Intramedullary Interlocking Nail Research Articles

Functional result of diaphyseal fractures of femur managed by closed Intramedullary interlocking nailing in adults

Introduction: Fractures of shaft of femur are among the most common fracture encountered in orthopedie practice in the road traffic accident.The femur is the largest and strongest bone in the body articulating with hip joint proximally forming knee joint with tibia at its distal end. As industrialization and urbanization are progressing year to year with rapid increase in traffic. Incidence of high energy trauma increasing with same speed. Hence, the aim of the present study was to assess the treatment of unstable diaphyseal fracture femur with femur intramedullary interlocking nailing. Material and methods: The present study was done among 15 patients where boot and bar traction in emergency was given. All routine investigation and surgical fitness were asked for intramedullary nailing was chosen for fracture shaft femur. Results: About 73.3% fractures of the mid shaft femur was present. The patten of fracture was found to be comminuted which was around 33.3%. The oblique pattern was around 26.6% and transverse pattern of fracture was observed to be 40%.The complications included were implant bending and breaking, infection, delayed and nonunion, rotational deformity. Conclusion: Unstable diaphyseal fractures with femur intramedullary interlocking nailing gives excellent result with this system there are minimal complications which help early return of patients to activity and work.

Use of poller screw in proximal and distal metaphyseal fractures of tibia treated with intra-medullary inter-locking nail: A prospective study of 25 patients

Introduction: Treatment of tibia metaphyseal fractures is still difficult. Interlocking tibial fractures is preferred because it allows for some load sharing, preserves extraosseous blood flow, avoids major soft tissue dissection, and is well-known by most surgeons. Nailing of metaphyseal fractures with a short proximal or distal fragment is linked to increased malalignment, especially in the coronal plane, non-union, and the necessity for subsequent treatments to accomplish union. Blocking screws (poller screws), temporary unicortical plating, alternative nail designs with variable proximal bends (proximal third fractures), and fibular plating have all been proposed to better nailing metaphyseal fractures (distal third fractures).''The study's goal was to see if poller screws might be used as a supplement to stability in tibia metaphyseal fractures treated with a statically locked intramedullary nail. Materials and Methods: It was a prospective trial in which 25 patients with extraarticular Tibia metaphyseal fractures presented between July 2020 and December 2021 were treated with an Intra-Medullary Inter-Locking nail augmented with Poller screws and observed for six months. Results: The average age was 45.92 years, with a male majority.

Comparative prospective study of knee pain in medial pararpatellar and transpatellar entry for interlocking nail fixation of tibia fracture

Objective: To compare two insertion techniques of intramedullary interlocking nails (medial parapatellar versus intrapatellar insertion) in patients with tibial fractures. Methodology: This study was performed at Al-Kindy Teaching Hospital from August 2020 until March 2022. All 32 patients with tibial fractures (29 males and 3 females) were included for tibial closed nail fixation and then followed up for 6 months. We categorized these patients into two groups; Group A (16 patients), those treated by medial parapatellar insertion of an interlocking nail, and Group B (16 patients) with transpatellar tibial nail insertion. All patients were treated by the same surgical team. Results: The range of movement in two weeks (from extension to flexion) was up to 30°. At the end of the follow-up period, all patients in Group A had functional flexion greater than 90°, whereas three patients in Group B had limited flexion that necessitated scheduled physical therapy. Regarding the functional outcome, in group A patients and in group B patients, the mean International Knee Documentation Committee score demonstrated a better outcome in patients with medial parapatellar insertion than those in group B. According to the visual analysis score, the transpatellar insertion demonstrated more discomfort than that in the paramedial insertion group, both clinically and statistically. Conclusion: Medial entry point in intra medullary tibial nailing had less anterior knee pain in post-operative follow up.

Functional outcome of management of open fractures both bones of leg with primary intramedullary interlocking nailing

Functional outcome of management of open fractures both bones of leg with primary intramedullary interlocking nailing

Effects of Dynamization on Delayed Union of Tibial Shaft Fractures After Reamed Intramedullary Interlocked Nailing

Objective: To determine the efficacy of dynamization in delayed union of tibia diaphyseal fractures Methodology: A descriptive cross sectional study was done at the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from July 2020 to April 2021. A total of 97 consenting patients who suffered from delayed union following intramedullary interlocking nailing were included in the study. Dynamization involved removal of proximal or distal locking screws in statically locked intramedullary nail. Patients were followed up for six months to check for delayed bone union. All the collected data were entered into a pro forma and used electronically for research purpose. Results: Over all union was achieved in 72 (74.2%) cases after dynamization. The mean age of our study population was 39.42+13.79 years. Advanced age, smoking, fresh or old fracture, the time of initial intramedullary nailing, and diabetes were associated with decreased efficacy of dynamization, with p-value <0.001, 0.033, 0.007, and <0.001 respectively. While no significant association was found between gender, BMI, hypertension, and union (p-value >0.05). Conclusion: The findings of this study support the idea that dynamization can be an effective method to promote healing in tibia diaphyseal fractures for delayed union. More randomized comparative clinical trials are necessary to evaluate the effectiveness of dynamization.

