Closed Interlocking Intramedullary Nailing Research Articles

A study of outcome of surgical management of diaphyseal fractures of tibia treated with intramedullary interlock nailing

Management of the fractures of the shaft of the tibia remained a controversial subject despite advances in both non-operative and operative care. Sir John Charnley stated that, “we have still a long way to go before the best method of treating a fracture of the shaft of tibia can be stated with finality” in 1961. Several published series regarding the treatment of fractures of the shaft of tibia have shown that closed treatment of fractures can have excellent results. But the drawbacks of prolonged healing time, malalignment and non-compliance of the patient has led to the thought of other modalities of treatment, finally resulting in the use of closed interlocking intramedullary nailing which has given excellent results. The method of closed nailing with or without reaming followed by early ambulation and weight-bearing has positive advantages over all existing methods, significantly lower complication rates and has comparable results. The intramedullary interlock nailing under image intensifier fulfills the objective of stable fixation with minimal tissue damage resulting in better and quicker fracture unions. The important aspects for its use are its ability to prevent axial collapse, rotational and angulation deformities and most important of all, being ealiest possible ambulation. The present study has been taken to review the results of diaphyseal fractures of tibia treated with intramedullary interlock nailing.

Outcomes of closed interlocking intramedullary nailing of the tibia without fluoroscopy in resource-limited settings: experience from two hospitals in Cameroon.

Introductionclosed static interlocking nailing with c-arm guidance is the standard procedure for the treatment of closed diaphyseal leg fractures. It is still very difficult to carry out such procedures in a low-income setting because of few or absent image intensifiers (c-arm) despite the necessity. The aim of this study was to describe the outcomes of patients with tibial fractures treated with closed interlocking intramedullary nails without c-arm guidance in a Cameroonian population.Methodsthis was a prospective study including adult patients treated for tibial fractures without a c-arm in two regional hospitals.Resultsfinally, 22 patients were included. The mean age was 34 ± 12.6 years with a male predominance (16 males and 6 females). Ninety percent of the fracture lines were simple or with a wedge fragment grade 42A or 42B respectively according to the AO classification. The mean surgery time was 1 hour 26 ± 34 minutes. The various aspects evaluated were the nail entry point which was good in 19 (86.4%) cases; proper nail driving which was considered good in 15 (68%) cases; the distal locking which was missed in 6 (27.3%) cases. Bone consolidation was obtained in an average of 4 ± 1.2 months in all 22 cases.Conclusionin resource constraints settings where c-arm are not always available, closed interlocked nail of tibia without c-arm guidance still gives overall good results. Nevertheless, there is a need to improve equipment in sub-Saharan African hospitals to make trauma surgery with c-arm a gold standard as currently recommended.

Surgical management of fracture shaft tibia with closed interlocking intramedullary nailing – A clinical study

Introduction: The tibia being the most commonly fractured long bone. A study was conducted to analyze the efficacy of closed intramedullary nailing tibial shaft fractures. Materials and methods: Study was conducted in the Department of orthopedics. Individuals with closed tibial diaphyseal fractures of >18 years, open diaphyseal fractures of tibia type I, type II were included. Open diaphyseal fractures of tibia Type III A, B, C, tibial fractures with intraarticular extensions and medically ill were excluded. Under spinal anesthesia, intramedullary locking was done as per the protocol. Results: During the study period, 50 fractures were included. the male-female ratio was 5.25. The youngest patient was 19 years and the oldest patient was 67 years. 60% of the participants had right tibial fractures and 40% with left. Thirty-nine (78%) participants simple and 22% (11) had type I and type 11 compound fractures. The majority of fractures (58%; 29) were united within 18-20 weeks. The average healing time was 19 weeks. Conclusion: In this study 16.9 weeks was the average healing time and 76% patients showed excellent outcome.

Study of interlocking nail in shaft tibia fracture

Introduction: The tibia is the most commonly fractured long bone in the body and understanding of the mode of injury, fracture pattern is necessary to decide an operative management. Tibia shaft fractures are commonly managed by interlocking nail. This study is to assess the surgical management and assess the functional outcome of tibia shaft fractures.Materials and Method: The study consist of 50 patients with tibia shaft fracture treated with tibia interlocking nail. Clinical outcome and function results were evaluated by Alho & Ekland’s criteria.Result: In this study, we have operated a total 50 cases with tibia interlocking nail in tibial shaft fractures. The average union time was 17.68 weeks. The study yielded about 82 % of excellent result.Conclusion: The present study shows that closed fractures of the tibia shaft treated with interlocking intramedullary tibia nailing involves minimal surgical trauma and negligible blood loss. It provides the advantages of early ambulation, lower rates of infection and non-union. A significant advantage of interlocking nail in addition to early joint mobilisation, is early weight bearing which allows earlier return to work. Hence the study concluded that closed interlocking intramedullary nail is the treatment of choice in closed tibia shaft fracture.

