Interlocking Nail Research Articles

Treatment Of Fracture Shaft Humerus By Intramedullary Interlocking Nail

The goal of this study is to evaluate surgical treatment outcomes of fracture shaft humerus by using intramedullary interlocking nail. Fifteen patients (ages ranged from 51 to 70 with an average age of 64.20 ± 6.338 years, (10 males and 5 females) with shaft humeral fractures from Beni-Suef University and General hospitals during the period from December 2012 to June 2014. The selected participants were treated with intramedullary interlocking nail. Patients were followed up for a mean of 9 (range 6–12) months. The mean length of hospital stay was 3 (range 1–5) days. All the fractures united radiographically after a mean of 14 (range, 12–20) weeks. Conclusion: That the majority of humeral shaft fractures can be treated safely and effectively by non-operative methods. However, for the subset of patients requiring surgical treatment, intramedullary nailing provides predictable means of achieving fracture stabilization and ultimate healing. Poor outcome in intramedullary interlocking nailing is attributable to rotator cuff tear and shoulder impingement and lack of expertise of surgeon.

Prospective study on functional outcome of fracture shaft of femur (Winquest Hansen type 1, 2 and 3) treated with intramedullary interlocking nail

The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the functional outcome after antegrade intramedullary nailing of traumatic femoral shaft fractures. In a prospective study, patients with a femoral shaft fracture but no other injuries to the lower limbs or pelvis were included. A total of 40 patients met the inclusion criteria. All were operated by standard procedure of antegrade intramedullary interlocking nailing. Patients were reviewed at 1,3,6,12 months and we used KLAUSS & KLEMN CRITERIA and McNAIRS LOWER LIMB QUESTIONNARE for quantification of functional outcome. Mean age of such fractures was 24 years(+/- 5 years) majority being male and main mechanism of injury being RTA. There were 2 cases of fat embolism and 2 cases of superficial infection which healed by conservation method. Average time of radiological union was 12-24 weeks. There were no case of non-union but 1 case of delayed union for which dynamization was done.Final functional outcome came out to be good to excellent in all the patients.

Outcome of closed intramedullary interlocking nailing of diaphyseal fractures of femur in adults, a prospective study

Outcome of closed intramedullary interlocking nailing of diaphyseal fractures of femur in adults, a prospective study

Management of gustilo and anderson type i and ii open tibial fracture using delayed primary nailing: An assessment of clinical and radiological outcome

Background: Open tibial fracture is one of the most common trauma emergencies. Marked delay in presentation is noticed in developing countries, especially sub-Saharan Africa due to poor pre-hospital care, presentation to traditional bone setters and out-of-pocket payment of services. Primary nailing at the time of initial debridement was noticed to have a high prevalence of infection in some series. Delayed primary nailing after a period of debridement and wound care was found to be safe with less complication rate in this study. Objective: The objective of this study is to determine the clinical and radiological outcome of management of Gustilo and Anderson (GA) Type I and II open tibial fracture using delayed primary nailing, especially in patient with delayed presentation. Methodology: Twenty-one (21) patients with open (GA I and II) tibial diaphyseal fracture were recruited into this study. They had initial debridement and a period of wound care before subsequent nailing. All patients had tibial interlocking nailing 5–9 days post-injury using open technique with aid of the external jig system. The patients were followed up for 9 months. Clinical outcome was assessed using Johner and Wruh's criteria at 6 months. The radiologic outcome was assessed using Radiologic union scale for tibia fracture (RUST). Results: The M: F was 4:1 with a mean age of 37.24 ± 13.8 years. Road traffic accident accounted for 85.7% (n = 18). Marked delayed presentation was noted, only four patients (19.1%) presented within 6 h from injury. GA Type II open fracture was the most prevalent fracture type accounting for 81.9% (n = 17). The clinical outcome using Johner and Wuh's criteria at 6 months post-nailing showed 18 patients (86%) had excellent and good outcome. Only one patient (4.8%) had poor outcome. RUST was used to assess the rate of union following the tibial nailing. Fractures were scored at 6 weeks, 12 weeks, 6 months and 9 months. Ten patients (47.6%) were united at 6 weeks, whereas 21 (100%) had achieved union at 9 months. The average time to radiologic union was 17.3 weeks. Seven patients (33.3% n = 7) had complications. Anterior knee pain, superficial surgical site infection (SSI) and delayed union were the complication recorded. Conclusion: Delayed primary nailing of open tibial fracture produces good to excellent outcome with acceptable complication rate, especially SSI.