A study of supra patellar versus infra patellar intramedullary interlocking nailing in tibial diaphyseal fractures

Introduction: Tibial shaft fractures are a common traumatic injury. Traditional infra patellar intra medullary nailing is a popular surgical procedure used in the treatment of tibia shaft fractures. Recently, the supra patellar approach has attracted the attention of orthopedic surgeons, as it seems to offer fewer complications and re-operations. Material and methods: The total of 30 patients with tibial diaphyseal fractures and underwent Intra medullary interlocking nailing, in which 15 with supra patellar approach and 15 patients with infra patellar approach. Results: There was a statistically significant difference in the final outcome in patients undergoing Intra medullary interlocking nailing through Supra Patellar and infrapatellar approach with better functional outcome in the former. Conclusion: we conclude that supra patellar approach had a better clinical outcome compared to Infra patellar approach for tibial diaphyseal fractures with relation to duration of surgery, Intra operative bleeding, Fluoroscopy time, Post-operative anterior knee pain and Knee functional outcome.

Comparative study of range of motion and anterior knee pain in parapatellar versus trans patellar approach in tibia nailing

<p><strong>Background:</strong> Tibial shaft fractures are common traumatic fractures especially in road traffic accidents. Intramedullary interlocking nailing is considered treatment of choice tibial diaphyseal fractures, minimizing soft tissue injury and permitting early weight bearing and fracture healing. Anterior knee pain and reduced range of motion are some common complications that patients have to face in post-operative period.</p><p><strong>Methods: </strong>The<strong> </strong>60 patients of both sex with traumatic diaphyseal tibial shaft fractures were included in this study out of which 30 were operated with interlocking tibia nailing with trans patellar (tendon splitting) approach while 30 were operated with medial parapatellar approach for tibia nail insertion. Range of motion at knee joint (in degrees) and anterior knee pain (on visual analogue scale) was evaluated on post-operative day 1, 2 weeks, 1 month, 3-month post operatively and compared for both groups.</p><p><strong>Results: </strong>Mean anterior knee pain was significantly lower in parapatellar approach group at 2 weeks, 1 month and 3 months while there was no significant difference on post-operative day 1. Mean range of motion at knee joint was more in parapatellar approach group on post-operative day 1 and 2 weeks while there was no significant difference in range of motion after 2 weeks.</p><p><strong>Conclusions: </strong>In our study medial parapatellar approach is superior than tendon splitting approach with comparatively greater range of motion and lesser anterior knee pain. Thus, medial parapatellar approach should be encouraged for interlocking tibia nailing.</p>

A comparison of functional and radiological outcome of combine compression antegrade intertrochanteric nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in elderly patients with intertrochanteric fractures.

To compare the functional and radiological outcome of combine compression interlocking intramedullary nail (InterTan) and proximal femoral nail anti-rotation II (PFNA-II) in the treatment of elderly patients with intertrochanteric fractures. As a retrospective cohort study, records of 88 patients with intertrochanteric fractures treated in our hospital from January 1st, 2019 to July 31st, 2021 were retrospectively reviewed. According to treatment records, it included 45 patients treated with InterTan (Group-A) and 43 patients treated with PFNA-II (Group-B). The operation safety and functional rehabilitation of the two groups were compared and analyzed. This study included 88 patients with intertrochanteric fractures (mean [SD] age, 68.72 [0.10] years at baseline), of whom 52 (59.09%) were males and 36 (40.91%) were females. Operation time and intraoperative blood loss in Group-B were less than Group-A, while fracture healing time was shorter in Group-A. The fracture separation distance was measured four weeks after the operation. The widening rate of the fracture line in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). The incidence of complications in Group-A was lower than Group-B (4.4% vs.18.6%; P<0.05). At three, six and twelve months after the operation, the Harris hip score of the two groups was higher than at discharge (P<0.05), with no significant difference between groups (P>0.05). We found no significant difference in the functional outcome in elderly patients with intertrochanteric fractures treated with InterTan and PFNA-II. Early fracture healing and reduced complication rate however has been noted with InterTan.

