Intramedullary Interlocking Nail Research Articles

Reamed versus Unreamed Interlocking Intramedullary Nailing in the Treatment of Femoral and Tibial Shaft Fracture

141 통신저자:김 철 홍 부산광역시 서구 동대신동 3가 1 동아대학교 의과대학 정형외과학교실 Tel:051-240-5167.Fax:051-254-6757 E-mail:kimch@dau.ac.kr *본 논문의 요지는 2003년 대한골절외과학회 추계학술대회에서 구연되었음. Address reprint requests to:Chul Hong Kim, M.D. Department of Orthopedic Surgery, School of Medicine, Dong-A University, 1, 3-ga, Dongdaesin-dong, Seo-gu, Busan 602-715, Korea Tel:82-51-240-5167.Fax:82-51-254-6757 E-mail:kimch@dau.ac.kr 대퇴골 및 경골간부 골절 치료에서 확공성 금속정과 비확공성 금속정의 비교

Open Kuntscher Nailing Of Closed Femoral Shaft Fractures: Revisited

Interlocking intramedullary nails is now the standard in the treatment of femoral shaft fractures however costs precludes its common use in developing countries, making open Kuntscher nailing a common procedure. This study was done to evaluate the outcome of Kuntscher nailing with regard to union, infection, limb length and range of motion. This was a three years prospective study from January 2002 to December 2004.Thirty seven patients were included in the study. The average age of the patients was 35years.Nineteen fractures occurred in the upper third and 18 in middle. All the 37 fractures healed on the average of 20weeks. Two patients had superficial wound infection, 4 had limb shortening of 1-2 centimetres and range of motion at the knee from 100 to 135 degrees at minimum twelve months follow up. It was concluded that open Kuntscher is still a relevant operation in the developing worlds with good functional and clinical results.

Strategy for treatment of peritrochanteric fractures in senile patients

To analyze the clinical manifestations, operative applications, complications and outcomes of peritrochanteric fracture of femur in patients 75-years old and over. The clinical data of 261 patients, aged 79.5 (75-96), of peritrochanteric fracture (265 hips) were analyzed. The incidence of different accompanied medical diseases was 2.6/person on average. The internal fixation methods included DHS, DHS plus trochanteric steady plate or intramedullary interlocking nails, such as Gamma nail, PFN and reconstructive nails. The mean operation time was 73 minutes. 224 cases were followed-up over 6 months after operation 81% of which got excellent or good results. The complications included acute heart failure, brain infarction, cerebral thrombosis, pulmonary embolism, deep venous thrombosis of lower extremities, lung infection, and stress ulceration, bed sore, and acute respiratory failure. Thirteen cases died of cardiopulmonary insufficiency, cardiac infarction, brain thrombosis, or pulmonary embolism. Complications are frequent in aged patients. Appropriate operative methods help reduce complications and mortality rates.

Gastric cancer acrometastases to all digits of one hand following closed intramedullary nailing

Metastatic malignant tumor of the hand is unusual and the most common site of the primary cancer is lung. Acrometastases to the phalanges of the hand usually involve a single bone, while those proximal to the phalanges often involve multiple bones. Metastasis to the hand from gastrointestinal cancer, particularly from gastric cancer, is extremely rare. To our knowledge, only five cases have been reported in the literature to date and there has been no reported case following closed intramedullary nailing for metastatic diaphyseal fracture of an ipsilateral long bone. We present a very unusual case of gastric cancer, which metastasized to all fingertips of the ipsilateral hand after closed interlocking intramedullary nailing of a pathologic fracture of the humerus.

Biomechanical Comparison of Intramedullary Nail and Blade Plate Fixation for Tibiotalocalcaneal Arthrodesis

Tibiotalocalcaneal arthrodesis is used to manage severe bone loss, arthritis, and/or instability. The goal is to relieve pain through a stable, well-aligned hindfoot and ankle. The purpose of this study was 2-fold: to biomechanically compare 1) initial stability, and 2) the effect of bone density on the stability of intramedullary nail and blade plate fixation in tibiotalocalcaneal arthrodesis. Biomechanical study using anatomic specimens. Ankle and subtalar joint capsules were exposed for 7 pairs of fresh-frozen anatomic specimens. One ankle from each pair was instrumented with an interlocked intramedullary nail inserted retrograde across the subtalar and ankle joint while the contralateral hind foot was stabilized with a lateral cannulated blade plate. Specimen stability was tested in plantar/dorsiflexion and inversion/eversion to a maximum bending moment of 12 Nm and in internal/external rotation to a maximum torque of 7 Nm. Physical measurements of bone density were made to determine its effect on stability. Maximum angular displacement of the constructs in plantarflexion, dorsiflexion, inversion, eversion, internal rotation, and external rotation. No significant differences were observed between the plated and nailed constructs in the 3 loading configurations (Power = 0.77). Only 6 pairs were included in the results because of fixation failures. A small but significant reduction in internal rotation alone of 1.8 degrees was found with the plated compared with the nailed construct (P = 0.045). Reduced stability was associated with lower bone density in torsion and inversion/eversion in the plated constructs (r = 0.67- 0.87) with a similar trend seen in torsion in the nailed constructs (r = 0.5). Initial construct stabilities and the effect of reduced bone density were found to be similar between the blade plate and the intramedullary nail in tibiotalocalcaneal arthrodesis, thus implant choice may be based on other clinical factors, such as surgeon preference or soft-tissue status.

