Intramedullary Interlocking Nail Research Articles

A comparative non-randomized study between locking compression plate and intramedullary nail-in the management of distal tibial fractures

37.8% of tibia fractures occur in the distal tibial region. Due to the poor soft tissue envelope and precarious blood supply in the distal tibial region, there is a very high incidence of complications like non-union, delayed union and wound dehiscence, with increased secondary procedure rate especially after implant failure. Literature review shows that there is no optimal treatment (implant) for the management of these fractures. Nailing provides lesser chances of wound dehiscence but fails in providing adequate stability. Compression plating provides increased complication due to bulky implants causing wound dehiscence. Some of it is offset by locking compression plate. Hence we decided to study which implant would be ideal to treat these fractures with the best functional outcome and low incidence of complications.This was a prospective study of 72 patients who had unilateral, displaced fracture of distal tibia. 41 patients where managed with intra-medullary interlocking nailing and 31 patients were managed with locking compression plate osteosynthesis.The incidence of complications was found to be higher in nailing when compared to that of plating. 2 of patients developed non-union in nailing. 4 of patients developed implant failure and required secondary procedures in nailing group when compared to 1in LCP group which was attributable to poor biomechanical construct.25 age matched pairs of patients were selected from each group and were assessed with the help of modified Klemm and Borner scoring system. Based on this scoring system the results were analyzed for the study group. Patients in the locking compression plate osteosynthesis group yielded scores that were significantly higher than the nailing group and were found to be statistically significant with a p value of < 0.05. 76% had excellent results, 16% had good results and 4% had fair results in the plating group when compared to 24% excellent results, 40% good results, 20% fair results and 16% poor results in the nailing group.The results of current study show statistically advantageous for locking compression plate osteosynthesis when compared to close intramedullary interlocking nailing for distal third of tibia fractures. With decreased incidence of complications &secondary procedure in LCP group. Particularly in MIPPO with LCP group did much better as no secondary procedures were required. A multicentric study with large population is necessary to confirm this.

Functional outcome of antibiotic coated interlocking intramedullary nail in open tibia diaphyseal fracture

Introduction: Open fracture of tibia is one of the most common injuries seen in ortho pedic practice. The appropriate treatment of open tibial fractures is one of the priority problems in modern era of traumatology. New tibial titanium nail with a biodegradable gentamicin-loaded coating (UTNPR Otect, Synthes) was CE-certified in August 2005. The main goal of locally delivered antibiotics is to prevent bacterial colonization of the implant surface, there by reducing the risk of implant-related infections. Aims and Objectives: To assess functional and clinical outcome after intramedullary locking nail fixation of open fracture shaft of tibia.Method and Materials: 25 patients were selected of age group 18-65 yrs presenting with open fracture shaft tibia on the basis of OPD and emergency admissions in M.B. Govt Hospital Udaipur. Fractures were classified as per gustilo anderson classification. All patients were treated operatively with antibiotic coated intramedullary interlocking nail. and its outcomes were assested on the basis of Alho and Ekeland Criteria and complications were observed with follow up to 6 months clinically and radiological imaging.Result: In this study of 25 patients of age group 18yrs to 65yrs were treated with antibiotic coated Intramedullary inter locking nail, 80% cases were male and 20% cases were female. Mean time of union 16.5weeks.no implant related infection occurred only superficial infection found in two patients.Conclusion: the use of the antibiotic coated nail was good clinical and radiological outcome after 6 months. These prelimnary results support the use of antibiotic coated implants as a new potiential treatment option for prevention of infection in trauma patients.

Retrograde intramedullary interlocking nailing for supracondylar fractures of femur: A prospective study

Objectives: We assessed whether a Retrograde intramedullary interlocking nail has a good outcome in cases of supracondylar Femur fractures, with respect to the degree of knee flexion, early weight bearing and return to the pre-fracture state. Methods: We conducted a prospective study of 32 patients which presented with supracondylar femur fracture, and had undergone a closed reduction and internal fixation by Retrograde Femoral nail. Neer’s and Sander’s evaluation scoring system was used for evaluation. Results: Neer’s rating was use to evaluate the outcome, according to which there was good to excellent results in 68.74% cases. Conclusion: Supracondylar femur nail is an optimum tool for many supracondylar fractures of femur, but it requires attention to technique in order to prevent the complications.

