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Results for “Fracture Fixation, Intramedullary”

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PubMed1994

Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures.

OBJECTIVE: Analysis of short-term and long-term complications after cemented osteosynthesis for pathological fractures. DESIGN: Retrospective study. SETTING: South Municipal Hospital and the Daniël den Hoed Cancer Centre, Rotterdam, The Netherlands. SUBJECTS: 199 patients consecutive surgically treated between 1978 to 1990 for 233 fractures (161 actual and 72 impending) caused by metastatic lesions of the femur, humerus and tibia. INTERVENTIONS: Local resection of the tumour was followed by endoprostheses (n = 52) and by internal plate osteosynthesis (n = 167); 14 fractures were treated with intramedullary nails. Bone cement was added in 211 cases (91%). MAIN OUTCOME MEASURES: Pain relief, mobilisation, complications. RESULTS: Pain relief was achieved in about 90%. 145 (76%) who were treated for fractures of the lower extremity were able to walk again. There were 13 local complications: 26 (11%) implanted devices failed (cumulative probability 40%, after 60 months). In 11 cases the fixation failed after 7 weeks. The failure rate was 16% in the subtrochanteric region treated with an angled blade (probability 70% after four years). The patients' survival rate was 55% after six months and 20% at two years. CONCLUSION: Despite the poor life expectancy, our results indicate that hemiarthroplasty or osteosynthesis with bone cement for treatment of pathological (impending) fractures is a safe way to restore limb function and to improve quality of life.

Adult↗
PubMed1975

A complication of intramedullary nailing.

A case is described of intramedullary nailing of the femur, complicated by non-union, fracture of the nail, pseudarthrosis, malunion and subsequent distal migration of the proximal nail fragment over a period of 8 years.

Aged↗
PubMed1998

Prophylactic intramedullary femoral rodding during total knee arthroplasty with simultaneous femoral plate removal.

Removal of a plate from the distal femur creates a risk of fracture through the screw holes. This is a particular concern when a total knee arthroplasty is present because supracondylar fracture may occur with minimal trauma. A patient who presents after prior plating of a distal femur fracture with osteoporosis, retained hardware associated with pain, and gonarthrosis severe enough to warrant total knee arthroplasty is often difficult to manage. Prophylactic intramedullary rodding is a well-accepted method of treating pathologic stress risers in the femur. An intramedullary rod can be inserted into the femur at the time of total knee arthroplasty. This method permits simultaneous plate removal and total knee arthroplasty while protecting the femur from postoperative fracture.

Bone Plates↗
PubMed2000

Use of a Rush pin to repair fractures of the distal femur in cats.

Nine fractures of the distal femur in eight cats were repaired by using a 2.4 mm Rush pin as an intramedullary nail, placed between the condyles via a lateral or medial parapatellar approach to the stifle joint. In all cases the fractures were reduced and stabilised accurately with good postoperative results.

Animals↗
PubMed2006

Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fractures.

BACKGROUND: Almost 9% of tibial shaft fractures occur in the proximal third of the bone. In order to address the problems of mal-alignment and late loss of fixation, all the specific surgical techniques described in the literature were used in nailing these fractures in our study. METHODS: From December 2001 to December 2003, 45 consecutive patients with fracture of the proximal third of the tibial shaft underwent nailing. The clinico-radiological outcome of these cases and the complications encountered were analysed. RESULTS: The average time to knee mobilisation and partial weight-bearing walking was 3.2 days. The fractures had united at an average of 4.3 months. At the last follow up, the average lower extremity functional score was 96%. There were seven cases of malunion (15.56%), with three valgus and four apex anterior angulations. Delayed union necessitated open bone grafting in three cases, at an average of 6.3 months. At 8 months, one patient with delayed union experienced nail breakage across the weakest point, i.e. the dynamic screw hole. He underwent reamed exchange nailing and, 3 months later, the fracture had united. CONCLUSION: Meticulous intramedullary nailing of fractures of the proximal third of the tibial shaft, using all current surgical principles and techniques, has excellent clinico-radiological outcome and is relatively safe. We recommend a nail similar to a Sirus nail, but with a more proximal bend of the nail and no dynamic interlocking screw hole.

