Intramedullary Nailing For Treatment Research Articles

Intramedullary nailing for irreducible spiral subtrochanteric fractures: A comparison of cerclage and non-cerclage wiring

PurposeIntramedullary nailing is the preferred internal fixation technique for the treatment of subtrochanteric fractures because of its biomechanical advantages. However, no definitive conclusion has been reached regarding whether combined cable cerclage is required during intramedullary nailing treatment. This study was performed to compare the clinical effects of intramedullary nailing with cerclage and non-cerclage wiring in the treatment of irreducible spiral subtrochanteric fractures. MethodsPatients with subtrochanteric fractures admitted to our center from January 2013 to December 2021 were retrospectively analyzed. The patients were enrolled in the case-control study according to the inclusion and exclusion criteria and divided into the non-cerclage group and the cerclage group. The patients' clinical data, including the operative time, intraoperative blood loss, hospital stay, reoperation rate, fracture union time, and Harris hip score, were compared between these 2 groups. Categorical variables were compared using Chi-square or Fisher's exact test. Continuous variables with normal distribution were presented as mean ± standard deviation and analyzed with Student's t-test. Non-normally distributed variables were expressed as median (Q1, Q3) and assessed using the Mann-Whitney test. A p value < 0.05 was considered significant. ResultsIn total, 69 patients were included in the study (35 patients in the non-cerclage group and 34 patients in the cerclage group). The baseline data of the 2 groups were comparable. There were no significant difference in the length of hospital stay (z = -0.391, p = 0.696), operative time (z = -1.289, p = 0.197), or intraoperative blood loss (z = -1.321, p = 0.186). However, compared with non-cerclage group, the fracture union time was shorter (z = -5.587, p < 0.001), the rate of nonunion was lower (χ2 = 6.030, p = 0.03), the anatomical reduction rate was higher (χ2 = 5.449, p = 0.03), and the Harris hip score was higher (z = -2.99, p = 0.003) in the cerclage group, all with statistically significant differences. ConclusionsIntramedullary nailing combined with cable cerclage wiring is a safe and reliable technique for the treatment of irreducible subtrochanteric fractures. This technique can improve the reduction effect, increase the stability of fracture fixation, shorten the fracture union time, reduce the occurrence of nonunion, and contribute to the recovery of hip joint function.

Wound infection and healing in minimally invasive plate osteosynthesis compared with intramedullary nail for distal tibial fractures: A meta-analysis.

To systematically explore the effects of minimally invasive plate osteosynthesis (MIPO) versus intramedullary nail (IMN) on wound infection and wound healing in patients with distal tibia fractures. A computerised search of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database (CBM) and China National Knowledge Infrastructure databases was performed, from their inception to October 2023, to identify relevant studies on the application of MIPO and IMN in patients with distal tibial fractures. The quality of the included literature was evaluated by two researchers based on inclusion and exclusion criteria, and basic information of the literature was collected, with wound infection, postoperative complications and wound healing time as the main indicators for analysis. Stata 17.0 software was applied for analysis. Overall, 23 papers and 2099 patients were included, including 1026 patients in the MIPO group and 1073 patients in the IMN group. The results revealed, when compared with IMN treatment, patients with distal tibia fractures who underwent MIPO treatment had a lower incidence of postoperative complications (OR = 0.33, 95% CI: 0.25-0.42, p < 0.001) and a shorter wound healing time (SMD = -1.00, 95% CI: -1.51 to -0.49, p < 0.001), but the incidence of postoperative wound infection was higher (OR = 2.01, 95% CI: 1.35-3.01, p = 0.001). Both MIPO and IMN are excellent treatments for distal tibia fractures. MIPO is effective in reducing the incidence of complications as well as shortening the time of wound healing time but increases the risk of wound infection. In clinical practice, surgeons can make individual choices based on the patient's wishes and proficiency in both techniques.

Clinical efficacy analysis of minimally invasive intramedullary nailing in the treatment of humeral shaft fractures combined with radial nerve injury.

