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PubMed1986

Interlocking nailing of complex fractures of the femur and tibia.

The interlocking nail widens the range of indications for medullary osteosynthesis of femoral and tibial shaft fractures. Stability is achieved by transverse threaded bolts in prefabricated holes in the nail, which anchor the implant directly to cortical bone, thereby controlling length, alignment, and rotation of the limb. Two hundred eighty-three femoral and 401 tibial fractures were treated with an interlocking nail and followed for an average of 20 months. Overall, 97% of the femurs and 94.3% of the tibias were judged to have an excellent or good result, based on both clinical and radiographic parameters. Delayed union or nonunion requiring bone grafts occurred in 2% of the femurs and 0.7% of the tibias following interlocking nailing. Deep infection developed in 2.4% of the femurs and 2.2% of the tibias. All of these patients eventually healed their fractures without evidence of chronic osteomyelitis. The main advantage of interlocking nails is that surgery can be performed using closed nailing techniques, allowing early protected weight-bearing and joint motion. The rates of nonunion and infection are very low, and there is little risk of refracture after implant removal.

Bone Nails↗
PubMed1985

[Biomechanical analysis of the medullary bone nail and its locking].

By mechanical definition an intramedullary nail is not a nail but rather a bendable feather, subject to longitudinal tension and to a lesser degree to transverse pressure. Reaming the medullary canal is necessary for centralization of the nail as well as to increase the area of contact with the bone. However, this procedure is detrimental to the bone metabolism and reduces its elasticity against torsional forces. The dynamic locking nail-system is more biologic than conventional nailing and it reduces rotatory instability with the help of additional components, such as transverse screws. Only static locking allows true static weight bearing with crutches, but not dynamic mobilisation. Nails with conventional strength and in leaf of trefoil formation are superior to other designs. However, an improved angle in the proximal locking is suggested, as this would allow for a three to four times greater weight bearing.

Biomechanical Phenomena↗
PubMed1985

[Biomechanics of intramedullary nailing and its interlocking].

Mechanically an intramedullary nail cannot be conceived of as a nail but rather as a bendable feather subject to longitudinal tension and, to a lesser degree, to transverse pressure. Reaming the medullary canal is necessary for centralizing of the nail as well as for increasing the area of contact with the bone. However, this procedure is detrimental to the bone metabolism, thus reducing its elasticity against torsional forces. The dynamic locking nail-system is more biologic than conventional nailing, with rotatory instability being reduced by additional components, such as transverse screws. By applying static locking only true static weight bearing with crutches, will be ensured but no dynamic mobilisation. Nails with conventional strength and in trefoil leaf formation are superior to other designs. However, an improved angle in the proximal locking is suggested, as this will allow the weight bearing to be increased three to four times.

Biomechanical Phenomena↗
PubMed1979

Closed Ender nailing of femoral-shaft fractures.

Closed Ender nailing was used in sixty fractures of the femoral shaft. Follow-up examination in fifty-two cases is reported. There were only two failures of the method, both in fractures with supracondylar extension. Simple transverse and short oblique fractures and those with unicortical comminution were shown to be stable after nailing, while long oblique fractures and lesions with bicortical comminution had a tendency to shorten and often required cerclage wiring, cast-bracing, or traction. The average hospital stay was 23.7 days. The operations were simple and quick. There was one case of osteomyelitis, one of clinically apparent thrombophlebitis, and one of fat-embolism syndrome in a patient with multiple fractures and multisystem injuries. There were no cases of breakage of the nail, delayed union, or non-union. In most cases knee motion returned to the preinjury level, although in five knees removal of the nails was necessary. The two failures of nailing which required plate fixation occurred in fractures extending into the supracondylar region. Therefore, these fractures are not suitable for Ender nailing.

Adolescent↗
PubMed1984

[Indication and technic of interlocking nailing of the femur].

