, if more endostium is affected, reaming should be performed after stabilization of the soft tissue damage, and fractures of the metaphysis should be interlocked in two dimensions (using all interlocking possibilities) if treated with the more unstable UTN, along with reduced weight-bearing for at least 6 weeks. The implant should be chosen in compliance with individual demands, taking the higher intramedullary stability of the RTN into consideration and the endostium-preserving insertion of the UTN.

Bone Nails↗