Study of outcomes of suprapatellar approach for tibia intramedullary nailing in patients coming to rural medical college, Loni

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tibia shaft fractures are most common lower limb long bone fractures. In approximately 80% of patients, tibia fracture occurs in diaphysis region. The procedure of intramedullary interlocking nailing is done by positioning the injured extremity at minimum of 90 degree of flexion in the knee joint to achieve optimal exposure of correct entry point. The tension of quadriceps tendon causes a typical apex anterior angulation of proximal fragment. Supra patellar nailing is done with knee in semi extended position, reducing the anterior angulation. The aim of this study is to study outcomes of supra patellar access of intramedullary nailing for tibia fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It is a descriptive longitudinal study which was carried out from October 2019 to September 2021 in Dr. Balasaheb Vikhe Patil rural medical college, Loni, Ahmednagar. In this study 60 case of closed shaft tibia fractures were treated by supra-patellar nailing technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study we selected, 60 patients with tibia fracture admitting in our institute. All patients underwent operative procedure in the form of intramedullary interlocking tibia nail which was done with suprapatellar approach. Out of all the 60 patients treated with suprapatellar approach, excellent results with good range of movements with excellent lower extremity functional scale score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Supra-patellar approach was found to provide excellent outcome for proximal 1/3&lt;sup&gt;rd&lt;/sup&gt; of tibia fracture.&lt;/p&gt;

Derotational Plate Augmentation with Retention of Intramedullary Interlocking Nail in Resistant Nonunion at Distal Femur Shaft

Background: Non-union in femur shaft after satisfactory treatment with closed intramedullary interlocking nail is not very common. This nonunion is always a challenging condition for surgeon. These nonunion are usually treated by dynamization, close exchange nail with larger diameter, retention of nail and onlay bone graft, removal of nail and fixed with plates and bone graft, removal of nail and application of cast brace and sometimes removal of nail and applications of external fixators. But no treatment is’ gold standard’ the rotational instability is blamed to be one of the most common reason of nonunion. Aim: To control rotational instability, we did plate augmentation with or without bone grafts without removing the nail to treat this nonunion. Methods: Total patients were 16. Proximal and distal interlocking screws were removed, nonunion site was opened, compression at nonunion site was done, and broad DCP was applied as de rotation plate with or without bone grating. We excluded fracture less than one-year duration and fracture with infective nonunion. Results: In 12 patients bone grafting was done where there was less callus or there was suspicion of atrophic non-union. We got union in all patients. 6.25 months were average time of union. 13 months was average time between the primary and secondary surgery. 71 minutes was means surgical time. Complications or implant failure were not noted. 0.9 cm was average residual limb shortening and 115 degrees was average range of motion at knee joint. Conclusion: Nonunion in distal femur shaft fracture with interlocking nail in situ is reliable and effective procedure Keywords: Distal femur, plate, External fixator. Bone grafting

A Comparative Study of Treatment With External Fixator Versus Antibiotic Coated Intramedullary Nail in Infected Non-union Long Bones.

Infected non-union of bones shows problems in providing stability and controlling the infection. The treatment comprises debridement with or without the use of antibiotic cement and achieving stability by either external or internal fixation with or without bone grafting. The use of antibiotic-impregnated cement-coated intramedullary nailing gives stability and treats the infection, thereby permitting early mobilization. External fixation is a definitive mode of fracture stabilization indicated in cases of infected non-unions of the humerus, tibia, and juxta-articular bone. The present study was conducted to compare the results of management of infected non-union long bones treated with an external fixator (Ilizarov and Limb Reconstruction System (LRS)) and vancomycin-coated intramedullary nail. The presentprospective study was conducted on 40 study subjects aged >18 years, and were randomly divided using the alternative method into two groups. Group A: 20 Patients were treated with antibiotic-coated intramedullary interlocking nail (ACIIN). Group B: 20 patients were treated with the external fixator (LRS/Ilizarov). All patients were then evaluated post-operatively using laboratory investigations, and for any sign of inflammation or infection. Results were evaluated usingassociation for the study and application of methods of Ilizarov (ASAMI) scoring system. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA). It was observed that 80.0% of patients in Group A, and 70% of subjects in Group Bshowed bony union, revealing a statistically significant (p-value<0.05) difference. Infection control, limb length discrepancy, and deformity were also assessed in both groups. Bone and functional outcomes were assessed using the ASAMI score in both groups. In LRS/Ilizarov, it was observed that 55% of subjects had no infection, 15% showed loosening, and 30% had an infection. The ACIIN should not be used for bone defects more than 4 cm as it does not achieve stability and for these cases, procedures like external fixators (Ilizarov and LRS) should be used. Antibiotic-coated nail eliminated the complications of the external fixators like pin loosening, and pin infections and was technically less demanding. In our study, stiffness of adjacent joints was more in external fixators (LRS/Ilizarov) than ACIIN.

