Intramedullary Nailing Osteosynthesis Research Articles

Primary stability in locking plate fixation for proximal humeral fractures may be increased by using an additional nail osteosynthesis in combination with locking plate osteosynthesis—A biomechanical comparison

BackgroundStability is regarded as an important factor for proper healing and avoiding secondary dislocation in osteoporotic fractures of the proximal humerus. Several surgical techniques have been proposed for treatment, including intramedullary nail osteosynthesis and locking plate fixation. This study introduces a novel approach that combines both techniques and compares its primary stability with conventional methods. MethodsThe study involved 25 osteoporotic humeri with two-part fracture models, which were randomly assigned to locking-plate fixation, intramedullary nailing, or a combination of both techniques. The specimens were subjected to sinusoidal loading at 250 N in 20° abduction for 5000 cycles and then to quasi-static loading until failure. Fracture movement, failure mode, and failure load were measured and compared among the groups. FindingsThe groups fixated with intramedullary nailing and the groups fixated with intramedullary nailing and locking plate fixation showed significantly lower fracture motion than the group using locking plate fixation only (p < 0.005) and significantly higher load to failure (p = 0.007 and p = 0.0062, respectively). There was no significant difference between the group using intramedullary nailing and the group using locking-plate fixation and intramedullary nailing in fracture movement or load-to-failure (p > 0.005). InterpretationThe results indicate that locking plate fixation provides less primary stability than intramedullary nailing or the combined of both techniques. This combined approach may offer advantages as a treatment for complex proximal humeral fractures in osteoporotic bone, and specific implants should be developed to ensure optimal treatment.

Major low-energy trauma results in non-specific immunoglobulin generation without evidence for specific autoantibody production: A prospective cohort study.

Cellular debris resulting from large trauma might overwhelm the scavenger mechanisms and lead to autoimmune reactions. We analysed whether a major well-defined trauma in humans induces laboratory signs of transient autoimmunity in the months after the insult. We included 50 patients with pertrochanteric femur fracture undergoing intramedullary nail osteosynthesis in a prospective cohort study and followed them at 3-4 days, 6 weeks, 12 weeks and 12 months postoperatively. By standard techniques, we assessed levels of total immunoglobulins, anti-nuclear antibodies (ANA), anti-cardiolipin antibodies, anti-dsDNA antibodies and anti-C1q antibodies, as well as antibodies against cytomegalovirus (CMV) as a control. Blood leukocyte differential and lymphocyte subpopulations were determined at baseline and in the first two postoperative samples. The mean age of the patients reached 80.1 years, and 23 (46%) completed all visits. Serum concentrations of total IgG, IgM and IgA increased at all follow-up time points. The ANA fluorescence light intensity units increased at 12 weeks and 12 months postoperatively (p < 0.0001), but the proportion of ANA-positive patients did not change (35%). The values of anti-C1q mildly increased at all follow-up visits, but not the ratio to total IgG. Anti-dsDNA remained negative in all patients, and anti-cardiolipin IgG/IgM antibodies did not change. Anti-CMV IgG antibodies increased significantly at all follow-up visits, without change in the ratio to total IgG. Flow cytometry showed an increased proportion of B-cells 3-4 days postoperatively. In conclusion, major musculoskeletal trauma in elderly patients induces a generalized non-specific increase in immunoglobulin production without laboratory signs for enhanced systemic autoimmunity.