The aim of this study was to research the therapeutic effectiveness of radial nerve damage paired with a humeral shaft fracture and intramedullary nailing. Retrospective research was performed on the medical records of 58 individuals who had humeral shaft fractures and radial nerve injuries. The admission period was between June 1, 2020, and June 31, 2022. All study subjects that satisfied the requirements for inclusion were separated, using the random number table approach, into two groups: one for internal fixation (group N), which included 29 cases, and one for minimally invasive procedures (group W), which included 29 patients. Group W received minimally invasive intramedullary nail treatment, and group N received internal fixation with compression plates. The changes in the clinical effects, surgery-related indicators, joint function, nerve function, and levels of stress indicators of the two groups of treatment were analyzed. The changes in adverse reactions and satisfaction of patients were compared. The effective rate of group W was 89.66% (26/29), and that of group N was 72.41% (21/29). Although group W's effective rate was higher than group N's, there was no discernible disparity between the two groups (p>0.05). Surgical blood loss and incision length were much smaller in group W than in group N, and overall operation duration and length of stay were considerably shorter in group W than in group N (p<0.05). The excellent and good rate of elbow joint function in group W was 93.10% (27/29), whereas the excellent and good rate of group N was 65.52% (19/29). The excellent and good rate of elbow joint function in group W was considerably greater than that of group N (p<0.05). In group W, the excellent and good rate of shoulder joint was 96.55% (28/29), and that in group N was 68.97% (20/29), and group W had a considerably greater probability of excellent shoulder joint function than group N (p<0.05); the excellent and good rate of neurological function was 82.76% (24/29) in group W and 58.62% (17/29) in group N, and group W had much greater rates of excellent and good neurological function than group N (p<0.05). prostaglandin E-2 (PGE2), C-reactive protein (CRP) and Substance P (SP) levels in the W group and the N group were substantially higher after the surgery than they were prior to it (p<0.05), and in the W group, the aforementioned stress markers were much lower than they were in the N group (p<0.05). Group W experienced a 3.45% (1/29) rate of adverse events, while group N saw a 24.14% (7/29) incidence. The incidence of adverse responses was substantially lower in group W than in group N (p<0.05). The contentment rate of group W was 93.10% (27/29), and that of group N was 72.41% (21/29). Group W had a much greater contentment percentage than group N (p<0.05). Minimally invasive intramedullary nailing is a successful therapeutic approach for humeral shaft fractures with radial nerve damage, which may successfully enhance patients' shoulder and elbow joint function and nerve function, reduce patients' stress response, and has the characteristics of minimal adverse responses and high contentment, which is worthy of popularization and deployment.

Is Sliding Compression Necessary for Intramedullary Nailing Fixation of AO/OTA Type A3.3 Intertrochanteric Fracture?

The intramedullary nail is considered the gold standard for treating AO/OTA type A3.3 intertrochanteric fractures. However, it still faces a significant rate of failure, mainly due to the critical factor of comminuted lateral wall defects leading to inadequate proximal sliding compression. The primary objective of this study is to investigate the requirement of sliding compression in the treatment of unstable AO/OTA type A3.3 intertrochanteric fractures. To achieve this, we conduct a comparative analysis between two approaches: InterTAN alone and proximal femoral anti-rotation blade nailing (PFNA) combined with lateral wall reconstruction for treating AO/OTA type A3.3 intertrochanteric fractures with lateral wall damage. A retrospective analysis was conducted on the clinical data of patients who underwent intramedullary nailing fixation for AO/OTA type A3.3 intertrochanteric fractures at our hospital from January 2012 to January 2022. Patient characteristics as well as treatment details, including operative time, intraoperative blood loss, weight-bearing time, fracture healing time, tip apex distance (TAD) loss, Harris hip scores (HHS), Parker-Palmer mobility score (PPMS), and postoperative complications, were collected and analyzed. Continuous variables were analyzed using independent sample t-tests, while categorical variables were examined using the chi-square test. For group comparisons, variance analysis was applied, and pairwise comparisons were conducted using the LSD-t test. These patients were divided into PFNA combined with lateral wall reconstruction group (sliding compression group) and InterTAN fixation group (static fixation group) based on surgical methods. The operation time, intraoperative bleeding loss, HHS at 12 months and PPMS at 12 months in the sliding compression group were significantly higher than those in the static fixation group, and time to weight-bearing and fracture healing time were significantly lower than those in the static fixation group (p < 0.05). There were no significant differences between two groups in terms of the TAD at 2 days, 2, and 12 months postoperatively, the incidence of complications (p > 0.05). At 6 months postoperatively, femoral neck length was shortened compared to 2 days postoperatively in both groups, and the sliding compression group had a significantly greater degree of femoral neck shortening than the static fixation group (p < 0.05). The use of PFNA with lateral wall reconstruction for A3.3 intertrochanteric fractures demonstrated superior mobility, efficiency, and reduced internal fixation failure rates compared to InterTAN. These findings suggest that sliding compression may be required for intramedullary nailing treatment.

