Abstract
ObjectiveThe purpose of this study is to compare the clinical effects of our self-designed rotary self-locking intramedullary nail (RSIN) and interlocking intramedullary nail (IIN) for long bone fractures.MethodsA retrospective study was performed in 1,704 patients who suffered bone fractures and underwent RSIN or IIN operation in our hospital between March 1999 and March 2013, including 494 with femoral fractures, 572 with humeral fractures, and 638 with tibial fractures. Among them, 634 patients were followed up for more than 1 year. The operative time, intraoperative blood loss, postoperative complications, healing rate, and the excellent and good rate of functional recovery were compared between two groups.ResultsCompared with IIN group, RSIN group exhibited significantly shorter operative time and less intraoperative blood loss no matter for humeral, femoral, or tibial fractures (all p < 0.001). The healing rate in patients with more than 1 year follow-up was significantly higher in RSIN group for femoral and tibial fractures (both p < 0.05). In RSIN group, no nail breakage or loosening occurred, but radial nerve injury and incision infection were respectively observed in one patient with humeral fracture. In IIN group, nail breakage or loosening occurred in 7 patients with femoral fractures and 16 patients with tibial fractures, radial nerve injury was observed in 8 patients with humeral fractures, and incision infection was present in 2 patients with humeral fractures and 1 patient with femoral fracture. The complication rate of IIN group was significantly higher than that of RSIN group (p < 0.05). However, there were no significant differences in the excellent and good rate of shoulder, elbow, knee, and ankle joint functional recovery between RSIN group and IIN group.ConclusionRSIN may be a reliable and practical alternative method for the treatment of long bone fractures.
Highlights
Long bone fractures, including tibial, femoral, and humeral fractures, are common traumatic injuries, accounting for approximately 4% of emergency department visits in the USA every year [1]
Compared with the interlocking intramedullary nail (IIN) group, the operative time was significantly shorter, and the intraoperative blood loss was significantly lower in rotary self-locking intramedullary nail (RSIN) group no matter for humeral, femoral, or tibial fractures
In RSIN group, no nail breakage or loosening occurred, but radial nerve injury and incision infection were respectively observed in one patient with humeral fracture postoperatively
Summary
The introducer was used to guide the main nail to the entry point of greater tuberosity, and the main nail was rotated into the medullary cavity to fix the fracture followed by inserting the locking tag into the groove of main nail (Figure 2 (A1, B1, C1)). The anterior border of the trochanteric fossa was selected as the entry point of nail, and the main nail was screwed into the medullary cavity under fluoroscopy for fracture fixation following inserting of the locking tag. The main nail was guided into the entry point of the trochanter and screwed into the medullary cavity for fracture fixation under direct vision followed by inserting the locking tag (Figure 3 (A1, B1, C1)). Following the expansion of the medullary cavity, the main nail was screwed under fluoroscopy and locking tag was inserted.
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