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PubMed2001

Long-term quadriceps femoris functional deficits following intramedullary nailing of isolated tibial fractures.

This retrospective study assessed 5 male and 5 female patients, age 35.1+/-16 years, height 171.8+/-12 cm, and weight 75.5+/-18 kg (mean+/-SD) who were more than 1 year post isolated tibial fracture (18+/-6 months) and had been treated with an intramedullary tibial nail. Subjects completed a 12-question visual analog scale, a physical symptom and activity of daily living survey, and were also tested for bilateral isokinetic (60 degrees/s) quadriceps femoris and hamstring strength. Knee pain during activity, stiffness, swelling, and buckling were the primary symptomatic complaints. Perceived functional task deficits were greatest for climbing or descending stairs, pivoting, squatting, and walking on uneven surfaces. Involved lower extremity knee extensor and flexor torque production deficits were 25% and 17%, respectively. Early rehabilitation focuses on maintaining adequate operative site bony fixation while providing controlled, progressive, and regular biomechanical loading to restore functionally competent tissue. Following adequate fracture healing, greater emphasis should be placed on lower extremity functional recovery including commonly performed activities of daily living and other functional tasks that are relevant to the patient's disability level. A cyclic rehabilitation program that progresses the weight-bearing environment to facilitate bone and soft tissue healing and neuromuscular re-education is proposed.

Adult↗
PubMed2002

Treatment of femoral shaft fractures with a titanium intramedullary nail.

Ninety-nine femoral shaft fractures were treated with locked intramedullary nails made from titanium alloy. One of the distal interlocking screws failed in six fractures (6%) and both screws failed in two fractures (2%). Delayed union was associated with all of the eight fractures that had locking screw failure. Young, heavier patients who had nails of small diameter had an increased risk of screw failure. Additional surgery was needed when both screws failed. The authors still use this nail, but currently prefer to ream the medullary canal more so that larger nails can be inserted. Decisions concerning weightbearing are made on an individual basis for each patient, and currently full weightbearing is delayed for young, active, and heavy patients. Two distal interlocking screws should be inserted for treatment of femoral shaft fracture when a Ti locked intramedullary nail is used.

Adolescent↗
PubMed1999

Treatment of fractures of femur and tibia with the telescopic locking nail: design of a new implant and the first clinical results.

BACKGROUND: This study was carried out to evaluate the first clinical experiences with the telescopic locking nail (TLN). The TLN is a newly developed universal locking nail system for both femur and tibia that permits cyclic dynamic loading at the fracture site while weightbearing. The nail can also be used for static interlocking or for compression of the fracture elements. The nail is strong enough to permit immediate weightbearing, and the diameter of 9 mm allows unreamed introduction in many cases. MATERIALS: Seventy-one consecutive patients were treated with the TLN, 24 patients with femoral and 47 patients with tibial fracture or nonunion. RESULTS: Functional outcome, complication rate, and union rate were comparable to other interlocking nail systems. CONCLUSION: Its distinctive biomechanical properties and its universal application in both femur and tibia make the TLN a sophisticated, yet in practice simple, new asset in the practice of intramedullary nailing.

Adolescent↗
PubMed2003

Distal tibial fractures and non-unions treated with shortened intramedullary nail.

We reviewed 18 patients, 14 with acute fractures and four with non-union of the distal tibia, treated between 1990 and 2001 with a shortened, reamed intramedullary nail. The mean follow-up was 38 (8-144) months. The fractures united at an average of 16 (12-18) weeks and the non-unions at 20 (12-30) weeks. Two patients required nail dynamization. No limb shortening nor material failures were seen. All patients returned to normal daily activities. Although technically demanding, intramedullary nailing for distal tibial fractures and non-unions with a shortened nail represents a safe and reliable method.

Adult↗
PubMed2001

Primary unreamed intramedullary nailing for open fractures of the tibia.

