Ender Nails Research Articles

Evaluation of diaphyseal femoral fractures in children treated with tens nailing: A clinical study

Femur fracture is very common fracture in children. Femur shaft fracture around 2% pediatrics age group fracture. Various methods are used to treatment in femur fracture. Like hip Spica, plating, nailing with tens or Enders nailing. Enders and tens are commonly used methods. Purpose of study: The know of outcome of elastic tens nailing in pediatrics shaft fracture. Material and Method: We study’s 24 children’s of fracture shaft of femur between age group 5 to 14. Result: The minimum fellow up to 8 month. The average time taken to full weight bearing and clinical union is 6 week to 8 week. In 3 cases there is superficial infection present in 2nd week of post-surgery. Which is cure by antibiotics and wound washing. No case of nonunion, out of 24 cases 12 cases have limb length discrepancy. 6 cases had lighting 6 cases had shorting. On the Flynn criteria 22 cases have excellent result 2 have satisfactory result. No cases show any unsatisfactory results. Conclusion: Cases which treated by tens elastic nailing achieved primary healing. The advantage of treating patient with enders nail had early weight bearing, reduced hospital stay, less bedridden and early to start to study. Overall tens elastic nailing is have many benefits either then conservation treatment.

A prospective study of functional outcomes and complications of trochanteric femoral nail in intertrochanteric fractures

Background: The incidence of fractures of the peri trochanteric fractures is increasing since the general life expectancy of the population and related osteoporosis has increased significantly during the past few decades. They are second most common fractures related to osteoporosis, by the year 2050, intertrochanteric fractures will be ones taking a major share of them. The mechanism of action of TFN is controlled collapse at the fracture site on weight bearing leading to compression at the fracture. It has been noticed complications such as implant failure, screw back-out, protrusion of implant over the tip of the greater trochanter causing impingement, the z effect involves lateral migration of inferior head screw and medial migration of superior head screw and opposite is reverse z effect. We have hereby conducted the study to evaluate the functional outcomes and complications of trochanteric femoral nail in intertrochanteric femur fractures based on clinical and radiological findings. Materials and Methods: A prospective, single blinded, randomized control trial with 43 cases, out of which 24 were males and 19 were females was conducted. The postoperative evaluation was done both clinically and radiologically. Out of the 43 cases, follow up at outpatient level at regular intervals at 6wks, 3months, and 6months for serial clinical and radiological evaluation was done. At each follow up, patients were evaluated clinically using the Modified Harris Hip Score and radiologically with appropriate X-rays. The intraoperative blood loss, duration of surgery, intra operative complications, post-operative complication, duration of hospital stay were studied.Results: Results were evaluated by modified Harris hip score in our series we had 30.2% excellent, 48.8% good, 16.3 % fair and 4.7% poor results. The nail protrusion height was >5 in 74.4% of the patient.Conclusion: Trochanteric femoral nail can be considered the most judicious and rational method of treating intertrochanteric fractures, but it we recommend a modification to the Trochanteric femoral nail that would further shorten the proximal nail end 5–10 mm for the Indian population, so as to avoid soft tissue irritation on lateral trochanter.

Peri-implant fractures proximal to a long retrograde femoral nail – A case series

Low energy peri-trochanteric fractures may happen in the presence of a retrograde nail in the femur. The management of these peri-implant fractures are very rarely reported. This is a series of seven cases from a level one trauma centre in Hong Kong. All fractures arose from low energy falls and were either inter-trochanteric or subtrochanteric. Removal of previous implants to allow cephalo-medullary fixation of the new fracture could be considered, but this is often difficult, time-consuming, and may inflict damage to the articular cartilage. Furthermore, this is not an option if the distal fracture is not yet well healed. Six of the seven fractures presented here were treated operatively with an extra-medullary device fixed to the proximal shaft with cerclage cables. The choice of fixation implants were based on the fracture type and available space above the proximal end of the retrograde nail. All seven fractures healed with no implant failure and major complications. There were no thirty-day and one-year mortality. A treatment algorithm is proposed for the management of these uncommon but difficult cases.