Role of fibular fixation in static intramedullary interlocking nailing for distal third tibia and fibula fracture

Treatment of distal third tibia and fibula fractures remains a challenge classically being treated with standard plating, but intramedullary nailing has gained popularity. As there is a mismatch between the diameters of the nail and the medullary canal, with no nail-cortex contact, the nail may translate laterally along coronally placed locking screws and increased stress in placed on the locking holes to maintain fracture alignment after surgery. Various techniques have been recommended to improve nailing in these fractures including fibular plating (distal third fractures), temporary unicortical plating, different nail design with different proximal bends (proximal third fractures) and blocking screws (poller screws). The aim of the study is to evaluate the clinical use of fibular plating as a supplement to stability in addition to intramedullary nailing in distal both bone fractures of leg. Methods: A prospective study of 20 cases of distal third tibia fibula fractures treated with statically locked intra medullary nailing with supplementary fibular plating between March 2017 and September 2018 at RIMS, Ranchi. All the fractures were followed through till union of fracture with clinical and radiological examination at intervals of 4 to 6 weeks. On follow up axial alignment was assessed and functional analysis was quantified using Karlstorm – Olerud score. Complications were divided into those which were related to fibular plate and those which were not. Results: All the fractures eventually united in a mean period of 12.8 weeks. Karlstrom-Olerud score was excellent in 12 fractures (60%), good in 5 patients (25%) and fair in 2 patients (10%) and poor in 1 patient (5%).The alignment was maintained in coronal plane till union with the mean remaining the same i.e 1.6 degrees. The mean sagital plane alignment at the time of union was 0.4 degrees, the loss of alignment was not statistically significant. The fibular plate related complications were encountered in two cases where we had skin necrosis and deep infection, which needed aggressive antibiotic therapy and those patients were also given cast support for twelve weeks. Conclusion: Fibular plating, when supplemented the intramedullary nailing of distal third tibia fibula fractures, were effective in achieving the fracture alignment especially in fresh fractures, Improves not only angular stability but also rotational stability, Maintained the fracture alignment till union and prevents loss of initial reduction.

Study of interlocking nail in shaft tibia fracture

Introduction: The tibia is the most commonly fractured long bone in the body and understanding of the mode of injury, fracture pattern is necessary to decide an operative management. Tibia shaft fractures are commonly managed by interlocking nail. This study is to assess the surgical management and assess the functional outcome of tibia shaft fractures.Materials and Method: The study consist of 50 patients with tibia shaft fracture treated with tibia interlocking nail. Clinical outcome and function results were evaluated by Alho & Ekland’s criteria.Result: In this study, we have operated a total 50 cases with tibia interlocking nail in tibial shaft fractures. The average union time was 17.68 weeks. The study yielded about 82 % of excellent result.Conclusion: The present study shows that closed fractures of the tibia shaft treated with interlocking intramedullary tibia nailing involves minimal surgical trauma and negligible blood loss. It provides the advantages of early ambulation, lower rates of infection and non-union. A significant advantage of interlocking nail in addition to early joint mobilisation, is early weight bearing which allows earlier return to work. Hence the study concluded that closed interlocking intramedullary nail is the treatment of choice in closed tibia shaft fracture.

A study of result of closed interlocking intramedullary nailing in femur shaft fracture

A study of result of closed interlocking intramedullary nailing in femur shaft fracture

Extra-articular distal tibial fractures, is interlocking nailing an option? A prospective study of 147 cases

PurposeDistal tibia fractures comprise about 7%–10% of lower extremity trauma. Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures. Plating is fraught with complications of wound dehiscence and infection. There are limited studies which document outcomes in such cases using intramedullary interlocking nail. We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing. MethodsThis is a prospective study conducted in a tertiary care orthopaedic hospital in southern India. There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study. Only cases with fresh injury (less than 1 week), fracture below the isthmus, closed and open Gustilo Anderson type 1 and 2 fractures were included in the study. Patients were reviewed at 3, 6, 12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing, any complications, time to union and functional outcome. ResultsThere were 102 males and 45 females (male/female ratio is 2.3:1) with a mean age of 38.96 (range 23–65) years. According to AO classification, there were 78 cases (53.06%) of 43-A1, 39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%. The fracture united in all the patients at an average of 18 weeks (range 16–22 weeks), none of the patient in our series had a delayed or non-union. Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°). The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score, there were no cases with poor score. ConclusionIntramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome. Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.

