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Results for “Fracture Fixation, Intramedullary”

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At least 19 recordsLinked to original sources
PubMed1986

The mechanics and biology of intramedullary fracture fixation.

Intramedullary (IM) fracture fixation serves to stabilize fracture fragments and maintains alignment, while permitting motion at the fracture site during functional activities. Acting as an internal splint, the implant serves as a load-sharing device and fracture healing progresses with the formation of peripheral callus. By allowing motion of adjacent joints, rehabilitation is concurrent with treatment, and stress-shielding is thought to be minimal using these techniques. Recently, IM nails have been introduced to widen indications for their use based on variations in the cross-sectional geometry, length and shape of nails, interlocking designs, and surgical techniques. Although the most important mechanical factors in the design of IM nails are strength, stiffness, and rigidity, anatomic constraints and surgical technique limit nail variations. Closed nailing is preferred to open procedures to preserve periosteal blood supply and minimize surgical trauma adjacent to the fracture. Blood flow to the fractured bone is elevated in nailing experiments, although callus maturation is somewhat delayed. However, the end result in terms of healing was similar to that of plate fixation.

Animals↗
PubMed1985

Biomechanics of intramedullary fracture fixation.

Intramedullary rodding allows excellent control of bending forces on long bone fractures when adequate sized rods are used. This is made possible by reaming when necessary. Torsional stability is poor if adequate bone nail contact is not obtained and there is little bone fragment interdigitation. This can be optimized with the interlocking system, especially with proximal and distal fractures. Intramedullary rods allow transmission of compressive load so there must be adequate bone to bone contact without comminution to prevent shortening. If a great deal of comminution is present, an interlocking system must be used to resist compressive loads. The interlocked devices have not been proven to be a detriment to union and indeed are a semi-rigid fixation system when used in comminuted shaft fractures. The strength of an osteosynthesis with an intramedullary rod depends on the geometry of the rod and the geometry of the fracture complex. Both locked and nonlocked intramedullary rods perform extremely well when one understands the mechanical principles involved in intramedullary rodding and pays close attention to detail.

Biomechanical Phenomena↗
PubMed2003

[The principles and practices of intramedullary nailing for fracture fixation].

Intramedullary nailing is fracture fixation for long bone fractures. The fixation system is stabilization at fracture site, using a metal rod, from the inside of medullary cavity of long tubular bone. This principle of fracture fixation is intramedullary splinting. The procedures of fixation are reduction at fracture site, decision of entry point, reaming, insertion of nail and interlocking screw fixation, additionally controlling of dynamization for acceleration of fracture healing. The development of intremadullary nailing has sequentially addressed the design of nail, fixation system and technical exploitation, and expanding of indication. This paper introduces the concept and recent development of intramedullary nailing.

English Abstract↗
PubMedDate not supplied

Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates.

OBJECTIVES: To compare the clinical and radiographic results for locked intramedullary (IM) nails and plates used in the treatment of humeral diaphyseal fractures. DESIGN: Prospective randomization by sealed-envelope technique of eighty-four patients into two study groups: those treated by intramedullary nailing (IMN group; n = 38) and those treated by compression plating (PLT group; n = 46). SETTING: Patients admitted consecutively to a university-affiliated Level I trauma center. PATIENT/PARTICIPANTS: All skeletally mature patients admitted to Harborview Medical Center with acute humeral shaft fractures requiring surgical stabilization. Fractures of the diaphysis were defined as being at least three centimeters distal to the surgical neck and at least five centimeters proximal to the olecranon fossa. INTERVENTION: Treatment with locking antegrade intramedullary humeral nails (Russell-Taylor design [Smith and Nephew Richards]) or with 4.5-millimeter dynamic compression and limited contact dynamic compression plates (AO design [Synthes]). MAIN OUTCOME MEASUREMENTS: Clinical outcome measurements included fracture healing, radial nerve recovery, infection, and elbow and shoulder discomfort. Radiographic measurements included fracture alignment, time to healing, delayed union, and nonunion. RESULTS: Follow-up averaged thirteen months. Forty-two fractures (93 percent) in the PLT group were healed by sixteen weeks versus thirty-three fractures (87 percent) in the IMN group (p = 0.70). Shoulder pain and a decrement in shoulder range of motion (ROM) were significant associations with IMN (p = 0.007 for both variables) but not with PLT. A decrement in elbow ROM was significantly associated with PLT (p = 0.03), especially for fractures of the distal third of the diaphysis, whereas elbow pain was not (p = 0.123). The sum of other complications demonstrated nearly equal prevalence for both treatment groups. CONCLUSIONS: For patients requiring surgical treatment of a humeral shaft fracture, intramedullary nailing and compression plating both provide predictable methods for achieving fracture stabilization and ultimate healing.

