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PubMed1996

Mechanical failure of the intramedullary hip screw in a subtrochanteric femoral fracture.

The Gamma nail, an implant specifically designed for intertrochanteric and subtrochanteric femoral fractures, has been criticized for its high risk of secondary shaft fractures. A modified design, the intramedullary hip screw has recently been introduced to correct this complication. We present a case of mechanical failure of this new implant that occurred in a pathological subtrochanteric fracture. The centering sleeve of the implant became loose and migrated while the head screw penetrated the acetabulum. Refixation was successful.

Aged↗
PubMed2006

[Early results of treatment with expandable intramedullary nails in femur shaft fractures].

OBJECTIVES: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of femur shaft fractures. METHODS: The study included 20 patients (10 females, 10 males; mean age 31 years; range 15 to 75 years) who were treated with expandable intramedullary nails (Fixion intramedullary femur nail) for femur shaft fractures. All the fractures were closed and were rated as type 32 A or B according to the AO classification. The mean duration from injury to surgery was three days (range 4 hours to 8 days). The results were evaluated using the Thoresen criteria. The mean follow-up was 26 months (range 9 to 38 months). RESULTS: The mean operation time was 79 minutes (range 45 to 120 min). Union was achieved in all the patients in a mean of 12.8 weeks (range 10 to 20 weeks). According to the Thoresen criteria, the results were excellent in 15 patients, good in one patient, fair in three patients, and poor in one patient. The results in all type A middle diaphyseal fractures were excellent. Of four patients with A2-3 distal metadiaphyseal fractures, one patient had a good result with a valgus of 5 degrees , and three patients had a fair result with a valgus ranging from 8 degrees to 10 degrees , one of which also had 8-mm shortening. Delayed union, early or late infections, compartment syndrome, or bone necrosis were not seen. Of six patients who completed a follow-up of two years, the nails were removed in five patients, whereas removal was not possible in one patient due to a break in the upper part. CONCLUSION: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in metadiaphyseal regions and in fractures with fragments greater than 50%.

Adolescent↗
PubMedDate not supplied

Prevention of malrotation deformity in femoral shaft fracture.

OBJECTIVE: To confirm the need to check anteversion (AV) of the intact femur to prevent malrotation deformity following intramedullary nailing in femoral shaft fracture. DESIGN: Prospective. RESULTS: Four patients out of forty-two (forty-three nailings) developed malrotation deformity of more than 15 degrees after femoral nailing. In the second part of the study, distal fragments of the fractured femurs were rotated 13.8 degrees on average to match with the rotational alignment of the intact femur. The malrotation deformity was controlled to less than 5 degrees in all cases. Closed reduction along the longitudinal axis of the femur was performed and was acceptable in forty-two cases (thirty-four cases in Part 1 of the study and eight cases in Part 2) prior to nailing. The coefficient of correlation between preoperative and postoperative AVs was 0.73 in these cases. CONCLUSION: Because true neutral rotation of the distal fragment alone is not accurate in preventing malrotation deformity of the femur following intramedullary nailing, we recommend measuring AV in both intact and fractured femurs and correcting rotational malalignment if it exists at the time of femoral nailing. Rotational alignment did not change significantly unless we failed to externally reduce the fracture due to a flexion deformity of the proximal fragment.

Femoral Fractures↗
PubMed2006

Flexible intramedullary nail removal using a broken screw removal set.

The use of flexible titanium intramedullary nails for management of pediatric long bone fractures and some adult fractures has become common. Nail removal after union can be challenging and often requires a larger exposure than nail placement to allow the insertion of grasping devices, such as pliers. A percutaneous technique for the removal of flexible intramedullary nails using extraction bolts from a broken screw removal set is presented. The technique is especially useful when the end of the nail is not prominent and where a hollow reamer from the same set can expose the nail end for the extraction bolt to be used.

Adult↗
PubMed1995

Diagnosis and management of infection after tibial intramedullary nailing.