Operative outcomes of antegrade intramedullary ineterlock nailing in femoral shaft fracture: A study of 30 cases

Femoral shaft fractures are one of the most common injuries. These fractures are often associated with polytrauma and commonly result from high energy mechanisms such as motor vehicle collisions with sequelae of limb shortening and deformities, if not treated appropriately. Intramedullary nailing is an effective method of treating femoral shaft fracture and has become one of the preferred procedures in orthopaedics. The present study attempts to clinically evaluate the outcomes of antegraded intramedullary nailing in shaft femur fractures.Materials and Methods: 30 patients with shaft femur fracture were studied with the minimum 12 months of follow up. Functional outcome was assessed by Thoresen’s criteria.Results: Out of 30 patients excellent functional status was seen in 76.6%, good in 13.33%, fair in 10% whereas there were 0% patients falling under the category of poor functional status. Conclusion: Intramedullary nailing is effective treatment for the stabilisation of the fracture shaft of femur. Femur interlocking nail is a good implant for the treatment of femoral shaft fractures because of its load sharing, closed insertion, rotational stability, restoration of anatomic length alignment and early mobilization.

Comparative study between dynamic compression plating versus interlock nailing in treatment of fracture of shaft of humerus

Comparative study between dynamic compression plating versus interlock nailing in treatment of fracture of shaft of humerus

Evaluation of a Feline Bone Surrogate and In Vitro Mechanical Comparison of Small Interlocking Nail Systems in Mediolateral Bending.

The aim of this study was to (1) evaluate bending structural properties of a machined short fibre epoxy (SFE) feline bone surrogate (FBS), (2) compare the bending behaviour of small angle-stable interlocking nails (I-Loc; Targon) and locking compression plates (LCP) and (3) evaluate the effect of implant removal on FBS bending strength. Part 1: Feline cadaveric femurs (n = 10) and FBS (n = 4) underwent cyclic four-point bending and load to failure. Part 2: Fracture gap FBS constructs (n = 4/group) were stabilized in a bridging fashion with either I-Loc 3 and 4, Targon 2.5 and 3.0, LCP 2.0 and 2.4, then cyclically bent. Part 3: Intact FBS with pilot holes, simulating explantation, (n = 4/group) underwent destructive bending tests. Bending compliance, angular deformation and failure moment (FM) were statistically compared (p < 0.05). Native bone and FBS were similar for all outcome measures (p > 0.05). The smallest and largest bending compliance and angular deformation were seen in the I-Loc 4 and LCP 2.0 respectively (p < 0.05). While explanted Targon FBS had the lowest FM (p < 0.05), I-Loc and LCP constructs FM were not different (p > 0.05). The similar bending properties of short fibre epoxy made FBS and native feline femurs suggest that this model could be used for mechanical testing of implants designed for feline long bone osteosynthesis. The I-Loc constructs smaller angular deformation which also suggests that these implants represent a valid alternative to size-matched Targon and LCP for feline fracture osteosynthesis. The significantly lower FM of explanted Targon may increase the risk of secondary fracture following implant removal.

Dynamically locked intramedullary interlocking nail for fracture shaft of tibia: An effective surgical protocol with minimal complications

Introduction: Fracture shaft of tibia is one of the most common injuries presenting to a trauma center. Closed intramedullary interlocking nail is the gold standard surgical procedure. But even with advanced techniques there are several reports of delayed and nonunion of these fractures. We evaluated the results of dynamically locked tibia IMIL nail for fracture shaft of tibia. Materials and Methods: 90 patients with fracture shaft of tibia were included in the study between 2013 to 2015. AO type A1 and A2 were included in the study. Comminuted fractures, open injuries were excluded from the study. Outcomes were evaluated based on time to fracture union, limb alignment, walking ability and range of motion. Results: There was fracture union in 100% of the cases an average duration of 16 weeks. There were no cases of nonunion/delayed union, significant mal-alignment of the fracture. The mean range of motion score was 3.6 and the mean walking ability score was 3.8. Discussion: Non comminuted fracture shaft of tibia treated with dynamically locked IMIL nail gave good to excellent results in 87 of the 90 cases with respect to fracture union, limb alignment, range of motion and walking ability. There were no cases with implant failure or limb length discrepancy. It produces good fracture compression and early weight bearing adds to its advantage. Conclusion: Dynamically locked IMIL nail for non comminuted fracture shaft of tibia gives excellent clinical and radiological outcome. It also avoids any chances of delayed/nonunion of the fractures of tibial shaft. Keywords: Tibia, Shaft, Fracture, Dynamic, Locking, Nail.

