Ender Nails Research Articles

The treatment of nonunion of femoral shaft fractures after intramedullarynaildynamizationwith temporary compression using external fixator followed by relocking of the internal intramedullary nail

Objective To introduce the technique we invented to treat hypertrophic and oligotrophic nonunion of femoral shaft fracture after dynamization of intramedullary nail (IMN) and to report its preliminary results. Methods The data of 2 cases with hypertrophic nonunions of femoral shaft fracture and 1 case with oligotrophic nonunion following IMN dynamization who had been treated by the technique from March 2006 to July 2017 in Beijing Jishuitan hospital were retrospectively studied. There were 2 females and 1 male, aged 50, 66 and 24 years old. 2 parallel half pins were inserted from anterior to posterior at the trochanteric and condylar zones of the femur for antegrade intramedullary nailing patients, and from lateral to medial sides for retrograde intramedullary nailing patient respectively, then the pins were connected with monolateral limb reconstruction fixator. The fracture nonunion site was compressed by the fixator up to 10-15 mm. The holes at the end of intramedullary nail where their screws were removed for dynamization were locked again with 2 locking screws, and then the frame was removed. The patients are allowed to start their rehabilitation and fully bear their body weight 1 day after the operation. Results The three patients were followed up for 25, 22, and 7 months after the surgery, respectively. The X-ray films showed the fracture healed at 7 months in two case, and at 12 months in one. One patient got her nail removed 25 months after the operation, feeling good 37 months after the removal. Conclusion This technique is an option to manage the hypertrophic and oligotrophic fracture nonunion of the femur after dynamization of IMN. It is mini-invasive to the nonunion site, easy to practice and allows early rehabilitation. Key words: Femoral fractures; Fractures, ununited; Fracture fixation, intramedullary; External fixators

Comparative study of external fixation and flexible intramedullary nailing (Enders nailing) in open tibial fractures

Background: Open tibia fracture, due to high energy or low enegy trauma classified according to Gustilo-Anderson classification system. The mode of fixation, been a subject of controvercy and some authors have proposed a need to address the issue of breach of soft tissue in these injuries.Methods: The study included a total 50 patients of open tibia fractures managed in AHRC from june 2010 to june 2015.There was 10 patients of type II, 4 patients of type IIIA and 36 patients of type IIIB according to Gustilo-Anderson classification.29 patients were admitted to ORTHO A unit managed with enders nail where 21 patients admitted to ORTHO B unit managed with external fixator. The outcome was assessed by duration of fracture union, number of surgeries required, incidence of infection and malalignment.Results: Open tibia fractures were mostly in males (90%) where 70% were young patients with a mean age of 36.2.Among these patients 80% sustained high velocity injury. Mean period of fracture union in enders group were 25+-7 weeks while in external fixator group was 39.4+-14 weeks. Our study also reveals fractures associated with head injury united earlier.24 out of 29 cases managed by enders nail required 4 furthur surgeries. Among these 50 cases infection detected in 12 cases (all were treated by external fixator; 11 cases belong to Gustilo-Anderson IIIB group). 35% malalignment in external fixator group in comparison to 4% in patients treated with enders nail.Conclusion: Open tibia fracture treated with ender nail united earlier than external fixator and total number of surgeries to achieve union in ender nail was significantly lesser than external fixator group. Infection and malalignment rate was also high in external fixation cases.

Intraoperative sonography may reduce the risk of extensor pollicis longus tendon injury during dorsal entry elastic intramedullary nailing of the radius in children

