Intramedullary Interlocking Nail Research Articles

Comparision of Distal Uniplanar Locking with Biplanar Distal Locking in Intramedullary Interlocking Nailing of Fractures Distal Shaft of Tibia

Objective: To study the effects of distal uniplanar locking and distal bi planar locking on union times in uncomplicated fractures distal shaft of tibia managed with an intramedullary interlocking nail.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Department of Orthopedics and Trauma Combined Military Hospital Rawalpindi from Jan to Nov 2020.
 Methodology: Fifty-three patients having fractures distal shaft of tibia managed with intramedullary interlocking nail were studied. Twenty-nine patients were managed using two interlocking screws distally (uniplanar) in coronal plane (group-1). Twenty-four patients were managed with three bi planar screws comprising two coronal and one sagittal distal interlocking screw (group-2). Patients were followed every 4 weeks, and bone union time was assessed. Isolated closed fractures treated with closed reduction were included.
 Results: Patients treated with distal bi planar locking (group-2) had significantly reduced union time in weeks (11.25 ± 1.42) compared to uniplanar distal interlocking (group-1) (15.79 ± 1.80) (p<.001).
 Conclusion: Union time for distal tibia shaft fractures is significantly reduced when treated with distal biplanar locking; it can be attributed to increased stability of the construct.

Prophylaxis and treatment of infection in long bones using an antibiotic-loaded ceramic coating with interlocking intramedullary nails.

Background: The study was done (1) to report on our recent experience with antibiotic-loaded calcium sulfate-coated interlocking intramedullary nails (CS-IMN) for infection prevention or infection eradication and (2) to compare the efficacy of CS-IMN versus antibiotic-loaded polymethylmethacrylate-coated IMN (PMMA-IMN) for infection eradication. Methods: We retrospectively reviewed the medical records of consecutive patients who underwent a limb salvage procedure for infection cure or infection prevention with PMMA-IMN or CS-IMN. We reviewed patient demographics, host-type, pre-operative infecting organisms, intraoperative cultures, as well as our main outcomes: infection control rate, achievement of union/fusion, and limb salvage. Results: 33 patients were treated with CS-IMN: 9 patients with goal of infection cure and 24 patients for infection prophylaxis. When used for infection prophylaxis, there was a 100 % ( patients) prevention of infection rate, 95.5 % union rate ( patients), and 100 % ( patients) limb salvage rate. Nine patients were treated with CS-IMN to eradicate infection and were compared to a cohort of 28 patients who were treated with PMMA-IMN. The infection was eradicated in patients (77.8 %) in the CS-IMN group versus 21/26 patients (80 %) in the PMMA-IMN group (). Bone union/fusion was achieved in patients (88.9 %) in the CS-IMN group versus 21/24 patients (87.5 %) in the PMMA-IMN group (). The limb salvage rate in the CS-IMN group was 100 % ( patients) versus 89 % ( patients) in the PMMA-IMN group. Conclusions: CS-IMN are safe and easy to use, and we have therefore expended our indications for them. CS-IMN are very effective at infection prophylaxis in high-risk cases where infection is suspected. Early analysis suggests that CS-IMN are non-inferior to PMMA-IMN for infection eradication. This is our preliminary data that show this novel technique to be safe in a small cohort and may be as effective as the more established method. Future studies with larger cohorts of patients will be required to confirm these findings.

Effect of Interlocking Intramedullary Nailing on Patients with Nonunion after Traumatic Fracture of Extremities

Effect of Interlocking Intramedullary Nailing on Patients with Nonunion after Traumatic Fracture of Extremities

Functional outcome following fixation of diaphyseal fracture of femur with closed intramedullary interlocking nail in adults: A prospective study