Adolescent↗
PubMed2006

The early response to major trauma and intramedullary nailing.

The stress response to trauma is the summation of the physiological response to the injury (the 'first hit') and by the response to any on-going physiological disturbance or subsequent trauma surgery (the 'second hit'). Our animal model was developed in order to allow the study of each of these components of the stress response to major trauma. High-energy, comminuted fracture of the long bones and severe soft-tissue injuries in this model resulted in a significant tropotropic (depressor) cardiovascular response, transcardiac embolism of medullary contents and activation of the coagulation system. Subsequent stabilisation of the fractures using intramedullary nails did not significantly exacerbate any of these responses.

Animals↗
PubMed1994

Comparison of dynamic compression plating and reamed intramedullary nailing in the treatment of aseptic tibial shaft nonunions.

Among 105 tibial shaft aseptic nonunions followed for a mean of 32 months, 30 were treated with dynamic compression plating and 75 were treated with either Küntscher or Grosse-Kempf interlocking intramedullary nailing. With the plating technique, the union rate was 90.0% (27/30), the period of time to union was 5.2 +/- 1.7 months, the complication rate was 16.7% (5/30), the infection rate was 13.3% (4/30), and the surgical time was 110 +/- 30 minutes. With the intramedullary nailing technique, the union rate was 93.3% (70/75), the period of time to union was 5.0 +/- 1.6 months, the complication rate was 17.3% (13/75), the infection rate was 13.3% (10/75), and the surgical time was 70 +/- 30 minutes. Thus, while the union rate was high with both techniques, the complication rate also was high, especially deep infection. However, the technique for nailing was simpler and required less surgical time than plating (p less than 0.001). With open reamed intramedullary nailing, a higher infection rate was noted in the cases initially treated with an external fixator than for cases in which other forms of treatment initially were used (p less than 0.05).

Adolescent↗
PubMed1998

[Solution to the problem of extra-articular, femoral hip fracture by the "sliding screw-nail principle". Results of 2 different systems (classical nail and gamma nail)].

Between January 1993 and December 1995 we treated 109 patients (median age: 75 years) with 112 extraarticular hip fractures including combined trochanteric and shaft fractures using two different "sliding-screw-nail implants" (intramedullary hip screw = classic nail: n = 61; gamma nail: n = 51). Comparing the two systems in detail certain advantages and disadvantages were seen, with both being equivalent. We encountered the following complications: secondary varus malalignment of the collum femoris with "cut out" of the sliding-screw (1.8%) and without "cut out" (1.8%), fissure of the femoral shaft occurring intraoperatively and being treated conservatively (1.8%), femoral perforation by the nail (0.9%), infection (2.7%). Thus, 5 reoperations (4.5%) were necessary. None of these complications were attributable to the principle itself or to the different implants used. Each patient was followed-up for a minimum of 12 months postoperatively. In 59% of all patients the pre-trauma range of mobility could be fully restored. Intramedullary hip screw and gamma nail are excellent and equivalent systems, which fully satisfy the biomechanical needs of above mentioned fractures.

Adolescent↗
PubMed2006

Closed and open grade I and II tibial shaft fractures treated by reamed intramedullary nailing.

OBJECTIVE: To evaluate the results of closed and open grade I and II tibial shaft fractures treated by reamed nail and unreamed nailing. SUBJECTS AND METHODS: Between 1997 and 2000, 119 patients with tibial shaft fractures were treated with reamed tibial nails. Postoperatively 96 patients (70 closed and 26 grade I and II open fractures) were followed clinically and radiologically for up to 18 months. The nail was inserted either by patellar tendon splitting or by nonsplitting technique. The nail was inserted after overreaming by 1.5 mm. Postoperatively, patients with isolated tibial fracture were mobilized by permitting partial weight bearing on the injured leg for 6 weeks. Patients with associated ankle fractures were allowed to walk with a Sarmiento cast. RESULTS: Postoperatively, 6 (6.3%) patients developed a compartment syndrome after surgery. In 48 (50%) cases, dynamization of the nail was carried out after a mean period of 12 weeks for delayed union. Overall, a 90.6% union was obtained at a mean of 24 weeks without difference between closed or open fractures. Two (2.1%) patients with an open grade II fracture developed a deep infection requiring treatment. A 9.4% rate of malunion was observed. Eight (8.3%) patients developed screw failure without clinical consequences. At the last follow-up, 52% of patients with patellar tendon splitting had anterior knee pain, compared to those (14%) who did not have tendon splitting. CONCLUSION: Reamed intramedullary nail is a suitable implant in treating closed as well as grade I and II open tibial shaft fractures.

