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PubMed2005

[Intramedullary interlocking of humeral fractures and nonunions with Seidel nail].

The advantages and disadvantages of interlocking Seidel's nails determined by their construction and the way of insertion were presented on the basis of own experience and literature. The advantages are strength and shape of the nails which are conductive to fragments stability and make insertion into humerus medullar canal easier. The tools set for insertion and locking of distal part. It doesn't truly protect from torsion displacements. Locking takes place by draw for a few weeks by external immobilization. The Seidel's nail has also disadvantages associated with proximal insertion. Unavoidable injury of supraspinatus tendon insertion can be the reason of loss of shoulder function. The antegrade fixation can cause pushing distal fragment downward by tip of the nail. It is necessary to control it's insertion under image intensifier. Presented disadvantages of Seidel's nail fixation didn't result in any problems in humerus fractures or pseudoarthroses healing. In one case it was necessary to perform additional decortication and space of fracture fulfillment with bone grafts.

Bone Nails↗
PubMed2000

Tibial shaft malunion treated with reamed intramedullary nailing: a revised technique.

Thirty-seven consecutive adult tibial shaft malunions which had not undergone surgical treatment were prospectively treated with reamed intramedullary nailing. Indications for this treatment modality included a malunion of a tibial shaft which had only been conservatively treated, lesion level fitting for traditional or locked reamed intramedullary nail fixation, less than 2 cm shortening, and without evidence of deep infection at present. The malunions were treated with fibulotomy, closed wedge tibial osteotomy, open reaming of the marrow cavity, stable reamed intramedullary nail stabilization with or without supplementation, and cancellous bone grafting. Thirty-four (92%) patients were followed up for at least 1 year (range 1.0-4.3 years), and all achieved a solid union. The union period was 5.8+/-0.8 months. Complications included 2 (6%) patients with deep infection and 1 (3%) with cortical perforation. However, all 3 patients recovered completely after adequate management. In conclusion, a reamed intramedullary nail is an ideal instrument for tibial shaft malunions in indicated cases. Good exposure of the bony segments to ream the marrow cavity precisely can avoid cortical perforation. Gentle dissection of the soft tissues may lower the infection rate. Concomitant cancellous bone grafting can improve the union rate.

Adolescent↗
PubMedDate not supplied

Bone metastasis in hepatocellular carcinoma. A report of five cases and a review of the literature.

Hepatocarcinoma occurs frequently throughout the world. Bone metastases are rare although incidence has increased because of progress in diagnosis and treatment. The authors report 5 cases of bone metastases and review the literature. The spine is the most frequent localization of bone metastases. Radiotherapy is the treatment of choice for this lesion. Surgery should be used to prevent and treat complications such as nerve compression and pathologic fracture, only if the coagulative pattern and the conditions of the patient allow it. The authors recommend the use of long intramedullary nailing when localization of the disease is in the femur, with prophylactic stabilization of the neck in diaphyseal metastasis.

Carcinoma, Hepatocellular↗
PubMed2001

Effect of unreamed, limited reamed, and standard reamed intramedullary nailing on cortical bone porosity and new bone formation.

OBJECTIVE: To compare the effects of unreamed nail insertion and reamed nail insertion with limited and standard canal reaming on cortical bone porosity and new bone formation. DESIGN: A canine segmental tibial fracture was created in fifteen adult dogs. The tibiae were stabilized with a statically locked 6.5-millimeter intramedullary nail without prior canal reaming (n = 5), after limited reaming to 7.0 millimeters (n = 5), or after standard canal reaming to 9.0 millimeters (n = 5). Porosity, new bone formation, and the mineral apposition rate of cortical bone were directly compared between the three nailing techniques. RESULTS: A significant increase in cortical bone porosity and new bone formation was seen in all three groups of experimental animals compared with the control tibiae. The overall lowest porosity levels were measured in the limited reamed group, with similar porosity levels measured in the unreamed and standard reamed groups. Porosity was lower in the limited reamed group in the entire cortex of the segmental and distal cross sections, as well as the endosteal, anterior, and posterior cortices along the length of the tibia. Overall, there was no difference in the amount of new bone formation or the mineral apposition rate between the three groups of animals at eleven weeks after surgery. DISCUSSION: The results of this study suggest that limited intramedullary reaming is a biologically sound alternative for the treatment of tibial diaphyseal fractures in which the circulation is already compromised.

Analysis of Variance↗
PubMed1996

[Treatment of tibial shaft fracture by Ender's closed intramedullary nailing].

Operative technique and results of treatment of tibial shaft fracture using Ender nails in 46 patients are presented. In all cases tibial shaft fracture was concomitant with massive soft tissue injury and in 18 cases the fracture was open. The fracture healed in all cases, bone infection occurred in one patient.

Adolescent↗
PubMed2002

[New techniques for bone synthesis on the humerus].