A series of 20 patients with infection after intramedullary nailing of the tibia is discussed. The most common pathogen was Staphylococcus aureus, which was found in 14 patients (64%). Eleven nails were originally inserted without reaming, and 9 were reamed. Treatment protocols were based on the time of onset of infection (acute, subacute, and chronic) and the status of bone healing. In eight patients, the fractures (6) and nonunions (2) were healed at diagnosis of infection and were treated by debridement, nail removal, and antibiotics. Twelve patients had fractures (8) and nonunions (4) that were not healed. Four were treated with debridement, nail removal, and external fixation, and four with debridement and nail retention. The overall success rate for eradicating infection was 90%. Infection after unreamed nailing had fewer complications and a higher success rate for infection control than did reamed nailing. Risk factors identified in this study for infection are previous external fixation, severe open fracture, and substance abuse.

Adolescent↗
PubMed1999

Simple method for retrieval of distal segment of the broken interlocking intramedullary nail.

A simple technique for removal of the distal fragment of the broken intramedullary interlocking nail is described. It was successfully used in three patients with a broken nail due to nonunion. The technique requires only cerclage wire, which is available in any operating room, avoiding the difficulties obtaining the custom made hook and of excessive exposure to radiation.

Bone Nails↗
PubMed2004

Intramedullary nailing in open tibia fractures: a comparison of two techniques.

We analyzed 51 patients with open tibial fractures treated with intramedullary nailing. In 29 patients the nailing was performed without reaming and in 22 after the "reamed-to-fit" technique. There was no statistically significant difference in the rate of union. The nonreamed group required a greater number of secondary procedures to achieve union and had a higher but not statistically significant incidence of infection. Analysis of the operative and anesthesia cost associated with the additional procedures revealed that on average, patients receiving nonreamed nailing incurred a cost of $4,900 more per fracture than patients of the reamed-to-fit technique. The healing rates of open tibia fractures using either minimally reamed or nonreamed techniques of intramedullary nailing are comparable. No increase in the rate of infection with the reamed-to-fit technique was found. A significant increase in the number of secondary procedures required to achieve union was found with the nonreamed nailing technique.

Adolescent↗
PubMed1982

Open fractures of the shaft of the tibia treated by intramedullary nailing.

The technique and results of treating 57 selected open tibial shaft fractures by intramedullary nailing are reviewed. All but three of the the fractures were located in the middle third of the tibia; two thirds of these were transverse or short obliques. Excellent or good results were obtained in 87.7 percent of all cases. The mean time to union of Type I fractures was 12.6 weeks, of Type II fractures 15 weeks, and of Type III fractures 20.5 weeks. Complications included two infections in two of the Type III fractures.

Adult↗
PubMed1997

The unreamed humeral nail--a biological osteosynthesis of the upper arm.

One hundred humeral shaft fractures have been treated by closed retrograde locked intramedullary nailing. The Russell-Taylor nail was used in 58, a Synthes prototype of an unreamed humeral nail in 42 cases. Excellent shoulder function after consolidation has been found in 90%, excellent elbow joint function in 86%. Among four cases of postoperative radial nerve palsy, three fully recovered within three months and one patient needed a secondary exploration. In three cases additional comminution at the fracture site occurred. Interlocking bolt breakage has been seen in three, slight nail migration with no adverse consequences in two cases, an additional supracondylar fracture in one case. Nine patients needed a secondary internal fixation because of disturbed fracture healing. Compared to complication rates and end results in shoulder and elbow function of plate fixation or anterograde nailing in the treatment of humeral shaft fractures, the retrograde locked humeral nail seems to present itself as the better implant for these fracture types. The number of radial nerve palsies is significantly lower than in plate osteosynthesis. A huge advantage compared to plate osteosynthesis is also the biological type of stabilization with minimal invasion of the soft tissues. There is also minimal damage to periosteal and endosteal blood supply.

Adolescent↗
PubMed2001

[Pathological fracture in osteofibrous dysplasia].

Osteofibrous dysplasia Campanacci is a rare tumor-like lesion mostly presented in the meta-epiphyseal region of the tibia. Different options exist about the treatment modalities. The rare case of a 4 1/2-year-old girl suffering from a pathologic fracture of the tibia shaft due to a osteofibrous dysplasia is presented. The fracture was stabilized by intramedullary nailing using elastic titanium rods. During this procedure a biopsy of the lesion confirmed the radiological suspected diagnosis of an osteofibrous dysplasia. The implant was removed after ten months when fracture and lesion were healed. The treatment options and the differential diagnoses are discussed by review of the literature.

