Intramedullary Interlocking Nail Research Articles

Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture.

To determine the outcome of intramedullary interlocking surgical implant generation network (SIGN) nail in diaphyseal tibial fractures in terms of union and failure of implant (breakage of nail or interlocking screws). Case series. Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Forty one (88%) patients had united fracture within 6 months, 5 (10%) patients had delayed union while 4 (8%) patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function.

OUTCOME OF SHORTENED INTERLOCKING NAIL IN DISTAL TIBIAL FRACTURES

This study was undertaken to investigate the outcome of shortened interlocking nail in distal tibial fractures.Thirty five cases of distal tibial diaphyseal fractures were treated with shortened nail. All these cases were followed up for a peroid of nine months and data regarding, infection, union, delayed union, nonunion and malunion was recorded. In our study union occured in all patients(100%) mean union time was 4.5 months (range 3-6 months),none of the patient had nonunion after course of follow up. No patient developed any sort of infection. Malunion was recorded in2(5.7%) patients. Because of the high rate of union and low rate of infection and malunion, We consider shortened intramedullary interlocking nail as the best mode of treatment for distal tibial fractures

PF12 Limb lenghthening with intramedullary Skeletal Kinetic Distractor (iSKD)

Introduction: Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice. These fractures are often the result of high-energy trauma and may be associatedwithmultiple system injuries. Intramedullary interlocking nailing is a common used method for the treatment of femoral shaft fractures. Bending of an intramedullary nail due to secondary high-energy trauma is a rare condition. Nevertheless, bending intramedullary nail without a major trauma is a very rare condition in the literature. Materials andMethods:We report bending of an intramedullary nail which had been used in the treatment of a prior femoral diaphyseal fracture in a 19-year-old male patient who was admitted on foot to our outpatient clinic for a deformity in his right thigh. There was not any major trauma history. Results: The patient was operated 9 months ago because of femoral shaft fracture and he has not come to the last follow-up. In the plain radiographies bent femoral intramedullary nail and nonunion with refracture was detected. The bent nail was corrected partially by applying external force under anesthesia and then removed by standard extraction technique and osteosynthesis was performed with a thicker intramedullary locking nail. Conclusion: Bending of an intramedullary nail withoutmajor trauma like in this patient is very rare. Most of the cases in the literature occur due to high-energy trauma, and different extraction methods are described in the literature. Applying external force carefully may help to correct bent nail and this may facilitate the removal of nail.

PF11 A rare case of bent femoral intramedullary nail without major trauma

Introduction: Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice. These fractures are often the result of high-energy trauma and may be associatedwithmultiple system injuries. Intramedullary interlocking nailing is a common used method for the treatment of femoral shaft fractures. Bending of an intramedullary nail due to secondary high-energy trauma is a rare condition. Nevertheless, bending intramedullary nail without a major trauma is a very rare condition in the literature. Materials andMethods:We report bending of an intramedullary nail which had been used in the treatment of a prior femoral diaphyseal fracture in a 19-year-old male patient who was admitted on foot to our outpatient clinic for a deformity in his right thigh. There was not any major trauma history. Results: The patient was operated 9 months ago because of femoral shaft fracture and he has not come to the last follow-up. In the plain radiographies bent femoral intramedullary nail and nonunion with refracture was detected. The bent nail was corrected partially by applying external force under anesthesia and then removed by standard extraction technique and osteosynthesis was performed with a thicker intramedullary locking nail. Conclusion: Bending of an intramedullary nail withoutmajor trauma like in this patient is very rare. Most of the cases in the literature occur due to high-energy trauma, and different extraction methods are described in the literature. Applying external force carefully may help to correct bent nail and this may facilitate the removal of nail.

Sa2.8 Interlocking intramedullary nail with reaming of intramedullary canal in treatment of femur pseudarthrosis

Sa2.8 Interlocking intramedullary nail with reaming of intramedullary canal in treatment of femur pseudarthrosis

Sonographically Assisted Percutaneous Removal of Screws in Dynamization of the Interlocking Intramedullary Nail

