Closed Intramedullary Nailing Research Articles

Intermittent low-dose administration of recombinant human parathyroid hormone (1-34) promotes the expression of Runx2 during early stage of fracture healing

To study the correlation of intermittent low-dose administration of recombinant human parathyroid hormone (1-34) [rhPTH (1-34)] and the expression of Runx2 during early stage of fracture healing. Sixty 2-month old male Sprague-Dawley rats underwent close unilateral femoral fracture and intramedullary nail fixation, and then were randomly divided into 2 equal groups: treatment group undergoing subcutaneous injection of rhPTH (1-34) 10 microgxkg(-1)xd(-1) immediately after the operation, and control group undergoing subcutaneous injection of normal saline of the same dose. Six rats from each group were killed with their bilateral femurs taken out on days 2, 4, 7, 14, and 21 after the operation to undergo X-ray photography Tissue RNA and protein were extracted from the bone tissues and the levels of Runx2 mRNA and protein expression were evaluated through real time quantitative PCR and Western-blotting. Blood samples were collected from the abdominal aorta before the rats were killed to undergo detection of serum calcium, phosphorus, and alkaline phosphatase (AKP). The Runx2 mRNA levels in the fractured femurs of the rhPTH (1-34) group on days 14 and 21 after the operation were 2.6 and 3.8 times as those of the control group respectively (both P<0.05). The Runx2 protein levels in the fractured femurs of the rhPTH (1-34) group on days 14 and 21 after the operation were significantly higher than those of the control group respectively too. Since day 14 fracture healing was seen, and the status of fracture healing was better in the rhPTH (1-34) group than in the control group on days 14 and 21. The levels of serum calcium ion on days 14 and 21 of the rhPTH (1-34) group were both significantly higher than those of the control group (both P<0.05). There were not significant differences in the serum levels of AKP, osteocalcin and collagen type Iat any time point between the 2 groups. Intermittent low-dose administration of rhPTH (1-34) up-regulates the levels of osteogenesis-specific Runx2 mRNA and protein expression to accelerate the early stage fracture healing during the early stage.

Closed Intramedullary Nailing of Femoral Shaft Fractures in an Echelon III Facility

This study was performed to assess the safety of performing intramedullary (IM) nailing in an established echelon III theater hospital. Twenty-two patients (23 fractures) sustained subtrochanteric or diaphyseal femur fractures and presented to the Air Force theater hospital (AFTH) at Balad Air Base, Iraq, for definitive treatment. Sixteen grade IIIA open fractures underwent staged intramedullary nailing. Seven closed fractures were treated with either immediate or staged intramedullary nailing as facility operations tempo dictated. Definitive follow-up was only available for 8 fractures at 2 months and for 5 fractures at 6 months, but no patient was readmitted to any U.S. military hospital in Iraq for treatment of infection or intramedullary nail removal. Although the results are not conclusive, the authors suggest that intramedullary nailing may be performed with acceptable infection risk in an established echelon III facility. Further study will help to establish the efficacy of this treatment approach.

Treatment of Peritrochanteric Hip Fractures A2 According to A.O. Classification, whose Preoperative Reduction was not Feasible, by Closed Intramedullary Nailing

Closed intramedullary nailing is a method of choice for the treatment of peritrochanteric femoral fractures. The preoperative reduction of the them is not always feasible. With a few changes on the standard procedure during the reaming and the placement of the lag screw guide, we can achieve reduction of these unstable fractures. We believe that is possible to treat all peritrochanteric fractures closed having minimal trauma and immediate weight bearing. We describe the technique and we present our experience on 45 operated on patients suffered from unstable periochanteric fractures.

Pseudoaneurysm of the Anterior Tibial Artery After Closed Intramedullary Nailing of a Tibial Shaft Fracture: A Case Report

We would like to present a case of pseudoaneurysm of the anterior tibial artery after closed intramedullary nailing of a tibial shaft fracture.In an automobile accident, a 56-year-old man sustained a transverse diaphyseal fracture of the left tibia. 10 days after closed intramedullary nailing with laterally inserted proximal and distal locking screws, an enlarging tender, pulsating mass was found over the anterolateral aspect of his left leg. Ultrasonography and angiography revealed a pseudoaneurysm of the anterior tibial artery at the level of the distal locking screw. Surgical resection of the injured segment of the anterior tibial artery associated with a pseudoaneurysm and a vein graft was performed.

Closed Intramedullary Nailing of Femoral Fractures

Intramedullary nailing was performed on 520 femoral fractures in 500 patients. The series included eighty-six open fractures and 261 comminuted fractures. Closed intramedullary nailing was used in 497 femora and open intramedullary nailing with cerclage wiring, in twenty-three. The union rate was 99.1 per cent. The range of motion of the knee at follow-up averaged 130 degrees. Complications included four infections (0.9 per cent). Shortening of more than two centimeters occurred in ten patients (2.0 per cent) and malrotation of more than 20 degrees was observed in twelve patients (2.3 per cent). After prompt emergency …

Fracture of Femur Neck Associated with Technical Errors in Closed Intramedullary Nailing of the Femur

Fracture of Femur Neck Associated with Technical Errors in Closed Intramedullary Nailing of the Femur

Closed Intramedullary Nailing of Diaphyseal Forearm Fracture in Adolescence

Closed Intramedullary Nailing of Diaphyseal Forearm Fracture in Adolescence

Closed Intramedullary Nailing of Femoral Fracture without a Fracture Table

Closed Intramedullary Nailing of Femoral Fracture without a Fracture Table

Management of Tibia Fracture by Closed Intramedullary Nailing

Management of Tibia Fracture by Closed Intramedullary Nailing

Treatment of Unstable Tibial Shaft Fractures by Closed Intramedullary Nailing With Flexible (Ender-Type) Pins

