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PubMed1996

[Intramedullary nailing in closed femoral fractures].

Intramedullary nailing of femoral fractures has gone through a revival in the past few years because of improvements in both materials and design. Axial forces are tolerated very well by the nail; however, its stiffness in both rotation and bending is related inversely to its working length. Fractures of the middle shaft can be stabilized without problems due to elastic contact forces that result in a tight grip inside the bone. Reaming and interlocking extend the indications to more complicated fractures. The development of solid nails with augmented stiffness, but smaller diameter, permits unreamed nailing with reduced damage to the medullary cavity and the avoidance of dead space. The AO developed a modular solid nail system with a variety of interlocking possibilities. With respect to soft tissue injury and biomechanics, nailing is the procedure of choice for femoral fractures.

Biomechanical Phenomena↗
PubMed1996

[Intramedullary nailing of the humerus as an alternative to conservative therapy and to plate osteosynthesis].

For humeral shaft fractures conservative treatment, plate osteosynthesis and IM nailing are possible options according to the localization, type of fracture or additional soft tissue problems. While the majority of humeral shaft fractures is still treated conservatively, today an increasing number of fractures is felt to be suitable for ORIF. Pseudarthroses, pathological fractures, multiple fractures or polytrauma, very severe open fractures, soft tissue interposition or concomitant nerve or vascular injuries are all indications for operative treatment. We think that plate osteosynthesis is still the standard. IM interlocking nailing has been shown to be advantageous for early rehabilitation and low radial nerve damage rates. In IM nailing it is still necessary to improve the implants and implantation techniques. A retrograde extra-articular nailing technique with elastic implants is preferable. The preliminary results for a newly developed elastic nail ("Monachia Nail") in 18 patients are very promising with respect to the implantation technique, fracture healing and functional rehabilitation.

Bone Nails↗
PubMed1996

[Intramedullary nailing of open fractures].

The goal of treatment of open fractures is to prevent infection, promote fracture healing, and restore normal limb alignment and function. The initial treatment of these fractures includes: debridement, soft tissue coverage, antibiotic therapy, and fracture stabilization. Four different techniques for intramedullary nailing for the fixation of open fractures have been employed: (1) unreamed, unlocked nails (i.e., Ender and Lottes, which have low infection rates, but are mechanically insufficient); (2) reamed unlocked nailing (which relies on overreaming to provide stability through bone-nail surface contact, but is associated with high infection rates); (3) reamed locked nailing (which may rely on limited reaming because of the interlocking screws); and (4) unreamed nailing (which always relies on interlocking screws and is associated with function better than and infection rates similar to those with external fixation, but has an increased incidence of screw breakage). In contrast to the biological problems in the tibia, those problems encountered in the femur are more predominantly mechanical in origin. For humeral shaft fractures, shoulder problems associated with the antegrade approach are frequent, and bypassing the rotator cuff with a retrograde approach appears advantageous.

Anti-Bacterial Agents↗
PubMed1996

[Value of intramedullary locked nailing in distal fractures of the tibia].

PURPOSE OF THE STUDY: This study is a retrospective analysis of 38 extra-articular distal tibial fractures treated by intramedullary locked nailing. PATIENTS AND METHODS: 38 patients with a distal metaphyseal extra-articular fracture (43 A AO type) or with minimal ankle joint extension were managed. There was 26 men and 12 women with a mean age of 32.3 years, 10 fractures were open. The fractures were transverse or oblique in 13 cases, with torsional or flexion wedge in 12 cases and spiroïd in 13 cases. In only 2 cases was the fibula intact. AO classification was not useful because many fractures began more proximally than the limit described by Müller. All the fractures were fixed by closed locked intramedullary nailing : the nail was cut just after the distal hole and impacted close to the subchondral plate. In 7 cases the fibula was fixed too. RESULTS: There was no postoperative complication in 27 cases. Three patients had a transient nerve palsy (one tibial nerve and two common fibular nerve). In ten cases the nail was dynamized. One patient had a non union but healed with a new dynamic nail. Two patients had a delayed union and healed after dynamization and osteotomy of the fibula. The mean time to union was 5 months (2 to 8). 8 patients had a varus or a valgus deformity of 3 to 6 degrees. 11 patients suffered from anterior knee pain and in 5 patients the fracture site was painful. In 18 patients a CT scan was performed : 6 had a rotational deformity from 4 to 26 degrees, and 2 a tibial lengthening (discrepancy of 7 and 9 mm). CONCLUSION: Closed intramedullary nailing is a safe and effective method for the treatment of distal metaphyseal tibial fractures. The authors propose a new classification.

Adolescent↗
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↗
PubMed1998

[Experiences with different telescope nails in treatment of pediatric osteogenesis imperfecta].