A PROSPECTIVE COMPARATIVE STUDY OF FUNCTIONAL OUTCOME IN PATIENTS TREATED WITH INTERLOCKING NAILING AND DYNAMIC COMPRESSION PLATING FOR FRACTURE SHAFT OF HUMERUS IN ADULTS

Aims of the Study: The purpose of this study is to compare the functional outcome between patients who underwent intramedullary interlocking nailing treatment and those who had Dynamic Compression plating applied to the fractured shaft of the humerus. Methods: A prospective comparative study involving 30 people who had humeral shaft fractures was carried out. Fractures treated at the Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, between December 2020 and November 2022 using intramedullary interlocking nailing and Dynamic Compression plating. Results: According to our analysis, there is no appreciable difference in the fracture union times between the two techniques. The incidence of infection was greater in the plating group than in the patients who received closure reduction and an interlocking nail procedure. Conclusion: The interlocking nail group in our study reported higher complications. The majority of them involved excruciatingly poor shoulder function. However, both treatment techniques’ secondary complications a group of interlocking nails were more common than they should have been. I, therefore, come to the conclusion that patients can be treated with dynamic compression plating and interlocking nailing for a fractured humerus shaft. Intramedullary interlocking nailing is a safe and effective alternative therapy of diaphyseal fractures in the humerus. It can be used by those who have osteoporosis segmentation-and polytrauma-affected fractures.

Comparison Between Plating and Intramedullary Nailing in Treatment of open Femoral Shaft Fracture from 2014 to 2017

Comparison Between Plating and Intramedullary Nailing in Treatment of open Femoral Shaft Fracture from 2014 to 2017

The comparison of the Effect of double reverse traction repositor (DRTR) and traction table assisted Anterograde Intramedullary nail in treatment of femoral shaft fractures

ObjectiveThe objective of this study was to compare the clinical efficacy of DRTR (Double Reverse Traction Repositor, DRTR)and traction table in the treatment of femoral shaft fractures with the aid of AN-IMN (Antegrade intramedullary nailing).Patients and MethodsIn this study, patients with femoral shaft fractures admitted to the Department of Orthopedics at Zhaoqing First People’s Hospital from May 2018 to October 2022 were recruited. All patients were treated with anterograde intramedullary nailing, with 23 patients in the DRTR-assisted group and 21 patients in the traction table-assisted group. The demographic characteristics, fracture classification, intraoperative data, postoperative data, and prognostic indicators of the two groups were recorded and analyzed retrospectively. All procedures were performed by the same team of experienced physicians.ResultsAll the patients in the two groups were followed up for more than 12 months. Both traction methods could provide stable traction for the operator during AN-IMN, and there was no significant difference in demographic characteristics and fracture classification. The intraoperative fluoroscopy times and opening reduction rate of the DRTR group were lower than those of the traction table group (P < 0.05), and the postoperative Harris Hip Score, as well as the Lyshol Lysholm knee function Score of the DRTR group, were significantly higher than the traction table group members (P < 0.05). Postoperative complications such as perineal soft tissue injury and lateral femoral cutaneous nerve injury occurred in the traction table group, but not in the DRTR group.ConclusionDRTR can safely and effectively provide continuous and stable traction in the femoral shaft fractures surgery, and outperforms the traction table in the number of intraoperative fluoroscopy, opening reduction rate, reduction of complications, and postoperative joint function score.

Titanium elastic nail treatment for a humeral shaft fracture of an adolescent arm wrestler: A case report and literature review

Arm wrestling is a sport where two people take opposing positions at a table and put their elbows on the table with their palms together, the aim being to make the opponent’s hand touch the table. Arm wrestling, which seems harmless, may become a show of strength for adolescents and young adults. Muscle and tendon injuries and bone fractures may occur due to arm wrestling. Fractures of the humeral shaft and distal third region can also occur due to arm wrestling. Here, we present the contribution of closed reduction and titanium intramedullary nail treatment to early return to school for a 14-year-old male patient with an AO 12.A1 fracture of the humeral shaft that occurred during arm wrestling. Our treatment reduced the duration of immobilization, provided complete union at the fracture site along with full range of motion of shoulder and elbow joints at 3 months after the injury.

Lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail in treatment of complicated subtrochanteric femoral fracture

To investigate the effectiveness of lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail in the treatment of complicated subtrochanteric femoral fracture. The clinical data of 16 patients with complicated subtrochanteric femoral fractures (Seinsheimer type Ⅲ-Ⅴ) treated with lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail between September 2017 and August 2020 were retrospectively analyzed. There were 13 males and 3 females with an average age of 47 years (range, 26-85 years). There were 12 cases of high-energy injury and 4 cases of low-energy injury. According to Seinsheimer classification, there were 3 cases of type ⅢA, 2 cases of type ⅢB, 7 cases of type Ⅳ, and 4 cases of type Ⅴ. The time from injury to operation ranged from 2 to 6 days, with an average of 4.7 days. The operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, surgical complications, fracture healing time, and collodiaphyseal angle of the affected and healthy sides before and after operation were recorded. Hip fracture Harris score was used to evaluate hip function. The operation time was 90-180 minutes (mean, 135.9 minutes), the intraoperative blood loss was 200-400 mL (mean, 288.8 mL), the postoperative drainage volume was 120-220 mL (mean, 140.0 mL), and the hospitalization stay was 12-22 days (mean, 15.8 days). All the 16 patients were followed up 9-12 months (mean, 9.9 months). There was 1 case of incision superficial infection after operation, which healed after anti-infection treatment; no complication such as deep venous thrombosis of lower limbs, coxa vara deformity, re-fracture, or broken nails occurred. All the fractures healed successfully, the healing time ranged from 12 to 20 weeks, with an average of 17.5 weeks. At 6 months after operation, the Harris score was 87-96, with an average of 91.5; the results were excellent in 11 cases and good in 5 cases, with the excellent and good rate of 100%. The collodiaphyseal angle of the affected side was (124.0±5.7)°, while that of the healthy side was (132.0±2.1)°, showing significant difference between the two sides ( t=-7.376, P=0.001). At last follow-up, the collodiaphyseal angle of the affected side was (129.0±3.2)°, which significantly improved when compared with that before operation ( t=-6.175, P=0.002), and there was no significant difference between the affected side and the healthy side ( t=-2.648, P=0.181). Lateral decubitus position assisted plate internal fixation through a lateral incision to assist reduction combined with intramedullary nail is a reliable internal fixation method for the treatment of complicated subtrochanteric femoral fractures. The use of plate reduction is conducive to maintaining the force line of the femoral trochanter. The enlargement of the incision is conducive to the accurate implantation of intramedullary nails without affecting fracture healing.

Aseptic femoral nonunion treated with exchange locked nailing with intramedullary augmentation cancellous bone graft

BackgroundClosed reamed locked intramedullary nailing has been the treatment of choice for most of femoral shaft fractures. A high union rate with a low complication rate is generally predictable. For an aseptic femoral shaft nonunion with a prior inserted intramedullary nail, exchange nailing is one of favored surgical techniques for treatment. However, a greatly varied success rate of 72–100% has been reported. To improve the success rate of exchange femur nailing, a modified bone grafting technique was developed. The purpose of this retrospective study intended to evaluate outcomes of such a revised technique.MethodsFrom July 2011 to March 2019, 48 consecutive adult patients (average, 38 years; range, 19–67 years) with aseptic femoral shaft nonunions after intramedullary nailing treatment were studied. All femoral shaft fractures were initially caused by traffic accidents, which were treated by a closed or open intramedullary nailing technique at various hospitals. The current revision treatment was performed after an average of 2.2 years (range 1.1–6.2 years) from initial injuries. In the surgery, the prior nail was removed and the marrow cavity was reamed widely (at least 2 mm as possible). Sufficient cancellous bone grafts harvested on the trochanteric marrow wall from the inside were placed in the marrow cavity of the junction of nonunion fragments. A new 1-mm smaller size locked intramedullary nail was inserted. Whether the dynamic or static mode of nails were used mainly depended on the nonunion level. Postoperatively, protected weight bearing with crutches was allowed for all patients.ResultsForty-one patients were followed for an average of 2.8 years (85.4%; range, 1.9–4.5 years) and all fractures healed. The union rate was 100% (41/41, p < 0.001) with a union time of an average of 3.4 months (range, 2.5–5.0 months). There were no complications of deep infection, nonunions, malunions, implant failures or an avulsed trochanter tip fracture. The satisfactory knee function improved from 73.2% (30/41) preoperatively to 92.7% (38/41) at the latest follow-up (p = 0.019).ConclusionsThe described modified bone grafting technique may effectively improve a union rate of exchange femur nailing while the surgical procedure is not complicated. It may therefore be used concomitantly in all aseptic femoral shaft nonunions when exchange nailing is performed.