Application of self-made fine-tuning device in distal locking process of femoral interlocking intramedullary nail

To evaluate the curative efficacy of self-made fine-tuning setting in the process of femoral distal implantation of intramedullary nail. From October 2015 to October 2017, 66 cases of femoral shaft fracture were treated with anterograde interlocking intramedullary nail including 45 males and 21 females with a mean age of(37.21±11.18) years old. Among them, 36 cases were treated with the manufacture's aiming device and self-made fine-tuning setting (research group), other 30 cases were treated with the manufacture's aiming device(control group). The mean operation time, the times of C-arm scan in surgery, the post-operation complications and the fracture union were observed and compared in two groups. Sixty-two cases acquired 8 to 15 months with a mean time of 12.4 months follow-up visit. The post-operation complications and the fracture union between the two groups had no significant difference(P>0.05), the mean operation time and the times of C-arm scan in surgery had statistically significant difference(P<0.05). Self-made fine-tuning setting in the process of femoral interblocking intramedullary nail could shorten operation time and reduce the the times of C-arm scan.

Perbandingan Tingkat Penyembuhan Tulang Antara Isolated Tibial Diaphyseal Fracture, Both Tibial dan Fibula Diaphyseal Fracture Setelah Terapi Interlocking Intramedullary Solid Nail

ABSTRACTOne of the fixation method is interlocking intramedullary solid nail that can enhance the callus formation in tibial diaphyseal fracture through the secondary healing. The research aimed to compare the rate of bone healing between isolated tibial diaphyseal fracture and both diaphyseal tibial and fibular fracture after therapy solid interlocking intramedullary nail. This research was conducted by comparing the results of the cure rate among patients with isolated fractures of the tibia and fracture of the tibia with fractures of the fibula during November 2007 to December 2015. The first group, comprising 29 patients and the second group comprised 47 patients. All patients had solid action intramedullary nail. The evaluation was done 30 weeks post-surgery, to assess the Union Rate using Radiographic Union Score for tibial Fractures (RUST). Data were analyzed using non-parametric test of Mann-Whitney test for comparing the union rate between the two groups. The results showed that 27 of 29 patients with isolated tibial fractures had RUST score &gt; 7 and 2 patients with RUST score &lt; 7. Meanwhile, 44 patients out of 47 patients with both diaphyseal tibial and fibular fracture, having RUST score &gt; 7 and 3 patients with a score &lt; 7. Keywords: Interlocking intramedullary solid nail, Isolated Tibial Diaphyseal Fracture Radiographic Union Score, Unionrate

A study of functional outcome of femoral diaphyseal fractures by closed reduction and internal fixation using intramedullary interlocking nail in adults

IntroductionFemur is considered to be the strongest, largest and heaviest tubular bone comprising the skeletal system. Femur is responsible to bear the load in the lower extremity region. Femoral shaft fractures are one of the most commonly encountered injuries in an orthopaedic setup and are responsible for a huge burden of morbidity and mortality in patients. The severity of injury depends on the level of impact causing the injury which eventually is dependent on the age of patients. Aims and objectives of the study1.To evaluate the result of intramedullary interlocking nailing in the treatment of fractures of the shaft of femur2.To study the complications of locked intramedullary nailing of femoral shaft fractures3.Early mobilization to prevent fracture disease and enhance fracture healingResultsThe present study was planned to study surgical management of fracture shaft of femur with intramedullary interlock nail. For this purpose, a total of 20 patients falling in sampling frame were enrolled in the study. Table 1 shows the age distribution of cases enrolled in the study:DiscussionManagement of diaphyseal femur fractures has seen a fundamental shift from non-surgical to surgical management and within surgical management from external to internal fixation using intramedullary nailing, plates and screws. Today, intramedullary nailing has become a standard for management of diaphyseal femur fractures and has been reported to be useful for all the age groups and in unilateral as well as bilateral fractures.ConclusionThe surgical management of fracture diaphysis of femur has taken a march ahead with the advent of interlocking nail, which has widened the range of indications for medullary osteosynthesis. The transverse interlocking bolts control the length, rotational alignment of the limbs.

Comparative study of clinical outcome in the management of open vs closed tibial shaft fractures with intramedullary interlocking nailing technique

Introduction: Incidence of tibial diaphyseal fractures (26 per 100,000 persons per year in an average population) is the highest among long bone fractures. The present study has been taken to review the results of diaphyseal fractures of tibia, both closed & open, treated with IMLIN. Result: Tibial fractures were more commonly seen in males, 30-55 years constituted majority of thr fractures, dominant side was commonly involved. Conclusion: Closed Tibial fractures have better union rates & lesser the complications when compared to open tibial fractures which are treated with intramedullary interlocking technique.