Background: Diaphyseal fracture of the femur in adults is one of the most commonly faced fractures in the orthopaedic practice. It is a major cause of morbidity and mortality in patients who sustain high-energy trauma, as the femur is the largest bone of the body and is covered with extensive soft tissue cover. There are multiple techniques available at present for their management. The technique chosen should cause minimal soft tissue and bone damage. We planned to study the functional outcome of the closed intramedullary interlocking nail in diaphyseal fracture of the femur in adults.Materials and Methods: A prospective observational study on 60 patients with femur shaft fractures managed by intramedullary interlock nails was done at a tertiary care centre between April 2018 to March 2019. The patients were followed up at regular intervals at 2 weeks, 6 weeks, 3 months, 6 months and one year. The clinical, radiological evaluation was done for each patient and the final observation was made according to the criteria by Thorsen et al. Results: The clinical, radiological evaluation was done for each patient and the final observation were made according to the criteria by Thorsen et al., There was excellent results in 70% of cases, good results in 23% and fair to poor results in 7% cases. Conclusion: Earlier the patients were taken up for surgery, easier the reduction and nailing by the closed method. Static locking is advisable in severely comminuted fractures to avoid shortening. We conclude that closed reamed interlocking intramedullary nail in femoral shaft fracture is the treatment of choice.

Comparison between Clinico-radiological outcomes of primary closed static and dynamic interlocking nailing in transverse or short oblique diaphyseal fractures of tibia: A prospective study

Introduction and Background: The objective of the study is to evaluate the comparative efficacy in terms of clinico-radiological outcomes in primary static versus primary dynamic intramedullary interlocking nailing of tibia. The principle of fixation for a tibial middle third fracture is to stabilize at the proximal metaphyseal region, the isthmus and the distal metaphyseal region. This 3 point fixation provides adequate resistance to the deforming axial and torsional forces at the fracture site. Two types of Locking techniques exist for the intramedullary nailing, Static and Dynamic. Materials and Method: A total of 17 patients of either sex who presented with closed trauma of transverse or short oblique diaphyseal fractures of tibia, which were observed between the years 2015-2017. Randomly, static and dynamic locking was done to the equal populations presented. The aims of the study conducted were to analyze time to union, functional recovery and incidence of complications. Johner and Wruh’s Criteria was used to analyze the functional outcome. All patients were followed for a period of 18months. Results: Upon evaluation with regard to Johner and Wruh’s criteria showed Excellent results in 9 out of 17 subjects, Good results in 7 out of 17 subjects and a Fair result in 1 patient. The average time of fracture union in case of dynamically and statically interlocked nailed tibiae is 13.00 and 15.22 weeks respectively. Therefore, the difference was 2.22 weeks. In our study, the results of tibia nailing was found to be in consonance with the earlier studies. Conclusion: We conclude that Primary Dynamic locking is a better option as compared to primary static locking in simple transverse or short oblique diaphyseal fractures of tibia as it leads to faster fracture healing and early return to function.

Application of anatomically contoured intramedullary interlocking nailing for fixation of femoral diaphyseal fractures in dogs

The study was conducted on 10 client-owned dogs of either sex presented for fixation of femoral diaphyseal fractures. After thorough clinical, orthopaedic and radiographic examinations, the patients were subjected to application of specially-designed anatomically contoured intramedullary interlocking nailing (ACIILN) for fixation of fractures. All the fractures were closed and involved mid (n=9) to slightly distal (n=1) diaphysis. The diameter of used ACIILN ranged from 5–7 mm and the length from 11–15 cm. All the ACIILN were applied in static fashion with at least 2 screws each in both proximal and distal fracture fragments. The duration of surgery for application of ACIILN ranged from 35–75 min. The technique was found to be moderately difficult with extent of tissue manipulation in the category of low to moderate. Pain and inflammation decreased gradually in all the cases in an anticipated manner.With gradual improvement in weight-bearing capability, the limb function was restored in all cases quiet fast in the postoperative period. More amount of the callus formed over medial and caudal surfaces indicating less amount of stability at these surfaces. Anatomically contoured intramedullary interlocking nailing technique provided clinically viable fracture fixation technique resulting into early limb function.

Evaluation of the Functional and Radiological Outcomes of Antibiotic-Coated Intramedullary Interlocking Nailing for Gustilo and Anderson Grades 2 and 3 Open Tibial Shaft Fractures.