Fractures of the upper arm near the shoulder are common. A consensus on treatment only occurs for simple, un-dislocated fractures and with the complete destruction of the concha in elderly people. For most of the 2-4 component fractures, there exist a variety of, in part contradictory, recommendations in the literature. The most diverse statements mirror the conflict between the best anatomical solution and the practically most stable position with the least possible additional damage of the surrounding structures through surgery. Whether the implants with the most stable angle using the latest generation of plates will lead to an improvement in the results is at present a matter under clinical study. The indications are clearer for the shaft. The development of the latest plates and intramedullary implants provides a surgical improvement, and implant specific complications (e.g., pin movement) will be reduced with further development. Whether there are also advantages for the patient remain to be seen.

Aged↗
PubMedDate not supplied

Fracture healing after stabilization with intramedullary xenograft cortical bone pins: a study in pigeons.

OBJECTIVE: To investigate the effectiveness of intramedullary xenograft cortical bone pins compared with stainless steel Kirschner wire for the repair of a standardized avian humeral fracture. STUDY DESIGN: Prospective randomized study. SAMPLE POPULATION: Thirty mature pigeons (Columba livia). METHODS: Birds were randomly assigned to 3 groups. Transverse mid-diaphyseal humeral fractures were created in 1 humerus in each bird. Fractures were stabilized with intramedullary ostrich or canine xenograft cortical bone pins or Kirschner wire. Radiographic, histological, and biomechanical assessments were used to compare fracture healing 6 weeks after fracture stabilization. The contralateral humerus of each bird was used as a control. RESULTS: All fractures healed regardless of intramedullary pin type. There were no statistically significant biomechanical differences among groups or within groups. Xenograft cortical bone pins induced a mononuclear inflammatory reaction that did not impair bone healing. Bones stabilized with intramedullary cortical bone pins had more periosteal callus and inflammation at the fracture site than bones stabilized with stainless steel Kirschner wires. CONCLUSIONS: Intramedullary xenograft cortical bone pins, derived from mammalian or avian sources, appear to represent an alternative for the repair of avian humeral fractures. CLINICAL RELEVANCE: Intramedullary xenograft cortical bone pins are biodegradable and may reduce the need for additional surgery to remove implants after fracture healing.

Analysis of Variance↗
PubMed1994

Intramedullary nailing of open femoral shaft fractures.

Twenty-seven patients with 28 open femoral shaft fractures were treated by intramedullary nailing. Ten fractures were Grade I, nine Grade II and nine Grade III according to Gustilo. After debridement and irrigation of the wounds, 26 fractures were nailed immediately, whilst two fractures were stabilized at an early stage. Two infections developed. One occurred before intramedullary nailing during a period of femoral traction. Both infections were treated successfully. The authors conclude that primary intramedullary nailing is safe in open femoral fractures of all grades. If a thorough debridement and irrigation are performed, the postoperative infection rate is low.

Adolescent↗
PubMed1980

Treatment of solitary cysts of the humerus. Treated by diaphyseal resection and bone grafting.

The 'classical' surgical treatment of unicameral bone cysts of the humerus with curettage and bone grafting is unreliable with approximately 40% failure rate. The author describes a technique of subperiosteal diaphyseal and metaphyseal resection and replacement with a section of fibula maintained in position with an intramedullary nail and further supported by massive tibial cortical and cancellous grafting. Consistent incorporation of the graft and excellent remodelling were observed in 36 patients so treated. No complications or recurrence were reported.

Adolescent↗
PubMed1991

Primary intramedullary nailing of open femoral shaft fractures.

The cases of 60 patients with 63 open femoral fractures treated by primary reamed intramedullary nailing were retrospectively reviewed. Twenty-two were classified as Type I open fractures, 26 as Type II and 15 as Type III open fractures by Gustilo's classification. All fractures were treated by wound debridement followed by immediate reamed intramedullary nailing. There were five early soft-tissue infections and three late deep infections. Of the late infections, only one was osteomyelitis (1.6%). There were three nonunions and seven malunions. All of the complications were dealt with effectively by standard methods. We concluded that primary reamed intramedullary nailing is an effective alternative for the treatment of Type I and II open femur fractures and for Type III open femur fractures associated with multiple trauma.

Adolescent↗
PubMed1980

Osteosynthesis with Rush's double nail by the "Eiffel Tower" method in pseudarthrosis impacted in good position and retarded union.

The "Eiffel Tower" method of nailing has not attracted the interest in Italy that it deserves, both because its utilisaton in fractures is difficult when closed reduction of the fragments is difficult, and because the attention of surgeons has been progressively directed towards osteosynthesis by open reduction. Our experience over many years, however, has convinced us that, in the diaphysis, only the intramedullary nail can provide the quick recovery that is not always forthcoming in the case of plating. We need only think of comminuted fractures, where the possible necrosis of one or more fragments demands a certain amount of prudence in allowing direct weight bearing. Therefore, in adopting the double Rush system, we extended its application to the intramedullary osteosynthesis of metaphyseal fractures. It was a short step from this to the surgical treatment of pseudarthrosis impacted in good position or retarded union, the results of which were encouraging, as demonstrated by the eighty-one cases reported in this paper.