Ender's nailing of displaced tibia shaft fractures in children - A nine-year experience.

Displaced fractures of the tibial shaft in children can be effectively treated with minimal complications with flexible nails. Our aim is to evaluate the outcome of displaced paediatric tibia shaft fractures treated with Ender's nails. We retrospectively reviewed the records of all unstable tibial fractures treated between 2010 and 2018, in our institution. Only children with a minimum of six months follow-up and complete clinical data were considered for the study. Of the 72 patients who fulfilled the inclusion-exclusion criteria, 8 were lost for follow-up and hence we had 64 patients included for the study. There were 54 boys and 10 girls, with an average age of 10.9 years(4 to 17 years). The average follow-up was 16.9 months (6 to 47 months). There were nine open fractures. Two nails were used in 52(81.25%) patients while a single nail was used in 6(9.37%) patients and three nails were used in 6(9.37%) patients. The union rate was 100% with an average union time of 10.6 weeks. There were 17 (26.5%) patients with delayed union but none required intervention. One (1.56%) child had a malunion >10° (recurvatum of 11.9° and varus of 8.1°). Radiographs at the final review demonstrated >5° of coronal plane malalignment in eight patients (12.5%) and >5° sagittal plane malalignment (recurvatum) in six patients (9.37%). There was an associated fibular fracture in 50 children and there was no significant association between the presence of fibular fracture and malalignment (p>0.05). All children who presented for implant removal had full range of movement at the knee and ankle joint and no limb length discrepancy. We report the largest series of paediatric tibial shaft fractures treated with Ender's nails. Ender's nail is a simple and cost-effective option for treating these fractures with excellent union rates and minimal complications.

MANAGEMENT OF ANEURYSMAL BONE CYST WITH BONE GRAFT AND TRICALCIUM PHOSPHATE WITH 6 YEARS OF FOLLOW UP: A CASE REPORT

Aneurysmal Bone Cyst (ABC) is a Benign tumor, Also known as Giant Cell Repetative Granuloma, They are locally destructive hemorrhagic benign cystic legion. According to the definition of the WHO Aneurismal Bone Cyst is expanding osteolytic lesion consisting of blood-filled spaces of variable size and that are separated by connective tissue septae containing trabecula of bone or osteoid tissue and osteoclast giant cells. We report a case of a giant aneurysmal bone cyst in the Middle one-third of Right humerus of a 16 -year-old boy, which was treated with Allograft, Autograft and ender's nail fixation. At 6 Years of follow up Patient regain a pain-free complete Range of motion with radiographically subside of legion.

Clinical and radiographic outcomes following retrograde SIGN fin nailing for femoral shaft fractures.

