Intramedullary Interlocking Nail Research Articles

Comparative Efficacy of Interlocking Intramedullary Nails and Percutaneous Plate Implantation in the Treatment of Femoral Shaft Fractures: A Meta-Analysis.

Interlocking intramedullary nailing and percutaneous plate implantation are commonly used techniques in the treatment of femoral shaft fractures. This study aimed to determine the most appropriate and effective treatment strategy between interlocking intramedullary nails and percutaneous plate implantation by analyzing and summarizing the available evidence. Relevant articles published from the date of database construction in PubMed, Embase, Web of Science, and Cochrane to 2024 were searched and downloaded according to PRISMA 2020. These studies were screened following pre-established inclusion criteria, and the data were extracted. Methodological quality assessment for retrospective studies was performed using the Newcastle-Ottawa Scale, whereas Review Manager Software was used for methodological quality assessment of randomized controlled trials (RCTs) and statistical analysis. Only 13 studies containing 1061 patients were included in the meta-analysis. Femoral shaft fractures treated with interlocking intramedullary nailing had shorter operative and fluoroscopic time and less estimated blood loss. Pediatric patients treated with interlocking intramedullary nails had less estimated blood loss and shorter healing time. Interlocking intramedullary nailing group in the retrospective study was associated with shorter operative time and less blood loss, whereas, in the randomized controlled trial (RCT) study, it was associated with less blood loss and shorter healing time. Interlocking intramedullary nailing is more advantageous in treating femoral shaft fractures and is a more appropriate option for treating femoral shaft fractures in pediatric patients. PROSPERO: CRD42024564563.

Lateral cortical notching for impaired healing of extra-articular proximal femur fractures (case report)

Introduction Dynamization of the nail can be used to improve osteoreparation during intramedullary interlocking nailing (IIN). The procedure can be difficult to perform in some sub- and intertrochanteric femoral fractures due to anatomical and functional features.The objective was to demonstrate a case of successful use of an original version of the lateral cortical notching (LCN) technique for dynamization of an intramedullary proximal nail in a patient with a nonunited subtrochanteric fracture.Material and methods The treatment was performed for a 66-year-old patient with a non-united intertrochanteric fracture of the right femur complicated by the breakage of an intramedullary nail. The LCN technique was successfully used to dynamize the IM nail.Results Radiological healing of the fracture and functional recovery of the patient were observed at a two-month follow-up. The absence of interfragmental compression in IIN could be caused by blocking of the sliding screw by the lateral cortical bone of the peripheral femur fragment. The complication could be prevented with LCN during primary osteosynthesis of the above fractures.Discussion Based on scientific publications and our clinical experience, we assumed that LCN can be indicated for failed healing of intertrochanteric AO/OTA 31A3.1–3 fractures, type 3 Boyd and Griffin trochanteric fractures and all types of subtrochanteric fractures as graded by Seinsheimer with a vector of interfragmental compression to be created along the femur axis during cephalomedullary osteosynthesis. The case report showed the mechanism of impaired consolidation in some intertrochanteric and subtrochanteric fractures of the femur.Conclusion The case report demonstrateed the successful use of the original version of the lateral cortical notching (LCN) technique for dynamization of an intramedullary proximal nail.

Effect of magnesium supplementation on diaphyseal tibia fractures: a pilot study

Background: This study aimed to assess and compare the efficacy of magnesium supplementation in patients with long diaphyseal tibia fractures who have undergone surgical management with intramedullary interlocking nailing. Methods: In a prospective, randomized trial, thirty patients were included, with half receiving magnesium (420 mg/day) along with calcium (500 mg/day) supplementation for 3 months alongside surgical treatment. Radiological outcomes were evaluated through postoperative X-rays using the radiographic union scale for tibia fractures (RUST) scoring system at 6 and 12 weeks. Results: A significant difference was observed between the two groups. Patients receiving magnesium supplementation exhibited a notable improvement in RUST score, indicating an accelerated bone healing process. Conclusions: This study demonstrates the efficacy of magnesium supplementation in achieving superior radiologic outcomes compared to patients who did not receive such supplementation. The findings suggest that adjuvant magnesium supplementation could be a viable therapeutic option to enhance bone healing outcomes in individuals with tibia diaphyseal fractures.