Bone Nails↗
PubMed1996

[Distal femoral fractures. Transarticular reconstruction, percutaneous plate osteosynthesis and retrograde nailing].

Techniques for operative treatment of supra- and intercondylar fractures have changed in recent years. Some of these changes have come about in reduction techniques and implant selection. Operative approach concepts, which had remained unchanged for several decades, have been critically evaluated and modified, leading to a minimally invasive osteosynthesis (MIO) with transarticular joint reconstruction, closed plate positioning techniques or retrograde intramedullary nailing. These techniques result in better operative visualization and management of intraarticular comminution, safer fracture healing and better functional outcome. New strategies and techniques for the avoidance of axial malalignment, rotational deformities and leg length discrepancies are described.

Bone Plates↗
PubMed1993

Intramedullary nailing of femoral shaft fractures: reoperation and return to work.

OBJECTIVE: To define the functional outcome and residual disability in adults treated for isolated femoral shaft fractures. DESIGN: A retrospective case study of HMRI records. The mean follow-up was 34.5 months from the time of injury. SETTING: A tertiary-care teaching hospital. PATIENTS: One hundred and thirty adults with femoral shaft fractures. Of these, 47 were isolated and qualified for study. INTERVENTIONS: Primary reamed intramedullary nailing performed between April 1987 and September 1990. MAIN OUTCOME MEASURES: Reoperation and return to work. RESULTS: Of the 47 patients, primary healing occurred in 41 (87%) patients; 6 (13%) patients had delayed union or nonunion. Twenty (43%) patients had delayed implant-related pain after fracture healing; 85% of these had relief of pain after implant removal. Of 41 patients available for analysis of function based on return to work, 33 (80%) had returned to work full time in their original occupation at the time of follow-up, and 4 (10%) were working in other full-time employment; 3 (7%) were working part time. Only one (2%) patient was disabled and unable to work. CONCLUSIONS: Primary reamed intramedullary nailing is an effective method of achieving consistent primary union in adults with femoral shaft fractures. However, the majority of patients will require secondary surgery. Most patients will be able to return to work after these injuries.

Adult↗
PubMed1996

[When is antibiotic prophylaxis required?].

In situations where the local host damage (either traumatic or iatrogenically induced) is the predominant co-factor for the development of infection, the antibiotic or other pharmacological reduction of the bacterial colonisation is of secondary or no importance at all. On the one hand, excellent hygienic conditions have reduced more and more the relative importance of the bacterial contamination in aseptic procedures. On the other hand, the surgical-technical evolution in the last 5 years (such as biological osteosynthesis, unreamed intramedullary nailing, stepwise procedures in complex fractures, initial open wound treatment and very early plastic reconstruction in open fractures) could create a significant improvement of the conditions concerning prevention and treatment of infection. Therefore, the relative importance of associated antibiotic treatment has to be considered to be essentially lower.

Antibiotic Prophylaxis↗
PubMed2003

The supracondylar femoral nail in tibia.

We have found the intramedullary supracondylar femoral nail to be useful in special situations involving the tibia: proximal tibial fractures and nonunions, intercalary resections for tumors in the proximal or distal tibial diaphysis, and tibio-talo-calcaneal arthrodeses. We report on ten such cases.

Bone Nails↗
PubMed2006

Intramedullary nailing for non-union of the humeral diaphysis: a review.

PubMed and Ovid Medline were searched to investigate the role of intramedullary nailing in the treatment of diaphyseal humeral non-union. Of 474 abstracts, 9 retrieved articles fulfilled our inclusion criteria and described management in 166 cases of humeral shaft non-union using several types of intramedullary nails. Union ranged from 40 to 100%; part of the variation could be explained by the quality index of the selected articles. Exchange nailing alone was not effective. Exposure of the fracture site and use of bone grafting were key to successful treatment. The total incidence of severe complications, including radial nerve damage, was very low. Thus, intramedullary nailing in the treatment of humeral shaft non-unions can lead to successful outcomes when associated with autologous bone grafting.

Adolescent↗
PubMed1995

Tibial fractures with bone loss treated by primary reamed intramedullary nailing.

We reviewed the results of the treatment of 30 tibial fractures with minor to severe bone loss in 29 patients by early soft-tissue and bony debridement followed by primary locked intramedullary nailing. Subsequent definitive closure was obtained within the first 48 hours usually with a soft-tissue flap, and followed by bone-grafting procedures which were delayed for six to eight weeks after the primary surgery. The time to fracture union and the eventual functional outcome were related to the severity and extent of bone loss. Twenty-nine fractures were soundly united at a mean of 53.4 weeks, with delayed amputation in only one patient. Poor functional outcome and the occurrence of complications were usually due to a departure from the standard protocol for primary management. We conclude that the protocol produces satisfactory results in the management of these difficult fractures, and that intramedullary nailing offers considerable practical advantages over other methods of primary bone stabilisation.

Activities of Daily Living↗