Purpose:The Surgical Implant Generation Network (SIGN) intramedullary nail was designed for use in resource limited settings which often lack fluoroscopy, specialized fracture tables, and power reaming. A newer design iteration, the SIGN Fin nail, was developed to further simplify retrograde femoral nailing by making proximal interlocking screw placement unnecessary. Instead, the leading end of the Fin nail achieves stability through an interference fit within the proximal femoral canal. While the performance of the traditional SIGN nail has been reported previously, no large series has examined long-term clinical and radiographic outcomes of femoral shaft fractures treated with the SIGN Fin nail.Methods:The SIGN online surgical database was used to identify all adult femoral shaft fractures treated with the SIGN Fin nail since its introduction. All patients with minimum 6 month clinical and radiographic follow-up were included in the analysis. Available demographic, injury, and surgical characteristics were recorded. Fracture alignment was evaluated on final follow-up radiographs using a previously validated on-screen protractor tool. Coronal and sagittal plane alignment measurements were recorded as deviation from anatomic alignment (DFAA), with units in degrees. Fracture healing was assessed on final follow-up radiographs, with union defined as any bridging callus and/or cortical remodeling across one cortex on orthogonal views. Clinical outcomes available in the database included knee range of motion (ROM) greater than 90° and weight-bearing status at final follow-up. Clinical and radiographic outcomes were then compared between patients with united and nonunited fractures.Results:The database query identified 249 femoral shaft fractures stabilized with the Fin nail in 242 patients who had minimum 6 month clinical and radiographic follow-up. Final follow-up radiographs were performed at an average of 48 weeks postoperatively. Average coronal and sagittal plane alignment measured on final follow-up radiographs were 2.18° and 2.58°, respectively. The rate of malalignment (DFAA > 10° in either plane) at final follow-up was 6%. Two hundred twenty-nine fractures (92%) were united at final follow-up. Overall, 209 (84%) of patients achieved full weight bearing and 214 (86%) achieved knee ROM >90° at final follow-up. Compared to patients with united fractures, those with nonunion were less likely to achieve full weight bearing (20% vs 90%, P < .001) and knee ROM >90° (30% vs 91%, P < .001). There was no significant difference in mean DFAA between united and nonunited fractures in the coronal (2.1° vs 3.8°, P = .298) or sagittal (2.5° vs 3.5°, P = .528) planes.Conclusion:The SIGN Fin nail achieves satisfactory radiographic alignment and clinical outcomes at minimum 6 month follow-up. The overall union rate is comparable to that achieved with the standard SIGN nail. Ease of implantation makes the Fin nail an attractive option in resource-limited settings.

Clinical and functional outcome of elastic stable intramedullary nailing in pediatric femoral fractures in the age group of 5-16 years

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of the femur are the most incapacitating fractures. The best treatment for children between five to sixteen years of age is still debated. The ESIN has the benefits of early immediate stability to the involved bone segment, permitting early mobilization and return to the normal activities of the patients, respect for the physes, minimal scarring with lower complications. The purpose of this study was to present this study results following fixation of femoral shaft fractures with titanium elastic nails between the age 5-16 years of age.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total 52 patients in the age group of 5-16 years with femoral shaft fractures were stabilized using flexible nailing. Clinical and radiological follow-up was for a minimum period of 24 months. The final results were analysed using Flynn’s criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mean age at surgery was 7.4 years (range 5.6-14.3 years). The average duration of surgery was 65.3 (45-95) minutes and the mean duration of hospital stay was 8 (5-14) days. Skin irritation due to nail ends was the most common complication followed by significant lengthening (n=6), infection (n=2), significant shortening (n=2), varus angulation (n=2) and delayed union (n=2). The final outcome was excellent in 65.4% cases, satisfactory in 30.8% cases and three patients had poor outcomes as per Flynn's scoring criteria.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In this study, ESIN showed good clinical and radiographic results in the age group 5 to 16 years, with minimal complications and high parent satisfaction consistent with previous studies but lesser number of mid adolescent age groups in the present study is a limitation.&lt;/p&gt;

Effects of ethnicity on proximal femoral intramedullary nail protrusion-a 3D computer graphical analysis.

Antegrade nailing of proximal femur or femoral shaft fractures is a proven treatment with good to excellent results. Nonetheless, clinical evidence from Asia indicates that proximal femur nails can be too proud at the greater trochanter (GT) causing irritation for some Asian patients. This study aimed to identify any significant differences in proximal nail misfit for a set of Asian and Caucasian femora. Two nails (Gamma3, TFNA) were virtually inserted into 63 femoral 3D models (28 Japanese, 4 Thai, 31 Caucasian). In AP, the entry point was 4° lateral for Gamma3 and 5° for TFNA; laterally the same location was used for both. Insertion depth was controlled by aligning the lag screw centre head. The distance of the nail end from the GT was measured at five (medial, lateral, anterior, posterior and centre) reference points (RPs). The correlation between GT height, CCD angle and proximal nail distance to GT was analysed. There was no significant difference between either nail (p = 1.0). The TFNA was overall less prominent than the Gamma3, and significantly less prominent at all RPs except lateral. The Asian femora were 3.76 (p = 0.016) times more likely to have the nail protruding proximally. The Asian subjects were shorter (p < 0.05) than the Caucasians. Their GT height was slightly shorter and CCD angles larger compared to Caucasian (Asian: 41.1mm, 128.1°, Caucasian: 42.2mm, 126.4°), but the differences were not significant (p = 0.36). Stature, GT height and CCD angle significantly correlated with nail distance to GT. This study illustrated a significantly increased incidence of proximal nail protrusion in Asian compared to Caucasian femora, corroborating clinical findings. The combination of shorter stature and GT height and a larger CCD angle in Asians likely contributes to this difference.

