Intramedullary Interlocking Nail Research Articles

A Comparative Study of the Functional Outcome of Patellar Tendon Splitting and Medial Parapatellar Approaches in Intramedullary Interlocking Nailing of Tibia

A Comparative Study of the Functional Outcome of Patellar Tendon Splitting and Medial Parapatellar Approaches in Intramedullary Interlocking Nailing of Tibia

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

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

Management of Humeral Shaft Fracture by Antegrade Interlocking Intramedullary Nail

<i>Background</i>: The humeral shaft fracture is relatively common fracture among the younger and older age groups of people followed by direct or indirect violence. Humeral shaft fractures account for approximately 3% of all fractures. We have very few data regarding issue. <i>Aim of the study</i>: The aim of this study was to collect information regarding the procedure and outcomes of antegrade interlocking intramedullary nail in treating humeral shaft fracture. <i>Material and methods</i>: This study was carried out during the period from January 2017 to January 2020 at TMSS Medical College and RCH Bogura & Natore Trauma Center and Hospital, Natore, Bangladesh. Total 15 patients were selected where 10 were male and 5 were female. The study was approved by the ethical committees of mentioned both the institution. Proper written consents were taken from all the participants before starting the main intervention. All data were collected analyzed and disseminated by MS Office program. <i>Results</i>: Postoperative infection were found in 2 patients (13.33%) and shoulder pain in 1 case (6.67%). In this study, excellent and good result were accepted as Satisfactory while fair and poor results were regarded as being unsatisfactory. Among them 5 (33.33%) cases were excellent, 7 (46.67%) cases good, 2 (13.33%) cases fair and 1 (6.66%) cases poor. In this study, overall satisfactory result was found in 12 (80%) cases and unsatisfactory in 3 (20%) cases. <i>Conclusion</i>: The antegraded interlocking intramedullary nail is an effective and technically demanding method for the treatment of humeral shaft fracture.

Outcomes of closed interlocking intramedullary nailing of the tibia without fluoroscopy in resource-limited settings: experience from two hospitals in Cameroon.

Introductionclosed static interlocking nailing with c-arm guidance is the standard procedure for the treatment of closed diaphyseal leg fractures. It is still very difficult to carry out such procedures in a low-income setting because of few or absent image intensifiers (c-arm) despite the necessity. The aim of this study was to describe the outcomes of patients with tibial fractures treated with closed interlocking intramedullary nails without c-arm guidance in a Cameroonian population.Methodsthis was a prospective study including adult patients treated for tibial fractures without a c-arm in two regional hospitals.Resultsfinally, 22 patients were included. The mean age was 34 ± 12.6 years with a male predominance (16 males and 6 females). Ninety percent of the fracture lines were simple or with a wedge fragment grade 42A or 42B respectively according to the AO classification. The mean surgery time was 1 hour 26 ± 34 minutes. The various aspects evaluated were the nail entry point which was good in 19 (86.4%) cases; proper nail driving which was considered good in 15 (68%) cases; the distal locking which was missed in 6 (27.3%) cases. Bone consolidation was obtained in an average of 4 ± 1.2 months in all 22 cases.Conclusionin resource constraints settings where c-arm are not always available, closed interlocked nail of tibia without c-arm guidance still gives overall good results. Nevertheless, there is a need to improve equipment in sub-Saharan African hospitals to make trauma surgery with c-arm a gold standard as currently recommended.

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

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

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

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

Перестроечный перелом дистального метаэпифиза большеберцовой кости как редкое осложнение интрамедуллярного остеосинтеза с блокированием

Introduction This article describes a clinical case of a stress fracture of the distal tibial metaepiphysis following a high-energy tibial shaft fracture stabilized with interlocking intramedullary (IM) nail to identify an underlying cause of the traumatic event. Objective To demonstrate the occurrence of a stress fracture after adequate interlocking IM nailing of a traumatic fracture due to systemic osteoporosis that presented no clinical manifestations prior to injury. Material and methods Magnetic resonance imaging was performed to diagnose the stress fracture. Bone mineral density and laboratory markers of bone metabolism were measured to identify underlying causes of the stress fracture. Consolidation of the traumatic fracture fixed with interlocking IM nail was re-evaluated with a radiograph of the fracture site. Results The stress fracture was seen off the IM nail on MRI scans. Osteoporosis was diagnosed with bone densitometry using dual energy X-ray absorptiometry, and deoxypyridinoline, a bone resorption marker and vitamin D deficiency were identified with laboratory tests. No signs of fracture union were seen radiologically. Conclusion A stress fracture of the distal tibial metaepiphysis detected 3 months after a tibial shaft fracture fixed with interlocking IM nail can be considered an insufficiency fracture caused by primary (idiopathic) systemic osteoporosis that was asymptomatic prior to the high-energy injury.