Background: Tibial shaft fractures are the most common fractures among long bones. At present, implants coated with broad-spectrum antibiotics have been developed, and antimicrobial eluting implants are widely used in clinical practice.Materials and methods: This prospective study was conducted among 40 patients with tibial shaft fractures who visited the Department of Orthopedics in RL Jalappa Hospital, Tamaka, Kolar, Karnataka, from February 2021 to September 2021. As it is a large trauma center near the national highway, all 40 cases, including the referral cases, were operated within two months of the initiation of the study, with the last case operated in March 2021. The inclusion criteria were: patients aged more than 18 years, diaphyseal tibial fractures definitively treated by antibiotic coated intramedullary nailing, and Gustilo and Anderson grades 2, 3A, and 3B open tibial shaft fractures. All patients with grades 2, 3A, and 3B open fractures of the tibial shaft were treated with antibiotic-coated nails and followed up at one, three, and six months post-surgery.Results: The mean age of patients was 35.6 years, and the mean union time of fractures was 4.2 months. Road traffic accidents (RTA) are the most common etiology for tibial bone fractures. In this study, grade 3A open fractures had the highest number of cases (N = 26). No patients in the present study developed superficial or deep infections post-operatively. All patients were assessed with Johner-Wruhs criteria at each follow-up, and they showed improvement in knee and ankle joint mobility, pain, and deformity. Most patients achieved good functional results after postoperative follow-up, followed by those with excellent results. According to the radiographic union scale in tibial shaft fractures criteria, 23 patients showed good radiological results after postoperative follow-up, followed by 15 patients with excellent and 2 patients with fair results.Conclusion: Most of the patients showed good to excellent functional and radiological results according to Johner-Wruhs and Radiographic Union Scale for Tibial fractures (RUST) criteria. The use of antibiotic-coated nails to treat compound tibial fractures was associated with a decreased risk of deep wound infections and good fracture healing.

Comparison of Plating Versus Intramedullary Nailing for the Treatment of Distal Tibial Metaphyseal Fractures: A Longitudinal Study

Aim: To evaluate the functional outcomes of intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis. Study design: A longitudinal study Place and Duration: This study was conducted at Dow University of Health sciences Karachi Pakistan from January 2019 to January 2021. Methodology: A total of 100 patients were recruited for surgical procedures. All the patients were asked to visit the hospital at the 6th week, 3rd month, and 6th month of surgery for radiography assessment and for analyzing the knee and joint movements. When callus became visible on radiographs patients were allowed for partial weight-bearing. When callus was visible in 3 to 4 quadrants we considered it as fracture union on both anteroposterior and lateral views with no pain and mobility. Bone grafting was considered in case of fractures nonunion. Functional assessment was taken place after one year of surgery. Results: We observed that the IMIL group attained fracture union in an average duration of 25.90. But no statistical difference was observed between both groups. IMIL procedure has less duration of hospital stay when compared with MIPPO (6.40 (4–9) ± 1.19 vs 6.82 (5–10) ± 1.27. We observed 5° malunion in the MIPPO group whereas the IMIL group reported 10° malunion with a significant difference of 0.001. Conclusion: Our study concluded that the plating technique can better restore the distal tibia alignment but also has chances of postoperative complications which would be manageable. Keywords: Intramedullary interlocking nailing, minimally invasive percutaneous plate osteosynthesis, distal tibia

A study of anterior knee pain after intramedullary interlocking nails used for tibial shaft fractures treatment

Background: Tibial shaft fractures remain the more common of all fractures and routinely treated with intramedullary interlocking nail. One of the most common complication is anterior knee pain after intramedullary nailing of tibia fractures. The exact etiology of anterior knee pain after tibia nailing is still debatable and unknown. Methods: We evaluated 48 patients treated for tibia shaft fractures with intramedullary interlocking nail at our institute from the period between January 2016- December 2020. All patients were treated with transtendinous approach by single surgeon. Patients were assessed at follow up and incidences of knee pain were noted. Serial x ray and clinical evaluation were done with VAS score at final follow up. Final clinical outcome evaluated with modified lysholm score. Results: In our study incidence of knee pain remained 33% in overall patients. As per Modified lysholm score 62% patients with excellent outcome followed by 23% good and 15% fair outcome respectively. Conclusion: Proper surgical techniques and correct placement and sizing may alleviate the incidences of anterior knee pain after tibia nailing.