Fast and accurate distal locking of interlocked intramedullary nails using computer-vision and a 3D printed device

IntroductionDistal locking is a challenging and time-consuming step in interlocked intramedullary nailing of long bone fractures. Current methods have limitations in terms of simplicity, universality, accuracy, speed, and safety. We propose a novel device and software for distal locking using computer vision.Methods and materialsThe device consists of an universal ancillary clamp, a telescopic arm, a viewfinder clamp, and a radio-opaque cross. The software uses a camera photo from the C-arm intensifier and adjusts for geometric projection deformities. The software employs edge detection, Hough transform, perspective interpolation, and vector calculation algorithms to locate the distal hole center. The device and software were designed, manufactured, and tested using 3D CAD, FEM, DRR, and performance testing on phantom bones.ResultsThe device and software showed high accuracy and precision of 98.7% and 99.2% respectively in locating the distal hole center and calculating the correctional vector. The device and software also showed high success ratio in drilling the hole and inserting the screw. The device and software reduced the radiation exposure for the surgeon and the patient. The success ratio of the device and software was validated by the physical testing, which simulated the real clinical scenario of distal locking. The radiation exposure was as low as 5 s with a radiation dose of 0.2mSv, drastically reducing radiation exposure during distal locking.DiscussionOur device and software have several advantages over other distal locking methods, such as simplicity, universality, accuracy, speed, and safety. Our device and software also have some disadvantages, such as reliability and legislation. Our device and software can be compared with other distal locking methods based on these criteria. Our device and software have some limitations and challenges that need to be addressed in the future, such as clinical validation, and regulatory approval.ConclusionThe device showed promising results in terms of low-cost, reusability, low radiation exposure, high accuracy, fast distal locking, high stiffness, and adaptability. The device has several advantages over other distal locking techniques, such as free-hand technique, mechanical aiming devices, electromagnetic navigation systems, and computer-assisted systems. We believe that our device and software have the potential to revolutionize the distal locking technique and to improve the outcomes and quality of life of the patients with long bone fractures.

SHORT TERM FUNCTIONAL OUTCOME OF CLOSED REDUCTION AND FIXATION OF TIBIA SHAFT FRACTURES USING UNREAMED ENDERS NAIL IN ADULT POPULATION - A PROSPECTIVE STUDY

Most of the tibial shaft fractures are the result of high energy trauma. There are various non surgical and surgical methods for managing tibial shaft fractures ranging from conservative casting, tubular external fixator, ring external fixator, open reduction and plating, reamed intramedullary interlocking nailing and unreamed intramedullary nailing. Aim of the study was to evaluate the functional outcomes of closed reduction with unreamed enders nailing as a definitive treatment option for closed tibial shaft fractures in adult population. In the study we included 150 adult patients who had sustained closed tibial fractures and underwent closed reduction and fixation with unreamed enders nailing within 12 hours of the injury. Eye of the nail, present at the distal end of the nails was locked. Total surgical time was averaged to 27.6 minutes. Evaluation was done by the time of clinical union, time of radiological union and VAS score. Ten patients had a delayed union. Two patients developed infection which was managed with oral antibiotics. In the conclusion, we found out that unreamed enders nailing procedure preserves the periosteum and its blood supply due to minimal exposure and improves the healing of fracture and decreases the incidence of infection. This method reduces the operative time, has a relatively less learning curve, reduces fluoroscopic exposure, reduces blood loss, reduces infection rate, doesnt expose the joint thus maintaining its congruity, reduces the cost of implant, reduces patient hospital stay, reduces the antibiotic usage and the implant removal at a later stage can be done as a day care procedure.