Novel Retrograde Tibial Intramedullary Nailing for Distal Tibial Fractures.

PurposePostoperative distal tibial fractures are often associated with complications such as difficulties in fracture healing and surgical incision infection. The purpose of this study is to evaluate the fracture healing time and functional recovery after a retrograde tibial intramedullary nail treatment for distal tibial fractures.MethodsWe retrospectively studied 9 cases of patients with distal tibial fractures treated with retrograde intramedullary nailing (IMN). Fracture healing time was based on monthly postoperative x-ray imaging results, and functional outcomes were defined according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.ResultsAmong the 9 patients with distal tibial fractures from July 2020 to April 2021, the mean age was 51.8 ± 13.8 years. The classification of distal tibial fractures in the 9 patients according to OTA (Orthopaedic Trauma Association) includes 6 extra-articular fractures (3 of type A1, 2 of type A2, and 1 of type A3) and 3 intra-articular fractures (1 of type C1 and 2 of type C2). Among them, there were 5 closed fracture cases and 4 open fracture cases (according to Gustilo classification: 2 of type I, 2 of type II). We treated the fractures surgically with new retrograde tibial intramedullary nailing. The mean follow-up time for this group was 7.9 months (5–12 months). According to monthly postoperative radiographs performed to monitor fracture healing, the mean healing time was 3.3 months (3–4 months). Final postoperative function according to the AOFAS ankle-hindfoot score shows 6 excellent cases, 3 good cases. No serious complications such as postoperative infection, bone and internal fixation exposure, osteofascial compartment syndrome, or vascular nerve injury occurred.ConclusionThe new retrograde tibial intramedullary nail (RTN) has some unique advantages, and its treatment of distal tibial fractures can achieve good efficacy, but further studies are still needed to verify it.

Experience in the management of distal third tibia and fibula fractures by interlocking intramedullary nail in Community Based Medical College Hospital

Objective: To determine the effect of interlocking intramedullary nail in treatment of tibia and fibula fractures and analyze its efficacy by clinical and radiological parameters.&#x0D; Methods: From August 2015 to September 2017, in Community Based Medical College Hospital, Orthopedics department, 15 patients with tibia and fibula fractures were managed by open reduction and interlocking nail and each case was followed up for 7 months. The cases were assessed clinically and by radiology.&#x0D; Results: There were 13 males and 2 females involving 10 right legs and 5 left legs. Ages of patients ranged from 17 years to 60 years with mean age 36.13 years and standard deviation 11.813 years. The location of fractures was 1 upper, 2 middle and 12 lower. There was association of 1 fracture femur right side.&#x0D; Conclusion: Use of interlocking intramedullary nail in management of tibia and fibula fractures was good in majority of cases.&#x0D; CBMJ 2021 January: vol. 10 no. 02 P: 91-97

Comparison of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly

To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. A retrospective analysis was conducted on 86 elderly patients with Neer two- and three-part fractures of the proximal humerus met the selection criteria between January 2015 and December 2018. Forty-six patients were treated with locking plate fixation (locking plate group), and 40 patients with intramedullary nail fixation (intramedullary nail group). There was no significant difference in gender, age, cause of injury, fracture side and type, time from injury to operation, and comorbidities between the two groups ( P>0.05). Visual analogue scale (VAS) score, American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score, and shoulder range of motion (forward flexion, abduction, and external rotation) were compared between the two groups. X-ray films were taken to assess the fracture healing, and the neck-shaft angle was measured at 2 days after operation and at last follow-up, and the difference between the two time points was calculated. Patients in both groups were followed up 18-40 months, with an average of 30.4 months. There was no significant difference in follow-up time between the two groups ( t=-0.986, P=0.327). X-ray films reexamination showed that the fractures of two groups healed, and the healing time was (11.3±2.1) weeks in locking plate group and (10.3±2.0) weeks in intramedullary nail group, which had significant difference between the two groups ( t=2.250, P=0.027). The difference of neck-shaft angle was (7.63±7.01)° in locking plate group and (2.85±2.82)° in intramedullary nail group, which had significant difference between the two groups ( t=4.032, P<0.001). There was no significant difference in Constant-Murley score, ASES score, VAS score, and shoulder range of motion between the two groups at last follow-up ( P>0.05). Complications occurred in 13 cases (28.3%) of locking plate group and in 4 cases (10.0%) of intramedullary nail group, and the difference between the two groups was significant ( χ 2=4.498, P=0.034). Both locking plates and intramedullary nails can be used for the treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. The intramedullary nail fixation surgery is more minimally invasive, which has fewer postoperative complications and faster fracture healing.