Clinical and radiographic assessment of the efficacy of demineralized bone matrix (DBM) in healing of long bone fractures stabilized by interlocking nail in dogs

The study was conducted on 6 clinical cases of long bone (femur/humerus) fractures in dogs. The cases with closed fracture were included in this study for open reduction and internal fixation using intramedullary interlocking nailing. Demineralized bone matrix was applied at the fracture site to hasten the fracture healing. Fracture healing was evaluated by clinical and radiographic examination at regular intervals. The weight bearing increased and lameness decreased as days progressed. It can be concluded that the osteoinductive and osteoconductive property of DBM accelerated fracture healing resulting in early weight bearing and radiographic union bone fractures. DBM can be used to accelerate the healing process in fracture of long bones stabilized with ILN in dogs.

Ultrasound Evaluation of the Rotator Cuff after Osteosynthesis of Humeral Shaft Fractures with Interlocking Intramedullary NailA Prospective Interventional Study

Introduction: Antegrade intramedullary nailing in humeral shaft fracture allows a stable fixation with satisfactory outcomes. However, shoulder impairment remains an important complication of intramedullary nailing. The procedure involving the splitting of supraspinatus tendon to expose humeral head for nail insertion has been attributed for it, even though it is followed by the repair of the tendon. Aim: To evaluate rotator cuff integrity with Ultrasound (USG) in patients who underwent humeral fracture fixation with an intramedullary interlocking nail and to evaluate the clinical outcome of the shoulder joint in patients with and without rupture of the rotator cuff using constant murley and QuickDASH scores. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics of AJ Institute of Medical Sciences, Mangaluru, India, from August 2018 to September 2020 in which 20 adult patients with acute humeral shaft fractures were treated with closed intramedullary nailing in antegrade manner. Patients were followed-up for six months clinically and radiologically. The USG evaluation of rotator cuff was done at six months follow-up, along with clinical evaluation using constant Murley and QuickDASH scores. Association between variables was analysed by using Chi-square test for categorical variables. Unpaired t-test was used to compare the mean of quantitative variables. The level of significance was set at 0.05. Data were entered into Microsoft excel (Windows 7; Version 2007) and analyses were done using the Statistical Package for Social Sciences (SPSS) for Windows software (version 22.0; SPSS Inc, Chicago). Results: At six months follow-up, patients were evaluated by USG showing ruptured supraspinatus tendon in 3 (15%) of the study patients. The results by constant murley score were 76.50±12.61 for the entire series, 77.82±12.75 for patients without rotator cuff rupture, and 69±10.53 for patients with partial rupture of the rotator cuff, with no statistical difference (p=0.275). QuickDASH scores were 9.90±7.69 for the entire series, better in the group without rupture of the rotator cuff (9.41±7.92 versus 12.70±6.84) but without statistically significant difference (p=0.510). Conclusion: The functional outcome of the shoulder joint is satisfactory and is not influenced by the presence or absence of a rotator cuff tear following the procedure.

Factors Determining the Functional and Radiological Outcome after Secondary Nailing in Open Fractures of Lower Extremity- A Prospective Cohort Study