Between 1973 and 1982 we treated 569 fractures of the femoral shaft by means of osteosynthesis. The internal nailing was performed in 41.6%. We used an interlocking nailing in 170 cases, 116 times statically and 54 times dynamically. An open reposition was performed in 48.2%. With only a very small incision we exposed the area of the fracture to insert the reamer guide under control of the fingers into the distal part of the femoral shaft. By using this technique there is no danger of disposing the fragments in order to achieve stabilisation in the correct position. 52.4% of the patients were younger than 30 years and 25.9% older than 30 years and 25.9% older than 60 years. In all cases we observed an osseous healing, twice a secondary cancellous bone craft was necessary. As complications we had an infection rate of 2.9%, loosening of the bolt in 0.6%, axial malalignment greater than 10 degrees in 0.6%, a rotary malalignment greater than 10 degrees in 1.2%. We did not observe any refracture. Less complications can be observed in interlocking nailing in comparison with plate osteosynthesis. Technique, indication, mistakes, and dangers as well as careful timing of operation are discussed. In open fractures delayed osteosynthesis by means of interlocking nailing is to be preferred to primary plate osteosynthesis. Fractures fixed by interlocking nailing had comparatively less complications in fracture healing and especially no more shortenings and rotation deformities, but the advantage of early full weightbearing. The interlocking nail has a very important value in the management of femoral shaft fractures.

Adolescent↗
PubMed1983

Treatment of tibial shaft fractures by percutaneous Küntscher nailing. Technical difficulties and a review of 50 consecutive cases.

Intramedullary nailing of the tibia is a controversial procedure for fractures of the tibial shaft. Experience with 50 fractures (58% acute, 8% pathologic, and 34% unsuccessfully treated previously by other methods) with an average follow-up period of one year proved that tibial Küntscher nailing is effective. Mean time to clinical union, with patients independently ambulatory and resuming all work activity, was 29 weeks. Union was demonstrated radiographically at 13 weeks. The major complications were delayed union (2 patients), nail protrusion at the knee (2 patients), osteitis (1 patient), and thrombophlebitis (1 patient). Antirotation wires were used in addition to a Küntscher nail for fractures with inherent rotational instability. Blocking screws were used for fractures predisposed to bending. Technical problems arose most often at the nail entrance site, in negotiation of Herzog's curve, and in selection of proper nail length and caliber. With experience and technical skill, even highly complex tibial fractures can be successfully treated by this method.

Adolescent↗
PubMed1982

[Growth of finger nails in psoriasis patients undergoing PUVA therapy].

In 78 persons aged 13-78 years with and without psoriasis the daily growth rate of fingernails was measured on three nails each of the right and left hand. Untreated patients with psoriasis had an increased growth rate (112.7 +/- 25.5 micrometers) compared to control subjects (102.5 +/- 18.5 micrometers) without psoriasis (p less than or equal to 0.001). In patients with psoriatic nail involvement the growth rate was significantly increased (113.9 +/- 29.2 micrometers). Photochemotherapy (PUVA) slowed down the nail growth rate in patients without nail involvement (92.8 +/- 21.8 micrometers) vs. untreated psoriatics without nail involvement (p less than or equal to 0.05). In psoriatics with nail involvement, PUVA therapy had no measurable effect on the growth rate of fingernails.

Adolescent↗
PubMedDate not supplied

Malrotation following Ender nailing.

External malrotation is a frequent complication following Ender nailing. Biomechanical studies demonstrate that the standard Ender nail tends to produce external malrotation when the fracture is unstable. This type of malrotation does not develop to the same degree if the nails are bent into a 25 degree angle of anteversion. The anteversion nail follows the natural anteversion curve of the upper femur and does not build up a torsional stress that might be released in an unstable fracture situation. It is recommended that anteversion nails be used in condylocephalic nailing.

Biomechanical Phenomena↗
PubMed1995

[Interlocking nailing of the tibia].

Centromedullary nailing is a well-established method of treatment for diaphyseal long bone fractures. The indications have been broadened greatly since the introduction in 1974 of interlocking centromedullary nailing. The purpose of this paper is to review our first results with locked intramedullary nailing of the tibia. We report our experience with the first 19 cases of interlocking tibia nails (15 fractures, 1 delayed union, 2 pseudarthrosis, 1 osteotomy). On the extension table, the insertion of the nail and the placement of the interlocking screws did not cause any problem. In 3 cases, a proximal screw had to be removed within two weeks because of spontaneous displacement. Complications have been noticed in three patients (15.8%) (pulmonary embolism on day 1, and compartment syndrome two days later in one case, sciatic nerve neuroapraxia in the other two). The other patients have been mobilized 24 to 48 hours after surgery. 94% of the fractures were consolidated 4 months post-operatively, with no major deformation. Interlocking tibia nailing seems to be an attractive method in the treatment of certain fractures of the tibia. Early mobilisation and weight-bearing are provided. The indications, the technical aspects as well as the dangers of the method must be carefully respected in order to avoid complications and poor results.