Functional assessment of long bone fracture healing in Samburu County Referral Hospital (Kenya): the squat and smile challenge.

Background:The burden of musculoskeletal trauma is increasing in low- and middle-income countries. Due to the low clinical follow-up rates in these regions, the Squat-and-Smile test (S&S) has previously been proposed as a proxy to assess bone healing (BH) capacity after surgery involving bone fractures. This study deals with various aspects of using S&S and bone radiography examination to obtain information about an individual's ability to recover after a trauma. In summary, we performed the S&S test to assess the possibility of recovering biomechanical function in lower limbs in a remote area of Kenya (Samburu County).Methods:Eighty-nine patients (17.9% F; 31.7 ± 18.9 yrs) who underwent intramedullary nail treatment for femur or tibia fractures were enrolled in this study. Both S&S [evaluated by a goal attainment scale (GAS)] and x-ray (evaluated by REBORNE, Bone Healing Score) were performed at 6 and 24 weeks, postoperatively. An acceptable margin for satisfactory S&S GAS scores was determined by assessing its validity, reliability, and sensitivity.Results:S&S GAS scores increased over time: 80.2% of patients performed a satisfactory S&S at the 24-weeks follow-up with a complete BH. A high correlation between S&S GAS and REBORNE at the 6- and 24- weeks’ timepoint was found. Facial expression correlated partially with BH. The S&S proved to be accurate at correctly depicting the BH process (75% area fell under the Receiver Operator Curve).Conclusion:The S&S provides a possible substitution for bone x-ray during BH assessment. The potential to remotely follow up the BH is certainly appealing in low- and middle-income countries, but also in high-income countries; as was recently observed with the Covid-19 pandemic when access to a hospital is not conceivable.

Are small-diameter intramedullary nails enough for treating simple diaphyseal tibial fractures? A comparative study between small versus large nails.

The aim of our study was to compare the results of using small-diameter versus large-diameter interlocking reamed intramedullary nails in treatment of simple tibial shaft fractures. This prospective randomized control trial involved 60 patients, divided into two groups, Group A (Small IMN) (10mm in males and 9mm in females) and Group B (Large IMN) (12mm in males and 11mm in females). All patients were followed up for at least 1year. The mean operative time in Group A was 79min versus 94.6min in Group B. The mean time of radiological exposure in Group A was 2.27min compared to 3.73min in Group B. The mean union time in Group A was 15.2weeks, while in Group B, the mean union time was 12.8weeks. Implant failure (screw breakage or nail breakage) or nonunion did not occur in any case in the two groups. Small IMN showed comparable clinical and radiological results to large IMN with lesser operative and radioscopic time. We can recommend that small IMN should be used more often in treating simple stable tibial fractures.