Bone Cysts↗
PubMed1995

Intramedullary nailing of tibial shaft fractures.

Sixty-four displaced tibial shaft fractures were treated using intramedullary nailing, either primarily or after an attempt at conservative treatment, which consisted of closed reduction under anaesthesia and immobilisation in a long-leg plaster cast. There were 37 closed and 27 open fractures. Three patients had a fracture of both tibiae. The median time period from the intramedullary nailing of the closed solitary fractures to union was about the same after primary nailing as after delayed nailing. Although the fractures were different in these groups, it is possible that the time spent in conservative treatment before intramedullary nailing brings no additional benefits. The incidence of deep infection in open fractures after primary nailing was 1/16. The fractures, in which an acceptable position could not be maintained using conservative methods, were mainly spiral in configuration and located in the distal third or at the junction of the middle and distal thirds of the tibia.

Adult↗
PubMed1999

Is routine removal of intramedullary nails justified.

This study investigates the outcome of 100 cases of lower limb intramedullary nail removal. 12 femoral and 25 tibial nails were removed for pain and 4 tibial nails for infection. For 22 tibial nails and 38 femoral nails there was no recorded indication. There where 3 operative complications, 2 abandoned procedures and 1 tibial fracture (nail extraction without prior removal of the distal locking screw). In 9 out of 16 cases anterior knee pain improved after tibial nail removal. 4 patients, previously asymptomatic, developed anterior knee pain following tibial nail removal. 40 patients who were discharged without crutches returned in pain and had to be given crutches to alleviate leg pain. 62 patients took a mean of 11 days sick leave. We conclude that all complications were avoidable. Intramedullary nail removal is safe. Patients with anterior knee pain should be told that their pain may persist and that knee pain may even arise. Most patients will require crutches and an average of 2 weeks away from work.

Adult↗
PubMed1994

Intramedullary nailing of (impending) pathologic fractures.

Forty-one (impending) fractures were reviewed in 39 patients with metastatic bone disease. Thirty-one lesions were located in the femur, and the remaining ten lesions were located in the humerus. In 22 cases there were multiple lesions in the affected bone. All patients were treated with intramedullary nailing, 21 times because of a pathologic fracture and 20 times because of an impending pathologic fracture. There was no mortality related to the surgical procedures. In nine patients the postoperative course was complicated (four technical and five systemic complications). Pain relief was achieved in 29 patients. Ambulatory status was improved in 27 patients. A pathologic refracture in the same bone occurred in five cases, all located in the femoral neck. Intramedullary nailing is useful in the treatment of metastatic bone disease. This technique facilitates stabilization of the whole bone, which in our view, with respect to the presented data, is mandatory.

Adult↗
PubMed1981

[Closed intramedullary nailing of femur shaft fractures - experiences in 245 cases (author's transl)].

A follow-up study is given of 245 femoral shaft fractures, treated 1961-1975 with closed reduction and intramedullary nailing. 141 patients were examined personally 19-5 years after operation. The results were excellent in 75,9%, fair in 20,6%, and poor in 3,5%. Deep infections occurred in 2,4%. The number of patients was also subdivided in regard to indication, concomitant injuries, postoperative fatalities, pathologic fractures etc.

Adult↗
PubMed1996

Treatment of supracondylar femoral fractures with a retrograde intramedullary nail.

From August 1992 to January 1995, 24 patients with 26 supracondylar femoral fractures were treated with a retrograde intramedullary nail. There were 22 patients with 24 nails available for review. Eight fractures were open and 13 were intraarticular fractures. There were a significant number of associated injuries. The average followup interval was 18 months (range, 4-36 months). All fractures healed by 4 months, (average, 3 months). Only 1 patient required bone grafting. There were no implant failures or superficial or deep infections. One malunion occurred. Average knee range of motion was 104 degrees. A previously described rating scale was used to evaluate function. There were 4 excellent, 16 good, 2 fair, and 2 poor results. The supracondylar nail provides rigid internal fixation for rapid healing and comparable functional outcomes to lateral fixation devices with significantly less soft tissue dissection.