A Dilemma in the Management of Distal Tibia Fractures Solved by Minimally Invasive Percutaneous Plate Osteosynthesis Technique: A Prospective Study.

Introduction Managing distal tibia fractures is challenging for trauma surgeons because of their peculiar anatomy with less soft tissue coverage and poor blood supply. There are various treatment options for distal tibia fractures such as open reduction and plating, minimally invasive percutaneous plate osteosynthesis, and intramedullary interlocking nailing. Open reduction and internal fixation can lead to excessive soft tissue dissection and devascularization of fracture fragments. We conducted a study on the functional outcome of distal tibia fractures treated by biological fixation with minimally invasive percutaneous plate osteosynthesis. Methods A total of 23 patients with distal one-third tibia fractures, fulfilling the inclusion criteria, who were treated at St. John's Medical College Hospital with minimally invasive percutaneous plate osteosynthesis between November 2020 and November 2022 were studied using the American Orthopaedic Foot & Ankle Society (AOFAS) score at six weeks, three months, and six months postoperative follow-up. Results This study included 17 males and six females. The mean age of the study participants was 43.78 years, with most of the participants being in the age group between 51 and 60 years (29.2%, n = 7). All the study participants were employed. The mean operative time was two hours and 10 minutes. The mean duration for the radiological union was 22 weeks. The mean AOFAS score at six months was 92.43 + 5.696. There was only one case of superficial infection, which was treated with intravenous antibiotics. There were no cases of malunion/nonunion. Conclusion Minimally invasive percutaneous plate osteosynthesis is an effective treatment for distal tibia fractures avoiding most of the complications such as wound dehiscence and malunion/nonunion involved in conventional open reduction and internal fixation with plating. Therefore, we recommend this technique for all distal tibia fractures.

BACTERIAL CULTURES AND OUTCOME OF INTRAMEDULLARY INTERLOCKING NAIL IN OPEN DIAPHYSEAL FRACTURES OF TIBIAL

Background: The tibial shaft is one of the most common open long bone fractures; treatment improperly can lead to many serious complications and frequently cause permanent sequelae. Infection is one of the most common and disastrous complications of an open fracture. Therefore, determining the role of qualitative bacterial cultures in implementing the most effective antibiotics for opening tibial fractures and managing promptly and with precision is extremely important to avoid these complications and restore the patient's rehabilitation. Due to the paucity of articles exclusively dealing with this topic, we conducted a study to determine bacterial cultures and the functional outcome of intramedullary interlocking nailing in these patients. Objectives: This study assessed Bacterial cultures and the outcome of intramedullary interlocking nails in open diaphyseal fractures of the tibial. Materials and Method: A cross-sectional descriptive study was conducted on 32 patients with open diaphyseal fractures of tibial who were initially treated with thorough wound debridement and lavage, followed by surgical treatment with intramedullary interlocking nails. The qualitative method of antibiotic disc diffusion in agar (Kirby Bauer) is often applied to determine the susceptibility of bacteria to different antibiotics. All 32 patients were followed up, which was conducted using clinical criteria, and a radiographic was assessed using the RUST score. Results: In our study, the injury surgery interval was 14.54±6.304 hours. Staphylococcus aureus and Staphylococcus epiderdimis were common bacteria in open tibial fractures. The mean union time was 15.43±3.726 weeks, which was assessed by RUST score and clinical criteria. The functional outcome with Ketenjian and Shelton Criteria was excellent results in 28 (87.5%) cases and good outcomes in 4 (12.5%) cases. Conclusion: Using the intramedullary interlocking nail in open diaphyseal fractures of the tibial is an excellent procedure that leads to good results with reduced hospital stay, good range of motion, and low infection rate, leading to better union.

Functional Outcome of Solid Interlocking Nail in Open Tibial Fracture at a Tertiary Care Center: A Descriptive Cross-sectional Study.