Optimized reamer geometry for controlled reaming of the proximal femur

Preparation of the femoral proximal medullary cavity by reaming is essential for intramedullary nail osteosynthesis and hip revision arthroplasty. The use of reamers sometimes exerts high torsional forces on the bone. Design and direction of rotation of the reamer are potential influencing factors. The aim of this biomechanical study is to evaluate the best combination of a right- or left-cutting reamer with a clockwise- or counterclockwise-rotating insert in terms of preparation and safety. Right- and left-cutting reamers with conical design were each introduced into five synthetic femurs in both clockwise and counterclockwise rotation with constant feed force. A specially constructed test system was used for this series of tests, with which the respective intramedullary channel were reamed step by step. This was then used to determine the required torque. In addition, the feed rate measurement was analyzed using a modified digital caliper. The feed rates of the reamers with rotation in the same direction as the cutting direction were significantly increased compared to rotation in the opposite cutting direction (CCRLC vs. CCRRC 76.8 ± 9.0 mm/s vs. 25.2 ± 8.3 mm/s and CRRC vs. CRLC 54.3 ± 12.3 mm/s vs. 19.3 ± 0.6 mm/s; p < 0.01). In contrast, the mean torque during the reaming process was identical in all four groups. When preparing the proximal femoral medullary cavity, especially in cases with fragile bone structure, the available reamers should be introduced in opposite rotation to the cutting direction to achieve a more controllable feed of the reamer. Left-cutting reamers represent an alternative, using them in the usual clockwise-rotating technique to reduce the risk of complications during reaming.

Rate of Complications after Hip Fractures Caused by Prolonged Time-to-Surgery Depends on the Patient's Individual Type of Fracture and Its Treatment.

Hip fractures are common injuries in the elderly and are usually treated with timely surgery. While severe postoperative complications are reported for up to 10% of patients, many studies identified predictive factors for the occurrence of complications postoperatively. A controversially discussed factor is "time-to-surgery". The aim of the study was to examine if time-to-surgery was associated with the occurrence of complications and if the complication rate differed between the patient individual fracture types of intracapsular on the one hand and extracapsular hip fractures on the other hand. We hypothesized that time-to-surgery had less impact on complications in intracapsular hip fractures compared to extracapsular ones, and therefore, guidelines should pay attention to the patient individual case scenario. All patients who were admitted to the Department of Trauma and Orthopaedic Surgery of an academic teaching hospital for hip fracture surgery (n = 650) over a five-year period were included in the study. After the application of the exclusion criteria, such as periprosthetic or pathologic fractures, cases needed immediate surgical treatment, and after outlier adjustment, 629 cases remained in the study. Hip fractures were classified into intracapsular fractures (treated by hip arthroplasty) and extracapsular fractures (treated by intramedullary nailing osteosynthesis). The occurrence of severe complications in patients treated within 24 h was compared with patients treated later than 24 h after injury. For statistical evaluation, a multivariate logistic regression analysis was performed to investigate the impact of time-to-surgery interval on the occurrence of complications. Patients with an extracapsular fracture, which was treated with intramedullary nailing (44.5%), rarely suffered a serious complication when surgery was performed within 24 h after injury. However, when the interval of the time-to-surgery was longer than 24 h, the complication rate increased significantly (8.63% vs. 25.0%, p = 0.002). In contrast to this finding in patients with intracapsular fractures (55.5%), which were treated with cemented arthroplasty, complication rates did not depend on the 24 h interval (26.17% vs. 20.83%, p = 0.567). The occurrence of complications after surgical treatment of hip fractures is associated with the time interval between injury and surgery. A 24 h time interval between injury and surgical procedure seems to play a major role only in extracapsular fractures treated with osteosynthesis but not in intracapsular fractures treated with arthroplasty. Therefore, guidelines should take notice of the patient individual case scenario and, in particular, the individual hip fracture type.

Predictive Value of Prognostic Nutritional Index for Early Postoperative Mobility in Elderly Patients with Pertrochanteric Fracture Treated with Intramedullary Nail Osteosynthesis

Early postoperative mobilization is essential for orthogeriatric patients. The prognostic nutritional index (PNI) is widely used to evaluate nutritional status. This study sought to investigate the predictive value of PNI for early postoperative mobility in patients with pertrochanteric femur fractures. This study included 156 geriatric patients with pertrochanteric femur fractures treated with TFN-Advance™ (DePuy Synthes, Raynham, MA, USA). Mobility was evaluated on the third postoperative day and by discharge. Stepwise logistic regression analyses were performed to evaluate the association significance of PNI with postoperative mobility together with comorbidities. The optimal PNI cut-off value for mobility was analyzed using the receiver operating characteristic (ROC) curve. Three days postoperatively, PNI was an independent predictor of mobility (OR: 1.14, 95% CI: 1.07-1.23, p < 0.01). By discharge, it was found that PNI (OR: 1.18, 95% CI: 1.08-1.30, p < 0.01) and dementia (OR: 0.17, 95% CI: 0.07-0.40, p < 0.001) were significant predictors. PNI correlated weakly with age (r = -0.27, p < 0.001). The PNI cut-off value for mobility on the third postoperative day was 38.1 (specificity = 78.5%, sensitivity = 63.6%). Our findings indicate that PNI is an independent predictor of early postoperative mobility in geriatric patients with pertrochanteric femur fractures treated with TFNA™.