Role of fibula in healing of closed diaphyseal tibial fractures treated with intramedullary interlocking nail

Isolated tibial shaft fractures with intact fibula are a fairly common injury. Hospital records often fail to mention the intact fibula in such injuries. Many studies blame that with an intact fibula, tibiofibular length discrepancy develops resulting complications associated with the management of tibia fractures like delayed union, non-union, and malunion. A prospective study in 59 patients of tibial shaft fractures with 33 having fibula fracture (FF) and 26 patients with an intact fibula(IF) were treated by closed intramedullary interlocking nail between June 2019 to July 2020. Radiological follow up were at 6 weeks, 3 months, 6 months. The final functional evaluation was done with Johner and Wruh’s criteria at the end of 6 months.The mean duration of surgery in group IF was 106.62 minutes wherein group FF was 97.91 minutes The radiological union was early with a mean union rate of 19.09 weeks in group FF compared to group IF where the mean was 22.23 weeks. The percentage of nonunion was 3.85% in group IF. 4 patients had a deformity where the level of tibia fracture was lower 1/3 diaphyseal with fibula fracture at the same level. At the final follow up the functional score had no significance. The union of a tibial shaft fracture was slower in patients with an intact fibula compared to those with a fractured fibula. Although the intact fibula was more proven for the delayed union, non-union, it prevents malalignment.

Does nail size or difference between canal and nail diameter influence likelihood of union or time to union of femoral shaft fractures treated with intramedullary nailing? A retrospective cohort study

BackgroundThis study aims to determine whether nail size or the difference between canal and nail diameter (CN difference) affects the union rate and time of femoral shaft fracture treated with an interlocking intramedullary nail (IMN).MethodsThis was a retrospective review of 257 patients with femoral shaft fractures treated with IMN at a tertiary trauma medical center. All the IMN inserted were the same (Stryker T2 Femoral Nail). The patients were divided into groups based on nail size (10-, 11-, 12-, or 13-mm) and CN difference (< 1, 1–2, or > 2 mm), and union rate and time to union were compared.ResultsThe 10-, 11-, 12-, and 13-mm groups based on nail size had 113, 74, 54, and 16 patients, respectively. The overall union rate was 97% (257/265). No significant differences in union rate or time to union were observed among these 4 groups. The groups based on CN differences of < 1-, 1 to 2, and > 2 mm comprised 143, 79, and 35 patients, respectively. Again, no significant differences were noted in union rate or mean time to union among the groups.ConclusionsSimilar union rate and time to union were observed, regardless of nail size or CN difference. This finding indicates that most simple femoral shaft fractures can be treated with a standard, reamed 10-mm IMN. A larger nail insertion is unnecessary and presents more risks; comparatively, the use of a small nail with less reaming is simpler, requires shorter operative times, results in less blood loss, and is less expensive.

Influence of different fixation modes on biomechanical conduction of 3D printed prostheses for treating critical diaphyseal defects of lower limbs: A finite element study.

BackgroundApplying 3D printed prostheses to repair diaphyseal defects of lower limbs has been clinically conducted in orthopedics. However, there is still no unified reference standard for which the prosthesis design and fixation mode are more conducive to appropriate biomechanical conduction.MethodsWe built five different types of prosthesis designs and fixation modes, from Mode I to Mode V. Finite element analysis (FEA) was used to study and compare the mechanical environments of overall bone-prosthesis structure, and the maximum stress concentration were recorded. Additionally, by comparing the maximum von Mises stress of bone, intramedullary (IM) nail, screw, and prosthesis with their intrinsic yield strength, the risk of fixation failure was further clarified.ResultsIn the modes in which the prosthesis was fixed by an interlocking IM nail (Mode I and Mode IV), the stress mainly concentrated at the distal bone-prosthesis interface and the middle-distal region of nail. When a prosthesis with integrally printed IM nail and lateral wings was implanted (Mode II), the stress mainly concentrated at the bone-prosthesis junctional region. For cases with partially lateral defects, the prosthesis with integrally printed wings mainly played a role in reconstructing the structural integrity of bone, but had a weak role in sharing the stress conduction (Mode V). The maximum von Mises stress of both the proximal and distal tibia appeared in Mode III, which were 18.5 and 47.1 MPa. The maximum peak stress shared by the prosthesis, screws and IM nails appeared in Mode II, III and I, which were 51.8, 87.2, and 101.8 MPa, respectively. These peak stresses were all lower than the yield strength of the materials themselves. Thus, the bending and breakage of both bone and implants were unlikely to happen.ConclusionFor the application of 3D printed prostheses to repair diaphyseal defects, different fixation modes will lead to the change of biomechanical environment. Interlocking IM nail fixation is beneficial to uniform stress conduction, and conducive to new bone regeneration in the view of biomechanical point. All five modes we established have reliable biomechanical safety.