Bone Nails↗
PubMed1995

Nonreamed nailing of closed and minor open tibial fractures in patients with blunt polytrauma.

A retrospective comparison of dynamic and static locking mode nonreamed nails in 88 closed, Grades I and II open tibial fractures is presented. Amount of time and number of reoperations required to unite fractures were compared for dynamic (Group 1, n = 31) and static locked (Group 2, n = 13) Winquist I and II fractures, and dynamic (Group 3, n = 14) and static locked (Group 4, n = 30) Winquist III, IV, and segmental fractures. Total reoperations also were compared; Tibias treated with dynamic nails united in an average of 20 weeks, with 3 reoperations; tibias treated with static locked nails united in an average of 30 weeks, with 21 reoperations. Group 1 fractures united in an average of 20 weeks, with 1 reoperation; Group 2 fractures united in an average of 32 weeks, with 4 reoperations. Group 3 fractures united in an average of 20 weeks; Group 4 fractures united in an average of 29 weeks, with 11 reoperations. In the group of tibias treated with dynamic nails, 3 additional operations were done; in the group of tibias treated with static locked nails, 7 additional operations were done. There was 1 infection and 3 deformities. Static locking mode appeared to delay union, especially when Groups 1 and 2 are compared; these fractures can be nailed without locking screws.

Adolescent↗
PubMed1995

Anatomic considerations of the human nail.

The nail unit is distinctive for human beings. Developmentally, the fetus demonstrates cranial and caudal paired anlage of the upper and lower extremities. The leg bud develops a foot plate and eventually toe rays that are first notched, later webbed, and then develop into separate toes. Distal on the toe, the primitive nail unit appears and eventually moves dorsal. When developed fully, the nail unit consists of the nail plate, nail bed, ungualabia, eponychium, hyponychium, lunula, and nail matrix. These structures are associated intimately with the terminal or ungual phalanges of the foot's five toes.

Adult↗
PubMed1995

Knee arthrodesis using a short locked intramedullary nail. A new technique.

This article reports on the use of a new intramedullary nail designed specifically for fixation of knee fusions. The nail is a short locked stainless steel nail that is inserted through a single anterior knee incision and uses an outrigger targeting rod to guide the insertion of the locking screws. The successful use of this technique is illustrated in two cases. The advantages of this nail compared with previously reported techniques of fixation for knee fusions are that the short locked nail avoids the second incision required for the insertion of long knee fusion nails, the bulkiness of the double plating technique in the relatively subcutaneous anterior knee area, and the difficulties inherent with the prolonged use of pins for external fixation.

Adult↗
PubMed1995

[Closed intramedullary nailing of tibial shaft fractures].

OBJECTIVE: To assess patient outcome after nailing of the tibial shaft with the unreamed AO/ASIF nail. DESIGN: A retrospective study of 54 nailed fractures of the tibial shaft treated between 1990 and 1994. Follow-up was done at the outpatient clinic and included measurements of the lower limbs and x-rays. SETTING: The study was conducted at the Hôpital de l'Enfant-Jésus, Québec, a centre specializing in trauma care. PATIENTS: Fifty-four acute displaced fractures of the tibial shaft occurring in 52 patients were studied. INTERVENTION: Nailing with the Synthes AO/ASIF unreamed locked nails. MAIN OUTCOME MEASURES: Time to bone fusion, rate of infection, incidence of deformity and failure rate of the implants, especially the lock screws. RESULTS: The majority of fractures were associated with a high-speed trauma (40/54 or 74% of cases) and 18 (33%) were open fractures. Osteitis developed in one (1.8%) open type IIIA fracture. Bone fusion was observed clinically and radiologically after 29 weeks on average; none of the fractures presented residual deformity on rotation of more than 5 degrees or a difference in length of more than 1 cm or a frontal or sagittal displacement of more than 10 degrees. A single case of pseudoarthrosis was noted. One or more lock screws became deformed or broke in 16 (34%) tibias; however, this did not lead to any reduction loss. Four compartment syndromes were diagnosed. CONCLUSIONS: Excellent results were obtained with respect to limb alignment and length. Loss of joint mobility was minimal. The number of lock screw failures indicates that a delayed weight bearing could prevent this complication, especially when an interfragment space remains after the nail placement.