Influence of Fracture Reduction on the Functional Outcome after Intramedullary Nail Osteosynthesis in Proximal Humerus Fractures.

Optimal treatment of proximal humeral fractures (PHF) is still controversial. Therefore, we aim to investigate the influence of fracture reduction after intramedullary nailing of a PHF on the clinical outcome. Patients treated with intramedullary nail for PHF from 2013-2018, (minimum follow-up 12 months) were retrospectively included. Constant Score (CS), DASH and Simple Shoulder Test (SST) were collected. Postoperative radiographs were used to determine head-shaft-alignment (HSA), head-shaft-displacement (HSD), integrity of the medial hinge and the cranialization of the greater tuberosity (CGT). The results of fracture reduction were categorized as either "anatomical", "acceptable" or as "malreduction". Malreduction exists when at least one of the following parameters are present: HSA &gt; 150/&lt; 110°, HSD &gt;5 mm, CTM &gt; 5 mm or lack of integrity of the medial hinge. 42 patients (mean age 65.5 ± 14.1 years, 15 male, 27 female) with a mean follow-up time of 43 months were included. The average CS was 60 ± 30, DASH 49.8 ± 24.3 and SST 62.9 ± 26.9. There was an "anatomic" reduction in 9 (21.4%), "acceptable" in 7 (16.6%) and a "malreduction" in 26 (62%) patients. Comparing the combined "anatomical" and "acceptable" reduction group with the "malreduction" group, worse scores were observed in the "malreduction" group (CS 67.2 vs. 55.2, DASH 45.2 vs. 51.9, SST: 69.3 vs. 58.6) without statistical significance (CS: p = 0.095, DASH: p = 0.307, SST: p = 0.400). By means of multiple logistic regression analyses no statistically significant risk factors were identified for lower DASH, CS and SST scores. Anatomical fracture reduction using intramedullary nails has a positive effect on postoperative outcome for the 3 scores recorded, without reaching statistical significance.

Proximal humerus fractures treatment in adult patients with bone metastasis.

The humerus is the second long bone most affected by pathological fractures. According to Capanna and Campanacci criteria, surgical choice is based on bone metastasis location, on the patient's status and on the residual functional capacity. Metadiaphysis is an area of conflict in the choice between megaprosthesis implant and intramedullary nail osteosynthesis. This study compares these two surgical procedures in terms of reacquired functionality and local control of metastasis. Thirty-eight patients (17 males and 21 females; mean age: 66 years old) treated in our institution between January 2010 and December 2020 for pathological humeral metadiaphyseal fractures caused by metastasis, were included in this study. We choose the Musculoskeletal Tumor Society rating system (MSTS) and the Quick Disability of Arm-Shoulder-Hand (QuickDASH) scores for the evaluation of the upper limb function after surgery. Eighteen (47%) pathological fractures were treated by resection and megaprosthesis implantation, twenty (53%) were treated by medullary nail osteosynthesis. A reduction in pain and greater mechanical stability in the immediate post-operative period was found in all patients. Twenty-two patients died (58%) and sixteen survived (42%). Long-term functional recovery of patients undergoing osteosynthesis is greater than megaprothesis group. Both medullary nail osteosynthesis and resection and megaprosthesis implantation guarantee excellent recovery at 72 months after surgery, improvement in quality of life and pain relief. Patients treated with osteosynthesis showed a great short-term functional recovery since the joint portion of the limb is not involved, whereas patients treated with megaprosthesis showed better local oncologic control. It is therefore possible to define the type of treatment not only on the localization of the fracture (diaphysis or epiphysis) but above all on the conditions and characteristics of the patient.