Dynamization is a method of removing the interlocking screw(s) farthest from the fracture site for improving healing in femoral and tibial fractures that show delayed healing after static interlocking nailing. We describe a simple sonographically assisted technique for percutaneous dynamization of deep-seated impalpable screws. Between March 2001 and March 2005, 20 dynamization procedures were completed using the developed technique under the diagnosis of delayed healing or a nonunion at a mean of 4.8 months after index surgery. After adequately positioning the involved leg, the transducer was placed on the area of the inlet of the screw. Longitudinal and transverse sonographically scanned sections, used to show the head of the screw, were then marked on the skin where the two sections intersected. After this precise marking, a small incision on the mark allowed insertion of the screwdriver and easy percutaneous removal of the screw using only local anesthesia for pain control. We removed 31 screws: 9 proximal femoral screws, 20 distal femoral screws, and 2 proximal tibial screws. The mean depth of the screws was 3.4 cm. The mean operation times were 1.6 minutes for the sonographic examination and 3.5 minutes for removal of one screw. No infections or morbidities were caused by the procedure. Sonography is an effective tool for localizing a locked screw and facilitates percutaneous removal of screws under only local anesthesia for dynamization. This method needs no special instruments and reduces the time needed for dissecting the tissue and locating the screw.

PF13 Interlocking intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults

PF13 Interlocking intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults

A prospective study of biological fixation with either plate or interlocking nail on the mean duration of union in diaphyseal fractures of tibia

Objective: To study the results of Biological plating or Interlocking nail for the closed diaphyseal fracture of the tibia in Department of Orthopedics, KLE University's, Dr. Prabhakar Kore Hospital and Medical Research Center, Belgaum. The aim of this study was the evaluation of the results of biological plating or interlocking nail for closed diaphyseal fractures of the tibia. Materials and Methods: The study included 30 patients. All the patients underwent a comprehensive orthopedic examination and work-up was done to diagnose and classify tibial fractures. The treatment modalities were suggested accordingly. Results: Intramedullary nailing should be the method of choice for treating the closed type of tibial shaft fractures. Biological plating should be considered as an alternative in intramedullary interlocking nail in specific indications. Conclusion: Comprehensive orthopedic examination with detailed study of fracture pattern and type of fracture help to evaluate the different modalities of treatment.

Comparative study between reamed versus unreamed interlocking intramedullary nailing in compound fractures of shaft tibia

Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA) by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.

Treatment of infected non union tibia: A novel technique - lengthening using limb reconstruction system over intramedullary nail

Background: To assess combination of an intramedullary interlocking (IMIL) nail with limb reconstruction system (LRS) in cases of infected nonunion tibia and to show influence of nail in predicting good outcome. Materials and Methods: From 2009 to 2011, records of 20 patients (17 men and three women) aged 18 to 65 years (mean, 38.4 years) with infected nonunion of the tibia treated with the LRS over IMIL Nail technique were prospectively reviewed. According to Jain et al., patients were classified into five cases of A1, five cases of type A2, seven cases of type B1, and three cases of type B2. All cases underwent LRS and IMIL. Mean amount of target lengthening was 54.65 mm. The mean follow-up was 14 months. Results: Mean amount of tibia lengthening was 51.70 mm. Leg length equalization was achieved in 19 cases (±5). According to modified scoring by Paley et al., 12 patients had excellent results, three patients had good, four patients had fair outcome, and one patient had poor outcome. Mean distraction index was 0.97. Mean maturation index was 2.43. Mean consolidation index was 3.47. Mean healing index was 1.40. One case had proximal locking screw failure. One case developed pre mature consolidation as distraction was started at delayed period due to non-compliance. Two cases developed decreased dorsi flexion of ankle. Two cases required flap surgeries for cover of bone. One case had pin breakage, which had to be exchanged. One case developed re-infection. Conclusion: The advantages of this technique include complete eradication of infective foci, reduced risk of deformity during lengthening, decrease risk of fractures post external fixator removal and reduction of time required for external fixator use thus decreasing healing index: Number of days of external fixation required per centimetre of lengthening.

Management of Chronic Osteomyelitis of Femur with Interlocking Intramedullary Nail in a Young Man: A Case Report

Chronic osteomyelitis is relatively unusual complication of intramedullary nail fixation of long bone fractures. Depending on the extent of infection, timing of diagnosis and progress of fracture healing, different treatment options have been developed. There is no hard and fast rule for the treatment of chronic osteomyelitis related to implant. Still now it is a big challenge for orthopaedic surgeons to handle such cases. Some options are very costly and time consuming. We are reporting here such a case of chronic osteomyelitis of femur fracture fixed with interlocking nail in a 23 year young man. His fracture was a closed one. Appropriate therapy for chronic osteomyelitis complicating a fracture is based on a multimodality approach even if there is no set algorithm to take in charge the two central problems related to it namely eradication of infection and fracture union. The surgical techniques and choice of fracture fixation determined according to age, weight, profession, intellectual status of patient and the expertise available. Clinical signs and investigation should alert the surgeon to the possibility of an underlying infection and appropriate measures should take quickly. It is important not to underestimate local skin irritation or signs of inflammation.DOI: http://dx.doi.org/10.3329/jsf.v11i1.19397