Introduction: Open long bone fractures of lower limb are cumbersome to treat. Because of the increased chances of infection, wound debridement and external fixation is the primary procedure followed by a secondary intramedullary nailing when the wound improves. Pin tract infection, loss of fixation, non union is the most frequently encountered complications of external fixation. These complications have discouraged surgeons all over the world in accepting external fixation as a definitive method of fracture treatment. Secondary intramedullary interlocking nailing provides intramedullary input of cancellous tissue at the fracture site due to reaming and nailing. Aim: To evaluate the factors determining the outcome after secondary nailing in open fractures of lower extremity. Materials and Methods: The prospective cohort study was conducted from October 2017 to April 2020 at Pondicherry Institute of Medical Sciences, Pondicherry, India, 33 patients who had open long bone fractures of lower limb and underwent secondary nailing following external fixation, were evaluated. The patients were followed up for a period of six months. Factors such as age, bone involved, grade of injury, timing of debridement, time interval between external fixation and secondary nailing were analysed to see whether they affect the outcome of secondary nailing of open fractures of long bones. All patients underwent an initial thorough wound debridement and external fixation application. A secondary nailing was done once wound had settled down. Age, gender, bone involved, grade of injury, timing of debridement and timing of secondary nailing were noted for all the patients and patients were followed up at six weeks, three months and six months. Final functional outcome (end of six months) was calculated using Lower Extremity Functional Scale (LEFS) and radiological union (end of six months) was calculated using Radiological Union Scale in Tibial fractures score (RUST). Results: There were no statistically significant differences in RUST/LEFS score at the end of six months, with respect to age (p-value=0.825/0.847), gender (p-value=0.235/0.348), bone involvement (p-value=0.726/0.757), grade of injury (p-value=0.107/0.546) and timing of debridement (p-value=0.117/0.374). The mean RUST scores at six weeks, three months and six months were 4.39, 6.57 and 9.28, respectively. The mean LEFS scores at six weeks, three months and six months were 20.96, 34.92, 49.5, respectively. The radiological union rate in this study was 60.61% at the final follow-up. But patients who underwent secondary nailing with 10 days of primary debridement and external fixation had a statistically significant (p-value) better outcome in terms of RUST (p-value at 3 months=0.045)/LEFS (p-value at 6 months=0.030). Conclusion: The interval between external fixation and secondary nailing was found to be a significant determinant of radiological outcome at three months (p-value at 3 months=0.045) and better functional outcome at six months (p-value at 6 months=0.030) with patients undergoing secondary nailing within 10 days of external fixation having a good final outcome. However, the radiological outcome between the two groups was comparable at six months follow-up.

A study of outcome of surgical management of diaphyseal fractures of tibia treated with intramedullary interlock nailing

Management of the fractures of the shaft of the tibia remained a controversial subject despite advances in both non-operative and operative care. Sir John Charnley stated that, “we have still a long way to go before the best method of treating a fracture of the shaft of tibia can be stated with finality” in 1961. Several published series regarding the treatment of fractures of the shaft of tibia have shown that closed treatment of fractures can have excellent results. But the drawbacks of prolonged healing time, malalignment and non-compliance of the patient has led to the thought of other modalities of treatment, finally resulting in the use of closed interlocking intramedullary nailing which has given excellent results. The method of closed nailing with or without reaming followed by early ambulation and weight-bearing has positive advantages over all existing methods, significantly lower complication rates and has comparable results. The intramedullary interlock nailing under image intensifier fulfills the objective of stable fixation with minimal tissue damage resulting in better and quicker fracture unions. The important aspects for its use are its ability to prevent axial collapse, rotational and angulation deformities and most important of all, being ealiest possible ambulation. The present study has been taken to review the results of diaphyseal fractures of tibia treated with intramedullary interlock nailing.

Long-term functional outcome of knee after antegrade versus retrograde intramedullary nailing for femoral fracture

ObjectivesTo evaluate functional outcomes of the knee after antegrade and retrograde intramedullary nailing for femoral shaft fractures in adults.BackgroundAntegrade reamed interlocked intramedullary nailing is the treatment of choice for femoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nailing.Patients and methodsThis was a prospective comparative study. A total of 40 patients were divided randomly by a closed envelope technique into two equal group: group A (antegrade nailing) and group B (retrograde nailing). A total of 20 patients with shaft femur fractures had interlocking intramedullary fixation via the antegrade nailing approach (group A), whereas another 20 patients with shaft femur fractures had fixation via the retrograde approach (group B).ResultsThe mean age of group A was 25.10 ± 10.41 years and 31.35 ± 10.11 years in group B. There were no significant adverse effects reported in both groups. The mean follow-up duration was 25.20 ± 8.39 months in group A and 25.00 ± 6.91 months in group B (P = 0.759). The mean Tegner Lysholm knee scoring scale was 94.05 ± 4.43 in group A and 82.45 ± 8.83 in the group B (P < 0.0001). Regarding Tegner Lysholm knee scoring scale categorization, group A recorded 90% as excellent, whereas group B revealed 65% as good.ConclusionOur study suggests that antegrade intramedullary femoral nailing fixation is favorable over retrograde nailing in knee function, range of motion, and knee pain for diaphyseal femoral fracture in adults using Lysholm knee function scoring.