A study of result of closed interlocking intramedullary nailing in femur shaft fracture

A study of result of closed interlocking intramedullary nailing in femur shaft fracture

Result of closed interlocking intramedullary nail in tibial shaft fracture

Result of closed interlocking intramedullary nail in tibial shaft fracture

A comparative study of locking plate by MIPO versus closed interlocking intramedullary nail in extra-articular distal tibia fractures

Background: Distal tibia fractures have the second highest incidence of all tibia fractures after the middle third fracture of the tibia. Management of the distal tibia fractures is the most challenging due to its superficial nature and propinquity to the ankle joint. There are various management methods of distal tibia fractures. Distal tibia fractures can be managed using closed reduction and casting or surgical interventions such as closed reduction and intramedullary nailing or open reduction and internal fixation with plating or closed reduction and percutaneous plating or external fixators. Methods: A comparative study of locking plate by MIPO versus closed interlocking intramedullary nailing in extra-articular distal tibia fractures was undertaken among 30 patients with closed extra-articular distal tibia fractures, in the department of orthopedics, Ruby Hall Clinic, Pune from March 2014 to March 2015. The results were assessed using Johner and Wruh’s criteria.Results: 15 patients were treated with closed interlocking intramedullary nail and 15 patients with MIPO technique. The patients were operated. No difference was observed in terms of duration of surgery, time for fracture union and malunion. Difference was observed in the terms of total weight bearing after surgery, infection and other complications. Conclusion: It is observed that interlocking nailing is better in terms of early total weight bearing, fast union, and decreased risks of complications. Thus, it is a better choice for patient undergoing the treatment for extra- articular distal tibia fractures.

Open interlocking nailing of the fracture of the shaft of tibia

Closed Interlocking intramedullary nail is now the standard in the treatment of tibial shaft fractures however use of image intensifier precludes its common use in developing countries. This study was done to evaluate the outcome of open interlocking nailing under heading of fracture union, early mobilisation and early functional return of the limb and complication. We retrospectively reviewed 36 patients with Fracture shaft of tibia treated with open interlocking nailing. All fractures were simple transverse, short oblique. Serial follow up assessment was done for radiological and clinical union. Major complications encountered were infection. It was concluded that open interlocking nailing is a safe procedure for tibial shaft fractures, in the developing worlds with good functional and clinical results in the following situations: in hospitals with no image intensifier, in irreducible fractures and in female patients with pregnancy.

Surgical management of open tibial shaft fractures in adults by reamed versus unreamed intramedullary interlocking nailing: A comparative study

Back ground and objectives: Tibial diaphyseal fractures are one of the commonest long bone fractures encountered by most of the orthopaedic surgeons. Because most of the length of tibia is subcutaneous throughout, open fractures are more common in tibia than in any other major long bone. Because of high prevalence of complications associated with these fractures, management is often is difficult and the optimum method of treatment remains a subject of controversy. This prospective study was conducted at the department of orthopaedics, KIMS Hubli to evaluate and compare the results of closed interlocking intramedullary nailing with and without reaming in the treatment of the open fractures of mid shaft tibia in adults. It was done to compare the efficiency of interlocking intramedullary nailing with and without reaming in treatment of open fractures of mid shaft tibia with other studies in terms of time required for union, rate of malunion and malrotation, rate of infection and range of motion of ankle and knee joint.Materials and methods: This study was done on 50 patients between the age group of 25-40yrs admitted under Department of Orthopaedics of Karnataka Institute of Medical Sciences Hospital, Hubli with open fractures mid shaft of tibia selected based on inclusion & exclusion criteria during the period from 1/08/2013 to 31/07/2015 treated surgically using reamed/unreamed intramedullary interlocking nailing. Of the 50 patients 25 were treated by reamed and 25 by unreamed intramedullary interlocking nailing. All the cases were fresh fractures and traumatic in nature. They were done with the procedure as early as possible and the secondary procedures were done when needed. The cases were followed up for an average period of 6-9 months. None of the cases were lost to follow up. Results: Open fractures of the tibial shaft managed with or without reamed interlocked intramedullary nailing gave good functional results and patient satisfaction It involves minimal surgical trauma and less blood loss. It provides the advantages of early ambulation, lower rates of infection, delayed union, non union and malunion compared to other treatment modalities. It provides with early weight bearing and earlier returns to work. In our series, the overall functional outcome according to Johner and Wruhs’ criteria is equal and there is no significant difference in both reamed and unreamed nailing in open tibial shaft fractures in adults. Interpretation and conclusions: Intramedullary nailing is one of the methods of treatment for open tibial shaft fractures in adults, despite the fact that controversy exists regarding the choice of reamed or unreamed intramedullary nailing. There are no clear indications or contraindications for choosing either option. Clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft. The over-all functional outcome according to the Johner and Wruhs’ criteria was similar between the two groups, with no evidence that reaming delays the process of union. Considering the ease of performing the technique and the decreased operative time, unreamed interlocking nailing may have an edge over reamed interlocking nailing.