A Study on the outcome of surgical management of Unstable Intertrochanteric Fractures in the geriatric population by various modalities

Background: Unstable hip fractures in elderly patients a unique challenge for orthopedic surgeons. Most of the cases are to be managed by surgical intervention. The problems of old age include the presence of osteoporosis, pre-existing arthritis, the overall health of the patient. We in the present study tried to evaluate the functional outcome of surgical management of unstable intertrochanteric fractures by various methods and study the effectiveness and complications of the operative management of unstable fractures. Methods: This cross-sectional study was carried out in the Department of Orthopedics, Prathima Institute of Medical Sciences, Nagunur, Karimnagar. All patients with unstable intertrochanteric fractures with age &gt; 65 years who are treated by the surgical intervention were included in the study. All the patients were operated in Spinal anesthesia and The standard surgical procedures were followed for different modalities like DHS, PFN, Enders Nail’s and cemented bipolar hemiarthroplasty was done. Results: Out of n=50 patients n=28(56%) were female and n=22(44%) were males. The average duration of hospital stay was 14 days, with a range of 10-25 days. The mean blood loss in cemented bipolar hemiarthroplasty was 300 ml, PFN 100 ml, DHS was 250ml, and Ender’s Nail was 50ml. In our study of Bipolar hemiarthroplasty out of n=9 patients n=3 (33.34%) had excellent, n=5(55.56%) good outcome, n=1(11.12%) had fair outcomes respectively. Out of n=9 patients of PFN n=4 (44.44 %) of excellent, good n=4(44.44%), fair n=1 (11.12%) patient and no poor results. Out of n=25 patients of DHS n=20 (80%) patients are excellent to good results, n=3(12%) patient had fair and n=2 (8%) patients had poor results. Out of 7 patients of Ender’s nails n=2(28.573) had excellent and n=3(42.85%) had good and n=1(14.28%) fair, n=1(14.28) had poor results. Conclusion: Intertrochanteric Fractures in the geriatric population are a unique challenge it requires early operative management which will reduce both mortality and morbidity. Early mobilization following operative treatment will reduce the risks associated with prolonged bed rest in geriatric patients. Since failure rate is still high in unstable intertrochanteric fractures selection of proper implants is important for the ultimate success of the treatment.

COMPARATIVE STUDY OF RESULTS OF FRACTURE DISTAL THIRD FEMUR TREATED WITH VARIOUS OPERATIVE MODALITIES

Distal femoral fractures are difficult to treat and ideal treatment of such fractures will include anatomical reduction, rigid fixation of articular surfaces and early mobilization of knee joint. The purpose of the study is to evaluate the end results of surgical management of fracture of distal end of femur using various surgical modalities and analyze the complications and the causes of fractures.&#x0D; Materials and methods: A Retrospective Study of 75 patients were evaluated from tertiary hospital for a period of july 2007 to July 2009. There were 75 fractures in 75 patients involving the distal femur, which were treated surgically by internal fixation using various surgical modalities.&#x0D; Results: At the end of study, the cases were followed up for an average period of 15.6 months and functional results were evaluated using modified Schatzker and Lambert (1982) criteria. 36 cases were fixed with Supra Condylar nail ( SC nail), 20 cases were fixed with dynamic Condylar screw(DCS), 6 cases were fixed with Dynamic Compression Plate(DCP), 6 cases were fixed with Cancellous Screw, 4 cases were fixed with Enders Nail, 3 cases were fixed with Ext. Fixator&#x0D; Conclusion; Fractures of distal femur can be very effectively treated by surgical methods. The satisfactory osteosynthesis of fractures and stable osteosynthesis is achieved by the right approach and correct surgical technique.&#x0D; Keywords: distal femur fracture, internal fixation, dynamic condylar screws, supracondylar femur nail