There is a high incidence of open fractures accounting 23% of all tibial fractures. The minimal soft tissue and precarious blood supply of the shaft of tibia make these fractures vulnerable to complications. The treatment should be decided through thoughtful analysis for personality of injuries and the status of the soft tissue. Intramedullary nailing allows stable fixation with minimal soft tissues dissection and preserve the soft tissue and allows early joint motion with higher rate of union. The purpose of our study was to find the outcome of open tibial fractures lower than Gustilo type IIIb, that were treated by unreamed solid interlocking intramedullary nails. A descriptive cross-ectional study was conducted from December 2021 to June 2023 after taking approval from ethical committee. All 34 patients treated with solid interlocking intramedullary nail, without reaming for open tibial fracture during 18 months period were included in the study. Final follow up was done at one year and the outcome was assessed by Modified Ketenjian's criteria. The mean time of union rate was 15.82±3.95 weeks. Complications were: superficial infections in 4 (11.76%) patients and deep infection in 1 (2.94%) patient. Using Modified Ketenjian's Criteria, 26 (76.47%) patients had an excellent result followed by good in 7 (20.59%), fair in 1 (2.94%) and there was no case with poor outcome. Solid intramedullary interlocking nail is an effective treatment with minimal soft tissue dissection for open tibia fracture less than GA III B as it provides stable fixation with early mobilization and provides a high rate of union, less complication and early return to function.

Evaluation of the mechanical behaviour of the expandable wedge locked nail fixation in retrograde use: A finite element study

IntroductionIn literature, there have been many studies conducted to research the alternatives of standard interlocking intramedullary nailing. The expandable wedge locked nail fixation, which is thought as a new alternative to the standard interlocking nailing, has been presented in previous numerical studies. The antegrade usage of the wedge locked nail fixation has provided promising results. From this point, the aim of the study is to evaluate mechanical behavior of its retrograde usage on femur models. Additionally, another aim of the study is to investigate the effect of fracture level on mechanical properties of the fixation. Materials and methodsThe mechanical behaviors of the wedge locked nail and standard interlocking nail fixations were compared by finite element methods. Sawbones femurs having osteotomies at five different levels to simulate different fractures were fixed with wedge locked nail or interlocking nail by using retrograde approach. With respect to the fracture level, two different nail lengths were used. Axial compression load was applied to fixations. The mechanical behaviors of the fixations were evaluated with respect to stiffness of the fixations and stresses occurred on both implants and bones. ResultsAny of the wedge locked nail fixation did not slip at canal. The stress and stiffness results were mostly close with each other for both nail types. The maximum stresses at locking elements or bones contacting these elements increased with decreased distance between the fracture and relevant locking elements. DiscussionThe wedge locked nail fixation showed comparable results to the standard interlocking nail fixation with respect to the stiffness and stress. Under axial loading, wedge locked nail provided a secured fixation without any slippage and preserved its position inside the medullary canal. It may be thought as a safe alternative to the standard interlocking nail fixation for retrograde usage. Additionally, according to stress results, it is advised to the surgeons to avoid a close locking to the fracture line.

Evaluation of the treatment outcome of tibia shaft fracture by close reduction and internal fixation with interlocking intramedullary nail, Freetown, Sierra Leone, 2023

Introduction: The tibia shaft is a common site for bone fractures and open fractures. Tibia shaft fracture is mostly caused by high-energy trauma such as a fall from a height or a road traffic accident. The objective of this study was to evaluate the treatment outcome of tibia shaft fracture managed by close reduction and internal fixation with interlocking Intramedullary Nails (IMN) and to determine factors that are associated with tibia fracture infection. Methods: This retrospective study was conducted at the Emergency Trauma Hospital, Freetown, Sierra Leone. We analyzed the medical records of a mixed cohort of patients who were treated for, tibia shaft fracture by closed reduction and internal fixation with interlocking intramedullary nails for the period January 2020 to January 2022; with at least 15 months of follow-up. We later used both bivariate and multivariate logistic regressions to determine the factors that are associated with wound infection post-internal fixation. Results: A total of Ninety (n = 90) patients’ medical records were reviewed of which 79 were included for analysis. The median age was 30 years (Inter Quartile Range: 16-67 years). The average hospital stay was 20 days (Inter Quartile Range: 6-156 days). The mean fracture nailing time was 11 days. Infection and non-union rates were at 18.99% and 3.8% respectively. Type of tibia shaft fracture (AOR = 25.51, 95% CI = 2.06-422.75,) and characteristics of wound (AOR = 29.51, 95% CI = 2.06-422.75) were significantly associated with wound infection. The treatment outcome categorization of IMN was successful in 88.61% of the patients. Conclusion: This study concludes that the type of tibia shaft fracture and characteristics of the wound are major predictors of wound infection. The findings of this study suggest that IMN fixation of closed and Gustilo type 1 Tibia shaft fracture led to successful healing in the majority of the cases with a low non-union rate.