Functional and radiological outcome of inter-trochanteric fractures treated with minimally invasive D.H.S or proximal femoral nailing: A comparative study

Introduction: Inter-trochanteric fractures are one of the commonest fractures encountered in orthopaedic practice. Treatment of inter-trochanteric fractures had turned from totally conservative in the pre ‘70s to totally surgical now. Many surgical methods like Jewet nail, Gamma nail and condylar plates had been tried and given up. The commonest method used now are Dynamic hip screw (D.H.S) system and Proximal Femoral inter-locking nail (P.F.N) system. Materials and Methods: This, prospective study was conducted in Sri Venkateswaraa Medical College, Pondicherry from May 2015 to May 2017. 30 (Thirty) consecutive patients of age over 55 years, with inter-trochanteric fractures were studied. Of these 30 patients alternate patients (15 patients) were treated with minimally invasive D.H.S and the other 15 patients were treated with P.F.N. They were reviewed every 2 weeks. Their functional results were analysed using modified Harris hip score.37 Results: Males predominated in our study. 70% were left sided. Mean time of surgery with incision for D.H.S group was little longer than P.F.N group. P.F.N group bone weight earlier than D.H.S group. Blood loss was more in D.H.S group. There was no difference in mean hospital stay in both groups. P.F.N group patients bore weight earlier in both unstable and stable fracture groups. P.F.N group healed earlier than D.H.S group. The D.H.S group bore weight much later. There was only one complication in both groups. Bony union occurred earlier in P.F.N group than D.H.S group. Conclusion: The P.F.N group required shorter incision and had less blood loss. They were able to bear weight earlier in both stable and unstable groups, whereas D.H.S group with unstable fractures took long time to bear weight. The P.F.N group fractures healed earlier than D.H.S group. At the end of six months, the modified Harris hip score showed no marked difference between two groups. Considering all this, we conclude PFN is a better device to treat inter

A Study on the Outcome of Antibiotic Eluting Intramedullary Interlocking Nails in the Primary Fixation of Gustilo and Anderson Grades II and IIIA Open Fractures of Tibia

Introduction:The incidence and outcome of infection in open tibial fractures is adequately recorded in literature. The aim of this study is to find out the deep infection rate, union rate, and functional outcome of open tibial fractures managed by prophylactic antibiotic eluting interlocking nail.Methodology:A total of 18 patients with 20 open tibial fractures who met the study criteria were included and followed up for a minimum of 1 year after surgical intervention. Reamed intramedullary interlocking nailing with antibiotic eluting nail was done followed by adequate skin cover.Results:The outcomes were assessed using lower extremity functional scale and radiological union scale in tibial fractures both of which showed maximum improvement in initial 3 months followed by a steady improvement till 1 year with a good degree of correlation between the two scales. The total incidence of deep infection in this study was 5% (n = 1). All cases achieved union and independent ambulation by 1 year.Conclusion:Our study shows good radiological and functional outcomes with prophylactic antibiotic-coated nailing of open tibial fractures of Grades II and IIIA. The rate of deep infection is 5% and union rate is 100% in our study. Further comparative studies are required for drawing more conclusions on application of the results in clinical practice.

Comparison between osteosynthesis with interlocking nail and minimally invasive plating for proximal- and middle-thirds of humeral shaft fractures.

Options for the treatment of proximal- and middle-thirds ofhumeral shaft fracturesinclude intramedullary interlocking nail (IMN) and minimally invasive plate osteosynthesis (MIPO). However, whether IMN provides better clinical outcomes than MIPO surgical technique still remains unclear. This study was designed to compare clinical outcomes of the IMN with MIPO technique for the treatment of proximal- and middle-thirds of humeral shaft fractures. A retrospective cohort analysis of 55 proximal- and middle-thirds of humeral shaft fracturessurgically treated using IMN (n = 25) or MIPO (n = 30) from January 2012 to January 2016. Peri-operative and follow-up data (a minimum of 1 year) of the patients (aged from 18 to 56 years) were collected. Operative time, union time, VAS scores, surgery-related complications, and implant removal rate were compared between the two groups in this study. Besides, the functional outcomes were evaluated using the Rating Scale of American Shoulder and Elbow Surgeons' Form (ASES) and Mayo Elbow Performance Score System (MEPS). We found significantly shorter operative time and much less blood loss in IMN group, and lower VAS scores in the IMN group after surgery at first and third months but not at the sixth month. Complication rate was found to be relatively higher in the MIPO group when compared to the IMN group. No significant difference was observed between these two groups regarding ASES and MEPS scores. Three patients in the MIPO group suffered iatrogenic radial nerve injury and recovered after four to five months later. No implant failures occurred in either group. Intramedullary interlocking nail seemed to be superior to minimally invasive plate osteosynthesis in the treatment of proximal- and middle-thirds of humeral shaft fractures due to shorter operative time and union time, less early post-operative pain, and fewer complications. The intramedullary interlocking nail could be considered a better surgical option for the management of proximal middle humeral fractures, though it may also depend on the surgeons' skills and learning curve. Further in-depth prospective studies are in great need to verify our conclusion.