Eighty patients with unstable tibial diaphyseal fractures were treated by closed intramedullary nailing with Ender-type flexible pins. The majority of injuries occurred from falling while snow skiing. Sixty-six fractures were closed and 14 were open. Fifty-eight fractures involved the distal, 21 fractures the middle, and one fracture the proximal one third of the tibial shaft. The average time to roentgenographic union was 15.5 weeks (range, ten to 34 weeks) for closed and open Grade I and II fractures. The time to union in Grade III fractures was 50 weeks (range, 36-64 weeks). There were two nonunions and two delayed unions. Both nonunions occurred in Grade IIIA open shaft fractures. Intramedullary stabilization with flexible, Ender-type pins provides good control of unstable tibial shaft fractures. The use of pins with a smaller diameter (3.5 or 4 mm) allows the surgeon to place more pins across the fracture site. The use of multiple pins and packing the intramedullary canal may provide better rotational stability. The use of Ender-type pins for fixation of Type IIIA open tibial shaft fractures is contraindicated.

A Clinical Comparison between Plate Fixation and Closed Intramedullary Nailing in the Treatment of Femoral Shaft Fractures

A Clinical Comparison between Plate Fixation and Closed Intramedullary Nailing in the Treatment of Femoral Shaft Fractures

Compartment Syndrome after Closed Intramedullary Nailing of the Tibia

Two patients developed an anterior tibial compartment syndrome after closed reamed intramedullary nailing of their fractured tibial shaft. Subsequently, a study was undertaken using a canine model to evaluate the risk of compartment syndrome after this operative procedure. A closed tibial fracture was created in 20 mongrel canines by applying a torsional load localized to the tibial shaft through a stress riser made with an intramedullary drill. Compartment pressures were measured in the canine anterolateral and deep posterior leg compartments. In 10 dogs, closed intramedullary nailing with reaming was performed while compartment pressures were measured. The remaining 10 dogs served as controls. Compartment pressures were monitored for 4 hours. In the experimental group, one dog attained and maintained a pressure greater than 50 mm Hg; a second dog maintained a pressure of 20 mm Hg during the postoperative monitoring period. In both of these cases, fasciotomy reduced the pressures to zero. The high tissue pressure readings were localized to the anterolateral muscle compartment. In the control group, no pressures higher than 8 mm Hg were recorded. Compartment syndrome is a potential complication of closed intramedullary nailing of the tibia, and the anterior muscle compartment appears to be the one most at risk. Therefore, perioperative tissue pressure monitoring is recommended.

Readily Improvised Wrench for Reduction of Fractures During Closed Intramedullary Nailing

Overhead frame traction equipment can be used to build an adjustable, radiolucent, sterilizable, reduction device. The method achieves a quick and easy reduction of the fracture for passage of intramedullary nailing guide wires.

Closed intramedullary nailing of the humerus: a modified technique.

Closed intramedullary nailing of the humerus: a modified technique.

Closed Intramedullary Nailing of Femoral Shaft Fractures

Closed Intramedullary Nailing of Femoral Shaft Fractures

Sharpening Treatment for Closed Intramedullary Nailing

Sharpening Treatment for Closed Intramedullary Nailing

Closing Intramedullary Nailing for the Treatment of Diaphyseal Forearm Fractures in Adolescence

Summary: The results of treatment of 20 unstable diaphyseal fractures of the forearm in adolescent patients by closed intramedullary nailing are presented. All fractures healed within 4-7 weeks. No cross-union, nonunion, pseudarthrosis, or infection occurred. The advantages of this method are (a) maintenance of accurate reduction, (b) reduction of complication rate, (c) negligible cosmetic defect, and (d) removal of the internal fixation device under local anesthesia.

Closing Intramedullary Nailing for the Treatment of Diaphyseal Forearm Fractures in Adolescence

The results of treatment of 20 unstable diaphyseal fractures of the forearm in adolescent patients by closed intramedullary nailing are presented. All fractures healed within 4-7 weeks. No cross-union, nonunion, pseudarthrosis, or infection occurred. The advantages of this method are (a) maintenance of accurate reduction, (b) reduction of complication rate, (c) negligible cosmetic defect, and (d) removal of the internal fixation device under local anesthesia.

A Clinical Experience of Closed Intramedullary Nailing for Long Bone Fracture

A Clinical Experience of Closed Intramedullary Nailing for Long Bone Fracture

Closed intramedullary nailing for ununited femoral shaft fractures.

Fifteen cases of ununited diaphyseal fractures of femurs were treated successfully by intramedullary reaming and closed Küntscher nailing through the small gluteal incision. The equipment used is the same as for nailing fresh shaft fractures. The cases included 10 nonunions, 2 delayed unions and 3 miscellaneous problems. All but one case had been initially treated by open reduction with some form of internal skeletal fixation. Two cases had been treated by 2 open procedures befor the closed Küntscher nailing. No supplemental bone graft or external immobilization was necessary. Two cases were nailed successfully in the presence of infection, resulting in solid union and no recurrence of infection. Five nails have been removed after union and no refracture has occurred. No important postoperative complication or instances of the fat embolism syndrome were encountered. No rotational deformity or further shortening of the femur occurred. Postoperatively, the patients ambulated with protected weight-bearing as early as possible. The average hospital stay was 15 days. In general, the patients had a functional extremity even while the fracture lines were still visible on roentgenographs; all have returned to their previous work.