Internal Fixation of Diaphyseal Fractures of the Forearm by Interlocking Intramedullary Nail

This study was designed to evaluate the efficacy of the treatment of diaphyseal fractures of the forearm using the ForeSight forearm interlocking intramedullary nail. Retrospective study. University-affiliated teaching hospital. Eighteen patients with 32 displaced diaphyseal forearm fractures were identified. All fractures were treated with the ForeSight forearm interlocking intramedullary nail. Eighteen fractures were stabilized with static interlocking technique. The assessment of patients was based on the time to union, the functional recovery, and the incidence of complications. Physical capability was evaluated by using the rating system of Grace and Eversmann. Patient-rated outcome was assessed by completion of the Disability of Arm Shoulder Hand questionnaire (DASH). All fractures healed with the index procedure. The average time to union for fractures utilizing a closed technique was 10 weeks; for fractures using an open reduction technique, 15 weeks. The mean pronation was 62 (range, 0-96) degrees, and the mean supination was 80 (range, 0-105) degrees. Compared with the normal arm, the mean loss of rotation of the forearm was 32 (range, 5-162) degrees. Using the rating system of Grace and Eversmann, 13 patients had an excellent or good result, 3 had an acceptable result, and 2 had an unacceptable result. Using the patient-rated functional questionnaire, the mean DASH of 19 (range, 4-72) points at the time of the most recent follow-up indicated a mild-to-moderate impairment. There were 7 postoperative complications. The incidence of complications was 22% (7/32). One cross-union between forearm bones occurred in a patient with a closed head injury and high-energy trauma. Two nondriving end screws of the ulna nail backed out causing wrist pain and had to be removed. There were 4 superficial infections occurring all in the fractures that necessitated an open reduction technique. The overall rate of infection was 12.5% (4/32). Three patients who presented with an open fracture needed a skin graft to cover the open wound. Forearm interlocking intramedullary nailing is an acceptable method to stabilize displaced diaphyseal forearm fractures in adult.

Interlocking intramedullary nailing for comminuted forearm fractures with soft tissue injuries

目的 介绍应用交锁髓内钉固定治疗前臂尺桡骨粉碎性骨折的经验.方法对21例尺桡骨骨折,按AO分型[1]:B3型8例、C1型10例、C2型3例,采用骨折复位、Smith-Nephew交锁髓内钉固定术.结果术后随访6～36个月,骨折愈合时间8～20周,平均16.2周.术后1例骨折延迟愈合,1例锁钉钉道感染,拔钉后愈合,无1例发生骨不连.按Anderson评分标准评定:优10例,良7例,可4例.肘关节伸屈活动功能丧失10°～35°,平均18.5°,前臂旋前功能丧失15°～55°,平均25.0°,旋后功能丧失15°～45°,平均33.5°.结论应用交锁髓内钉固定方法是治疗前臂软组织损伤同时伴有尺桡骨粉碎性骨折的良好手术选择。

Monomicrobial necrotising fasciitis due to staphylococcus aureus as a complication of infected intramedullary interlocking nail

Monomicrobial necrotising fasciitis due to staphylococcus aureus as a complication of infected intramedullary interlocking nail

Treatment of nonunion of femoral inferior segment by antegrade compressive interlocking intramedullary nail and memory connector

目的 探讨顺行加压交锁髓内钉结合天鹅记忆接骨器(SMC)治疗股骨远端骨不连的临床疗效.方法18例股骨远端骨不连患者,采用顺行加压交锁髓内钉与SMC相结合内固定,确保不连端的牢稳固定,并利用SMC的植骨优势作用.植骨采用自体髂骨,骨移植形式为加垫法、夹板法、播种法相结合,充分发挥移植骨的骨诱导与骨传导作用,术后短期行CPM训练膝关节功能.结果所有患者随访12～48个月,平均18个月.18例全部获得骨性愈合,愈合时间3～6个月,平均4.8个月.术后膝关节活动范围由术前的平均84°(30°～135°)增加到101°(75°～135°).按Shelbourne疗效评定标准,优良率88.9%.结论利用顺行加压交锁髓内钉与SMC,并结合良好的自体髂骨移植技术,是治疗股骨下段骨不连的有效方法之一。