Intramedullary nailing of adult forearm fractures: Results and complications

IntroductionThe aim of this study was to evaluate the clinical and radiological results of adult forearm fractures treated with interlocking intramedullary nailing. MethodsThis retrospective study included 21 patients who were treated with intramedullary interlocking nailing for forearm fractures between January 2010 and September 2017. All patients were treated with intramedullary forearm nails designed to allow interfragmentary compression. The medical records and radiographs of all patients were evaluated. Fractures were classified according to the AO/OTA classification system by analyzing the radiographs. Union time, union rate, clinical outcome, and complications were evaluated. ResultsPrimary intramedullary osteosynthesis was performed in 17 patients with forearm shaft fractures. The average union time was 10 weeks (range, 8–16 weeks) in the primary osteosynthesis cohort. Secondary intramedullary osteosynthesis was performed in four patients following the removal of plates and screws due to nonunions. For this group of patients, bone union took an average of 17 weeks (range 8–24 weeks). The overall union rate was 95.24% in the 21 forearm fractures which were treated with an intramedullary interlocking nail with a compression screw that allows interfragmentary compression to be obtained. Overall complications included one nonunion, one postoperative rupture of the extensor pollicis longus tendon, and 1 postoperative transitory radial nerve palsy. ConclusionsIntramedullary interlocking nailing with a compression screw is an alternative method of fixation for treating adult forearm fractures and provides good clinical outcomes with reliable union rates.

Retrospective analysis of minimal invasive plating versus intramedullary nailing for treatment of extra-articular distal tibia fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The volume of cases of distal tibia fractures at trauma care centre are quite high in Indian scenario. These type of fracture often creates a dilemma for the orthopaedic surgeons over the choice of the implant for the management. The aim of our study was to compare intramedullary interlocking nail (IMILN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) on the basis of various parameters.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We collected data of 40 patients with extra-articular distal tibial fractures (within 2 muller square from tibial plafond). Patients were divided into two groups: IMILN and MIPPO. We compared the 2 groups for demographic variables, union time, complication rate and functional score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was no statistical difference of union time, complication rate, functional outcome and other demographic variables among the groups. Only 2 patients developed non-union and two patients had infection. Overall 38 patients obtained excellent or good result (95%) and two patient had fair outcome (5%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The overall analysis suggested that both MIPPO and IMILN treatment option are comparable with consideration of all the parameters. Detailed results indicate a superiority of MIPPO over IMILN in terms of better anatomical reductions of the fracture with less incidence of malalignment while IMILN is better in terms of having lower rates of infections.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Prospective study of clinical, radiological and functional outcome of anterior bridge plating for shaft of humerus fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Shaft of humerus (SOH) fracture has been conventionally treated with either open reduction internal fixation with plate osteosynthesis or immobilization as conservative treatment. Intramedullary interlocking nailing (IMIL) and anterior bridge plating (ABP) are both newer modalities of internal fixation for SOH fracture. Rotator cuff irritation is a known complication of IMIL nailing of the humerus. Here, we present clinical, radiological, and functional outcome of SOH fracture fixation by ABP using a minimally invasive method.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Thirty patients with SOH fracture were treated surgically via an anterior minimally invasive plate osteosynthesis (MIPO) approach with ABP. There were 21 male and 9 female patients, and the average age was 38.6±10.45 years. The mechanism of injury was road traffic accidents (60%) and ground level fall (40%). Functional assessments were obtained with University of California at Los Angeles (UCLA) score and mayo elbow performance index (MEPI) during the follow-up period.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At the end of 6 months follow-up, 29 (96.7%) patients had excellent to good UCLA and MEPI scores. Varus/valgus angulation was reported in 4 (13.3%) patients. Two patients (6.7%) had radial nerve neuropraxia and delayed union, while 1 (3.3%) patient had screw back-out or loosening. The mean duration of radiation exposure was 178±41.2 seconds. ABP for SOH fractures is a safe and effective treatment modality.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This treatment protocol produces high rates of union, excellent functional recovery, and minimal biological disruption.&lt;/p&gt;

In vitro comparison on a gap fracture model of a novel angle-stable interlocking nail to locking plate fixation in torsion, compression and bending

The use of interlocking nails is a standard of care for the treatment of most of long bone fractures in human. This minimally invasive method is used to stabilize comminuted, diaphyseal fractures w...