Functional and Radiological Outcomes with Intramedullary Interlocking Nailing of Tibial Shaft Fracture

Introduction: Tibia is the most common long bone involved in fracture during Road Traffic Accident (RTA) because of its subcutaneous location. Intramedullary nail fixation remains the treatment of choice for unstable and displaced tibial shaft fractures in the adult. The goals of surgical treatment are to achieve osseous union and to restore length, alignment, and rotation of the fractured tibia. Intramedullary nailing carries the advantage of minimal surgical dissection with appropriate preservation of blood supply to the fracture site. Materials and Methods: This is a prospective observational study conducted in the Department of Orthopedics, National Medical College and Teaching Hospital,Birgunj, Parsa, Nepal for the 1 year duration. Patients included in this study were above 16 years with Tibia shaft fracture with or without fibula fracture which includes Type I,II and IIIA of Gustilo-Anderson fracture. Patients with tibia shaft fracture were treated surgically by using intramedullary interlocking nail then follow up done in OPD at regular intervals during which radiographs was taken in appropriate views and diagnosis is established by functional and radiological means. Result: Out of 53 patients, 45 patients with Tibia shaft fracture are treated by closed intramedullary interlocking nailing in the National Medical College, Birgunj. Eight patients are lost during follow-up. In our study tibia shaft Fracture was more common in male (77.8%) than female which mostly involved 18-30 years of age group (62.2%) and most common cause was Road Traffic Accident (82.2%). Thirty cases (66.7%) had excellent and 10 cases (22.2%) had good healing and complication were seen in eight patients (17.7%). Conclusion: Closed interlocking tibia nailing allows earlier fracture union with less morbidity. Because of the high union rate and low infection rate, we consider closed interlocking nailing as the best mode of treatment for diaphyseal tibial fractures.

Functional and radiological outcomes of primary ring fixator versus antibiotic nail in open tibial diaphyseal fractures: A prospective study

Management of open fractures of tibia is still a matter of debate due to high incidence of infections. Traditionally external fixators have been advocated in managing open tibial fractures. Due to limited efficacy of systemic antibiotics, recently antibiotic coated intramedullary interlocking nails have been developed for the management of open tibia fractures. Therefore, we conducted this prospective randomized study to compare the functional and radiological outcomes of primary ring fixator versus antibiotic coated nail in open diaphyseal tibial fractures. The study included 32 patients with Gustilo-Anderson type II and type IIIA fractures of tibial diaphysis. Out of them 16 patients were managed with Ring External Fixator (Group I) and 16 were managed with OssiproÒ gentamicin intramedullary interlocking tibial nail (Group II). The radiological and functional outcomes were assessed at final follow-up according to and SMFA criteria. Statistical analysis of the data was performed using IBM SPSS statistics 2.0 software. Chi square test and independent student t-test were used and a P value <0.05 was considered statistically significant RESULTS: Union was achieved in 15 patients (93.8%) in group I and 13 patients (81.2%) in group II. Pin tract infection was seen in 6 patients (37.5%) in group I, whereas infection was present in 2 patients (12.5%) in group II. Bone results were excellent in 13 patients (81.3%), good in 2 patients (12.5%), poor in one patient (6.3%). In group II, bone results were excellent in 12 patients (75%), good in one patient (6.2%), poor in 3 patients (18.8%). At 1 year of final follow up, mean SMFA score was 24.41±5.87 in group I, whereas mean SMFA score was 23.703±8.02 in group II. Ring fixator as well as antibiotic coated tibial interlocking nail achieved comparable rates of union in the present study. Complication rates were similar in both the groups and the functional and radiological outcomes were comparable in both groups. Results of this study indicate that although ring fixation is an established option for management of open tibial fractures, antibiotic-coated intramedullary nail is also a reliable option in open Grade II and grade IIIA injuries. Level II.