The Incidence of Infection in Interlocking Intramedullary Nailing after Skeletal Traction of Distal Femur

Purpose: The insertion site of K-wire for skeletal traction is proximal part of tibia or distal part of femur. However, people prefer proximal tibia over distal femur due to lower risk of infection rate when change to interlocking IM nailing is needed. We evaluated the infection rate of interlocking IM nailing. Materials and Methods: Fourty-seven patients were included in this study who underwent interlocking IM nailing due to femur shaft fracture. Traction was applied at the distal femur in 19 cases and proximal tibia in 10 cases before interlocking IM nailing. No skeletal traction was applied to the remaining 18 cases. Thirty-eight patients were male and 9 were female. The average age at the time of surgery was 36.7 years old (range, 15~17 years). The average traction period was 9.5 days (range, 3~33 days) and the average followed-up period was 17.2 months. Results: In the distal femoral traction group, 8 cases of superficial pin tract infection developed, but no case of deep infection such as osteomyelitis occurred. In the proximal tibia traction group, 2 cases of superficial pin tract infection developed, but no case of deep infection occurred. In the group that received no skeletal traction before interlocking IM nailing, no case of infection developed. Conclusion: In femur shaft fracture, the distal femoral skeletal traction followed by interlocking IM nailing of femur, compared to proximal tibia skeletal traction, did not increase the risk of deep infection such as osteomyelitis.

Outcomes Related to Closed Interlocking Intramedullary Nailing for Segmental Tibia Fracture

Outcomes Related to Closed Interlocking Intramedullary Nailing for Segmental Tibia Fracture

Value of self-made adjustor in positioning distal lockholes for femoral intramedullary interlocking nails

目的 设计一种调节器,协助股骨带锁髓内钉远端锁孔定位.方法应用自制调节器协助带锁髓内钉远端锁孔定位治疗股骨干骨折56例,其中横断骨折18例,粉碎骨折15例,斜形和螺旋形骨折23例.结果所有患者随访7～25个月,平均14.3个月,其钻孔、交锁成功率达到100%.结论带锁髓内钉配合使用调节器,在应用时无需X线引导,操作简便、固定可靠、效果确切,尤为适于在基层医院推广。

Anterior knee pain following intramedullary nailing of tibial shaft fractures: does bony portal point in the sagittal plane affect the outcome?

Forty-four consecutive diaphyseal extra-articular tibial fractures (43 patients) were treated with intramedullary interlocking nail. There were 35 men and eight women with a mean age of 38 years. Average follow-up was 25 months. Cases were divided into two groups: anterior-knee-pain group, 20 knees; and no-pain group, 24 knees. The lateral projection radiographs of their tibiae were scrutinised for precise bony portal point. The distance between articular surface and tibial tubercle was divided into three equal zones. In the superior zone, six had pain and six did not. In the central zone, eight had pain and 15 did not. In the inferior zone, six had pain and three did not. There was no significant difference between anterior knee pain and the three zones of the bony entry, age, gender, mechanism of injury, dynamisation, nail protrusion, approach and union time. We conclude that bony entry point in the sagittal plane is not a significant prognostic indicator for anterior knee pain following intramedullary tibial nailing.

Unreamed Interlocking Nailing in Open Fractures of Tibia

To assess the clinical outcome of unreamed intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open fractures as a result of the unreamed intramedullary nailing. Between June 1999 and May 2000, a total of 60 cases of open tibial shaft fractures were operated on with unreamed interlocking nails at Safdarjung Hospital, New Delhi, India. Records of 56 patients (4 women and 52 men) were available for study. Only injuries associated with the tibial shaft were included. Traffic accidents were the cause of fractures in all patients. All fractures were classified according to Gustilo and Anderson system for open fractures. There were 30 (53.6%) type-I, 18 (32.1%) type-II, 4 (7.1%) type-IIIA, and 4 (7.1%) type-IIIB fractures. After thorough debridement under anaesthesia, an unreamed interlocking nail was inserted with assistance by an image intensifier. All nails were statically locked with one screw each proximally and distally. The patients were followed up for a mean period of 20 months (range, 18-24 months) and were evaluated according to the modified Ketenjian's criteria. Results were good to excellent in 85.8% cases, and poor in 10.7% cases. Only 2 of 8 patients with type-III fractures had good results. Two of 4 type-IIIA and all 4 type-IIIB fractures had chronic osteomyelitis. Of 56 patients, 6 had early infection, 6 had delayed union, 6 had infected non-union, 2 had nail breakage, 8 had screw breakage, and 10 had anterior knee pain. Unreamed interlocking tibial nailing can be safely used for type-I and type-II open injuries even with delayed presentation. Use of unreamed nailing in those type-III fractures with delayed presentation was not recommended, because of high incidence of complications.