Clinical outcome of treatment of fractures of lower third shaft humerus by Enders nails in adult age group

Clinical outcome of treatment of fractures of lower third shaft humerus by Enders nails in adult age group

A study of an operative outcome of a basitrochanteric fractures of the hip treated by dynamic hip screw and enders nail with percutaneous canulated cancellous screw

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Basicervical or cervicotrochanteric fracture of the femur is considered stable variety of fracture pattern. Most common incidence is seen in elderly patient and in young patient with probably high energy trauma. Appropriate Osteosynthesis confers excellent outcome when reduction is optimally achieved.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 86 basitrochanteric fractures had been treated with enders nail or dynamic hip screw (DHS) at our institute by a single surgeon. Implant selection was done purely based on plain radiograph, associated co-morbidities and fracture geometry. Patients had been followed up at 1 month, 3 month and 6 month.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study there were 86 patients out of which 63 patients (73.25%) were treated with enders nail and 23 patients (26.74%) were treated with DHS. Mean age of patients was 57 years. We noted minimum follow up of 8 months while maximum follow up of 4.5 years where as mean follow up duration is 18 months. We almost noted excellent to fair results in both groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Most of the implants in basitrochanteric fractures worked on control collapse principle. Both DHS and enders nail with percutaneous cc screw follow this principle and when used with a proper technique, optimal reduction usually fetch the favourable outcomes with minimalistic approach.&lt;/p&gt;

Clinical outcomes of PFNA-II in the Asian intertrochanteric fracture patients: Comparison of clinical results according to proximal nail protrusion

PurposeThis study intended to explore the clinical outcomes of PFNA-II, one of the commonly used fixation devices for intertrochanteric fractures and the association of clinical results with the extent of proximal nail protrusion. Materials and MethodsOf 315 cases that underwent internal fixation using PFNA-II between September 2010 and June 2018 among intertrochanteric fracture patients aged over 65 years, a total of 86 patients with an ability to communicate clearly and a minimum follow-up of 6 months were retrospectively reviewed. We classified the subjects according to PFNA-II protrusion over the greater trochanter area on anteroposterior radiographs. Differences between the two groups were examined by comparing demographic characteristics including gender, age, height, weight and BMI, instrumental characteristics including PFNA nail size, nail diameter, blade length and blade position, radiologic characteristics including reduction quality, Dorr type and bone union, and clinical characteristics including GT pain,VAS score and Harris Hip Score (HHS). ResultsA total of 86 cases were divided into 30 (34.9%) in the protrusion group (group A) and 56 (65.1%) in the non-protrusion group (group B). No significant difference was found in demographic characteristics such as gender, age, height, weight and BMI between the two groups. Two groups had no statistically significant difference in PFNA nail length, nail diameter and blade length, but showed a statistically significant difference in blade position.At the latest follow-up, the mean HHS shows no statistically significant difference between the two groups. On the contrary, the number of patients complaining of GT pain and VAS score were statistically significantly higher in group A. Removal of metal implants was performed in two patients in the protrusion group due to a complaint of persistent GT pain. ConclusionNail protrusion over the greater trochanter area occurs frequently after the surgical treatment of intertrochanteric fracture using PFNA-II. When the nail protruded into the greater trochanter, the number of patients who clinically complained of pain was statistically significantly high. We recommend a modification to the PFNA-II that would further shorten the proximal nail end suitable for the Asian population to achieve better clinical results in the fixation of intertrochanteric fractures.