Forty-six open tibial fractures (42 patients) were treated by primary unreamed intramedullary nailing, with debridement of open wounds and treatment of soft tissue. According to Gustilo-Anderson classification there were 18 grade I cases, 18 grade II cases and 10 grade III cases. The incidence of infection was low with two cases of superficial infection and one of deep infection. The mean time for union was 21.9 weeks and the rate of nonunion was 10.8%. There was no significant difference in the mean time to union, infection rate and rate of nonunion with different site and grade of fracture, but there was a longer union time and a higher rate of nonunion in complex and comminuted fractures. Unreamed intramedullary nailing, with appropriate soft tissue treatment, gives good results in the treatment of open tibial fractures including grade III.

Adolescent↗
PubMedDate not supplied

Closed intramedullary nailing for ununited femoral shaft fractures.

Fifteen cases of ununited diaphyseal fractures of femurs were treated successfully by intramedullary reaming and closed Küntscher nailing through the small gluteal incision. The equipment used is the same as for nailing fresh shaft fractures. The cases included 10 nonunions, 2 delayed unions and 3 miscellaneous problems. All but one case had been initially treated by open reduction with some form of internal skeletal fixation. Two cases had been treated by 2 open procedures befor the closed Küntscher nailing. No supplemental bone graft or external immobilization was necessary. Two cases were nailed successfully in the presence of infection, resulting in solid union and no recurrence of infection. Five nails have been removed after union and no refracture has occurred. No important postoperative complication or instances of the fat embolism syndrome were encountered. No rotational deformity or further shortening of the femur occurred. Postoperatively, the patients ambulated with protected weight-bearing as early as possible. The average hospital stay was 15 days. In general, the patients had a functional extremity even while the fracture lines were still visible on roentgenographs; all have returned to their previous work.

Adolescent↗
PubMed2004

Technique for percutaneous insertion of intramedullary nail for intertrochanteric hip fracture.

Intramedullary nailing has been proven to have biomechanical advantages over the use of a side plate and screw system. Further advantages may be gained with the use of a percutaneous technique, thereby minimizing blood loss, operative time, and overall morbidity. This article describes a technique for inserting an intramedullary nail percutaneously using a minimal-incision technique by utilizing fluoroscopy in cases of intertrochanteric hip fracture.

Aged↗
PubMed1991

Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur.

A review of the data on 684 fractures of the femur that had been treated with intramedullary nailing led to the identification of twenty-three patients who had had a fracture of the shaft of the femur with an accompanying ipsilateral supracondylar fracture (twelve patients, group I) or a concomitant ipsilateral intercondylar fracture (eleven patients, group II). The group-I fractures had been treated with interlocking nailing without supplemental fixation. In group II, ten fractures were stabilized with interlocking nailing and supplemental screw fixation and one, with interlocking nailing and a supplemental plate and screws. The average time to union for all fractures was nineteen weeks (range, twelve to thirty-six weeks), and the average duration of clinical and radiographic follow-up was thirty months (range, nine to fifty-nine months). In group I, alignment of the femur was within 5 degrees of normal in ten of the twelve fractures. In group II, seven intra-articular fractures healed in anatomical alignment, three had slight articular displacement (1.0 to 3.0 millimeters), and one had displacement of more than 3.0 millimeters. The average range of motion of the knee at the most recent follow-up was 0 to 120 degrees in group I and 0 to 115 degrees in group II. Two patients (both in group II) needed a reoperation for a previously unrecognized fracture of a femoral condyle in the coronal plane; post-traumatic arthritis developed in both. No patient in either group had loss of fixation or failure of the implant. We concluded that ipsilateral diaphyseal, supracondylar, and intercondylar fractures of the femur can be adequately stabilized with interlocking nailing and supplemental intercondylar screw fixation. The presence of a fracture in the coronal plane of a femoral condyle (AO type-B3 and type-C3 injuries) is a relative contraindication to the use of this technique.

Adolescent↗
PubMed2003

[Treatment of femoral shaft fractures by interlocking intramedullary nailing in adults].