Adolescent↗
PubMed2000

Interlocking intramedullary nailing in distal tibial fractures.

This retrospective study examined the results of non-pilon fractures of the distal part of the tibia treated with interlocking intramedullary nailing. Seventy-three patients with equal numbers of fractures treated surgically between 1990 and 1998 were reviewed. Mean patient age was 39.8 years, and follow-up averaged 34.2 months. The AO fracture classification system was used. Concomitant fractures of the lateral malleolus were fixed. All but three fractures achieved union within 4.2 months on average. Satisfactory or excellent results were obtained in 86.3% of patients. These results indicate interlocking intramedullary nailing is a reliable method of treatment for these fractures and is characterized by high rates of union and a low incidence of complications.

Adult↗
PubMed2002

[Minimal invasive biological osteosynthesis of the clavicle with a titanium nail].

Until December 2001 84 midclavicular fractures in 80 patients were treated with intramedullary nailing. Postoperatively there was a significant decrease of pain and a significant increase of mobility compared to the situation preoperatively. 6 months after hardware removal the mean Constant-Score was 97.4 points. There was one none union. In one patient there was a loss of reduction with shortening of 1.5 cm. In 5 patients a shortening of the proximal end of the nail had to be performed, due to painful skin irritation. Intramedullary nailing of midclavicular fractures is a safe and minimally invasive operation technique. It should be offered to the patient as an alternative to conservative treatment.

Adult↗
PubMed1998

[Unreamed interlocking intra medullary nailing in treating tibial and fibular fractures].

OBJECTIVE: To report the experience in the use of unreamed interlocking intramedullary nails. METHOD: From 1995 to 1997, 54 tibial and fibular fractures were treated with unreamed interlocking intramedullary nails they included open fractures (9 cases) and close fractures (45). RESULT: All fractures healed within 6 months and showed good knee and ankle joint functions. Slight postoperation infection was found in one of the open fractures. Incomplete injury of peroneal nerve was noted in 1 case. CONCLUSION: Unreamed interlocking intramedullary nail can be used to treat diaphyseal fractures effectively. It can protect the soft tissue envelope around the fracture and prerent local blood supply from further damaginge.

Adolescent↗
PubMed1997

Compartment pressures during nonreamed tibial nailing without traction.

OBJECTIVE: To assess the intracompartmental pressure changes during the nailing of acute tibia fractures with the extrinsic factors of 90 degrees/90 degrees positioning, posterior thigh posts, continuous traction, and remaining removed. STUDY DESIGN: Prospective case control. METHODS: Fifty-eight acute tibia fractures were nailed using an unreamed technique without leg elevation, thigh post, or continuous traction. Two presented with compartment syndrome and had fasciotomy before nailing. Thirty of the remaining fifty-six tibias had continuous intracompartmental pressure monitoring of the anterior compartment. RESULTS: The highest pressures were routinely seen during manual reduction of the fracture (20-58mms Hg; avg = 34mm Hg) and during nail passage (15-56mms Hg; avg = 26mms Hg). In fifteen tibias, the pressure rose to within 30mmg Hg of the diastolic pressure and in 12 tibias the pressure exceeded 40mmg Hg. The pressures in all cases returned to baseline immediately following nail passage (avg = 13.8mms Hg). No sequelae of compartment syndrome was found in any of the 56 tibias presenting without compartment syndrome. There were no iatrogenic compartment syndromes in the series. CONCLUSION: When extrinsic factors that increase intramedullary pressures are avoided, then intramedullary nailing raises the intramedullary pressure only momentarily. The pressure peaks during manual reduction and nail passage, and then returns to normal before the patient is awakened. Intramedullary nailing performed without reaming or traction is safe with respect to compartment syndromes and continuous pressure is not required.

Adolescent↗
PubMed1993

[Initial experiences with the unreamed AO tibial nail].