English

the aim of the present study is to evaluate the results of closed interlocking intramedullary nail in the management of fractures of shaft humerus.20 humeral shaft fractures were treated by closed reduction and intramedullary interlocking nailing in the department of orthopaedics, government medical college, government general hospital, anantapuramu from November 2010 to Aug 2012. The cause of fracture was RTA in 17 cases and fall in 3 cases. Age incidence varied from 20 years to 60 years, 14 were male 6 female. Out of 20 cases in 18 cases fracture united by 3 to 4 months. 2 non-unions occurred after 6 months., Excellent results were obtained in 40% of the cases, good results in 20%of the cases, fair results in 25% and Poor results in 15% of the cases. Most common complication was shoulder stiffness occurring in 5 cases. We conclude that interlocking nailing for humerus shaft fractures is an effective means of fixation. The most common complication is shoulder stiffness which can be minimized by preventing proximal protrusion of nail, proper repair of rotator cuff and early rehabilitation.

Result of closed interlocking intramedullary nail in tibial shaft fracture

The management of tibial diaphyseal fractures has always held a particular interest for orthopedic surgeons. Not only they are relatively common but also they are often difficult to treat. This prospective study was carried out at Rangpur from April 2008 to November 2009. 34 patients were treated by closed interlocking intramedullary nail. Goal of this study was to find out a safe & effective management of fracture, early mobility of patient, functional joint motion and short stay in hospital. Routine follow up was carried out in 29 patients. In 24 cases, fracture (81.76%) were united, 4 cases (13.79%) needed dynamisation with autogenous bone grafting and 1 case devoloped non union. Study showed interlocking nailing in tibia provides early mobility of patients, reduces hospital stay and fracture unites without joint stiffness and less complication.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10470Bang Med J (Khulna) 2011: 44(1&2) 15-17

Management of Radial Nerve Palsy Associated with Humeral Shaft Fractures by Closed Interlocking Intrameduallary Nail

Purpose: The purpose of this prospective study was to assess the results of immediate radial nerve palsy associated with closed humeral shaft fractures treated by the closed interlocking intramedullary nail without radial nerve exploration. Methods: Eighteen patients suffered from immediate radial nerve palsy associated with closed humeral shaft fractures treated by closed interlocking intramedullary nail, without exploration of the radial nerve. Results: Patients were followed up for a mean of 18 months (range from 12 to 24 months). All the cases had united in a good alignment within 12 weeks. Full clinical and electrodiagnostic radial nerve recovery as regarding the range of shoulder, elbow, wrist and hand movements occurred at 6 months examination. Conclusion: Closed interlocking nailing for immediate radial nerve palsy associated with closed humeral shaft fractures, provides immediate stability and can be done with a closed technique, brief operative time and minimum violation to the radial nerve, with early return of optimal extremity function.