OBJECTIVE: The present study aims to examine and compare results after intramedullary rodding of long bones with the original Bailey/Dubow-nail and two modifications. PATIENTS AND METHODS: During the period 1985 to 1995 21 patients with an average age of 6.3 years (2-11 yrs) underwent intramedullary rodding of 83 long bones. Therefore 38 original Bailey/Dubow-nails, 36 nails with distal screws and 9 nails with distal K-wires were used. The mean observation period amounted to 5.7 years after insertion. Operation success was judged by bone growth, rod elongation, complications, implantation period, revision- and refracture rate. RESULTS: Bone growth was about 90.6% of the normal value accompanied by an elongation of 71.4%. Best results could be achieved by the use of conventional nails, whereas nails with distal screw or K-wires showed most disturbance. Complications had to be scored in 33.7% and mainly consisted of rod migration with cortical perforation (15.7%), metaphyseal position of the distal screw (9.6%) or no elongation (6.0%). Average implantation period was 4.6 years with a 66.3% revision rate. Refractures after inadequate trauma happened in 3 cases (3.6%) after insertion of the screw-type nail. CONCLUSIONS: The use of elongation rods in children with osteogenesis imperfecta promises successful fracture prevention and a comparably long implantation period. However, the original Bailey/Dubow-nail showed best results although the modified nails had been expected to be superior.

Bone Nails↗
PubMed1990

Reconstruction of a functional and esthetic nail.

The most common cause of nail bed deformity is trauma, but other causes are infection, tumor, ischemia, or congenital anomalies. This article includes discussions of nonadherence, split nail, reconstruction of the eponychium, crooked and hooked nail, bony irregularity, pachyonychia, ischemic deformities, and absence of the nail. New problems are encountered daily and other deformities have no method of correction recorded in the literature. For these cases, we provide suggested treatments based on the anatomy and physiology of the nail.

Amputation, Traumatic↗
PubMed1993

Relevance of osteotomy and implant characteristics in inter- and subtrochanteric osteotomies. Experimental examination under alternating and static load after stabilisation with different devices including gamma nail osteosynthesis.

The purpose of this experimental examination was to determine the load-bearing capacity (LBC) of different inter- and subtrochanteric fractures under alternating physiological and static loads. These fractures are typical injuries of the geriatric patient, and full LBC restoration is needed for mobilisation. From patients over 60 years old at the time of death, 301 femora were obtained and randomly allocated to the following osteotomy (OT) groups: A1, flat and steep OT; A2, OT with 2/3 and complete medial cortical defect; reversed inter- (A3) and subtrochanteric OT; subtrochanteric resection and double plate compound osteosynthesis (DPCO); and the control group (no OT). Following osteosynthesis various devices were tested: condylar plate, 130 degrees angle nail plate, 145 degrees angle nail plate, double T profile angle nail plate, 135 degrees DHS, 150 degrees DHS after valgisating displacement OT, Ender nails, gamma nail and Orthofix external fixator. The femora were tested under alternating physiological load and under static load. The load-bearing capacity (LBC) was 5141 +/- 1621 N in flat A1 OT, 4501 +/- 1621 N in steep A1 OT and 3767 +/- 1500 N in A2 OT with partial defect. In reversed intertrochanteric OT the LBC was 3770 +/- 1798 N and in the reversed subtrochanteric OT, 5308 +/- 2330 N. In A2 OT with complete medial defect, only the gamma nail (5672 +/- 726 N) and the DHS after valgisating displacement OT (7261 +/- 1794 N) showed a high LBC and no alternating load instability. After subtrochanteric resection and DPCO (7415 +/- 1840 N) the LBC was the same as that of the control femora (7271 +/- 1941 N).(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1982

[Investigation about the stability of a fixateur-externe using a new screw nail (author's transl)].

Since former investigations showed that the 4.5 mm Steinmann-nails hitherto were the weakest part of fixateur-externe systems, we developed a screw nail with a shank thickness of 7 mm and a thread identical to that of the cortical screw developed by the Arbeitsgemeinschaft für Osteosynthese (Workshop Society for Osteosynthesis). By conducting experiments with a metal alloy (square tube made of aluminium) in cadaver bones, the bending stress of a frame assembly R and of a three-dimensional assembly with 2 Schanz-screws Z2S was examined with 4.5 mm Steinmann-nails as well as with screw nails. The systems mounted with the new screw nails bent considerably less than the other systems. The improvement in stability achieved by screw nails is relatively more significant for the external frame fixator and in cases of a defect at the fracture gap than for the three dimensional fixateur externe with 2 Schanz-screws and in case of a compression at the fracture gap.