Management of Metaphyseal Tibial Fractures by Expert Tibial Nail System

Background: Metaphyseal tibial fractures contain distal and proximal metaphyseal fractures which account for (3-11%) and (5-11%) of total tibial fractures, respectively. Numerous treatment options exist for treating metaphyseal tibial fractures. Objectives: The aim of the current work was to assess the clinical and radiological functional outcomes of expert tibial intramedullary nail in treatment of metaphyseal tibial fractures in adult. Patients and Methods: This prospective study included a total of 12 patients who had metaphyseal tibial fractures, attending at Zagazig University Hospital and Damietta Specialized Hospital. Patients were operated by closed reduction and internal fixation with expert interlocking tibial nail and followed up for average 6 months from November 2019 to December 2020. Results:All patients underwent full history taking, Clinical examination and Radiographic views were taken for other skeletal injuries if suspected. 2 patients (16.7%) has proximal tibial fracture, 1 (8.3%) of them had excellent final result and 1 (8.3%) had good final result. 2 patients (16.7%) had segmental tibial fracture,1(8.3%) of them had excellent final result and 1 (8.3%) had fair final result. 8 (66.7%) patients had distal tibial fractures, 6 (50%) had excellent final result, 1 (8.3%) had good final result,1 (8.3%) had poor final result. Conclusion: It could be concluded that intramedullary fixation with expert interlocking tibial nail is a safe and effective method for the treatment of metaphyseal tibial fractures. Multiple reduction aids as percutaneous clamps, blocking screws/wires help in obtaining and maintaining reduction. The nail design allows the distal or proximal segment to be controlled through placement of multiple locking screws within a small distance from the articular surface. The alignment can be well maintained despite the short metaphyseal segment. Expert nail showed excellent and good results in more than 83% in this study.

Cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with femoral shaft fractures in Malawi

Background and purpose — In Malawi, both skeletal traction (ST) and intramedullary nailing (IMN) are used in the treatment of femoral shaft fractures, ST being the mainstay treatment. Previous studies have found that IMN has improved outcomes and is less expensive than ST. However, no cost-effectiveness analyses have yet compared IMN and ST in Malawi. We report the results of a cost-utility analysis (CUA) comparing treatment using either IMN or ST. Patients and methods — This was an economic evaluation study, where a CUA was done using a decision-tree model from the government healthcare payer and societal perspectives with an 1-year time horizon. We obtained EQ-5D-3L utility scores and probabilities from a prospective observational study assessing quality of life and function in 187 adult patients with femoral shaft fractures treated with either IMN or ST. The patients were followed up at 6 weeks, and 3, 6, and 12 months post-injury. Quality adjusted life years (QALYs) were calculated from utility scores using the area under the curve method. Direct treatment costs were obtained from a prospective micro costing study. Indirect costs included patient lost productivity, patient transportation, meals, and childcare costs associated with hospital stay and follow-up visits. Multiple sensitivity analyses assessed model uncertainty. Results — Total treatment costs were higher for ST ($1,349) compared with IMN ($1,122). QALYs were lower for ST than IMN, 0.71 (95% confidence interval [CI] 0.66–0.76) and 0.77 (CI 0.71–0.82) respectively. Based on lower cost and higher utility, IMN was the dominant strategy. IMN remained dominant in 94% of simulations. IMN would be less cost-effective than ST at a total procedure cost exceeding $880 from the payer’s perspective, or $1,035 from the societal perspective. Interpretation — IMN was cost saving and more effective than ST in the treatment of adult femoral shaft fractures in Malawi, and may be an efficient use of limited healthcare resources.

A Comparative Study of Intramedullary Nailing and Minimally Invasive Percutaneous Plate Osteosynthesis for Type A Tibial Fracture Healing

Objective This study aimed to retrospectively compare the efficacy of intramedullary nailing and minimally invasive percutaneous plate osteosynthesis (MIPPO) on the fracture healing of patients with type A tibial fractures. Methods Patients who had been diagnosed with type A tibial fracture (AO classification method) and treated with minimally invasive surgery in our hospital from January 2016 to January 2019 were included in the study. There were 21 patients in the MIPPO group and 27 patients in the intramedullary nailing group. The operation time, intraoperative blood loss, surgical incision length, callus formation time, and fracture healing time of the two groups were analyzed and compared. Results In the intramedullary nailing group, the callus formation time and the fracture healing time were shorter than those in the MIPPO group (P&lt;0.005). Their operation time, intraoperative blood loss, and the surgical incision length were comparable between the two groups. Conclusions For patients with type A tibial fracture and poor wound tissue conditions, intramedullary nailing fixation treatment may be a better choice than MIPPO. Because in patients receiving intramedullary nailing treatment, the callus formation time and fracture healing time are short, and functional exercises can be performed soon after the surgery, which can reduce the occurrence of related complications.

Flexible Intramedullary Nails for Treatment of Femoral Shaft Fracture in Children, Aden, Yemen

Flexible Intramedullary Nails for Treatment of Femoral Shaft Fracture in Children, Aden, Yemen

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.