Extensor pollicis longus tendon (EPL) injury is a potential complication of dorsal entry radial elastic nailing technique in children. The aim of this study was to investigate if intraoperative ultrasonographic guidance can reduce the risk of (EPL) injury.Correlation between sonographic and operative findings were examined first in 6 adult cadavers. Position of Lister's tubercle, EPL, and extraosseal end of the elastic nail were detected by ultrasound imaging during a minimally invasive dorsal entry nailing. Radial slope of Lister's eminence was determined as a safe and easily identifiable entry point for opening the medullary canal. Extraosseal ends of the nails were bended in a slight radial direction and cut immediately beneath the skin in a maximally palmar-flexed wrist position. Cadaveric dissections followed our procedures all correlated with ultrasonographic findings, we have not seen tendon damage, obstruction or friction by the implant's end.After cadaveric experiments, we began using intraoperative sonography for monitoring elastic nail insertion in pediatric radial fractures.Between January 2015 and November 2016, 77 pediatric closed diaphyseal radial fractures were operated by dorsal approach ESIN under intraoperative sonographic checking.Procedures were executed by 2 orthopedic surgeons experienced in ESIN technique with basic musculoskeletal ultrasonographic qualifications.Sonographic identification of EPL and Lister's tubercle in the transverse view was possible in all cases. Determination of the position of the nail end to EPL was also possible in all cases. Mean distance of the transverse view center of the EPL and nail was 0.49 cm (range 0.3–0.62 cm, SD = 0.66). Based on the sonographic transverse view, the operator decided repositioning the nails by 2 patients.We have not found EPL injury postoperatively. All patients were followed for at least 12 months after operations. Nails were removed in all children without further complications.Intraoperative sonography helps determining optimal insertion point and the risk of EPL injury may be reduced during dorsal entry approach.Although the procedure is relatively easy, authors take note that surgical and sonoanatomic knowledge, basic sonographic skills and experience in the ESIN technique are equally necessary for its successful application. A greater number of cases is necessary to confirm our initial promising experiences.

Rescate de osteosíntesis intertrocantéricas y subtrocantéricas fallidas con un reemplazo articular. Técnica y resultados de una serie de 61 casos. [Rescue of failed inter - and subtrochanteric osteosynthesis with a joint replacement. Technique and results of a series of 61 cases.

IntroducciónEl objetivo del trabajo es revisar los aspectos técnicos de la artroplastía de cadera como rescate de una osteosíntesis fallida de un fractura intertrocantérica o subtrocantérica así como evaluar los resultados funcionales y las complicaciones asociadas en una serie consecutiva de 61 casos.Materiales y MétodoRealizamos 61 artroplastías de cadera, en 61 pacientes, como rescate de una osteosíntesis fallida de una fractura intertrocantérica o subtrocantérica. El promedio de edad fue de 76 años (50-93). %). Treinta y cuatro casos (56%) fueron tratados inicialmente con un tornillo deslizante de cadera, 8 (13%) con un DCS, 2 (3%) con clavos de Ender y 17 (28%) con un clavo de fémur proximal (corto o largo). Cincuenta y cinco 55 (90%) fueron rescatadas con una artroplastía total y 6 (10%) con una hemiartroplastía. En 17 (28%) casos utilizamos tallos no cementados y en 44 (72%) tallos cementados. En 12 casos el largo del tallo fue estándar y 49 de revisión.ResultadosAl año post-operatorio el HHS (Harris Hip Score) mejoró de 47 (rango de 32 - 54) en el pre-operatorio a 84 (rango 67-93). Siete pacientes (11.5%) presentaron complicaciones. Tres (4.9%) fueron fracturas femorales periprotésicas. Dos (3.2%) luxaciones. Una (1.6%) infección y un (1.6%) hematoma de la herida.ConclusiónLa artroplastía de cadera se presenta como un método eficaz para el salvataje de las osteosíntesis fallidas de fracturas intertrocantérica y subtrocantéricas. La mayoría de los pacientes logran recuperar una significativa mejoría del dolor y de su capacidad funcional. Sin embargo, es un procedimiento más demandante y con más complicaciones asociadas que el de una artroplastía de cadera primaria. AbstractIntroduction: The aim of this study was to review technical issues of hip arthroplasty after a failed proximal femur fixation, as well as to evaluate results and complications associated with this procedure.Methods: Sixty-one hip arthroplasties after a failed intertrochanteric or subtrochanteric fixation were performed. Average age of patients was 76 years (range 50-93). Thirty-four patients (56%) were originally treated with a dynamic hip screw, 8 (13%) with a DCS, 2 (3%) with Ender nail and 17 (28%) with proximal femoral nail. Fifty-five patients (90%) were treated with total hip arthroplasty and 6 (10%) with hemiarthroplasty. Uncemented stem was used in 17 patients (28%) and a cemented stem in 44 (72%). A standard length stem was used in 12 patients, and a long stem in 49 cases.Results: The HHS improved from 47 (range 32-54) before surgery to 84 (range 67-93) at one-year follow-up. Seven patients (11.5%) had complications: 3 (4.9%) periprosthetic femoral fractures, 2 (3.2%) dislocations, one (1.6%) wound hematoma, and one (1.6%) deep infection.Conclusions: Hip arthroplasty after a failed fixation of an intertrochanteric or subtrochanteric fracture is an effective method. Pain and functional outcomes improve significantly in most patients. However, it is a more technically challenging procedure and causes more complications than primary hip replacement.