The Fate of Butterfly Fragments in Extremity Shaft Comminuted Fractures Treated with Closed Interlocking Intramedullary Nailing

46 통신저자:김 윤 준 부산시 부산진구 개금동 633-165 인제대학교 의과대학 부산백병원 정형외과학교실 Tel:051-890-6129ᆞFax:051-892-6619 E-mail:fracture78@yahoo.co.kr 접수: 2011. 7. 23 심사(수정): 1차 2011. 9. 2, 2차 2011. 10. 18 게재확정: 2011. 11. 7 Address reprint requests to:Yoon-Jun Kim, M.D. Department of Orthopedic, Busan Paik Hospital, Inje University College of Medicine, 633-165, Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea Tel:82-51-890-6129ᆞFax:82-51-892-6619 E-mail:fracture78@yahoo.co.kr 상하지 간부 분쇄 골절 시 교합성 골수강내 고정술로 치료 후 잔존한 나비형 골편의 운명

Therapeutic Embolization for Pseudoaneurysm of the Anterior Tibial Artery after Tibial Nailing

Closed intramedullary nailing is a favorite surgical technique for tibial shaft fracture. After closed interlocking intramedullary nailing, proximal and distal locking screws are inserted for increasing rotational force and axial stability. Vascular complications associated with tibial nailing for fractures are very rare. Here, we described a case of a pseudoaneurysm of the anterior tibial artery after tibial nailing. We opted for minimally invasive treatment consisiting of thrombin injection and vascular plug insertion. Because pseudoaneurysm of the anterior tibial artery can induce severe complications, one should, when performing closed intramedullary nailing, make a quick diagnosis and start treatment right away.

Gastric cancer acrometastases to all digits of one hand following closed intramedullary nailing

Metastatic malignant tumor of the hand is unusual and the most common site of the primary cancer is lung. Acrometastases to the phalanges of the hand usually involve a single bone, while those proximal to the phalanges often involve multiple bones. Metastasis to the hand from gastrointestinal cancer, particularly from gastric cancer, is extremely rare. To our knowledge, only five cases have been reported in the literature to date and there has been no reported case following closed intramedullary nailing for metastatic diaphyseal fracture of an ipsilateral long bone. We present a very unusual case of gastric cancer, which metastasized to all fingertips of the ipsilateral hand after closed interlocking intramedullary nailing of a pathologic fracture of the humerus.

Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value<0.05. Mean hospital stay in nailing group was 12.8±2.75 day and plating group 21.1±2.73 days, p>0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection.Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.

Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur.

Thirty-seven fractures of the distal part of the femur in thirty-five patients were treated with interlocking intramedullary nailing. All fractures were nailed by a closed technique after any intercondylar extension of the fracture had been managed by reduction and stabilization with percutaneous lag-screws. Patients who had an isolated condylar fracture or a severely comminuted intercondylar fracture were treated with other types of implants. There were thirty extra-articular (type-A) fractures and seven intra-articular (type-C1 and type-C2) fractures. Postoperatively, early mobilization exercises and weight-bearing were begun. At an average duration of follow-up of 20.5 months (range, fifteen to twenty-six months), all thirty-seven fractures had healed. There were no malunions of either the supracondylar or the intercondylar fractures. Complications were infrequent and included chronic irritation from the distal screws in three patients and delayed union in one; the latter healed with two centimeters of shortening after bone-grafting. There were no infections. The functional results were assessed with the modified knee-rating system of The Hospital for Special Surgery. Thirteen knees (35 per cent) had an excellent result; twenty-two (59 per cent), a good result; and two (5 per cent), a fair result. The results correlated with the age of the patient and the presence of an intra-articular fracture. We concluded that closed interlocking intramedullary nailing is an excellent technique for both supracondylar and simple intercondylar fractures in which closed reduction and percutaneous fixation of the articular fracture is possible.

Radiation exposure to the surgeon during closed interlocking intramedullary nailing.

During interlocking intramedullary nailing of twenty-five femoral and five tibial fractures, the primary surgeon wore both a universal film badge on the collar of the lead apron and a thermoluminescent dosimeter ring on the dominant hand to quantify the radiation that he or she received. When distal interlocking was performed, the first ring was removed and a second ring was used so that a separate recording could be made for this portion of the procedure. At the conclusion of the study, all of the recorded doses of radiation were averaged. The average amount of radiation to the head and neck during the entire procedure was 7.0 millirems of deep exposure and 8.0 millirems of shallow exposure. The average dose of radiation to the dominant hand during insertion of the intramedullary nail and the proximal interlocking screw was 13.0 millirems, while the average amount during insertion of the distal interlocking nail was 12.0 millirems. Both of these averages are well within the government guidelines for allowable exposure to radiation during one-quarter (three months) of a year. Precautions that are to be observed during this procedure are recommended.