Improving Equine Intramedullary Nail Osteosynthesis via Fracture Adjacent Polymer Reinforcement

Abstract Introduction: Osteosynthesis of the equine femur is still a challenge for veterinary medicine. Even though intramedullary fracture fixation is possible nowadays, the varying geometry of the medullary cavity along the bone axis is a critical factor. Limited contact area between implant and bone can cause insufficient primary stability. In this study, it was investigated whether the osteosynthesis stability can be improved with a form-adaptive reinforcement for the diaphyseal part of the proximal fragment. Material and Methods: Eight equine femora were fitted with intramedullary nail osteosynthesis and analyzed by 4-point bending. Virtual position planning of the ex-vivo implantation using CT-data increased comparability. For five femora the proximal fragment was reinforced with a flexible polymer mixture. Longterm stability was tested via cyclic loading. Bending stiffness and its development due to cyclic loading was evaluated before and after reinforcement procedure. Finally, load-to-failure was tested in the same setup. Results and Discussion: The application of the polymer reinforcement increased the maximum torque in the load-tofailure measurement by 26%. Bending stiffness was not affected in the measured loading range by the reinforcement. Cyclic loading increased bending stiffness for a conditioned state but showed to be reversible for the most part. Conclusion: The fracture adjacent reinforcement showed to be beneficial to the osteosynthesis stability, but further investigation is necessary for surgical application.

Translated article] Metaphysary fractures of the distal tibia: Comparative analysis of the results obtained by means of a blocked plate and intramedular nail

IntroductionFractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men.These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis.The objective of the present study was to analyse and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. Material and methodsWe carried out a retrospective study with patients diagnosed of “distal third tibia fracture” segment 43A according to the classification proposed by the “Trauma Orthopedic Association” who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. ResultsThe study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15–77 years). The mean follow-up time was 6 months (3–30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. DiscussionCurrently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. ConclusionsAfter analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.

Fracturas metafisarias de tibia distal: analisis comparativo de los resultados obtenidos mediante placa bloqueada y clavo intramedular

IntroductionFractures of the distal third of the tibia are mostly the consequence of high-energy trauma with significant soft tissue involvement, being more frequent in men.These types of fractures differ from the tibial pilon joint fracture in their mechanism of injury, management and prognosis.The objective of the present study was to analyze and compare the results obtained in the treatment of fractures of the distal third of the tibia without joint extension using a locked plate and intramedullary nail. Material and methodsWe carried out a retrospective study with patients diagnosed of “distal third tibia fracture” segment 43A according to the classification proposed by the “Trauma Orthopedic Association” who were intervened between January 2015 and May 2019 were included. We obtained 24 patients intervened with a nail intramedullary and 29 using a blocked plate. ResultsThe study included 53 patients, 36 men and 17 women with a mean age of 51 years (range: 15-77 years). The mean follow-up time was 6 months (3–30 months). No significant differences were found in the time to fracture healing, although the beginning with load walking was earlier in the nail group. DiscussionCurrently there is no consensus on the therapeutic management of distal tibia fractures without joint extension. ConclusionsAfter analyzing the results, we consider that both intramedullary nail osteosynthesis and a locked plate are valid options in the treatment of fractures of the distal third of the tibia.

New ways of treatment of fractures of the humeral shaft: does the combination of intramedullary nail osteosynthesis and cerclage improve the healing process?

IntroductionThe humeral shaft fracture is a rare fracture of the long bones with various treatment options. Dreaded complications such as lesions of the radial nerve or non-unions make the decision for what kind of therapy option more difficult. Biomechanically the upper arm is mostly exposed to rotational forces, which affect intramedullary nail osteosynthesis. Additive cerclage may compensate for these in spiral fractures. The aim of this study is to investigate what effect a combination of intramedullary nail osteosynthesis and limited invasive cerclage has on the rate of healing. In addition, this study addresses the question if complications arise as a result of cerclage.MethodsIn this retrospective study, 109 patients were evaluated, who, during a period of 6 years, underwent operative treatment of a humerus shaft fracture with a combination of intramedullary nail osteosynthesis and additive cerclage. The primary end point was to establish the rate of healing. A secondary end point was to evaluate complications such as infections and damage to the nerve. This was followed by an examination of patient files and X-ray images and a statistical analysis with SPSS.Results and conclusionThe healing process shows a non-union rate of 2.6%, and complications such as secondary radial nerve lesions of 4.6%. The antegrade intramedullary nail osteosynthesis with limited invasive, additive cerclage reduces the risk of non-union and does not lead to an increased risk of iatrogenic damage to the radial nerve. Wound healing was not impaired and there were no infections through the cerclage in our patient cohort.