Result of closed interlocking intramedullary nail in tibial shaft fracture

Result of closed interlocking intramedullary nail in tibial shaft fracture

融合式股骨近端交锁髓内钉治疗老年股骨近端骨折的临床研究

融合式股骨近端交锁髓内钉治疗老年股骨近端骨折的临床研究

Open reduction and internal fixation of intramedullary interlocking nail of tibia with fibula plating in lower 1/3rd tibia fibula fracture

Open reduction and internal fixation of intramedullary interlocking nail of tibia with fibula plating in lower 1/3rd tibia fibula fracture

Reliability of Radiographic Union Scale for Tibial Fractures (RUST) when used in determining Bone Healing in Femoral Fractures treated with Interlocked Intramedullary SIGN Nailing

Reliability of Radiographic Union Scale for Tibial Fractures (RUST) when used in determining Bone Healing in Femoral Fractures treated with Interlocked Intramedullary SIGN Nailing

Study of fracture shaft of Femur and its outcome treated with K- Nail in Manipal Teaching Hospital

Background: Intramedullary interlocking nail is commonly accepted standard treatment in fracture shaft of femur. Its cost, technique, necessity of fracture table and image intensifier make it difficult in using for such cases where facilities are not available. In developing countries like Nepal open Kuntscher nailing is still an option for treating fracture shaft of femur. Its results and outcomes are comparable to that of intramedullary interlocking nails.Aims and Objectives: This study was undertaken to evaluate the outcome of Kuntscher nailing in fracture shaft of femur with regards to operative duration, union, infection, limb-length, and range of motion of knee and hip joints.Materials and Methods: This retrospective study included seventy-six patients with fracture shaft of femur. This study was conducted for a period from December 2014 to December 2017. The study outcome was assessed in terms of operative time duration, union, infection, limb-length, and range of motion of knee and hip joints.Results: Seventy six patients with fracture shaft of femur with mean age of 32.36 years ranging from 15 to 65 years were included in the study. Operation duration ranges from 55 to 95 minutes, with average healing time of 17 weeks. Wound infection was seen in 5% cases, with not much limb length discrepancy and knee range of motion 100 -135 degree achieved by the end of 9 months in more than 95 % cases. Conclusion: Kuntscher nail is still a relevant option for treatment of fracture shaft of femur with good functional and clinical outcome.Asian Journal of Medical Sciences Vol.9(6) 2018 90-92

Individualized treatment of aseptic femoral nonunion after intramedullary nailing

Objective To evaluate individualized treatment of aseptic femoral nonunion after interlocking intramedullary nailing based on the morphology of each nonunion and nailing stability in each specific patient. Methods This study reviewed 108 patients who had been treated and followed up for more than one year for aseptic femoral nonunion following interlocking intramedullary nailing between February 2012 and February 2016. They were 89 men and 19 women, aged from 23 to 65 years (average, 45.5 years). The classification and corresponding treatments were as follows: Type Ⅰ (15 cases), characterized by callus (+)/bone defect (-) and nailing stability (+), were treated by augmentation plating; Type Ⅱ (43 cases), characterized by callus (+)/bone defect (-) and nailing stability (-), were treated by exchange for larger nailing/larger nailing with poller screws; Type Ⅲ (23 cases), characterized by callus (-)/bone defect (+) and stability of nailing (+), were treated by augmentation plating with bone grafting; Type IV (27 cases), characterized by callus (-)/bone defect (+) and stability of nailing(-), were treated by double plating and bone grafting. The healing of bone nonunion, complications and assessments for bone and function were followed up. Results All these patients received follow-up for 12 to 14 months (average, 12.5 months). All the nonunions were healed with no postoperative complications. Bone healing was achieved after 4 to 8 months (average, 5.5 months). The good to excellent rates for bone and function were 100%. Conclusion To achieve better surgical outcomes, the treatment of aseptic femoral nonunion after interlocking intramedullary nailing should be individualized according to the morphology of each nonunion and nailing stability in each specific patient. Key words: Femur; Fractures, ununited; Bone nails

Surgical management of fracture shaft of femur with intramedullary interlocking nail