Bone Screws↗
PubMed2004

[Periprosthetic supracondylar femoral fractures: LISS or retrograde intramedullary nailing? Problems with the use of minimally invasive technique].

Retrograde intramedullary locking nailing as well as the LIS system are propagated as minimally invasive treatment options for distal femoral fractures following total knee arthroplasty. In a retrospective study, we reviewed the clinical results after operative treatment of 18 periprosthetic supracondylar femoral fractures. The fracture was stabilized with the less invasive stabilization system (LISS) in nine patients (average age: 80.3 years) and with a retrograde intramedullary locking nail in the remaining nine patients (average age: 76.8 years). The mean follow-up was 18.2 months (6-35 months). We did not find significant differences concerning the operation time (nailing 99.8 min vs 102.3 min with the LISS) or the length of stay in the hospital (nailing 10.6 days vs 12.7 days with the LISS). In one patient of the nailing group we found a valgus malalignment of 18 degrees. Seven patients in each group were satisfied with the clinical results. In one patient of the LISS group a revision due to an infection was necessary. In one patient of the nailing group a reosteosynthesis had to be performed. To sum up, both systems are useful tools in the treatment of dislocated periprosthetic fractures and both systems are not without any problems. However, under special consideration of the complications we found in our study, the LISS seems to be a better alternative in osteoporotic bone with a small distal fragment. The choice of the optimal implant should therefore depend on the type of fracture and knee arthroplasty, the type of bone, and the experience of the surgeon.

Activities of Daily Living↗
PubMed1997

[Seidel humerus intramedullary nailing. Clinical results of 100 surgeries].

Between 01.01.88 and 30.07.94 we treated 81 traumatic and 19 pathologic humeral shaft fractures with the Seidel humeral locking nail (HLN). The majority of the 100 patients (60 women, 40 men) were older than 60 years of age. The dominant fracture type according to AO was type A. Operative stabilization was considered indicate because of fracture distraction during functional bracing in most cases. In general, patients choose surgical intervention in preference to conservative management. Radiological consolidation was observed within 10 weeks. In 48 cases sonography revealed motor disturbances between the gliding sheath of the rotator cuff, but there was no correlation between this and the shoulder mobility. In 7 cases an additional fracture was created during introduction of the nail. This complication can be avoided by using the right technique. There were no cases of non-union or radial nerve lesion. There were 2 patients who developed an infection, which disappeared after removal of the nail and introduction of antibiotic-loaded beads. Functional results were recorded in 63 patients: 53 patients (84%) had an excellent or satisfactory result (NEER score > 80). Among the others, problems at the site of nail insertion predominated. In our view, the Seidel humeral locking nail is an implant that provides exercise stability without intraoperative positioning problems or risk of injury to nerves or vessels. Nevertheless, this method needs a skilled surgeon with special training to handle typical technical nailing problems.

Adult↗
PubMed1997

[Unreamed intramedullary nailing as minimal invasive palliative intervention in osteolysis and pathologic fractures of long tubular bones].

Pathological fractures and osteolyses with impending fractures of long bones impose a severe problem in patients with advanced cancer. For palliative treatment between June 1993 and October 1995 intramedullary nailing was performed in 19 patients with 13 femoral, 7 humeral and 1 tibial lesions; AO unreamed nails were used for this purpose (unreamed femur nail UFN with or with spiral blade for femoral lesions and unreamed tibia nail UTN for humeri and tibia). Stabilization was achieved without severe complications; full weight bearing of both femora and humeri (while using crutches) was allowed. Simultaneous and bilateral nailing was done. Follow-up until death due to advanced cancer demonstrated no implant failure and improved quality of life as well. Unreamed intramedullary nailing seems to be a minimally invasive procedure with a low complication rate for palliative treatment of (impending) pathological fractures in advanced cancer.

Adult↗
PubMed1998

[Removal of a massive broken tibial intramedullary nail].

A problem arose when the reamed tibia nail was replaced by a massive unreamed tibia nail. Of the nail fractures, it is difficult to remove the distal fragment from the medullary cavity. It may also happen that the connecting screw between the insertion handle and the nail breaks off at the edge of the implant, which complicates removal of the nail. The authors have developed a technique for removing the implant without having to saw a fissure in the marrow. A concave instrument is slid over the part of the nail left behind after which the two are connected by means of a K wire. This method has been successfully applied in two patients.

Adult↗
PubMed1998

[Avascular femur head necrosis as severe complication after femoral intramedullary nailing in children and adolescents].