COMPARISON OF EFFECTS OF DIFFERENT NAIL TIP POSITIONS ON ANTERIOR KNEE PAIN AFTER INTRAMEDULLARY INTERLOCKING NAILING FOR TIBIAL SHAFT FRACTURES

Objective: To determine the frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures and to compare the intensity of anterior knee pain between positive and negative anterior cortex nail groups.Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi, from Oct 2018 to Apr 2019.&#x0D; Methodology: 100 cases of tibial shaft fracture were divided into two groups according to anterior cortex nail distance. Patients 18-40 years of age of both genders, closed fractures, Gustilo Andersen I open tibial diaphyseal fractures and nail tip more than 5mm from tibial tuberosity were included. Patients with osteoarthritis, pathological fractures, renal disease, open fracture GA-II &amp; GA-III and knee instability were excluded from the study. Both groups with positive and negative anterior cortex nail distance were compared for pain using the chi-square test.&#x0D; Results: Frequency of anterior knee pain after intramedullary interlocking nailing in tibial shaft fractures was found in 24% of patients. 8 (16%) out of 50 patients in the group with nail tip deep to anterior cortex had anterior knee pain while 16 (32%) out of 50 patients in the group with nail tip protruding from anterior cortex suffered anterior knee pain (p-value = 0.061).&#x0D; Conclusion: Intramedullary interlocking nailing in tibial shaft fractures with nail tip deep to anterior cortex showed less pain as compared to nail tip protruding from anterior cortex although it was not statistically significant.

A follow up study on the treatment of tibial fractures with intramedullary interlocking nail through the suprapatellar approach

To investigate the short-term effect of suprapatellar interlocking intramedullary nail in the treatment of tibial fractures. Eighty patients with tibial fractures treated from January 2016 to June 2018 were treated with interlocking intramedullary nail, who were divided into observation group (suprapatellar approach) and control group (patellar ligament approach) according to different surgical approaches. There were 40 cases in the observation group, including 28 males and 12 females, aged 28 to 67 years with a mean of (46.70±10.34) years. There were 40 cases in the control group, including 30 males and 10 females, aged 31 to 69 years with a mean of(49.38±10.74) years. The operation time, incision length, intraoperative C-arm X-ray fluoroscopy times, intraoperative blood loss, fracture healing time, postoperative active straight leg raise (SLR) time, hospital stay, visual analogue scale (VAS), knee pain rate and postoperative Hospital for Special Surgery (HSS) score were recorded and compared between two groups. All the patients were followed up, and the duration ranged from 19 to 38 months, with an average of(24.60±4.52) months. In the observation group, the operation time was(53.83± 7.01) min;the incision length was (3.98±0.83) cm;the number of intraoperative C-arm X-ray fluoroscopy was (18.90±1.75) times;the fracture healing time was (10.03±0.89) weeks;the postoperative active SLR time was (1.19±0.25) days;and the hospital stay was(6.73±1.06) days. The above indexes were better than those in the control group (P<0.05). In the latest follow-up, 34 cases got an excellent result, 5 good, 1 fair and 0 poorin the observation group. In the control group, 25 cases got an excellent result, 9 good, 6 fair and 0 poor. The curative effect of the observation group was better than that of the control group(P< 0.05). The treatment of tibial fractures with suprapatellar interlocking intramedullary nail has the advantages of less trauma and better recovery of knee function. It can obtain more satisfactory clinical results and can be further widely used.

