Intramedullary Nailing Group Research Articles

Which Implant Is Best After Failed Treatment for Pathologic Femur Fractures?

Successful treatment of pathologic femur fractures can preserve a patient's independence and quality of life. The choice of implant depends on several disease- and patient-specific variables; however, its durability must generally match the patient's estimated life expectancy. Failures do occur, however, it is unclear which implants are associated with greater risk of failure. We evaluated patients with femoral metastases in whom implants failed to determine (1) the rate of reoperation; (2) the timing of and most common causes for failure; and (3) incidence of perioperative complications and death. From a prospectively collected registry, we identified 93 patients operated on for failed treatment of femoral metastases from 1990 to 2010. We excluded five patients who subsequently underwent amputations leaving 88 who underwent salvage procedures. These included intramedullary nails (n = 11), endoprostheses (n = 61), and plate fixation (n = 16). The primary outcome was reoperation after salvage treatment. Seventeen of the 88 patients (19%) required subsequent reoperation a median of 10 months (interquartile range, 4-14) from the time of salvage surgery: 15 for material failure, one for local progression of tumor, and one for a combination of these. Five patients died within 4 weeks of surgery. Although perioperative complications were higher in the endoprosthesis group and dislocations occurred, overall treatment failures after salvage surgery were lower in the that group (four of 61) compared the group with plate fixation (eight of 16) and intramedullary nail groups (five of 11). Despite relatively common perioperative complications, salvage using endoprostheses may be associated with fewer treatment failures as compared with internal fixation. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Intramedullary nail versus plate for distal tibial shaft fractures in adults: a Meta-analysis

Objective To systematically compare the related complications of distal tibial shaft fractures in adults treated by intramedullary nails and plates.Methods According to the methods of systematic review of Cochrane,we searched for articles comparing intramedullary nail and plate for distal tibial shaft fractures in adults in MEDLINE (from 1966 to March 2012),EMbase databases (from 1974 to March2012),Cochrane library,CBM discs (from 1979 to March 2012) and the relevant Chinese and English orthopedic journals.All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were included for the present study.The total complications,infections,malunion,nonunion,delayed union and secondary operation were chosen as evaluation indexes for the present Meta-analysis.The system review was performed using the method recommended by the Cochrane Collaboration.Results Three RCTs and 4 CCTs with a total of 463 patients were included (258 in the intramedullary nail group and 205 in the plate group).Compared with the plate treatment,intramedullary nail significantly increased the risk of malunion[RR =3.81,95％ CI(2.01,7.21 ),P ＜ 0.05].There were no statistically significant differences regarding total complications[RR =1.46,95％ CI(0.90,2.38),P =0.12],infection[RR =0.54,95％ CI(0.27,1.07),P =0.08],nonunion[RR=1.74,95％CI(0.62,4.90),P=0.30],delayed union[RR=2.03,95％CI (0.56,7.31),P =0.28]and secondary operation[RR =1.22,95％ CI(0.71,2.10),P =0.47]between the 2 groups.Conclusion Since intramedullary nail may significantly increase the risk of malunion,the plate may be a better choice for distal tibial shaft fractures in adults. Key words: Tibial fractures; Bone nails; Bone plates; Meta-analysis

Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures

BackgroundThere is no robust evidence for the best treatment practice for metacarpal neck fractures. The purpose of this comparative study was to investigate whether the intramedullary nail or low-profile plate allows for good clinical and radiological results for displaced metacarpal neck fractures. MethodsWe prospectively reviewed 30 patients with a displaced metacarpal neck fracture who underwent surgery: 15 with intramedullary nails and 15 with low-profile plates. Radiographic and clinical outcomes of both groups were compared. Objective findings of range of finger motion and grip strength were assessed at 3, 6, and 12months postoperatively. ResultsThere was no non-union, and postoperative complications included extensor tendon rupture in one and transient ulnar nerve neuritis in two. Radiological parameters after the fracture healing were comparable between the two groups. Postoperative range of finger motion was better in patients with the intramedullary nail, and acquired grip strength in the low-profile plate group was superior to that in the intramedullary nail group. ConclusionsThe current results indicate that both procedures are highly effective in maintaining fracture restorations. Plate fixation provides earlier recovery of powerful hand function, and intramedullary nailing allows a wide range of finger motion.