Adolescent↗
PubMed1995

Fatigue failure in small diameter tibial nails.

The prevalence of implant failure in small diameter tibial nails has not been well characterized. In a series of 130 tibial fractures stabilized with 8-mm and 9-mm nails, implant failure occurred in 18 fractures (13.8%): 4 nails (3%) broke and 16 (12.3%) screws failed. All nail failures occurred in open, unstable fractures with delayed union, and all of the nails that broke were dynamically locked during the failure. Of the 130 fractures, 128 (98.5%) eventually united. Delayed union, degree of comminution, metaphyseal location, and dynamic locking of unstable fractures contribute to hardware failure. Based on these findings, dynamization could be used to treat delayed union only in axially stable diaphyseal fractures. Exchange nailing is recommended to treat delayed union in comminuted or metaphyseal fractures to prevent hardware failure. Bone grafting should be performed at 6 to 12 weeks for fractures with > 50% bone loss.

Bone Nails↗
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↗
PubMed1995

Exchange intramedullary nailing. Its use in aseptic tibial nonunion.

Exchange nailing for failure of union after primary intramedullary nailing of the tibia is widely used but the indications and effectiveness have not been reported in detail. We have reviewed 33 cases of uninfected nonunion of the tibia treated by exchange nailing. This technique was successful without open bone grafting in all closed fractures and in open fractures of Gustilo types I, II and IIIa. The requirement for open bone grafting was reduced in type-IIIb fractures, but exchange nailing failed in type-IIIb fractures with significant bone loss. For these we recommend early open bone grafting. The most common complication was wound infection, seen more often than after primary nailing. We discuss our protocol for the use and timing of exchange nailing of all grades and types of tibial fracture.

Adolescent↗
PubMed1993

[Gamma nail in the treatment of closed trochanteric fractures. Results and indications apropos of 121 cases].

The Gamma Nail, developed at the Centre for traumatology and orthopaedics of Strasbourg, is the latest advance in the treatment of trochanteric fractures, based on the intra-medullary principle and on the closed procedure. It was inspired both by the Y nail of Küntscher and by the interloking nail. This is the study of the results of a first series of 121 cases treated between 1988 and 1990 and followed until consolidation. The mean age was 75 years, mostly patients in poor general condition, unstable fracture types were predominant. The preoperative reduction was anatomic in 72 per cent and the quality of osteosynthesis was good in 66 per cent, acceptable in 27 per cent; 83.4 per cent of the patients resumed full weight bearing during the first week. Only one case of deep infection occurred, treated by Gentamicyn beeds without removal of the nail. The mortality rate was 12.3 per cent at three months. We note 7 malunions in varus > 10 degrees, 3 in valgus > 10 degrees, 2 in external rotation > 10 degrees and 1 internal rotation > 10 degrees. In six cases, there was a cut out of the femoral head by the screw (in two cases the screws were too short, in four cases they were in a bad position). The same criticism against all surgical methods of treatment of trochanteric fractures can be done against the Gamma Nail. Nevertheless, it keeps the advantages of a closed procedure and, in comparison to the Ender nail, the absence of knee pain and the systematic weight bearing whatever the fracture type.

Aged↗
PubMed1993

A comparison of femoral neck fixation with the reconstruction nail versus cancellous screws in anatomic specimens.

Femoral neck fixation techniques were applied to five matched pairs of autopsy specimens to evaluate the fixation of the Russell-Taylor femoral nail in ipsilateral neck and shaft fractures of the femur. Reconstruction nail fixation of the femoral neck was compared with that of three parallel screws. The intact and postfixation femora were subjected to an applied bending moment in 0 degrees, 30 degrees, and 90 degrees of simulated hip flexion. The bending stiffness was determined from the load deformation data for each intact femur and then after the appropriate fixation. The fatigue response of the fixation, presence of osteopenia, degree of fracture reduction, and device alignment showed that the stiffness ratio (fixed to normal) of the nail was greater in most specimens. There was no statistical difference in retained stiffness after cyclic loading between the nail and cancellous screw fixations. The ultimate strength of the nail was 2.5 times the strength of the screw fixation of the femoral neck. Thus, the nail provided biomechanically sound fixation of the femoral neck.

Aged↗