A clinical study of treatment of paediatric femoral shaft fractures with elastic intramedullary nail

Background: The fractures of paediatric femoral shaft is a common major fracture treated by Orthopaedic surgeon. The treatment of femoral shaft fractures in children is a subject of controversy. It is conventionally managed by traction and hip spica casting. Although the majority heals without long term sequelae but the closed intramedullary operative procedure allows early weight bearing and early rehabilitation. It has the advantage of haematoma preservation and restoration of continuity of bone.Methods: Twenty one children of aged 6-14 years with femoral shaft fractures were treated with elastic intramedullary nails. Seventeen fractures were in middle third, two in proximal third and two in distal third. Fourteen fractures were transverse, three oblique, two were spiral and two were comminuted. Average injury surgery interval was 5 days. All fractures were treated by closed reduction and elastic intramedullary nails. The patients were assessed clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al.Results: Results were assessed for range of motion (ROM), irritation at the distal end of nail, deformity, limb length discrepancies and union. Radiologically union was achieved in a mean time of 9 weeks (6-12 weeks). The most common problem encountered was soft tissue discomfort near knee joint. Excellent results were achieved in 14 patients (67%), successful results in 5 patients (23%) and poor results in 2 patients (10%).Conclusion: It is concluded that paediatrics femoral shaft fractures treated by elastic intramedullary nail gives satisfactory results with minimal complications.

To study the results of humeral Enders nail in diaphysial fracture of humerus

Introduction: It is generally admitted that most humeral shaft fractures can be managed successfully by non-operative methods. Whenever operative treatment is required, a choice has to be made between plate osteosynthesis and intramedullary nailing. Fixation with plates requires extensive dissection and is complicated by the proximity of the radial nerve and the risk of mechanical failure in osteopenia bones. Biomechanically intramedullary nail is a better implant. They are subjected to smaller bending loads and are less likely to fail by fatigue, they act as load sharing devices, stress shielding with resultant cortical osteopenia is minimum, refracture after implant removal is rare and they do not require extensive exposure Methods: We have done a prospective study of 30 patients with Fracture shaft Humerus stabilized with intramedullary nail of Enders type by antegrade approach. These nails were available in 3 & 3.5 mm diameter and in lengths ranging from 18-28 Cms. The nail by design had proximal band of 6 degrees (apex medial band) to accommodate offset of the infusion portal with the medullary canal. Results: Study shows more incidences of Humerus fractures in young patients as it is active age group in the society, more prone to vehicle accidents and falls. Most of the fracture of shaft humerus unites in 10-14 weeks and in minor cases more than 18 weeks were observed for union. Most common complication associated with operative method of fracture shaft humerus is non union. Joint involvement in form of shoulder or elbow stiffness can occur in small number of cases. There are no cases of infection noted in our study Interpretation and Conclusion: Internal fixation by close intramedullary nail for fractures involving middle two third shaft of humerus is a good technique if facilities are provided for image internsifier machine in operation theater. In comparision to other operative techniques close intramedullary nailing is less invasive with minimal blood loss and hardly any chance of infection. This technique gives rotational as well as torsional stability to fractured bone humerus, allowing faster practice of physiotherapy to achieve full range of motion and power.

End cap missing the proximal end of the tibial interlocking nail to migrate posteriorly into the medullary canal: A complication that may be avoided

An End cap for an Intra- medullary nail is normally used to prevent bone overgrowth into the proximal end of the nail and to facilitate nail removal at a later date. End cap migration into the proximal redundant space in the medullary canal behind the nail is rare but an avoidable complication. Maintenance of a fixed position of knee flexion during reaming and nail insertion and the use of Cannulated End Cap systems with Image control and may reduce the incidence of this complication. For the retrieval of the end cap from the canal a haemostatic forceps may be used.