It is generally accepted that intramedullary nailing in combination with reaming should be avoided in treating open fractures. However the use of an unreamed, solid nail combined with interlocking allows stabilization also of open and complex fractures. 20 tibia fractures (65% open, 45% complex fractures) have been treated by the AO unreamed tibial nail (UTN), 12 (5 of them open fractures) by direct nailing and 8 after initial stabilization by an external fixator. In our series no intraoperative complications, no soft-tissue healing problems and no infections occurred. Thus, treatment of both, open and comminuted fractures by UTN appears to be rather safe and generally needs no secondary stabilization.

Adult↗
PubMed1993

[Initial results with the unreamed AO tibial nail].

It is generally accepted that intramedullary nailing in combination with reaming should be avoided in treating open fractures. However, the use of an unreamed, solid nail combined with interlocking also allows stabilization of open and complex fractures. 20 tibia fractures (65% open, 45% complex fractures) have been treated by the AO unreamed tibial nail (UTN), 12 (5 of them open fractures) by direct nailing and 8 after initial stabilization by an external fixator. In our series no intraoperative complications, no soft-tissue healing problems and no infections occurred. Thus, treatment of both open and comminuted fractures by UTN appears to be safe and generally needs no secondary stabilization.

Adult↗
PubMed1996

Compound osteosynthesis of pathological fractures of the proximal femoral shaft. Experimental studies on the biomechanical effects of additional intramedullary splinting.

The biomechanical stability of two compound osteosynthesis techniques with and without intramedullary splinting were compared in 20 paired cadaver femora. Group A was stabilised using a contoured 12-hole DC plate and polymethylmethacrylate cement. In group B an additional intramedullary semi-diameter osteosynthesis plate was inserted parallel to the outer plate and transfixed with the same screws. The specimens were tested in a universal testing machine using a force applied to the specimen at 45 degrees to the load to provoke the most unfavourable condition, consisting of a bending moment and torsion. Both force and extension were recorded. The compound osteosynthesis with an additional intramedullary plate (group B) reached an average higher load stability. This increase of stability was not significant statistically.

Aged↗
PubMed2003

Intramedullary nailing of tibial diaphyseal fractures in adolescents with open physes.

An analysis of 36 adolescent patients who presented with tibial diaphyseal fractures and open tibial physes has been undertaken. All patients were treated by reamed intramedullary nailing using a hollow, slotted nail. They were examined clinically and radiologically for late evidence of the effects of premature physeal closure secondary to nailing damage, but none were found. The speed of union in Tscherne C0 and C1 fractures in 13-16-year-old patients is highlighted and shown to be considerably faster than in adult patients. The speed of union in Tscherne C2 fractures is similar in adolescents and adults. The relatively high incidence of compartment syndrome in this age group is noted. Intramedullary nailing of tibial diaphyseal fractures in adolescents with open physes, using a slotted nail, appears to be safe and does not cause late growth problems.

Adolescent↗
PubMed1995

Unstable fractures of the tibia treated with a reamed intramedullary interlocking nail.

One hundred thirty-four acute unstable fractures of the tibia were treated with a reamed intramedullary nail with locking capabilities. There were 101 closed and 33 open fractures (20 Grade 1 fractures, 12 Grade 2 fractures, and 1 fracture from a gunshot wound). Patients were seen in followup for an average of 16 months after nailing. The time to fracture union averaged 28 weeks in closed fractures and 39 weeks in open fractures. Delayed union (> 6 months) developed in 14 fractures (8%): 11 closed (11%) and 3 open (9%) fractures. Eleven of the 14 delayed unions healed spontaneously, or after dynamization of statistically locked nails. Seven fractures (5%) were not healed by 9 months and were classified as nonunion (2 closed, 5 open). All fractures required major additional procedures to obtain union. Infection developed in 13 fractures (10%). In closed fractures, there were 2 superficial (2%) and 3 deep (3%) infections; in open fractures there was 1 superficial (3%) and 7 deep (21%) infections. The authors conclude that reamed intramedullary nails should be restricted to unstable, closed tibial shaft fractures. Its use in open fractures even on a delayed basis cannot be recommended because of unacceptably high infection rates.

Adolescent↗