Delayed Pseudoaneurysm of the Femoral Artery after Intramedullary Nailing of a Femur Shaft Fracture

Interlocked intramedullary nailing is widely accepted for treatment of closed femoral shaft fractures. An interlocking screw is inserted percutaneously, and especially the distal screw is inserted without use of a guide. Vascular complications associated with an interlocking screw in intramedullary nailing are rare. No case of delayed pseudoaneurysm caused by a distal interlocking screw has yet been reported in Korea. We present two cases of delayed pseudoaneurysm caused by a distal interlocking screw several months after intramedullary nailing.

Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures

275 Copyright c 2013 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received January 18, 2013 Revised (1st) May 9, 2013, (2nd) July 25, 2013 Accepted August 7, 2013 Address reprint requests to: Jun-Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea Tel: 82-62-220-3147ᆞFax: 82-62-226-3379 E-mail: leejy88@chosun.ac.kr 경골 분절 골절에서 교합성 골수강 내 금속정 내고정술 후 결과 및 골유합에 영향을 미치는 인자 분석

Comparative study of operative treatment of mid shaft fracture of humerus by locking plate versus intramedullary interlocking nail

<b>Background:</b> Treatment of humeral shaft fractures with intramedullary nailing compared with dynamic compression plating leads to comparable results. No single treatment option is superior in all circumstances for a particular fracture and each case has to be individualized <b>. Objectives:</b> Comparative assessment of results of plating and Intramedullary Nailing in a rural set up so that proper management techniques can be provided for better functional outcome and minimum complications. <b>Materials and Methods:</b> This prospective study was conducted over a period of three years on sixty patients with closed acute humeral shaft fracture requiring operative interventions. <b>Results:</b> Forty percent of cases were in the age group 31-40 years with males outnumbering females. Motor vehicle accidents (63.3%) were most frequent cause. Right humerus was more frequently (66.6%) involved. Maximum patients (40%) were operated within 4-6 days after injury. Out of 30 patients of plate group complications were: Infection-6.6%; delayed union-13.3%; shoulder movement restriction-13.3%; elbow movement restriction-6.6%. Out of 30 patients of nail group complications were: Splintering of fracture end-6.6%; infection-6.6%; delayed union-26.6%; shoulder movement restriction-13.3%; elbow movement restriction-6.6%; shoulder pain-46.6%. Maximum number of fractures (73.3% in plating group and 60% in nailing group) clinically united in the interval of 11-13 weeks. Maximum number of patients had radiological union in period of 12-16 weeks (73.3% plate group and 66.6% nail group). There was no significant difference between the two groups. On functional assessment, excellent results were obtained in 22 patients (73.3%) in locking plate group and 18 patients (60%) in locking nail group. <b>Conclusion:</b> For patients requiring surgical treatment of mid shaft humeral fractures, locking plating and interlocking intramedullary nailing both provide statistically comparable results but a higher rate of excellent and good results and a tendency for earlier union was seen with locking plating group in the present series.

Primary Nailing in the Open Fractures of the Tibia-Is it worth?

Context (Background): The tibial shaft is one of the most common sites of open fractures. The specific methods of skeletal stabilization and soft tissue treatment of open fractures continue to be topics of debate in the orthopaedic traumatology. To evaluate the results of the intramedullary nailing in the open fractures of the tibia, especially in the Indian scenario. An observational, descriptive study which was done at a tertiary care hospital from 2006 to 2010. A prospective study was done on thirty cases which had sustained open fractures of t/hable Gustilo and Anderson grades I, II and III, who were operated for primary intramedullary interlocking nail fixation after thorough debridement and closure of their wounds with suturing, lateral skin release, split thickness skin grafting and muscle pedicle flap, where ever necessary. All the patients were followed up for a minimum of two years. Descriptive statistics and Fisher's Exact test were used. Of the total thirty cases, ten were of grade I, seven were of grade II, three were of grade IIIA, seven were of grade IIIB and three were of grade IIIC. Dynamization was done in nine cases. The average time to union was 16.0 weeks in the grade I cases, it was 18.3 weeks in the grade II cases, it was 23.6 weeks in the grade III A cases, it was 28.4 weeks in the grade III B cases and it was 32 weeks in the grade III C cases. The mean time to union was 20.7 weeks. Infection occurred in 3 cases. Delayed unions were observed in 4 cases. A non union occurred in 1 case of type IIIC. A mal union was observed in 1 case of type IIIB. 1 case of grade IIIC had the compartmental syndrome. No case had any implant failure (nail / screw breakage), or deep vein thrombosis. We conclude that the unreamed intramedullary nailing in cases of open fractures of the tibia, with an early soft tissue coverage, results in a faster soft tissue and bony healing, an easier soft tissue coverage, a better biomechanical stability and early rehabilitation and infection rates as comparable to those which are seen with other methods.