Effect of Denosumab Injection in Early Union and Consolidation o f Callus in Aseptic Tibial Shaft Non-union

Fractures of the tibial shaft is one of the most common fractures than any other long bone fractures in the human body. Surgical treatment offers better functional outcome than a conservative management. Reamed intramedullary interlocking (IMIL) nailing is the treatment of choice for most of the closed tibial shaft fractures. Despite after a good surgical fixation non-union still persists after reamed IMIL nailing. Plate augmentation and bone grafting with nail in situ was found to have superior results and union rates than any other methods, but the average union time was almost 3 to 5 months. To enhance faster union and recovery here we have used Injection Denosumab 60 mg Sc post operatively during follow up. So, the aim of the study is to find the efficacy of injection Denosumab in enhancing early union and consolidation of callus. It is a comparative prospective study involving 43 patients treated for aseptic non-union of tibial shaft fractures following reamed intramedullary interlocking nailing between 2020 and 2023. All the patients treated by reamed intramedullary interlocking nailing who met the inclusion and exclusion criteria were included in the study. Group A was managed with plate augmentation and bone grafting following non-union IMIL nailing and Group B was managed with Plate augmentation bone grafting with Injection Denosumab Sc post operatively. Both the groups were followed up post operatively for period of one year. Total of 43 patients were included in the study. The average duration of union in GROUP A -14.82 weeks and in GROUP B- 9.45 weeks. Excellent results were obtained in both the groups. There was no complication such as malunion, non-union, implant loosening, nerve palsy, infection and plate/IMIL nail breakage. Augmentation plating, decortication and autogenous iliac crest bone grating is a better treatment option compared to exchange nailing in case of tibial shaft aseptic non-union following IMIL nailing. Using injection denosumab 60mg Sc postoperatively after plate augmentation and bone grafting offers early union and early consolidation of callus. Keywords Tibial Shaft Fractures, Intramedullary Interlocking Nailing, Plate Augmentation, Bone Grafting

A Comparative Analysis of Locking Plate versus Intramedullary Nail for Humerus Shaft Fractures

Introduction: Humerus shaft fractures pose a significant challenge in Orthopaedic practice, with various treatment approaches available, including surgical methods like conservative management, Plating and Nailing. The choice between these methods remains debatable, necessitating further comparative studies. Methods: This study compared Open Reduction Internal Fixation (ORIF) with Locking Compression Plates and Closed Reduction Internal Fixation (CRIF) with Intramedullary Interlocking nails for Humerus shaft fractures. Patients were categorized into two groups based on the intervention received. Perioperative parameters, radiological outcomes, and complications were assessed. Results: Baseline demographics were comparable between the two groups. The Plating Group had longer surgery duration and higher blood loss compared to the Nailing Group. Both groups had similar rates of union and non-union, with no significant difference in shoulder function and pain outcomes at one year post-operation. Discussion: Functional outcomes post-union remain acceptable despite notable deformities, suggesting the viability of conservative treatments. While ORIF with plating has been conventional, concerns over blood loss and nerve injury have led to exploration of CRIF with intramedullary nails. This study, consistent with previous findings, found no significant disparity in outcomes between the two methods, emphasizing the need for personalized treatment decisions. In conclusion, this study adds to the understanding of Humerus shaft fracture management, highlighting the need for individualized treatment decisions and further research in this field.