Nailing of femoral fractures before closure of the growth plates may lead to avascular necrosis of the femoral head in 3-4% of cases. In addition to the 14 cases described in the literature we present 3 more. Analysis of these cases reveals a common pathogenesis. The nails were all inserted anterograde and were designed for the adult femur. The problem appears to be related to the large diameter of the nail and its entry point in the relatively small femoral neck basis, close to the vessels supplying the femoral head. The role of the open physis remains unclear. Even though the complication of femoral head necrosis is rare, it is a severe complication. Therefore we do not recommend anterograde femoral nailing, using the classic entry point, in children or adolescents. We believe that there is a need for a new design of femoral nail. If both femoral head necrosis and coxa valga are to be avoided, we suggest that the entry point of the nail should be dorsolateral, below the trochanteric physis.

Adolescent↗
PubMed1998

[Removal of a broken massive tibial intramedullary nail].

A problem has arisen when replacing the reamed tibia nail by the massive unreamed tibia nail. In case of nail fracture it is difficult to remove the distal fragment from the medullary cavity. It may also occur that the connecting screw between the insertion handle and the nail breaks off at the edge of the implant, which much complicates removal of the nail. The authors have developed a technique to remove the implant without having to saw a fissure in the marrow. A concave instrument is slid over the part of the nail left behind after which the two are connected by means of a K wire. This method has been successfully applied in 2 patients.

Equipment Design↗
PubMed2000

[Intramedullary compression nailing of long tubular bones].

The biomechanical principle of intramedullary compression osteosynthesis is based on the implantation of a movable intramedullary nail that is statically interlocked in distal round holes and dynamically interlocked in a proximal slot. Distraction of the nail against the proximal interlocking screw by means of a compression screw leads to a relative movement of the proximal fragment directed distally against the nail. This results in direct contact of the main fragments under increasing compression. Simple fractures, pseudarthroses and osteotomies within the diaphyses of the long bones represent promising indications for the use of compression nailing. Furthermore, this method enables extraordinarily stable knee and ankle arthrodeses. Major positive aspects are controlled adaptation of fragments and a significantly increased stability of the fracture as compared to conventional intramedullary nailing techniques, especially as rotational forces are concerned. The biomechanical advantages result in earlier full weightbearing and an increased rate of fracture union in delayed healing. Given the use of optimized implants and instruments, compression intramedullary osteosynthesis offers a remarkable potential for further improvement in both the spectrum and success of intramedullary nailing.

Ankle Joint↗
PubMed2004

Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation.

INTRODUCTION: Antegrade intramedullary (IM) nailing of humeral shaft fractures is reported to cause shoulder joint impairment. This retrospective study compared shoulder joint symptoms, range of motion (ROM), and isometric strength after antegrade IM nailing and dynamic compression (DC) plating of humeral shaft fractures. MATERIALS AND METHODS: We compared 29 patients with DC plating and 44 with antegrade IM nailing of their humeral shaft fractures. Shoulder pain, L'Insalata and Constant scores, shoulder joint ROM and isometric shoulder strengths were measured after mean follow-up of 6.2 (1-15) years (DC plating) and 5.5 (2-10) years (IM nailing). RESULTS: Patients had nonsignificantly more shoulder pain after IM nailing than after DC plating. Shoulder scores and isometric strength measurements showed no difference between the groups. Flexion was significantly better after DC plating, but none of the other ROM parameters differed between the groups. The shoulder scores and all ROM and strength parameters of the injured side were significantly lower than on the uninjured side in both groups. CONCLUSIONS: Shoulder joint ROM and strength does not recover to normal after humeral shaft fracture. Antegrade IM nailing if performed properly is not responsible for shoulder joint impairment.

Adolescent↗
PubMed2004

Antegrade interlocking nailing of humeral shaft fractures.

The results of 39 humeral shaft fractures (37 patients) treated with antegrade locked nailing using a Russell-Taylor nail were reviewed. There were 30 acute fractures, 6 fractures malaligned in a hanging cast or brace, and 3 pathological fractures. Patient age ranged from 26 to 80 years (average, 59.7 years) and average follow-up was 25.7 months (range, 6-48 months). Fracture union was achieved in 92.3% of our cases, while shoulder function was excellent or good in 87.2% of cases. Antegrade locked nailing offers a dependable solution for the treatment of humeral shaft fractures, especially in polytrauma patients and cases of segmental or pathological fractures. Far less satisfactory results were obtained in comminuted fractures of the proximal third in the humerus, especially in osteoporotic patients, and we therefore advocate caution with the use of intramedullary nailing in this type of fracture. Certain technical aspects such as avoiding nailing the fracture in distraction, properly countersinking the tip of the nail, and achieving adequate fixation stability have been found to be of paramount importance to reduce the incidence of delayed union/non-union rate and to obtain better functional results from the shoulder joint.

Adult↗