Comparing the Functionality in Outcomes for Management Tibial Shaft Fracture Using Intramedullary Interlocking Nailing Technique in Patients Coming with Tibial Shaft Fracture in Dr. Hardas Singh Orthopedic Hospital and Superspeciality Research Centre, Circular Road, Amritsar, Punjab

Comparing the Functionality in Outcomes for Management Tibial Shaft Fracture Using Intramedullary Interlocking Nailing Technique in Patients Coming with Tibial Shaft Fracture in Dr. Hardas Singh Orthopedic Hospital and Superspeciality Research Centre, Circular Road, Amritsar, Punjab

Safety Evaluation of Medical Implants in the Human Body for a Wireless Power Transfer System in an Electric Vehicle

One of the important safety aspects regarding electromagnetic fields is their coupling with medical implants in the human body. In this article, an adult model (Ella), with different medical implants, was exposed to a leaked magnetic field from a wireless power transfer (WPT) system in an electric vehicle, operating at a frequency of 85 kHz, with transferred powers of 3.7, 7.7, 11, and 22 kW. The induced electric field (E-field) in the human model, standing close to the vehicle and sitting inside the vehicle, was evaluated with a prosthetic hip implant, an interlocking nail implant, an InterStim neurostimulator implant, a traditional pacemaker implant, and a leadless pacemaker implant. The results indicated that medical implants influenced the maximum magnitude of the induced E-field and its distribution inside the body. A notable enhancement in the E-field was observed around the implants. In worst-case scenarios, the effects of implant shape and size were investigated. The highest induced E-field (12.68 V/m) was observed with the interlocking nail of length 340 mm for standing posture, which exceeded the prescribed limit of 11.5 V/m in the International Commission on Non-Ionizing Radiation Protection guidelines. The presence of a medical implant in the body likely limits the transferred power of the WPT system, depending on the implant type, size, location, and the body posture.

Management of tibial shaft fractures with reamed intramedullary interlocking nail: A prospective study

Management of tibial shaft fractures with reamed intramedullary interlocking nail: A prospective study

Study on functional outcome of primary closed nailing in compound diaphyseal fractures of tibia

Introduction: Open fractures of the tibia are among the most common of serious skeletal injuries, can cause permanent sequelae if not managed timely and precisely. Material and Methods: The study group comprised of 30 patients who underwent closed locked intramedullary nailing. Follow up done for period of one year from July 2019 to June 2020 in prospective and retrospective manner at Department of Orthopaedics, Rajah Muthiah Medical College, Annamalai University. Results: The Mean time of union was found to be 14 weeks 4 days for all compound fractures, for grade I compound – 13 weeks 3 days, for grade II cases – 15 weeks, and for grade IIIA cases – 17 weeks 1 day. Based on Johner-Wruhs criteria 90% and 10% of grade I cases had excellent and good outcome. 80% and 20 % of grade II cases had excellent and good outcome. 75% and 25% of grade IIIA patient had excellent and good outcome. Overall 83.3% of compound fracture had excellent outcome and 16.7% of compound fractures had good outcome respectively. Complication encountered was superficial infection (6.6%) in 2 patients, 3 (10%) patients had anterior knee pain, non union in 2 patients and delayed union in 1 patient. Conclusion: our study concluded that in Grade I, II and Grade IIIa tibial diaphyseal fracture, treated with closed intramedullary interlocked nail had excellent to good functional outcome with proper alignment, good range of motion, low infection rate and less patient morbidity.

A short-term functional outcome of proximal diaphysio-metaphyseal fracture of tibia treated with intramedullary interlocking nail in combination with poller screw

Non-articular fractures of the proximal third of the tibia account for 5 to 11% of tibial shaft injuries. Intramedullary nailing for metaphyseal tibial fractures with a shortproximal fragment (unlikediaphyseal tibial fractures) is associated with an increased risk of frontal and sagittalplane malalignment. This can be solved by the use of intramedullary interlocking nail in combination with blocking screws or Poller screws. A series of 20 cases of proximal diaphysis-metaphyseal fracture of tibia treated with intramedullary interlocking nail in combination with poller screw and were followed up regularly till 6months and evaluated using Modified Karlstrom-Olerud Score. Most patients had Excellent score at 6th month follow-up. Our study suggests intramedullary interlocking nail in combination with poller screwis an effective management of proximal diaphysio-metaphyseal fracture of tibia.