Multiple Comparisons of the Efficacy and Safety for Seven Treatments in Tibia Shaft Fracture Patients.

Background: A tibia shaft fracture is one of the most common long bone fractures, with two general types, open fracture and close fracture. However, there is no universally accepted guideline suggesting which treatment to use under certain circumstances. Therefore, a comprehensive network meta-analysis (NMA) is needed to summarize existing studies and to provide more credible data-based medical guidelines.Methods: Available literature was identified by searching medical databases with relevant key terms. Studies that met the inclusion and exclusion criteria, baseline, intervention, and the outcome of treatments, were extracted. A comparative connection of these studies was demonstrated through net plots. Continuous variables and binary variables were reported as mean difference (MD) and odds ratio (OR) with a 95% credible interval (CrI), respectively. The comparison of direct and indirect outcome and their P-value were listed in the node-splitting table. Treatments for each endpoint were ranked by their surface under the cumulative ranking curve (SUCRA) value. A heat plot was created to illustrate the contribution of raw data and the inconsistency between direct and indirect comparisons.Results: According to the search strategy, 697 publications were identified, and 25 records were included, involving 3,032 patients with tibia shaft fractures. Seven common surgical or non-surgical treatments, including reamed intramedullary nailing (RIN), un-reamed intramedullary nailing (UIN), minimally reamed intramedullary nailing (MIN), ender nailing (EN), external fixation (EF), plate, and cast, were compared, in terms of time to union, reoperation, non-union, malunion, infection and implant failure. Plate performed relatively better for time to union, while cast might be the best choice in close cases to reduce the risks of reoperation, non-union, malunion, and infection. To prevent implant failure, EN seemed to be better.Conclusion: Cast might have the highest probability of the most optimal choice for tibia shaft fracture in close cases, while reamed intramedullary nailing ranked second.

A study on complications of expert tibial intramedullary nailing of tibial fractures

The mechanical behaviour of IM nails depends on both material and geometry of the design. Intramedullary nails, such as Lottes and Ender nails, used without reaming, have been employed successfully in the treatment of open tibial fractures and have been associated with low rates of post-operative infection. They are, however, contraindicated for comminuted fractures, as there tends to be shortening or displacement of such fractures around these small nails. Twenty five patients with proximal 1/3rd and distal 1/3rd tibia fractures were selected for the study. In total number of 25 patients admitted, there were 17 males (68%) and 8 females (32%). There were 20 closed fractures (80%) and 5 open fracture (20%) (GA type I-3, GA type II-2). The average range of motion in the knee joint was 135.6 degree, full ankle motion was observed in 20 patients. One patient showed a loss of >250 of motion at ankle compared to the normal side while 4 patients showed < 250 of loss of joint motion. One case (4%) of deep infection and implant failure was noted in the present study. Two patients (8%) showed a superficial soft tissue infection. One case (4%) of malunion was found with an anteroposterior angulation of 10 degrees, one case (4%) with a distal 3rd showed a shortening of < 1cm.No cases of significant rotational deformities and varus or valgus angulation deformities was noted.

Ender’s nailing in intertrochanteric femur fracture

Intramedullary ender nailing in intertrochanteric fractures was very popular in the past. Although it has advantages like short operative procedure, minimally traumatic, little blood loss, early mobilization, negligible risk of infection and risk of delayed union or non-union is also reduced. However other complications such as irritation at the knee, decreased range of knee motion, distal and proximal migration of nail are still present in some cases. The osteoporosis is considered as a significant factor contributing to complications. External rotation deformity has not been a major problem in the present study and improved by using nails with ante version bend. All intertrochanteric fractures healed within 3 months which represent favorable results in comparison with other method.

Treatment of lower limb shaft fractures with Ender nails: A report of three cases

Treatment of lower limb shaft fractures with Ender nails: A report of three cases