Short term outcome of Gustilo Anderson open type 3A mid shaft tibia fractures using intramedullary interlocking nail and external fixator

Aim: The purpose of the present study is to assess the outcome of treating Gustilo Anderson open Type 3A mid shaft tibia fracture with intramedullary interlocking nail as well as external fixator. Methodology: In this prospective cohort study, adult patients (≥18 years-old) with Gustilo 3A open tibia shaft fractures treated by either intramedullary nail or external fixation (EF) were involved. This study was directed for a period of twelve months from March 2021 to February 2022. After registration, patients were followed-up at 2, 6, 10, 14, and 18 weeks postoperatively. At these appointments, degree of callus formation at fracture site and surgical problems (e.g. infection, limb length discrepancy, malalignment) were assessed. Results: Out of 50 patients registered in the study, 26 were treated by IM nail and 24 by external fixation. Twenty-four patients (92.3%) in the IM nail group and 6 (25%) in the external fixation group had callus formation by the 10th week. The mean times to callus formation in the IM nail group and external fixation group were 8.2±2.6 weeks and 14.7±3.3 weeks, individually (p=0.000). Two (7.7%) patients in the IM nail group and 3 (12.5%) in the external fixation group developed infection (p=0.661).

A prospective comparative study on osteosynthesis of distal tibial metaphyseal fractures with plating V/s intramedullary nailing

Background: Tibial fractures are the most common long bone fractures, while distal tibial fractures are even more complicated due to their proximity to the ankle and the close relationship with thin,Objectives: To assess and compare fractures' functional outcomes in Group A versus Group B. To assess the efficacy, advantages, and disadvantages of the treatment modalities and their complications. Materials and Methods: This is a comparative study done from October 2018 to March 2020 in the Department of Orthopaedics, Narayana Medical College, attached to Narayana general hospital, Nellore. In this study period total of 40 patients were taken for study as per inclusion criteria. The patients are randomized into two groups of 20 cases each. Group A treated with plating, and Group B was treated with intramedullary nailing. Results: In our study, the average duration for the radiological union in the intramedullary interlocking nail group was 20.1 ± 1.14 weeks and in the plating group, it was 24.1 ± 1.16 weeks. Thus, the union occurred significantly faster in the nailing group.3 patients from the plating group had delayed union. In this study, better ankle rom was noticed in the intramedullary interlocking nail group as compared to that of the distal tibia plating. Average dorsiflexion at the final follow-up was 12.8 degrees and 9.7 degrees in the intramedullary interlocking nail group and the distal tibia plating group.Conclusion: Intramedullary nailing has the advantages of shortened operating time, early weight-bearing decreased wound problems an early union of the fracture, decreased implant-related problems, and overall reduced morbidity.

Management of tibial shaft fractures with closed intra medullary interlocking nail among Indians.

It is of interest to document data on the well Reamed Intramedullary Nailing in Isolated Tibial Diaphyseal Fractures without Fibular Osteotomy among Indians. 120 patients with isolated tibial diaphyseal fractures were treated with IMIL nail (84 closed fractures, 16 type I open fractures, and 20 type II open fractures) were involved in this study. Research was carried out over a five-and-a-half-year period, from July 2013 to December 2018.According to Johner and Wruh's criteria, good functional findings were achieved in 70% of patients, better operational results in 15%, reasonable functional results in 5%, and poor functional results in 10% of cases after surgery. The percentage of union in the present analysis was 90%. The average time for union was 5 months, with 84 fractures healing before 5 months. Intramedullary Interlocking Nailing reduces length of stay in hospital, lowers the financial load, and promotes early return to work without the need for further surgical treatment such as partial fibular osteotomy.

Failure of Distal Femoral Locking Plate: Case Report

The Less Invasive Stabilization System (LISS) and titanium distal femoral locking compression plate (DF-LCP) was designed by the AO Group to combine the advantages of both interlocked intra-medullary nailing and biological plating techniques in one system. The stiffness of the construct is similar to a 95° condylar plate, dynamic condylar screw, or condylar buttress plate.&#x0D; We report a case of the DF-LCP and screw breakage. Early weight bearing and lack of callus consolidation precipitated failure of the implant. Non-weight bearing and early autologous bone grafting may be indicated in open distal femoral fractures.