Clinical Efficacy on the Use of Titanium Intramedullary Interlocking Nailing (Ti-IILN) for Repair of Communited Diaphyseal Femur Fractures in Dogs

Clinical Efficacy on the Use of Titanium Intramedullary Interlocking Nailing (Ti-IILN) for Repair of Communited Diaphyseal Femur Fractures in Dogs

The efficacy of augmentative anti-rotational plating plus decortication and autogenic bone grafting for aseptic nonunion after intramedullary nailing of femoral shaft fracture

Abstract Background: Femoral interlocking intramedullary (IM) nailing fixation is an effective method for the treatment of femoral shaft fractures. Aseptic nonunion of femoral shaft fracture after IM nailing is uncommon. Currently, the treatment for aseptic femoral shaft nonunion is controversial. The aim of this study was to investigate the clinical effect of augmentative antirotational plating plus decortication and autogenic bone grafting for aseptic femoral shaft nonunion after IM nailing failure. Methods: A retrospective study was conducted on 25 cases of aseptic femoral shaft fracture nonunion treated with IM nailing from January 2015 to August 2019. All patients were treated by leaving the nail in situ, debridement of nonunion sites, decortication, autogenous iliac bone grafting, and augmentative antirotational plating fixation. The time to fracture union and complications were recorded. Results: All patients were followed up for 12–18 months. The union rate after revision surgery was 100%. The average union time was 5.5 months (range, 4-10). Subjective pain symptoms had disappeared in all patients. There were no incision infections or internal fixator fatigue fractures. Average scores of the physical function and bodily pain components of the SF-36 were 95.5 (range, 91-98) and 94.1 (range, 90-97), respectively. No other obvious complications occurred postoperatively. Conclusion: Augmentative antirotational plating plus decortication and autogenic bone grafting is an excellent choice for treating femoral shaft fracture nonunion after IM nailing; this approach has an overall high union rate and few complications.

A STUDY ON FRACTURE OF FEMUR SHAFT TREATMENT WITH INTRAMEDULLARY INTERLOCKING NAILING

Background: Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. Closed reduction and intramedullary interlocking nailing is the surgical treatment of choice for the closed shaft fractures of femur. Present study conducted to study the principles of intramedullary interlocking nailing and to assess the outcome of the patient.&#x0D; Methods: The present study comprises of 30 cases of fracture shaft of the femur in adults about &gt;20 years old. All the fractures, which were included in the study were traumatic in origin, most of them are due to road traffic accidents.&#x0D; Results: The delayed union rate in our series was 6.67%. There were no non-unions.&#x0D; Conclusions: It is concluded that closed intramedullary interlocking nailing method given good result in treatment of shaft fractures of femur.&#x0D; Keywords: Intramedullary nailing, Femur, Diaphysis fractures, Interlocking

Union in Fracture Tibia Managed with Closed Intramedullary Interlocking Nail, Our Hospital Results

Introduction: The purpose of this research was to present our hospital results in union of fracture Tibia managed with close intramedullary interlocking nail.&#x0D; Methods: This research was carried out at Liaquat University of Medical and Health Science Jamshoro Pakistan from June 2020 to June 2021. A total of 250 patients with a closed tibial shaft fracture were recruited from the emergency room and outpatient clinics for this study. Our study's clinical outcomes were categorized as union, nonunion, delayed union, or malunion based on the criteria. All of the patients were given anesthesia, either general or spinal. All of the patients were tracked for a period of nine months.&#x0D; Results: In 90–150 days, about 88 percent (220/250) of patients had union, with a mean of 110.68. Union occurred in 11.2 percent (28/250) of patients in 95–109 days, with a mean of 103.38. There were 7.2 percent (18/250) delayed unions and 4.8 percent (12/250) non unions treated with dynamization and bone transplant. The outcomes were outstanding in 88 percent (220/250) of the patients and good in 7.2 percent (18/250). Our patients all had full range of motion in their knees and ankles at the time of their examination.&#x0D; Conclusion: We found that this approach is beneficial due to early mobilization (early weightbearing), reduced complexity, good outcomes, and low cost.