OBJECTIVES: We evaluated the radiological, clinical, and functional results of femoral shaft fractures treated by interlocking intramedullary nailing. METHODS: Interlocking intramedullary nailing was performed in 48 femoral shaft fractures of 46 patients (35 men, 11 women; mean age 30.5 years; range 20 to 69 years). Of the fractures, 31 were in the right femur, 13 were in the left femur, and two were bilateral. There were 44 closed and four open femoral fractures. The results were evaluated according to the Thoresen criteria. Final evaluations included 44 fractures whose follow-ups (mean 26.9 weeks; range 20 to 56 weeks) were completed. RESULTS: The mean time to union was 16.5 weeks (range 12 to 42 weeks). Four patients (9%) had a varus angulation, and one patient (2.3%) a valgus angulation of 5 degrees; one patient had a posterior angulation of 10 degrees, one patient had an internal rotation of 10 degrees, and one patient had both an external rotation and valgus angulation of 10 degrees. Two patients (4.5%) developed a shortening of 2 cm. Knee flexion was 90 degrees and extension loss was 15 degrees in one patient. Knee flexion was 90 degrees in two patients, and 110 degrees in one patient. Chronic osteomyelitis developed in one patient who had a segmental femoral shaft fracture. According to the Thoresen criteria, 88.6% of patients had excellent or good results. CONCLUSION: The high success rate obtained with interlocking intramedullary nailing makes it an appropriate method in the treatment of femoral shaft fractures in adults.

Adult↗
PubMed2005

Comminuted refracture of the distal femur and condyles in patients with an intramedullary nail: a report of 5 cases.

Patients with in situ intramedullary nails sustaining a second distal femoral fracture following high-velocity trauma are infrequently reported in the literature. We report 5 such patients who sustained a second injury after 6 to 24 months, resulting in another fracture at the nail-tip level. These second fractures severely comminuted the femoral condyles. These patients required removal of the intramedullary nail, reconstruction of the comminuted femoral condyles, and stabilisation using an angled or buttress plate. Four of the 5 patients were followed up for a mean period of 36 months and were evaluated for knee status and outcome using Judet's criteria. Postoperative knee stiffness was common, and further interventions such as manipulation, hardware removal, arthrolysis, and quadricepsplasty were needed. One patient was lost to follow-up. The final results of the knees were good, with more than 100 degrees range of movement. It is important to adhere to established internal fixation protocols in the treatment of these complex nail tip fractures.

Accidents, Traffic↗
PubMed1992

[Fatigue fracture below the internal tibial plateau after locked intramedullary nailing].

The authors present a case of stress fracture of the medial condyle of the tibia following intramedullary nailing with distal locking. This complication, which appeared two years after the surgical procedure and one year after the removal of the nail, has not yet been described in the literature. The patient was a young man without any excessive physical load. The presence of the intramedullary nail was accompanied by a bone clearness in the medial part of the superior epiphyseo-metaphyseal level of the tibia.

Adult↗
PubMed1980

[Secondary intramedullary nailing osteosynthesis in primarily conservative treatment of fractures of tibia and fibula shafts (author's transl)].

In a retrospective trial 235 patients with fractures of the tibia and/or fibula shafts were followed up. In 16 cases non-union of the fracture occurred after closed reduction and plaster cast treatment. In 16 of these patients closed nailing of the tibia was performed 8--14 weeks after the accident. The healing of the fracture was uncomplicated and occurred in 10--14 weeks p. op. The results in primary nailing cases 8--14 days after the accident were much better than in cases treated with plaster casts, with regard to joint mobility, venous insufficiency and duration of treatment; however two serious complications occurred. In two patients, osteitis occurred after primary nailing of the tibia. Localisation of the fractures (distal part of the tibia) and type of the fracture (short torsion fracture) correlated more frequently with formation of non-union than the rare changes in blood chemistry observed in our study. We regard intramedullary nailing of the tibia as the best available method in treating non-union or pseudarthrosis of the tibia.

Adult↗
PubMed1997

Reamed interlocking intramedullary nailing of open fractures of the tibia.