Multi-segment osteotomy with interlocking intramedullary nail fixation in the treatment of lower limb deformity in older children with hypophosphatemic rickets.

Malformations of the lower limbs caused by hypophosphatemic rickets in older children are mostly complex, occurring on multiple planes without a single apex and showing arcuate bending of the diaphysis combined with torsion deformity, and are difficult to correct. This study retrospectively investigated the effect of and indicators for multi-segment osteotomy with interlocking intramedullary nail fixation in the treatment of bony deformity caused by hypophosphatemic rickets. The clinical data of 21 hypophosphatemic rickets patients seen between August 2007 and March 2022 were collected. The age range of the patients at the first surgery was 11 years and 1 month old to 15 years and 3 months old, with an average age of 12 years and 8 months. There were 6 males and 15 females. All patients had abnormal alignment of their lower limbs, with 32 limbs having varus deformity and 10 limbs having valgus deformity. A total of 67 surgeries were performed across the 21 patients, including 24 cases of femoral osteotomy with antegrade intramedullary nail fixation, 6 cases of femoral osteotomy with retrograde intramedullary nail fixation, and 20 cases of tibial osteotomy with interlocking intramedullary nail fixation. A total of 34 limbs eventually underwent interlocking intramedullary nail fixation, 9 with genu valgum and 25 with genu varus. All 21 patients were followed up for a period of 14∼96 months, with an average of 42.6 months. The ends of the osteotomies achieved bony union in 4-9 months (average 6.8 months), after which normal weight-bearing walking could be resumed. No infection, vascular or neurological complications, or nonunion occurred. During postoperative follow-up, the alignment the lower limbs passed through zone 1 in 13 limbs, zone 2 in 12 limbs, and zone 3 in 5 limbs. The overall rate of an excellent effect was 83.3%. For lower limb deformity caused by hypophosphatemic rickets in older children, multi-segment osteotomy and strong fixation with interlocking intramedullary nails can achieve good correction outcomes.

A Major Orthopaedic Surgery in a Hundred-year-old Patient During Pandemic of COVID 19: A Case Report

It has been undoubtedly assumed that COVID-19 imposes an immense economical and psychological trauma to all common people. It is also true that COVID-19 had been appeared like a “world war” for health care workers all over the world. However, either conservative or operative treatment were offered for all trauma patients even during that period. We report a 100 years old female patient with femoral shaft fracture who was treated with intramedullary interlocking nail with full precautions to prevent virus transmission during lock down period. The post and perioperative complications were uneventful, and she was walking comfortably after surgery. Keywords: COVID 19; Femoral fracture; Lock down; Pandemic

An Experience in Managing an open Fracture Shaft of the Femur Due to a Gunshot with Intramedullary Interlocking Nailing

Objective: To evaluate functional outcomes and complications in gunshot femur shaft fractures treated with intramedullary nailing primarily. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Orthopaedic Combined Military Hospital, Nowshera, Combined Military Hospital Sialkot, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2016 to Dec 2021. Methodology: A total number of 53 cases of open fracture of the femur shaft due to gunshot were included in the study. After initial wound debridement, an X-ray was taken, and fractures were classified according to the Gustilo–Anderson classification. All fractures were fixed with titanium I/M I/L Nail in static mode by the same orthopaedic surgeon. Rehabilitation was instituted immediately after the operation, and the outcome was assessed in regards to infection, range of motion at the knee, full weight bearing and radiological union achieved. Results: Thirty-four (64.15%) patients had Type-1 fractures of the femur shaft, and 19(35.8%) patients had Type-2 fractures. Fracture union was observed in 47(88.67%) patients after three months and 6(11.32%) over the next five months. Complications were wound infections 5(9.44%), leg length discrepancy 4(7.53%), and non-union 2(3.77%) at six months. In these two cases, bone grafting was done, and union was achieved. Conclusion: Primary intramedullary (IM) is the preferred mode of treatment of Type 1 and 2 shafts of femur fractures if early good debridement is done. It avoids secondary procedures, has fewer complications and helps in early mobilization.