Comparison of flexible intramedullary nailing with external fixation in compound tibial shaft fractures

Aim: This study compared the results of flexible intramedullary nailingusing Ender nails (EN) with those of external fixation (EF) in compound tibial shaft fractures. Materials and Methods: Twenty-eight patient with tibial shaft fractures were evaluated in thestudy. The patient ages ranged from12 to 40 years, and the average period of follow-up was 24 months. Fifteen patients underwent flexible intramedullary nailing using Ender nails and thirteen patients underwent external fixation. The outcomes were assessed based on the clinical and radiology findings. Result: Bone union was achieved in all cases, and no patients sustained a complication that was expected to cause disability. For EN union occurred at an average of 12 weeks (10-14 weeks). For EF, union was observed at an average of 16 weeks (14-18 weeks). EN group, one patient suffered proximal pin migration. In the EF group, three patients had a pin site infection and loosening. Conclusion: The EN and EF groups showed similar results at the last follow up. However, in the EF group, refracture, pin site infection, and angular deformity were some of the possible complications during the healing process. EN is recommended for grade I & II tibia fractures, not require secondary operative treatment, stable as it is intramedullary implant.

The effect of canal fill on paediatric femur fractures treated with titanium elastic nails.

PurposeTraditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs).MethodsRetrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD.ResultsA total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%.ConclusionThere was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters.Level of EvidenceIII

Ender Nail versus Dynamic Compression Plating For Humeral Shaft Fractures

Aim: To compare ender nail with dynamic compression plating for humeral shaft fractures in terms of functional outcomes, union and complication rates. Methods: 30 men and 20 women aged >18 years with fresh humeral shaft fractures without neurological deficits underwent either ender nail (n=30) or dynamic compression plating (n=20). Functional outcome of the upper limbs, pain, rates of union, and complications in the 2 groups were compared. Results: Respectively in the nailing and plating groups, mean operating times were 65 and 112 minutes, mean blood loss volumes were 20 and 232 ml, complication rates were 20% and 24%, non-union rates were 13% and 8%, and delayed union rates were 7% and 4%. Conclusion: Both techniques were equally appropriate for treating humeral shaft fractures.

Elastic Stable Intramedullary Nailing of Femoral Shaft Fracture-Experience in 48 Children.