No difference in the long term final functional outcome after nailing or cast bracing of high energy displaced tibial shaft fractures

BackgroundCast bracing (CB) has been a well established method of treating tibial shaft fractures. Majority of the recent literature on treatment of tibial shaft fractures have upheld intramedullary nailing (IMN) as the treatment of choice. Most of these studies are from the west, in public funded health set ups and in hospitals with very low rates of infection. This has lead to bewilderment in the minds of surgeons wishing to opt for conservative treatment in countries with scarcity of health resources. We therefore undertook this study to compare the two modalities in the scenario of the developing world.Material and methodsSixty-eight consecutive patients were treated alternately with CB and IMN for high energy, displaced, closed and Gustilo Grade 1 open fractures of the tibial shaft, between 1995 and 2001.ResultsAn average follow up at 4.3 years revealed no statistical difference in the final functional outcome as per Johner and Wruhs' criteria with modification to Indian lifestyle. IMN group had a) slightly shorter time to fracture union (mean 21.3 weeks versus 23.1 weeks for CB, p > 0.05), (b) lesser time off work (mean 17.6 weeks versus 25.6 weeks for CB, p <0.01), (c) fewer outpatient visits (mean 6.2 versus 9.7 for CB, p < 0.05), (d) less limb length discrepancy (mean 4.3 mm versus 6.6 mm for CB, p < 0.05). The difference in residual antero-posterior angulation (mean 3.2 degrees for IMN versus 4.9 degrees for CB, p = 0.14) and varus-valgus angulation (mean 3.7 degrees for IMN versus 5.1 degrees for CB, p = 0.7) were not statistically significant. However CB group had no deep infections as compared to two in the IMN group. The average cost of hospital treatment of CB group was less than half incurred by the IMN group (average USD 831 versus USD 2071 for nailed group, p < 0.05).ConclusionTreating tibial shaft fracture either with IMN or CB provided equally gratifying results with no statistical difference in final functional outcome. The economic cost to the patient in Indian conditions is significantly less with CB and therefore stands as an equally reliable treatment option, especially in countries with fewer resources.

Intramedullary nailing versus percutaneous locked plating of distal extra-articular tibial fractures: a retrospective study

The aim of this study is to compare distal tibial fractures (4-10 cm proximal to the plafond) treated by intramedullary nailing with those treated by percutaneous locked plating and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures. Thirty-six patients received percutaneous locked plate treatment and 25 patients received intramedullary nail treatment. The results obtained from these two treatment methods were assessed by comparing infection rates, starting time for wight-bearing, local implant irritation, union and malunion rates and along with secondary procedures. In the percutaneous locked plate group, two deep infections, four superficial infections, two nonunions, one malunion and 10 local implant irritations were observed. In the intramedullary nail group, one nonunion, four malunions and two local implant irritations were observed. The incidence of deep and superficial infections, local implant irritations and secondary procedures in the percutaneous locked plate group was greater than those in the intramedullary nail group. The time to full weight bearing was shorter in the intramedullary nail group. There was no significant statistical difference in malunion and nonunion rates between the two groups. The need for secondary procedures was more common in group receiving the percutaneous locked plate treatment and the time to full weight bearing was shorter in the intramedullary nail group.

Treatment of Two-Part Proximal Humerus Fractures: Intramedullary Nail Compared to Locked Plating