Treatment of distal femoral fracture with retrograde interlocking intramedullary nail

目的 总结股骨逆行交锁髓内钉应用的适应证、优点及其疗效.方法2001年6月～2003年6月,采用切开复位股骨逆行交锁髓内钉内固定,治疗股骨远段骨折21例,早期行膝关节功能锻炼.结果18例获随访,全部骨性愈合,功能恢复良好,无膝痛、跛行、膝关节僵直等.结论股骨逆行交锁髓内钉治疗股骨远段骨折具有明显优势,固定牢固、坚强,功能恢复快,并发症少等优点,手术不需要C臂X线机和骨科手术牵引床,适合基层医院临床应用。

Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value<0.05. Mean hospital stay in nailing group was 12.8±2.75 day and plating group 21.1±2.73 days, p>0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection.Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.

211 cases of long bone shaft fracture at lower limbs treated with intramedullary interlocking nails

目的 对211例下肢长骨骨折带锁髓内钉内固定治疗的临床结果进行评价.方法用不扩髓带锁髓内钉为主要固定方法,对211例股骨、胫骨骨折进行手术复位内固定治疗,术后进行包括CPM在内的有序功能锻炼.结果获得随访189例,时间4～26个月,平均9个月.全组病例获得骨性愈合,无骨不连发生,骨折延迟愈合7例,膝关节功能受限4例.按Johner-wruch标准:优158例,良22例,中9例,优良率95.2%.结论带锁髓内钉是治疗下肢长骨骨折较好的方法,其适应证较以往有进一步的拓展,术中骨折复位与保存骨折块血供并重的理念是正确的。

Treatment of comminuted femoral shaft fractures with combination of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator

目的 观察联合应用带锁髓内钉及西脉TiNi记忆合金骨卡环治疗股骨干粉碎骨折的疗效.方法本组股骨干粉碎骨折35例,均为AO分型中的B型和C型.其中B型25例,C型10例.全部病例采用开放复位带锁髓内钉加记忆合金骨卡环内固定治疗,5例行植骨.结果经12～24个月随访(平均18.5个月),除1例因骨卡环脱落而行手术外,全部病例骨折二期愈合.术后18～24个月取出带锁髓内钉.按Klemm功能恢复分级标准,总体优良率98.2%.结论带锁髓内钉加记忆合金骨卡环内固定治疗股骨干粉碎骨折可互相取长补短、稳定固定,是一种可行有效的方法。

Defect or nonunion of tibia fracture treated with medial femoral condylar bone flap and periost flap pedicled with retrograde saphenous artery and interlocking intramedullary nail

Objective To look for a new method to treat defects or nonunion of tibia fracture. Methods From March 2000 to June 2002, 9 patients with defect or nonunion of tibia fracture were treated with medial femoral condylar bone flap and periost flap pedicled with retrograde saphenous artery and intramedullary interlocking nail. In the primary treatment of the 9 cases, 5 of them were fixed by plate, 2 by external fixation, 2 by Ender nail. Results 7 cases were followed up for more than half a year, and all the cases healed up well. The functions of ankle joint and knee joint recovered well. Conclusion The method is characterized by reliable fixation, accelerated progress of healing up, early activity of ankle joint and knee joint, and easy handling, so it is an excellent way to treat nonunion of tibia fractures.

TIBIOTARSAL FRACTURE REPAIR IN A BALD EAGLE (HALIAEETUS LEUCOCEPHALUS) USING AN INTERLOCKING NAIL

A 14-yr-old, 5.13-kg bald eagle (Haliaeetus leucocephalus) was hit by a car and presented to the Michigan State University Small Animal Clinic with an open, grade II, transverse, midshaft, Winquist-Hansen type-II-comminuted left tibiotarsal fracture. The fracture was reduced and fixation established with a 4.7-mm-diameter, 112-mm-long, four-hole veterinary intramedullary interlocking nail maintained in position by single 2-mm transcortical screws placed in the main proximal and distal fragments. The bird was weight bearing on the bandaged limb 48 hr postoperatively. Radiographs obtained 4 wk postoperatively revealed bridging callus over three of four cortices. The bird was released after 5 mo of rehabilitation.