Comparative clinical study on interlocking intramedullary nails and locking plate fixation for humeral shaft fracture

Objective To analyze and compare the clinical efficacy difference of interlocking intramedullary nails and locking plate fixation of humeral shaft fracture.Methods From February 2008 to July 2011,80 humeral shaft fracture patients were chosen in our hospital,randomly divided into control group and observation group,40 patients of control group were given the treatment of cross-locking intramedullary nail fixation,40 patients of observation group were treated with locking plate fixation,then we analyzed and compared the differences of the two groups about functional recovery and adverse effects.Results The excellent and good rate of control group was 92.5％; the functional recovery excellent rate of observation group was 85.0％,and the occurrence of adverse reactions in control group was significantly better than that of the observation group (P＜0.05).Conclusion The interlocking intramedullary nail fixation is not only conducive to the function of the patients' recovery,but also has good safety,it is an ideal humeral shaft fractures within fixed treatment. Key words: Humeral shaft fracture; Interlocking intramedullary nail; Locking plate; Fixation

L-F1.4 Complications after interlocked intramedullary nailing of the humeral shaft fractures

L-F1.4 Complications after interlocked intramedullary nailing of the humeral shaft fractures

Results of treatment of patients with fractures of low bones of their extremities in cases of multiple injuries by means of the method of blocking intramedullary osteosynthesis

On the basis of experience of treatment of 52 patients with fractures of bones of the lower extremities with polytrauma by the method of interlocking intramedullary nailing (IIN), results of restoration of an extremity in the early and late postoperative periods were studied. Treatment of patients with polytrauma by IIN and osteosynthesis with superimposed plates was comparatively analysed. It was found out that stable-functional osteosynthesis of the femoral and tibial bones by means of mini-invasive technologies with use of interlocking intramedullary nails was the method of choice for treating this group of casualties.

Biomechanical evaluation of various fixation methods for proximal extra-articular tibial fractures

ObjectiveProximal tibial fractures are a challenging clinical problem. The treatment protocols for these fractures include a dynamic compression plate (DCP), a locking compression plate (LCP), interlocking intramedullary nailing (IMN), and external fixation (Ex-Fix). However, the optimal fixation method for proximal tibial fractures remains controversial. The purpose of this study was to investigate the biomechanical properties of these four fixation instruments in the treatment of tibial proximal fractures. MethodsThirty-two tibial specimens were retrieved and randomly divided into four groups. Extra-articular proximal tibial fractures (AO classification 41-A2) were created in each specimen. The fractures were subsequently fixed by DCP, LCP, IMN, and Ex-Fix. The bone density of the proximal tibiae was examined by quantitative computed tomography. Each specimen was subjected to axial compression and three-point bending tests. ResultsBone mineral density did not significantly differ among the groups. In compression testing of the four fixation instruments, the highest degree of axial stiffness was found in the IMN group; there was no significant difference between DCP and LCP groups (P>0.05). The results of the three-point bending test revealed that DCP demonstrated the highest bending stiffness, which differed significantly from the other groups (P<0.05). The Ex-Fix had the lowest level of stiffness during the compression and three-point bending tests. ConclusionsIMN has good mechanical properties, but its clinical application for proximal tibial fractures often leads to malalignment deformities. Compared with DCP, LCP is strong enough to fix the proximal tibial fractures and has the additional benefit of minimally invasive surgery.

Result of closed interlocking intramedullary nail in tibial shaft fracture

The management of tibial diaphyseal fractures has always held a particular interest for orthopedic surgeons. Not only they are relatively common but also they are often difficult to treat. This prospective study was carried out at Rangpur from April 2008 to November 2009. 34 patients were treated by closed interlocking intramedullary nail. Goal of this study was to find out a safe &amp; effective management of fracture, early mobility of patient, functional joint motion and short stay in hospital. Routine follow up was carried out in 29 patients. In 24 cases, fracture (81.76%) were united, 4 cases (13.79%) needed dynamisation with autogenous bone grafting and 1 case devoloped non union. Study showed interlocking nailing in tibia provides early mobility of patients, reduces hospital stay and fracture unites without joint stiffness and less complication.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10470Bang Med J (Khulna) 2011: 44(1&amp;2) 15-17