Adolescent↗
PubMed2002

Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation.

The reliability of the radiological assessment of the healing of tibial fractures remains undetermined. We examined the inter- and intraobserver agreement of the healing of such fractures among four orthopaedic trauma surgeons who, on two separate occasions eight weeks apart, independently assessed the radiographs of 30 patients with fractures of the tibial shaft which had been treated by intramedullary fixation. The radiographs were selected from a database to represent fractures at various stages of healing. For each radiograph, the surgeon scored the degree of union, quantified the number of cortices bridged by callus or with a visible fracture line, described the extent and quality of the callus, and provided an overall rating of healing. The interobserver chance-corrected agreement using a quadratically weighted kappa (kappa) statistic in which values of 0.61 to 0.80 represented substantial agreement were as follows: radiological union scale (kappa= 0.60); number of cortices bridged by callus (kappa = 0.75); number of cortices with a visible fracture line (kappa= 0.70); the extent of the callus (kappa = 0.57); and general impression of fracture healing (kappa = 0.67). The intraobserver agreement of the overall impression of healing (kappa = 0.89) and the number of cortices bridged by callus (kappa = 0.82) or with a visible fracture line (kappa = 0.83) was almost perfect. There are no validated scales which allow surgeons to grade fracture healing radiologically. Among those examined, the number of cortices bridged by bone appears to be a reliable, and easily measured radiological variable to assess the healing of fractures after intramedullary fixation.

Bony Callus↗
PubMed1981

Intramedullary fixation for fractures of the hand.

Twenty-seven fractures in 22 patients were treated with an intramedullary rod, introduced through the fracture fragments, without violating the joint surfaces. Twenty-six fractures united. There was one nonunion and one migration of the pin into the joint; there were no infections. Advantages of this procedure are (1) that it is quicker and easier to perform than a procedure requiring Kirschner wires or plates, (2) no special equipment is needed, and (3) motion can often be started as early as 10 days after the operation.

Adolescent↗
PubMed1999

Effect of femoral fracture and intramedullary fixation on lung capillary leak.

BACKGROUND: Pulmonary injury is an important complication in the trauma patient with long-bone fractures. The purpose of this study was to determine the effect of femoral fracture or fracture and intramedullary fixation on lung capillary leak. The contribution of leukocytes to lung injury in this model was also determined. METHODS: The pulmonary capillary filtration coefficient was determined in lungs of rats after femur fracture or fracture and reamed or unreamed intramedullary fixation. Pulmonary arterial vascular resistance and lung neutrophil content were also determined. RESULTS: Fracture alone did not cause lung injury, whereas fracture and intramedullary fixation elicited lung capillary leak. Fracture alone and intramedullary fixation increased pulmonary vascular resistance, whereas unreamed intramedullary fixation caused lung leukosequestration. CONCLUSION: Femoral fracture alone does not cause an increase in pulmonary microvascular permeability. Femoral fracture and intramedullary fixation causes lung capillary leak, which is not increased by reaming the femoral canal.

Animals↗
PubMed2005

Arthroscopically assisted retrodrade intramedullary fixation for fractures of the distal femur: technique, indications and results.

The purpose of this study is to present our experience with the technique, the problems and the potential pitfalls of arthroscopically assisted retrograde femoral nailing for supracondylar femoral fractures. In a 2-year period, nine patients (seven women, two men, average age 72 years) with supracondylar femoral fractures were treated in our department with a retrograde nailing under arthroscopic control. The mean operative time was 63.8 min (42-84 min) and the mean follow up period was 34.5 months (ranged 12-52). Solid union of the fracture was achieved in all patients without additional intervention, in 14 weeks (range 12-18). There was no malalignment (more than 5 degrees in any plane) or implant failure. In conclusion we believe that the arthroscopically assisted technique is a very good method to treat supracondylar fractures of the femur. It has very low morbidity since the knee is not opened through the operation, and the surgeon has the ability to inspect the joint for any additional damage. It is very helpful in multitrauma patients and in young patients, where the precision of the entry point is critical. However, we do not recommend the technique in intraarticular fractures because the reduction is difficult and the fixation is performed with safety only under direct vision.

Adult↗
PubMed1988

Intramedullary fixation of fracture of the sternum.

A case of fracture of the sternum in a patient suffering from osteogenesis imperfecta is presented. Internal fixation was carried out using a plate which was placed within the medulla. The described technique is simple and useful for the rarely indicated operative treatment of fractures of the sternum.