Adult↗
PubMed2002

Complicated femoral shaft fractures.

The treatment of femoral shaft fractures has become safe and reproducible since the advent of popularization of intramedullary nailing, however, many femoral shaft fractures are complicated by associated fractures, extensive comminution, extensive contamination, and arterial injury compartmental syndrome. Other conditions associated with the use of femoral nailing include femora nonunions, broken hardware, acute fractures with prior implants, and infections. The management of these complex femoral shaft fractures demands special techniques for successful outcome.

Bone Nails↗
PubMed1996

[Treatment of pathological fractures of long tubular bones in childhood using elastic stable intramedullary nailing].

Pathological or spontaneous fractures in childhood are rare and are mostly caused by benign bone diseases; the fractures must be treated on an individual basis, as there are no constant rules. Since the new method of osteosynthesis called "elastic stable intramedullary nailing" (ESIN) or "embrochage centro-medullaire elastique stable" (ECMES) has demonstrated the best results in the treatment of normal fractures in childhood, this method is rapidly being used in the treatment of spontaneous or pathological fractures. We report our experience in the treatment of spontaneous fractures in childhood with "elastic stable intramedullary nailing", in nine patients with ten fractures. The pathological diagnosis was in 5 cases a juvenile bone cyst; in addition, there were cases of histiocytosis X, lymphangiomatosis, hemangiomatosis and osteoporosis (one each). The location was the femur (two cases) and humerus (seven cases). All fractures healed completely without pseudarthrosis; as complications we saw one incidence of osteomyelitis, one of a second fracture after "elastic stable intramedullary nailing" and one coxa vara in a child with histiocytosis X of the proximal femur. In the 5 children with juvenile bone cysts the nails are still in situ; in two cases the nails had to be changed.

Adolescent↗
PubMed2004

Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures.

BACKGROUND: Cephalocondylic intramedullary nails, which are inserted proximally to distally (cephalocondylic), have been used for the surgical treatment of extracapsular hip fractures. OBJECTIVES: To compare all cephalocondylic intramedullary nails with extramedullary implants for the surgical treatment of extracapsular hip fractures in adults. This is the fourth substantive update of our original review which compared the Gamma nail with the sliding hip screw (SHS). SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, several orthopaedic journals and conference proceedings, and reference lists of relevant articles. We contacted trialists, colleagues and implant manufacturers. Date of the most recent search: May 2003. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, results were pooled. MAIN RESULTS: Eighteen trials comparing the Gamma nail with the SHS were included, with data available for 2575 patients. The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased re-operation rate. There were no major differences in the incidence of wound infection, mortality or medical complications between implants. Data were inadequate for other outcomes. Five trials involving 623 patients compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group: all cases of operative and later fracture of the femur occurred in this group. Results for post-operative complications, mortality and functional outcomes were similar in the two groups. One trial of 206 patients with a trochanteric fracture showed no advantages for proximal femoral nail (PFN) compared with the SHS. One trial of 60 patients reported favourable preliminary results for an experimental mini-invasive static intramedullary nail compared with the SHS. One trial of 230 patients, which compared the Kuntscher-Y nail with the SHS, reported no major difference in outcome aside from a significantly increased number of patients with leg shortening, and a tendency for poorer recovery of mobility in the Kuntscher-Y nail group. Two trials, involving 65 patients with reverse and transverse fractures at the level of the lesser trochanter, compared an intramedullary nail (Gamma or PFN nail) with an extramedullary implant (a 90-degree blade plate or dynamic condylar plate). The intramedullary nails were associated with better intra-operative results and fewer fracture fixation complications for these rare fractures. REVIEWER'S CONCLUSIONS: Given the lower complication rate of the SHS in comparison with intramedullary nails, it appears that the SHS is superior for trochanteric fractures. Further studies are required to determine if different types of intramedullary nail produce similar results, or if intramedullary nails have advantages for selected fracture types (for example, reversed fracture lines and subtrochanteric fractures).

Adult↗