One hundred twelve open tibial fractures were treated by reamed interlocking nailing in 108 patients. There were 31 (28%) Grade I fractures, 38 (34%) Grade II, 23 Grade IIIA (21%), and 20 (18%) Grade IIIB fractures. Early amputation was performed in 2 (10%) Grade IIIB fractures for severe crushing injuries. Compartment syndrome complicated 8 (7%) fractures. Mean time to union was 29 weeks for Grade I fractures, 32 weeks for Grade II, 34 weeks for Grade IIIA, and 39 weeks for Grade IIIB. Nonunion complicated 9 (8%) fractures: 1 (3%) Grade I fracture, 2 (5%) Grade II fractures, 3 (13%) Grade IIIA fractures, and 3 (17%) Grade IIIB fractures. Deep infection complicated 4 Grade II fractures (10%) and 2 (11%) Grade IIIB fractures. Reamed locking intramedullary nailing is a safe and effective technique for management of open tibial fractures.

Adolescent↗
PubMed2002

[Stabilizing intramedullary pediatric shaft fractures].

Intramedullary stabilisation (Prévot-nailing) of shaft fractures in childhood allows full weight bearing without cast. Early fracture healing is seen by respecting soft tissue around fracture and by using distal or proximal approaches. Good indications of femoral shaft osteosynthesis are recommended in oblique and transverse fractures. Intramedullary stabilization seems to be a good alternative method instead of casting calf-shaft fractures. An unstable fracture of forearm may be treated intramedullary to avoid often observed displacement ad axim and rotation. Humoral fractures primary have to be treated conservatively. Only in displaced fractures or in cases with additional injuries an intramedullary procedure with free range of motion is recommended.

Adolescent↗
PubMed1996

Management of humeral nonunion after the failure of locking intramedullary nails.

We reviewed 21 cases of humeral nonunion following the failure of "locking" humeral nails. The nails had been inserted as the primary operative procedure following humeral fracture in fifteen cases or after the failure of closed treatment in six cases. Reconstruction after the failure of these implants was complicated by poor bone stock and difficulty in achieving union. Although technically difficult, open reduction and internal fixation with plating and bone grafting (successful in nine of nine cases) was more consistent than exchange nailing (successful in four of 10 cases) in achieving union (p = 0.01). Two patients refused further surgical intervention. The degree of bone loss associated with a loose nail, the lack of success of exchange nailing, and the insertion site morbidity associated with humeral nail removal differentiate these nonunions from similar lower extremity problems. The degree of bone loss following failed locking nailing of the humerus is a major concern, and exchange nailing alone may not be an acceptable option to deal with this problem.

Adolescent↗
PubMed1985

[Twenty-year record of osteosynthesis of bone metastases. Analyses of 300 cases].

The authors have analysed the results of 300 operations for metastases in bone carried out in the last 20 years. The best results were obtained where prosthetic replacement was possible, and where deposits in long bones were treated by closed intramedullary fixation. This type of surgery gives satisfactory, comfortable function and should be part of a multidisciplinary approach in the management of patients with cancer.

Adult↗
PubMedDate not supplied

Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail.

OBJECTIVE: To assess the role of the Russell-Taylor humeral nail in the treatment of humeral shaft fractures. STUDY DESIGN: Retrospective with a mean radiologic and clinical follow-up at thirty-two months. SETTING: University teaching hospital. PATIENTS: Total of thirty-seven patients treated with the Russell-Taylor humeral nail. INTERVENTION: All patients were treated with the Russell-Taylor humeral nail inserted in an antegrade fashion. OUTCOME MEASURES: Radiologic union and shoulder function in terms of pain, power, range of movement, and activities of daily living. RESULTS: There were four established nonunions and four cases of delayed union (time to union > four months). Age of patient was the only predictor of nonunion. There was one infection and one intraoperative fracture. Two prominent proximal screws required removal, and one nail was removed after union because of impingement. Three patients required manipulation under anesthesia to improve shoulder movement. At review, six patients had residual poor shoulder function as per Constant score, four attributable to shoulder stiffness and two to residual pain. CONCLUSION: The authors' findings indicate a significant rate of delayed or nonunion in the elderly patient. When the high rate of union with conservative treatment is considered, the indications and rationale for intramedullary humeral nailing should be clearly defined.

Adult↗