Frequency of complications at shaft fractures according to kharkiv traumatological medical-social expert committee (MSЕC) data

Objective: to determine the incidence of complications after treatment of shaft fractures according to the inter-regional Specialized Traumatological Medical and Social Expert Commission in Kharkiv and Kharkiv region.Methods: we studied the incidence of nonunions, osteomyelitis, radial nerve neuropathy in 773 patients with shaft fracture of the extremities, who underwent primary examination at the MSEC for the period 01.01.2016–31.12.2018. Among them, 96 % were patients of preretirement age. There were 461 patients with tibia fractures, forearm — 49, femur — 173, humerus — 90. The frequency of nonunion in subgroups is analyzed depending on the method of fragments fixation.Results: after bone fragments osteosynthesis at isolated tibia fractures nonunion was found in 11.9 % of cases, at intramedullary blocking nail — 16.0 %, external rod fixators — 3.0 %, Ilizarov fixator — 18.4 %, plaster cast bracing — 7.6 %. After treatment of femur fracture with plate osteosynthesis, nonunion was found in 9.4 %, after intramedullary nailing — in 12.8 %. At humerus fractures and forearm fractures which were treated with plate osteosynthesis, nonunion was recorded in 19.0 and 28.6 % of patients respectively, and radial nerve neuropathy – was observed in 25.0 and 26.4 %. The incidence of osteomyelitis at internal osteosynthesis was 2.9– 7.7 %.Conclusions: osteosynthesis was used in 36.6 % of cases of tibia shaft fractures and was the most common used method of fragments fixation in isolated shaft fractures: 64.9 % — femur; 75.6 % — humerus; 100.0 % — forearm bone fragments. The second most frequent method of fixation was intramedullary nailing osteosynthesis. The main complication of treatment was fragments nonunion, and in the case of plate osteosynthesis at humerus and forearm fractures was radial nerve neuropathy.

Increased therapy demand and impending loss of previous residence status after proximal femur fractures can be determined by continuous gait analysis – A clinical feasibility study

Proximal femur fractures account for increased healthcare costs whenever patients are unable to return to their previous state of residence. Studies suggest that patients benefit from early weight-bearing, yet compliance to weight-bearing regimes is poorly investigated. Aim of the study was thus to show the clinical feasibility of a new measurement tool able to determine continuous weight-bearing behavior after intramedullary nail osteosynthesis of intertrochanteric femur fractures, assess the influence of weight-bearing on clinical outcome and determine rehabilitation demand based on early postoperative gait performance.In an observational study, gait data of 22 patients with intertrochanteric femur fractures were evaluated. During the inpatient stay patients were continuously monitored with a gait analysis insole. Primary outcome was the amount of weight-bearing reached. Short-term functional outcome, as well as return to the previous state of living were evaluated in relation to weight-bearing and activity during the inpatient stay.With the presented technique continuous gait data of all patients during postoperative mobilization could be obtained. Only 13 patients reached full weight-bearing. The technique was feasible to determine correlations between weight-bearing and outcome, as well as between gait activity and outcome. Significant gait differences between patients able to return to their previous state of living and those who could not were seen.Dynamic insole measurements are feasible to continuously determine the postoperative gait performance. Their postoperative use showed, that the continuous compliance to permissive weight-bearing after intertrochanteric fractures is low. The presented measurement technique has the potential to identify patients at risk for reduced outcome and impending loss of previous residence status. Further studies will have to investigate the effects of technology assisted “patient at risk” identification and adapted therapy on clinical outcome.