Adult↗
PubMed1996

Intramedullary fixation of metacarpal and proximal phalangeal fractures of the hand.

The use of intramedullary fixation for fixation of fractures of the metacarpal and proximal phalanx is reported. Flexible intramedullary rods are used for unstable transverse and short oblique diaphyseal fractures of the proximal phalanx and metacarpal. The fracture site is not opened and the rods are introduced under xray control. The rods are cut flush with the bone so that there is no soft tissue tethering. Intramedullary spacers are used in comminuted metacarpal fractures associated with crush injuries and gunshot wounds. The fracture site is opened and a single rod is placed to fill the intramedullary canal. A supplementary plate may be used to control rotation, and bone graft is usually necessary. A new spacer has been designed that has proximal and distal locking screws to control length and rotation. This also is used routinely with bone graft. The techniques outlined stabilize the fracture site allowing immediate motion postoperatively.

Adult↗
PubMed2006

Intramedullary fixation of unstable metacarpal fractures.

Intramedullary stabilization of metacarpal shaft and neck fractures is a relatively simple, cost-effective, and safe technique with good published outcomes (Fig. 9); however definite advantages over other techniques of fracture stabilization, or indeed simple early mobilization in some instances, have not been clearly demonstrated. A recent publication does suggest that the technique is comparable to percutaneous transverse fixation in the context of fifth metacarpal neck fractures.

Bone Wires↗
PubMed2004

Torque resistance after fixation of Jones fractures with intramedullary screws.

BACKGROUND: Intramedullary screws frequently are used for fixation of Jones fractures of the fifth metarsal. While the ability of intramedullary screw fixation in fifth metatarsals to resist bending and tensile forces is well known, the ability to withstand torsion has not been studied. This paper compares the torsional stiffness of Jones fractures treated with 6.5-mm short- threaded intramedullary screws to those treated with 5.0-mm cannulated short-threaded intramedullary screws. METHODS: Nine fresh-frozen, matched pairs of cadaver fifth metatarsals had an acute Jones fracture simulated with an osteotomy. They were stabilized with intramedullary screws and then loaded to failure. RESULTS: The torsional stiffness of the metatarsals fixed with the 6.5-mm did not differ significantly from that using 5.0-mm screws. However, to achieve stability, the 5.0-mm screw had to be long enough to reach the metatarsal head and neck. This tended to straighten the normally curved fifth metatarsal bone and caused lateral gapping at the fracture site. CONCLUSION: Both 5.0-mm or 6.5-mm screws provide equal torsional rigidity, but 5.0-mm screws may need to be longer, which could potentially straighten the fifth metatarsal shaft in patients who have a curved fifth metatarsal.

Aged↗
PubMed1996

Intramedullary fixation of forearm fractures in adults.

The authors present a retrospective study of acute fractures of the diaphysis of the radius or ulna, or both, in adults treated by intramedullary nailing. Seventy diaphyseal fractures in 38 patients (30 men and 8 women) were treated by intramedullary fixation. The mean age of the patients was 31.5 years. Union occurred in 66 fractures (94%). The average union-time was 73 days. Compared with the results published by other authors, using the same evaluation criteria, union-time with the intramedullary technique was shorter than with other techniques. Union-rates and functional results were similar to those in comparable studies. Closed nailing does have many advantages, including early union, low incidence of infection, small scars, less blood loss, and short operating time with minimal surgical trauma.

Adolescent↗
PubMed1994

Postoperative femoral fracture after intramedullary fixation with a Gamma nail: case report and review of the literature.

The Gamma nail, an intramedullary nail that is combined with a sliding hip screw, has recently been introduced as an alternative method of treatment for peritrochanteric fractures of the femur. We report a case of a postoperative femoral fracture that occurred in the area of the device after Gamma nailing of a stable intertrochanteric fracture. A review of the literature reveals that postoperative fracture is not an uncommon complication of Gamma nailing. This complication results in a difficult management problem. The possibility of a femoral fracture around the Gamma nail should be entertained before the use of the nail is considered. The availability of alternative fixation devices must be confirmed in the event that such a fracture is encountered.

Aged↗
PubMed1993

Interlocking intramedullary fixation of hand fractures.

Reduction and stabilization can be especially difficult in treating comminuted hand fractures with bone loss or nonunion. Two cases are presented to illustrate a method of intramedullary fixation using an AO mini fragment reconstruction plate, which allows interlocking fixation proximally and distally. Any defect can be filled with corticocancellous bone graft. When necessary, this graft can be fixed to the metal plate that acts as a strut. The fixation obtained is stable against rotational, angular, and compressive forces, making it a useful adjunct to the hand surgeon's armamentarium.

Adolescent↗