Femoral shaft fractures are an incapacitating pediatric injury accounting for 1.6% of all pediatric bony injuries. Management of these fractures is largely directed by age, fracture pattern, associated injuries, built of the child and socioeconomic status of the family. We retrospectively evaluated the use of elastic stable intramedullary nail (ESIN) in surgical management of femoral shaft fractures in children and its complications. Fifty two children were treated with titanium elastic nails (TEN) from June 2009 to June 2014 at our institution. At the end of the study there were 48 children. Fractures were classified according to Winquest and Hansen's as Grade I (n=32), Grade II (n=10), Grade III (n=6) and compound fractures by Gustilo and Anderson's classification, Grade I (n=5), Grade II (n=3). There were 36 mid-shaft fractures, 7 proximal third shaft fractures, 5 distal third shaft fractures. The final results were clinically evaluated by using Flynn's criteria and radiologically by Anthony et al's criteria. The mean duration of follow-up was 20 months (range 12 - 40 months). All fractures healed radiologically with grade III callus formation at 9 - 12 weeks (mean 9.7 weeks). The results were analyzed using Flynn's criteria and were excellent in 40 children (83%) and satisfactory in 8 children (17%). The soft tissue discomfort near the knee produced by nail ends was the most common problem in our study (25%). Other complications include limb shortening (n=5), Varus malunion (n=4), Nail protruding site infection (n=4) and nail migration (n=2). There was no delayed union, non-union or refractures. TEN is minimally invasive, safe, relatively easy to use and an effective treatment for fracture shaft of femur in properly selected children.Level of evidence: III.

Elastic nailing in diaphyseal fractures of femur in children

Background: Fracture shaft femur in children is conventionally managed by traction followed by hip spica. Prolonged hospitalization, difficulty in maintaining child with traction for 3 weeks, then hip spica makes toileting and personal hygiene difficult. This may cause malunion/limb length discrepancies, rotational deformities, and sometimes psychological problems. Materials and Methods: A total of 32 children in the age group of 4-16years,25 boys and 7 girls having diaphyseal femoral fractures were stabilized with two stainless steel/titanium elastic nail retrograde way under fracture table. The average duration of surgery was 45 min (30–75 min). Patients were assessed clinically and radiologically before and after surgery for 2 years. Early mobilization and weight-bearing allowed. The results were evaluated using the criteria of Flynn et al. Technical problems and complications were also analyzed. Results: Duration of hospitalization was 4 days (3–7 days). The average duration of appearance of bridging callus was 6 weeks. Radiological union in all cases was achieved in a mean time of 8.7 weeks. All children showed sound union at an average 8 weeks without significant complications. Return to school was early with an average 10–12 weeks. Result assessed for range of motion (ROM), irritation at the distal end of the nail, pain, deformity, limb length discrepancies, union, and malunion. Overall results observed were excellent in 24, satisfactory in 5 and poor in 3 patients. The soft-tissue discomfort near the knee produced by the nail ends was the most common problem encountered. Three patients had decreased terminal ROM at the knee. Later, all the 32 patients had full ROM at hip and knee after 3 months. Conclusion: Elastic nailing in pediatrics femoral shaft fracture-simple and effective, small incisions, biological, dynamic fixation, early mobilization, rapid wound healing, rapid functional recovery.

Therapy for Chronic Recurrent Osteomyelitis with Multi-Resistant Pseudomonas aeruginosa Using Local Antibiotic Release by a Polymethylmethacrylate Custom-Made Tibia Nail

Background: The treatment of chronic osteomyelitis by antibiotics administered intravenously is limited by the blood supply that is not present in bone sequestra. Local delivery of antibiotics using acrylic bone cement has been reported with favorable results for treatment of chronic osteomyelitis. Case Presentation: Treatment of a patient with recurrent osteomyelitis after a third- degree open tibia fracture at our hospital failed several times because of recurrent infection with Pseudomonas aeruginosa that later became multi-resistant. Suitable antibiotic treatment was limited to colistin that was mixed with polymethylmethacrylate (PMMA) matrix (Copal® G+C Plus, Heraeus, Hanau, Germany) and used to cover an Ender nail. The PMMA–tibia nail construct was placed intra-medullary for two weeks under appropriate antibiotics applied intravenously. The patient has been pain free for 18 months without any signs of infection and with normal blood tests. Conclusion: We provide evidence that colistin can be applied locally with Copal G+C providing appropriate concentration because of elution over a period of at least two weeks. This technique demonstrates a custom-made solution for patients with multi-resistant osteomyelitis for P. aeruginosa when conventional treatment fails.