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

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

Intramedullary nailing of adult forearm fractures: Results and complications

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

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

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

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

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

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

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

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

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

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

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

Surgical Management of Tibial Shaft Fracture of Adult Patients with Closed Antegraded Interlocking Intramedullary Nail

Surgical Management of Tibial Shaft Fracture of Adult Patients with Closed Antegraded Interlocking Intramedullary Nail

Comparison of clinical, radiological, and functional outcome of closed fracture of distal third tibia treated with nailing and plate osteosynthesis

Aim: This is a prospective study of 30 patients with distal tibia fracture (Closed extra-articular distalthird tibia fractures - 4 to 11cm from tibial plafond) who underwent surgical fixation were included inthis study after excluding compound, pathological and pediatric fractures. Materials and Methods:15 underwent closed intramedullary interlocking nail and 15 were treated with plate osteosynthesis(MIPO). Results: The age distribution ranged from 23 to 68 years with the mean age of 39.4 years.The mode of injury in all patients was due to vehicle accidents. All 30 patients were classifiedaccording to AO classification of which 15 belonged to A1, 14 belonged to A2, and 1 belonged to A3.The time of fixation from injury varied from 6 hours to 18 days. Conclusion: Plate osteosynthesisby minimally invasive technique and Intramedullary interlocking nailing is an equally effectivemethod of stabilization for distal tibia fracture when considering the union rates and final functionaloutcome. However, malunion, nonunion and secondary procedures were more frequent afterintramedullary interlocking nail. In MIPO platting Infection followed by an exposed plate occurs in 2patients. Randomized prospective evaluation of distal tibia fractures may clarify the efficacy of plateversus nail treatment and optimize patient care.

Kuntscher Nail: A Forgotten Entity Yet a Reliable Modality in Treatment of Winquist Type I and II Closed Femoral Shaft Fractures.

BackgroundInterlocking intramedullary nail is used for almost all types of femoral shaft fractures worldwide because of its better mechanical stability. In countries like India with limited healthcare infrastructure, the use of Kuntscher nail (K-nail) in Winquist type I and type II isthmic fractures is still debated. Therefore, we conducted this study to compare the functional outcome, radiation exposure, and cost of the implant between closed reduction and internal fixation of Winquist type I and II fractures in the middle one-third shaft region by K-nail and intramedullary locked nails (IMILN), respectively.MethodsThis was a hospital-based non-blinded randomized trial which included 56 patients with closed Winquist type I and II femoral shaft fractures of the middle one-third femoral shaft (isthmic and paraisthmic zone). All the patients were either treated by K-nail or IMILN. The patients were followed up every three weeks for the initial six months and quarterly thereafter. Per operative duration of surgery and radiation exposure by C-arm was documented and assuming scattered radiation 20%, radiation exposure to the surgeon was calculated and patients were assessed clinically and radiologically for union.ResultsThe patients were divided into two groups: group I (K-nail, n = 25) and group II (IMILN, n = 31). In groups I and II, the patients achieving radiological union were 88% (n = 22/25) and 84% (n = 27/31) at six months’ duration, respectively. The mean duration for the radiological union was 3.65 ± 0.55 months in group I (K-nail) and 3.76 ± 0.59 months in group II (IMILN), respectively. There was no statistically significant difference in the duration of the union (p = 0.4963). The average number of C- arm exposures was 16.36 ± 3.18 in group I as compared to 27.29 ± 4.01 in group II, and the mean scattered radiation was 5.0 ± 1.63 in group I and 6.61 ± 4.06 in group II. This difference was statistically significant.ConclusionKuntscher intramedullary nailing can provide comparable rates of union as is achieved with interlocking intramedullary nailing with an advantage of less radiation exposure and duration of surgery, provided the patient selection is proper (isthmic and paraisthmic zone).