Reduction techniques in intramedullary nailing osteosynthesis

Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities, the spectrum of nailing has significantly increased. Nailing of fractures beyond the isthmus is technically challenging because fractures need to be reduced before the nailing procedure starts. Indirect techniques of reduction include the use of an extension table, a large distractor or an external fixator. Direct reduction with pointed reduction forceps, lag screws, acerclage wire or ashort plate can optimize indirect reduction. The choice of the correct entry portal is of utmost importance for an optimal operative result. The location of the entry portal is dependent on the local anatomy and the bend of the nail. The optimal entry portal at the proximal tibia is directly behind the patellar tendon and accessible with the knee in more than 90° of flexion, alternatively through asuprapatellar approach with aslightly flexed knee joint. Insertion of the nail through the suprapatellar approach is possible without stress on the reduced fracture fragments. Blocking screws create an artificial isthmus in the metaphyseal area and force the guide wire in the desired direction. Blocking screws help to avoid axial malalignment during nail insertion. Interlocking of the nail with screws coming from different directions prevents secondary dislocation.

Diagnosis and management of long-bone nonunions: a nationwide survey

PurposeThere is variability among surgeons on definitions regarding the degree of bone healing of long-bone fractures. A lack of consensus may negatively affect communication between surgeons, and lead to unintended and unwanted variability in treatment of patients suffering from abnormal healing of long-bone fractures. We aimed to identify differences between surgeons regarding their views on the degree of union of long-bone fractures.MethodsWe performed a survey among 114 surgeons who worked at 11 level I trauma centers and 68 level II/III hospitals in the Netherlands. We asked them to represent their institutional colleagues and answer questions regarding their views on the definition, factors influencing bone healing, clinical practice, views on scientific evidence, and the use or need of guidelines for non-union of long-bone fractures. A total of 26 trauma surgeons and 37 orthopedic surgeons responded (59%).ResultsCompared to trauma surgeons, more orthopedic surgeons maintain 6 months as the timeframe for classifying a fracture without healing tendencies as a non-union fracture (50 vs 70%; P = 0.019). Compared to orthopedic surgeons, trauma surgeons use the bone scan (46 vs 19%; P = 0.027) and the PET scan (50 vs 5.4%; P < 0.001) more often, and consider medication use to be a factor influencing bone healing more often (92 vs 69%; P = 0.040). Furthermore, they utilize bone marrow aspiration (35 vs 11%; P = 0.029), reaming of long bones (96 vs 70%; P = 0.010), synthetic bone substitutes (31 vs 5.4%; P = 0.012), bone morphogenetic proteins (58 vs 16%; P = 0.001), and the Diamond concept (92 vs 8.1%) more often as treatment modalities for non-union of long-bone fractures. Surgeons agreed on that intramedullary nail osteosynthesis was the treatment option supported by the highest level of evidence. 80% of the respondents feel a need for a clinical guideline on the management of long-bone non-union.ConclusionThere is no consensus among surgeons on the definition, factors influencing healing, clinical practice, and scientific evidence regarding non-union of long-bone fractures. The vast majority of surgeons believe that their practice would benefit from (inter)national guidelines on this topic, and efforts should be made to reduce surgeon-to-surgeon variability in treatment recommendations and facilitate more homogenous scientific research on non-union of long-bone fractures.Level of evidenceLevel V.

Comparative study of operative management of humeral shaft fractures by dynamic compression plating versus locked intra-medullary nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Operative management of humeral shaft fractures is mostly accomplished by surface plating or intra-medullary nail osteosynthesis. Both the treatment options have been variably reported to give good rates of union and functional outcome. We compared both the options to know the better one in multitude of variables.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Thirty patients with fracture shaft of humerus were followed up for a period of 12 to18 months. 15 patients each underwent open reduction and internal fixation with dynamic compression plate and closed antegrade locked intra-medullary nailing. All patients were clinically and radiologically assessed till fracture union&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Diaphyseal humeral fractures in all the patients treated with nailing united and had a tendency to unite early compared to plating. Shoulder pain was initially complained by 2 patients from the nailing group and got subsided later on. The incidence of complications was more in the plate osteosynthesis group. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;In our study Intra-medullary nailing turned out to be superior to plating for amenable diaphyseal fractures of humerus in terms of higher rate of union, early union and lesser complications.&lt;/span&gt;&lt;/p&gt;