Evaluation of fracture shaft femur fixation with ender's nailing in children

Background: Fixation of femoral shaft fractures by flexible intramedullary nailing has been accepted as boon procedure. In the resent past operative procedure had an upper hand over conventional spica cast fixation which was associated with psychosocial, educational and economical disadvantages. The present study is conducted with an aim to observe ender's nailing in children might be advantageous in healing and recovery of the patient. Methodology: The study was conducted at Government General Hospital, Nizamabad during the period from January 2015 to July 2017. Children between the age group of 5-16 years with femoral shaft fractures were includedand all patients underwent ender's nailing fixation for the sustained fracture. Result: The study comprised 13 male patients and 3 female patients aged from 5 to 16 years with mean of 10.65 years. 10 (62.5%) were closed fractures and 6 (37.5%) were open fractures. Closed type of reduction is done in 75% of cases. The average time of union was 10.12 weeks. No delayed or nonunion and malalignment was seen. Conclusion: Flexible intramedullary ender's nail is a boon to children and adolescence which helps in rapid fracture union with minimum complications and early recovery.

Role of locking compression plate (LCP) in periarticular fractures knee

The number of hospitalized patients of peri articular fractures knee joint have been reported to be 32-35% of total trauma patients. The armamentaria of internal fixation devices available for these type of fractures are supracondylar nail dynamic condylar screw, T-butress plates, Dyanamic compression plates, Fixed angle blade plate, Zicker nail, Enders nail, Locking compression plate (LCP). The purpose of this study was to determine whether fixation by LCP is an effective method in the management of periarticular fractures around the knee joint. The average age in the present study was 40.96 years (ranging from 21 to 80 years). 22 cases were male and 3 cases were female. The average time to union was 20.32 weeks (range from 14 to 32 weeks). Based on functional criteria we recorded excellent results in 15 cases (60%), good in eight cases (32%), fair result in two cases (8%) with no poor result Based on anatomical criteria we recorded excellent results in nine cases (36%), good in 16 cases (64%) with no fair and poor result. The chief complications are infection, varus collapse, knee stiffness, articular N and secondary osteoarthrosis

Ender nail fixation of humeral diaphyseal fracture: Indications and outcome – A series of 46 cases

ObjectivesTo evaluate the clinical and functional results of closed fixation of humeral diaphysial fractures using Ender nails. Material and methodsThis was an observational study conducted between January 2008 and September 2014 in which 46 cases of humeral diaphyseal fractures were treated by closed reduction and percutaneous fixation with Enders nails. Clinical follow up evaluation was done and Serial radiographs were taken to look for the time taken for the fracture union and the fracture alignment, positioning and migration of the nails if any. ResultsAverage blood loss during the surgery was 30ml while average radiation exposure time was 1min. Fracture united in mean 12.8 weeks (range 12-28 weeks). Primary union was achieved in 40 cases, whereas 6 had delayed union at 24 weeks for which autogenous bone grafting was done. Proximal migration of nails occurred in 6 cases and 3 cases had superficial stitch infection. Full range of shoulder and elbow movement was achieved in 40 cases within 24 weeks. In rest of the cases, there was limitation of abduction (average 75°, Range 65° to 85°). ConclusionEnder nailing for fracture shaft of humerus is a cost effective, time saving, minimally invasive technique with minimal blood loss. It has many benefits, with good results attainable and comparable with those seen with conservative modalities and other surgical modalities making it a viable option.

Evaluation of Complications from Stainless-Steel Flexible Intramedullary Nailing in Children’s Femoral Shaft Fractures and Recommendations for Continued Use

[b]Background.[/b] Flexible intramedullary nailing is currently considered the treatment of choice for femoral diaphyseal fractures in school-aged children. The purpose of our study was to critically evaluate and analyze the complications of stainless steel flexible intramedullary nailing in children's femoral shaft fractures. (mean age, 8.2 years) with a femoral shaft fracture treated with stainless steel flexible intramedullary nailing from January 1, 2009 to July 31, 2015 and evaluated for complications.[b]Results.[/b] All fractures united in a mean time of 9.2 weeks. Minor complications were noted in 19 patients, and major complications were noted in two patients. The Flynn score was excellent in 74 patients, satisfactory in 23 patients, and poor in three patients.[b]Conclusions.[/b] 1. Stainless steel flexible intramedullary nailing in children's femoral shaft fractures is associated with minimal complications. 2. These complications are not related to the alloy of the implant and are mostly due to the long nail end; these complications can be prevented easily. 3. Stainless steel flexible intramedullary nailing is also cost effective, and we recommend its use be enhanced for the treatment of femoral shaft fractures in children.