Ilizarov Fixator-Assisted Management of Neglected Femur Fractures by Open Intramedullary Nailing: A Case Series.

Fourteencases of NFFspresented to Kalinga Institute of Medical Sciences, Bhubaneswar, India, between January 2020 and June 2022 were recruited for the study. After preoperative evaluation and explanation of available treatment options to patients, they were operated on with a two-stage procedure of Ilizarov fixator application, followed by intramedullary interlocking nailing, with a period of gradual distraction in between. They were then followed up for a minimum of 12 months to assess functional and radiological outcomes. The average time for all of the fractures to heal was 25.2weeks. The average knee flexion increased from 28.2degrees before surgery to 87.1degrees after surgery. All 14 patients could walk with complete weight bearing on the operated limb postoperatively after proper pain control measures were taken.The mean Tegner Lysholm knee score was 77.8. There was residual limping in six of the cases, which could be attributed to muscle atrophy and/or shortening in the affected limbs. In three cases, skin blisters were formed due to the acute nature of the distraction, but they all healed with a scab and scar, otherwise uneventfully. The shortening, in 13 cases, came down to 4 cm or less, which was managed with a shoe raise. The one case with a residual 5 cm shortening had a short, limping gait, and it was attributed to an extremely overriding osteopenic femur preoperatively. A two-stage operation with distraction by an Illizarov fixator followed by an intramedullary fixation provides the basic advantage of not having to excise an excessive amount of bone, which may be required in primary open reduction and intramedullary fixation. It also allows the patient to carry on his daily activities as mobilization is not restricted, which is the case in an individual to whom skeletal traction is applied. Hence, in any NFFcase, this algorithm of management can be considered a frontrunner in the comprehensive management of disability and deformity.

The value of ultrasonography in predicting the outcomes of simple long bone fractures treated by closed intramedullary nail fixation

PurposeUltrasonography has been used increasingly in orthopaedic practice credited to its low cost, easy accessibility, non-invasiveness, reproducibility, and safety from radiation. The purpose of this study was to test the validity and efficacy of ultrasonography as an adjunct in the assessment of fracture healing in long bones treated with intramedullary interlocking devices and its predictive value in determining the need for a secondary surgical procedure. MethodsThis was a descriptive longitudinal study of 40 skeletally mature patients who sustained long bone fractures of the tibia or femur treated using intramedullary interlocking nails. Patients with comminuted and segmental fracture patterns were excluded from the study. Each patient was evaluated at 6- and 12-week post-surgery using standard orthogonal radiographs and ultrasonography to assess fracture healing. Patients were then followed up until fracture union. Quantitative data was analyzed using frequency statistics and descriptive data with inferential statistics. ResultsUltrasonography predicted 87.5% union and 12.5% delayed or non-union as early as 6 weeks after surgery, while radiographs predicted 22.5% union as late as 3 months of follow-up. The sensitivity and specificity of ultrasonography in assessing fracture healing were 100% and 97.2%, respectively, with a positive predictive value of 80.0%. Vascular resistance index was less than 0.5 in all patients who developed delayed or non-union. ConclusionUltrasonography is able to predict fracture outcomes much earlier than standardized radiographs with comparable sensitivity and specificity. Vascular resistance index is an objective parameter in assessing callus quality and predicting fracture outcomes.