Static or Dynamic Intramedullary Nailing of Femur and Tibia

Introduction:The basic principle of non-surgical fracture treatment is to restore the original anatomical position of fractured fragments by different techniques, without direct access to the bone and without further traumatizing of tissues. Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goal to gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment.Aim:The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results.Material and methods:The study was conducted at the Clinic for Orthopaedics and Traumatology, Clinical Center University Sarajevo from January 2004 to June 2009. The study was retrospective-prospective, manipulative, controlled and it was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B, with different segments of bone, regardless of sex and age structure, with the exception of children under 14 years of age.Results:Precisely there were 47 patients with femoral fractures and 82 patients with tibial fractures. The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382). The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978). We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus.Conclusion:Static intramedullary osteosynthesis resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

The role of intramedullary nailing in treatment of open fractures.

The management of open fractures remains one of the greatest challenges to orthopedic trauma surgeons. Damage to the soft tissue envelope together with periosteal stripping are the most important factors making open fractures prone to complications such as nonunion and infection. Urgent and thorough soft tissue debridement, proper surgical fracture stabilization as well as the administration of intravenous and local antibiotics as adjunctive therapy are mandatory to reduce the risk of infection. Intramedullary nail osteosynthesis has become an accepted treatment method of open long bone fractures. Especially at sites of sparse soft tissue coverage like the proximal and distal tibia, early intramedullary stabilization proved advantageous for its superior biomechanical stability, the chance of early soft tissue reconstruction, shorter healing times, and quicker rehabilitation. However, due to a potential risk of deep infection, especially when a reamed technique is applied, nailing of open fractures remains contentious. In this review, we focus on the current evidence of nail osteosynthesis in open fractures and delineate its value with respect to other possible treatment options.

A comparison of effi cacy of femoral and tibial fractures healing treated by static and dynamic intramedullary nails

Introduction: Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goalto gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment. The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results.Methods: The study was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B. Patients were divided into two groups, based on the applied operating method, static or dynamic intramedullary osteosynthesis.Results: The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382). The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978).Conclusion: We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus. Static intramedullary ostesinthesys resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

Femoral shaft fractures treated by intramedullary nail and plate osteosynthesis: a multi-center study in Jiangxi Province

Objective To compare the clinical outcomes of intramedullary nail versus plate osteosynthesis for the treatment of femoral shaft fractures in the adult patients in Jiangxi Province,China.Methods A retrospective investigation was conducted to review the 390 patients with femoral shaft fracture (410 sides) who had been treated from January 2007 to December 2009 and completely followed up in 5 major hospitals in Jiangxi Province,China.In the plate osteosynthesis group,there were 257 cases (271 sides),197 men and 60 women.In the intramedullary nail osteosynthesis group,there were 133 cases (139 sides),108 men and 25 women.The 2 groups were compared in terms of operation time,surgical bleeding,postoperative hospital stay,ambulant time,postoperative complications and Karlstr(o)m-Olerud score at the last follow-up.Results The nail group had significantly longer operation time (149.2 minutes ± 27.9 minutes vs.120.2 minutes ± 28.1 minutes) and significantly more surgical bleeding (459.7 mL ± 108.8 mL vs.429.9 mL ±13.7 mL) than the plate group ( P ＜ 0.05).There were no significantly differences regarding hospitalization time [(13.7±5.2) d vs.(14.1±5.6)d],ambulanttime[(3.5±0.9) months vs.(3.7±0.9) months],complications (43/257 vs.15/133) or Karlstr(o)m-Olerud score (232/257 vs.125/133) between the 2 groups ( P ＞0.05),but the failure of internal fixation in the plate group (17/257) was significantly higher than in the nail group (1/133) [OR=9.24,95％ CI(1.22,70.14),P=0.03].Conclusions Our study reveals that the outcomes of intramedullary nail and plate osteosynthesis are both satisfactory,but the intramedullary nail osteosynthesis is used much less and yields less satisfactory outcomes in treatment of femoral shaft fracture in Jiangxi Province than in the advanced hospitals in other regions of China and the world. Key words: Femoral fractures; Fracture fixation, internal; Bone plates; Bone nails