Implications of three-dimensional modeling of the proximal femur for cephalomedullary nailing: An Asian cadaver study

PurposeTo determine the variability in the ideal entry point of cephalomedullary (CM) nail around the greater trochanter (GT) and the consequent conformity with the proximal femur by analyzing three-dimensional (3D) modeling and virtual implantation Materials and methodsA total of 105 cadaveric femurs (50 males and 55 females) underwent continuous 1.0mm slice computed tomography (CT) scans. CT images imported into Mimics® software to reconstruct the 3D model of the proximal femur and medullary canal. PFNA-II® was processed into a 3D model using a 3D-sensor at the actual size and optimally implanted in the proximal femur model using Mimics® software. The ideal entry point, nail conformity with the proximal femur, and the relationship between the entry point and adjacent structures were assessed. ResultsThe ideal entry point was located a mean of 2.38mm (SD, 3.53mm) medial to the tip of GT. No lateral cortex impingement of the proximal femur occurred in the coronal plane based on the recommended point. However, a disparity in the sagittal plane between the proximal shaft and nail curvature was found in 47 models (44.8%). Rotation and magnification of the 3D model exposed all nails above the surface of the medial side of the GT. The proximal nail end was contained entirely within bone and circumferential endosteal cortical contact was present at the nail-bone interface.

Surgical outcome of fracture shaft femur in children using flexible intramedullary nailing

5Background and Objective: Femoral shaft fractures account for 1.6% of all paediatric bony injuries. Angulation, malrotation and shortening are not always corrected effectively by conservative methods. Fixation of femur fractures in children & adolescents by flexible intramedullary nailing is becoming widely accepted because of the lower chance of iatrogenic infection and prohibitive cost of in hospital traction and Spica cast care. The objective of our prospective study was to study the various aspects of Managing diaphyseal fractures of femur in children aged between 5-15 years by using Titanium Elastic Nailing System& Ender nailing. Subjective and objective study of clinical parameters like pain, comfort to the patients, early mobilization, operative technique, radiological evaluation for union, stages of weight bearing till complete recovery and any associated complications by using the above mentioned methods. Method: Children and adolescents between the age group of 5-15 years with femoral shaft fractures who were admitted Adichunchanagiri Institute of Medical Sciences meeting the inclusion criteria were selected. All patients underwent titanium elastic nailing & Enders nailing fixation for the femur fracture. Patients were followed up for a period of 6 months at 4,8,12 and 24 weeks after surgery. 50 such cases were studied. Result: The outcome is excellent in 38 (76%) cases, satisfactory in 12 (24%) cases and there were no cases of poor outcome. Conclusion: Flexible intramedullary nail leads to rapid fracture union by preservation of fracture hematoma and limited soft tissue exposure. It also helps in preventing damage to the physis.Our study confers all the advantages which the previous studies have shown at various institutes and is fairly a simple, reliable technique with a shorter learning curve imparting lot of advantages over other intramedullary techniques or other methods followed for management of pediatric diaphyseal femur fractures.

Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fracture

Introduction: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third) managed with closed ante-grade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications.Materials and Methods: A retrospective analysis of 25 patients treated with ante-grade intramedullary titanium elastic nailing was done during the period of August 2014 to June 2016 at our tertiary care centre. Skeletally mature patients with closed and acute fractures of the upper and middle shaft humerus of both sexes were included in the study.Results: Twenty-five (100%) fractures united with an average consolidation time of 14.98 weeks (10-32 weeks), and no fractures ended in non-union. Nail impingement was seen in two (8%), shoulder stiffness in one (4%). Functional results were excellent in 22 (88%), moderate in two (8%) and poor in one (4%). There were 17 males and eight females with an average age of 39.08 years (range: 18-65 years). The average duration of hospital stay was 3.84±2.30 days.Conclusion: Closed ante-grade intramedullary titanium elastic nailing offers a safe and reliable method of fixing fractures of upper humeral shaft in adults. This method provides early fracture union, high union rates and less complications, in addition to early rehabilitation and reduces the hospital stay.

Outcome Analysis of Enders and Other Elastic Nails in Diaphyseal Fractures of Tibia

Outcome Analysis of Enders and Other Elastic Nails in Diaphyseal Fractures of Tibia

3D Computer graphical anatomy study of the femur: a basis for a new nail design.

Current intramedullary nails with a radius of curvature (ROC) of 1500-2000mm sometimes cause distal anterior cortical encroachment. Furthermore, clinical data indicate that the proximal nail end is too long for some Asian patients. The objective of our study was to develop a comprehensive 3D measurement protocol that measures both the anatomy of the canal and the proximal region. The protocol was used to obtain measurements from Caucasian and Asian (Japanese and Thai) specimens. A total of 90 3D bone models representative of hip fracture patients were reconstructed from CT data. RapidForm 2006 was used to generate the reference geometries required for determining radius and angulation of shaft antecurvature as well as measurements of the proximal anatomy. Multiple linear regression analyses were used to determine the relative contribution of height, age, ethnicity, gender, and body side on the total variance. The mean ROC in the natural 3D antecurvature plane was 885mm overall, 974mm in Caucasians and 787mm in Asians. Height, age, ethnicity, gender, and body side significantly predicted ROC (R = 0.53, p = 0.000). The mean values of anteversion measurements for Asians (Japanese: 22.1°; Thai: 22.7°) were significantly larger than those of the Caucasians (14.5°; p = 0.001). There was virtually no difference (p = 0.186) between the measurements pertaining to the length of the proximal nail end between Caucasian and Asian samples. There was no significant difference between the mean neck-to-shaft angles (Caucasian: 126°; Japanese: 128.2°; Thai: 125.7°; p = 0.198 for Asians vs Caucasians). The developed comprehensive anatomical 3D measurement protocol could serve as standardised approach for anthropometric studies in the future. Our data suggest that the ROC of current nail designs should be reduced from between 1500 and 2000 to 1000mm to achieve an improved fit for the investigated population.

Flexible intramedullary nail is still a cost-effective, minimally invasive treatment for stable tibial diaphyseal fracture - A large scale study

Background: Many times, we come across patients who ask for conservative line of treatment either because of lower socioeconomic status or many people are unable to stay in the hospital for various reasons. Being orthopedicians, mere treatment of fracture should not be our only aim. Our aim also should be to treat patient as a whole. In country like India, especially in rural set-up, economy plays a major role. Hence, we conducted a study to evaluate the cost-effectiveness of flexible unreamed nailing, using Ender nails for the most common long bone fracture, i.e., tibia. Materials and Methods: Nearly 590 patients with diaphyseal fractures were fixed with Ender nails from September 2002 to September 2016. The mean age of the patients was 39 years (range 18–65 years). Inclusion criteria were closed fractures and type 1 compound fractures with relative stable configuration. Exclusion criteria were long oblique and spiral fractures; type 2 and type 3 open fractures. Two Ender nails of 4.5 mm each were passed across the fracture site into the distal fragment. The mean follow-up was 16 months. Results: Average time to fracture union was 11 weeks (range 8–14 weeks). Average peri-operative blood loss was 120°. Conclusions: Ender nailing in cases of tibial diaphyseal fractures could achieve reliable fracture stability, better union with least complications. Advantage of low-cost intramedullary device, its easy removal, and less hospital stay makes this even more attractive for the poor patients.