Advantage of antibiotic cement-coated interlocking intramedullary nail (tibia nail/femur nail) over conventionally used antibiotic cement-coated Kuntscher nail in infected nonunion

Background: Open fracture are very prone to chronic infection. The infection of long bones during its process of fracture healing not only delay but may completely abort the fracture healing and leads to nonunion. Infection along with its nonunion is very difficult to treat and a debilitating disorder which bother both the patients and surgeon. However in many studies, this situation is usually managed with multiple steps first to cure the infection before dealing with nonunion. But this is a single step procedure to cure both infection and nonunion simultaneously with intramedullary nail that coated with antibiotic cement. It is difficult to achieves axial and rotational stability along with controlling infection by antibiotic cement-coated Kuntscher nail. This study we have compare the outcome in term of control the infection and treating nonunion and copmplication associated with these. And also the advantage of antibiotic cementcoated interlocking intramedullary nail (tibia nail / femur nail) for achieving good stability. Materials and Methods: In our study we included 20 adult patients all have stablisted infective nonunion and divided into two group according to types of intramedullary nail used. In group A 12 adult patients with infective nonunion of tibia & femur (9 tibia and 3 femur) were managed using antibiotic cementcoated interlocking intramedullary nail (group A)(tibia nail / femure nail) with proximal and distal locking screws. And in group B 8 adult patients with stablised infective nonunion of tibia & femur (7 tibia and 1 femur) were treated using antibiotic cement-coated K-nail. Combination of Antibiotics used are 4gm vancomycin and 3gm clindamycin in 40gm bone cement package. Results: Controlled of infection is 90% (18 out of 20 patients) similar in both. Bony union achieved in 83% (10 out of 12 patients) in group A with average time of union is 6 months. Bony union 62.5% (5 out of 8 patients) in group B with average time of union 8 months. The ad

Fracture-dislocation of the thoracolumbar spine without neurological deficit: a report of two cases and literature review.

We report two cases of fracture-dislocation of the thoracolumbar spine without neurological deficit and outline the putative mechanisms responsible for the escape of neural tissues from injurious forces and the surgical management strategies for this type of injury. We also review similar cases described in the literature. A 24-year-old female with post-traumatic fracture dislocation at the T10-T11 level without neurological deficit, along with a right femoral shaft fracture, was managed with laminectomy of T10-T11 levels with bilateral facetectomy and transpedicular screws and with an intramedullary interlocking nail for the femur fracture. Another 26-year-old female (post-traumatic fracture dislocation at the T12 - L1 level treated by open reduction and pedicle screw instrumentation elsewhere) presented with implant failure and re-dislocation which was managed with laminectomy of T12- L1 levels, facetectomy and discectomy, and deformity correction, followed by 9 mm × 25 mm bullet cage insertion and fixation using transpedicular screws. Neurological function was preserved postoperatively. Both individuals returned to household activity 6 months postoperatively. Fracture-dislocations of the thoracolumbar spine without neurological deficit have been infrequently reported. The mechanism responsible for the preservation of normal neurological function; is either posterior element fractures leading to free-floating laminae or a fracture-separation of the vertebral arch, in which pedicle fractures allow the posterior elements to remain nearly aligned, with preservation of the spinal canal integrity and maintenance of normal spinal cord function. These fracture-dislocations need to be managed carefully to achieve a good outcome.

The prophylactic use of antibiotic coated intramedullary nail in treatment of open tibia fractures

Introduction: Open tibia fractures are the most common type of all open injuries and are more prone to infection than other long bones. To control infection various surgical techniques and antibiotic therapy are used. Local delivery of antibiotics at the tissue-implant interface using Gentamicin-coated implants is one of the methods which provide mechanical stability, effectively prevent infection and promote bony union by simple one stage procedure. Materials and Methods: Thirty patients were selected with open fracture of shaft tibia, treated operatively with antibiotic coated intramedullary interlocking nail and were followed up for a minimum of six months duration. Radiological Union was assessed using RUST Score and clinical assessment results were graded as excellent, good, fair and poor. Result: In this study of 30 patients, time taken in wound healing in 15 patients is 5 weeks. RUST score at 6 months in 16 patients is 8. Infection found in 2 patients and 1 patient undergone non-union. 29 patients can bear weight without pain after 6 months of surgery. 16 patients have fair outcome. Conclusion: The use of the antibiotic coated nail has good clinical and radiological outcome at six months and preliminary results support the use of antibiotic coated implants as a new potential treatment option for prevention of infection in open tibia fractures. Keywords: Open fracture, Intra medullary nail, Antibiotic coated.