Outcome of Open Reduction and Internal Fixation with Interlocking Intra-Medullary Nail in the Treatment of Fracture of Shaft of Femur without Fluoroscopy

Introduction: Femoral shaft fractures are among the common fractures generally managed by close reduction and internal fixation (CRIF) with interlocking intramedullary nailing (ILIMN) as the nail provides the rotational as well as longitudinal stability along with good clinical and functional outcomes but requiring fluoroscopy guidance. Also, in delayed cases, the close reduction might not be possible intimidating the need of open reduction.
 Objective: To assess the clinical outcome of the treatment from Open Reduction and Internal Fixation (ORIF) technique as well as placement tricks of locking screws in the absence of a traction table and fluoroscopy.
 Methodology: Fourteen cases of close femur fractures with transverse and oblique type in the middle 1/3 shaft coming to Koshi Hospital, Nepal, from June 2019 to December 2021 were included in this study. All patients were treated with ORIF with ILIMN technique without the use of a traction table and fluoroscopy. Data collection included demography, mechanism of injury, mobilization time, union rate, infection, and complication. The study was also designed to evaluate the method of our technique which could be helpful in case of dysfunction of fluoroscopy during intra-operative of CRIF in a resource-limited setting.
 Results: The average age of patients was 39.86±14.93, the average hospital stay duration was 12 ± 8.60 days, full weight-bearing walking was around 11.64 ± 3.15 weeks and the average union time was observed to be 14.54 ± 3.36 weeks.
 Conclusion: This technique was successful with an efficient duration of the surgery and satisfactory results in early mobilization and fracture union time. Thus, concluding it to be a safe procedure in situations like old fracture (more than 3 weeks), pelvic injury with urethral injury, lack of traction table, and dysfunction of fluoroscopy.

Results of the Pediatric Shaft Femur Fracture Treated with Closed Rigid Lateral Trochanteric Entry Intramedullary Nail in North Indian Population

Objectives The femoral shaft fractures constitute 1.6% of the pediatric fractures. Intramedullary nailing is a common mode of fixation in older children and adolescents. The rigid intramedullary locking nail is a preferred choice over flexible nails in overweight patients and children older than 11 years of age. The adolescent age group with skeletal immaturity deserves special attention from the surgeons because of grave complications like avascular necrosis of the femur head and angular deformities. The aim of this study is to report the outcome of an adolescent femur shaft fracture treated with a rigid intramedullary interlocking nail in North Indian patients. Material and Methods This is a retrospective analysis performed by retrieving records of 19 patients. Patients with open fractures, polytrauma and neurovascular injuries were excluded. The preoperative and post-operative radiographic orthogonal views were analyzed to assess parameters like alignment, union and avascular necrosis (AVN). Results The mean age was 12.3 years. The mean follow-up was 1.5 years. The average time for union was 8 weeks. All the fractures were united in an acceptable alignment and rotation. There was no avascular necrosis, angular deformity and infection. The mean femur length discrepancy was 7 mm. Conclusion The rigid intramedullary interlocking nail is a valuable option for the fixation of femoral shaft fractures in an adolescent age group with a good union rate and minimal complications.

Assessing the effectiveness of intramedullary nailing for tibial shaft fractures in a low-income setting: a prospective study in Yemen.

Tibial shaft fractures are common injuries that can be treated with various methods, including interlocked intramedullary nail (IMN). However, there is limited data on the clinical outcomes of IMN for tibial shaft fractures in Yemen. To evaluate the clinical outcomes of primary IMN for tibial shaft fractures in Yemen. This was a prospective study of 134 patients who underwent primary IMN for tibial shaft fractures et al.-Thawra Modern General Hospital in Sana'a, Yemen, between June 2016 and June 2020. The patients were between 18 and 70years old, and the fractures were classified according to the AO classification system. The fractures were treated with IMN using a standard technique. The patients were followed up for a minimum of 2years. The outcome measures included union time, complications, and functional scores. The mean union time was 17weeks. The overall complication rate was 18.7%. The most common complications were infection (8.2%), delayed union (6.7%), and nonunion (3.7%). The mean functional scores at the final follow-up were 91.4 for the Knee Society Score and 90.2 for the American Orthopaedic Foot and Ankle Society Score. Primary IMN is an effective and reliable method for treating tibial shaft fractures in Yemen, with acceptable union time, complication rate, and functional outcomes.