Background: Diaphyseal femur fractures, most often result from high-energy trauma, and must have high index of suspicion for complications. Currently surgery is indicated for most femur fractures because of high rate of union, low rate of complications and advantage of early stabilization which decreases the morbidity and mortality rate in patients. While the main stay of the treatment has been reamed interlocking intramedullary nailing. Methods: We studied a total of 40 patients (32(80%) male, 8(20%) Female) of fracture shaft of femur admitted in the Orthopaedic Department of Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga treated with reamed femur intramedullary interlocking nailing. The common age group was ranging from 20 to 71 yrs (mean age - 36 yrs). 26(65%) patients had closed fracture, 10(25%) had Gustillo Anderson Grade I compound and 4(10%) had Grade II compound fracture. In 22(55%) patients fracture was at M/3rd, in 10 (25%) patients it was at L/3rd level and in 8(20%) patients it was at U/3rd level. 4(10%) patients were operated by open interlocking nail and other 36(90%) by closed technique using C-arm. Average Injury to surgery interval was 6.20 days.Results: Mean time for union was more in patients treated by open procedure (20 weeks) as compared to closed technique (18.35 weeks). 2 patients developed superficial infection, which healed completely and 2 patients developed deep infection with non-union. In our series of 40 patients, 24(60%) patients had excellent result, 12(30%) patients had good result, 2(5%) patients had fair result and 2 (5%) patients had poor result. Conclusions: Interlocking intramedullary nailing is a very effective and successful method of definitive primary treatment, in most types of fractures of the shaft of the femur. It provides strong fixation, rotational stability and earliest return to functional status, as the rate of healing is good with this method.

Is dynamic compression plate better than interlocking nail in treatment of adult fracture shaft of Humerus? - A prospective comparative study

Introduction: In past all fracture shaft humerus due to low velocity trauma was managed conservatively. However, in recent years the increasing high-speed motor vehicular accidents has posed a greater challenge on treating surgeon for managing varied patterns of those fractures. The advances in implants, operative techniques and expectations of the patients has led to change in the perspective of management towards more of surgical treatment. Material and methods: For closed fracture shaft humerus two main modalities of fixation are available. 1. ORIF using DC plate, 2. CRIF using intramedullary interlocking nails. This study intends to study and compare the advantages and disadvantages of both modalities. Two groups of 15 patients each having fracture shaft of humerus were managed by above two methods from July 2015 – Dec 2017. The results were assessed on following points: primary union rate, time needed for union, incidence of complications and functional scoring was done using Stewart and Hundley criteria. Results: There were 9 (60%) excellent results in the DCP group and 4 (27%) in interlocking group. 5(33%) good results in the DCP group and 4(27%) in interlocking group. 5 (33%) fair results in interlocking group and none in DCP group. 2(13%) under interlocking group and 1(7%) under plating group got poor. The complications were more in the interlocking group with most of them pertaining to poor shoulder function with pain. Though both modalities of treatment offer good union, the rate of secondary complication were more with interlocking nail, which makes dynamic compression plating a more favorable option. Conclusion: Open reduction and internal fixation with a DCP remains a better treatment option as against intramedullary interlocking nails for fractures of the shaft humerus.

The study of distal ¼ diaphyseal extra articular fractures of humerus treated with antegrade intramedullary interlocking nailing

Humerus fractures are one of the most commonly encountered Orthopaedic injuries after fall and road traffic accidents. In general, humerus diaphysis fractures accounts for 1 to 2 % of all fractures occurring in the human body and 15% of all the fractures of humerus. In the operative management, there has been a long-term debate between nailing and plating. The purpose of our study is to evaluate the clinical outcome of antegrade intramedullary closed interlocking nailing in distal ¼ humeral diaphyseal fractures. A total of 42 patients with acute distal ¼ humeral diaphyseal fracture were selected on the basis of anatomical location and, managed with closed reduction and antegrade intramedullary interlocking nailing over the period of 13 years (January 2003 - July 2016). They were evaluated using AMERICAN Shoulder and Elbow Surgeons’ Score. All 42 patients’ fracture got united with primary fracture healing in mean time of clinical union of 13.61 weeks (range 10 to 18 weeks). Amongst all, two patients suffered from shoulder stiffness post operatively. None of the patient suffered from iatrogenic neurovascular injury. For patients having distal ¼ humeral diaphyseal fracture closed antegrade intramedullary nailing is dependable solution for achieving fracture stabilization and ultimate healing with less amount of blood loss, complications and less operating time. It is minimally invasive surgery and has minimum morbidity if performed using basic principles.