Two-part proximal humerus fractures are common orthopedic injuries for which surgical intervention is often indicated. Choosing a fixation device remains a topic of debate. The purpose of this study is to compare two methods of fixation for two-part proximal humerus fractures, locking plate (LP) with screws versus intramedullary nailing (IMN), with respect to alignment, healing, patient outcomes, and complications. To our knowledge, a direct comparison of these two devices in treating two-part proximal humerus fractures has never before been studied. We hope that our results will help surgeons assess the utility of LP versus IMN. A retrospective chart review was performed on 24 cases of displaced two-part surgical neck fractures of the humerus. Twelve shoulders were treated using IMN fixation and 12 others were fixated with LP. Data collected included sociodemographic, operative details, and postoperative care and function. Radiographic comparison of fixation demonstrated an average neck-shaft angle of 124° and 120° in the IMN group and LP group, respectively. Adjusted postoperative 6-month follow-up range of motion was 134° of forward elevation in the IMN group and 141 in the LP group. The differences in range of motion and in complication rates were not found to be significant. Our results suggest that either LP fixation or IMN fixation for a two-part proximal humerus fracture provides acceptable fixation and results in a similar range of shoulder motion. Although complication rates were low and insignificant between the two groups, a trend toward increased complications in the IMN group is noted.

A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia

The ideal form of fixation for displaced, extra-articular fractures of the distal tibia remains controversial. In the UK, open reduction and internal fixation with locking-plates and intramedullary nailing are the two most common forms of treatment. Both techniques provide reliable fixation but both are associated with specific complications. There is little information regarding the functional recovery following either procedure. We performed a randomised pilot trial to determine the functional outcome of 24 adult patients treated with either a locking-plate (n = 12) or an intramedullary nailing (n = 12). At six months, there was an adjusted difference of 13 points in the Disability Rating Index in favour of the intramedullary nail. However, this was not statistically significant in this pilot trial (p = 0.498). A total of seven patients required further surgery in the locking-plate group and one in the intramedullary nail group. This study suggests that there may be clinically relevant, functional differences in patients treated with nail versus locking-plate fixation for fractures of the distal tibia and differences in related complications. Further trials are required to confirm the findings of this pilot investigation.

Intramedullary nailing versus submuscular plating in adolescent femoral fracture

BackgroundFemoral fractures in adolescents usually need operative treatment, but the optimal method is unclear. The purpose of this study is to compare intramedullary nailing (IN) and submuscular plating (SP) in adolescent femoral fractures. Materials and methodsWe performed the prospective, comparison study of IN and SP in adolescent femoral shaft fractures at a mean age of 13.9 years (11–17.4). Twenty-two cases of IN and 23 cases of SP were followed for a minimum of 1 year. We compared radiological and clinical results, surgical parameters, and complications of two techniques. ResultsBony union was achieved in all cases except one case of IN. Time to union was similar in both groups. None showed mal-union over 10° or limb length discrepancy over 1cm. None of SP group and 2 in IN group experienced re-operation; one patient had deep infection with nonunion. The other patient sustained mal-rotation. Both patients healed after revision procedure. All patients showed excellent or satisfactory results of Flynn's criteria. The time to full-weight bearing was shorter in IN (IN: 57.3 days, SP: 89.2 days, p<0.05). In surgical parameters, operative time seemed shorter in IN (IN: 94.7min, SP: 104min, p=0.095), and fluoroscopy time was shorter in IN (IN: 58s, SP: 109s, p<0.05) than SP group. ConclusionAlthough both IN and SP yield good results and minimal complication in adolescent femoral fractures, IN may be advantageous in less need of fluoroscopy, technical easiness in reduction and early weight bearing.

Prospective comparative study of functional outcome of treatment of tibial shaft fracture in adult by cast versus intramedullary nailing

All patients with an isolated closed unilateral fracture of the tibial diaphysis admitted in our institution between November 2009 and October 2010 were evaluated for inclusion in the present study. Inclusion criteria were displaced closed fractures. The fractures of type A and B, according to the AO-classification system, were considered suitable for the study.16 The following exclusion criteria were used: 1) Patients who had other major injuries which could influence the final functional result, 2) patients with cardiopulmonary, rheumatological, neurological, or metabolic disease, 3) patients with previous injuries which influenced their general function, 4) patients with fractures within 5 cm distal to the tibial tuberosity or 7 cm proximal to the ankle joint, 5) open fractures, and 6) those with open growth plates. Thirty-four patients (26 men) having a mean age of 38 years fulfilled the criteria and entered the study. The patients gave their informed written consent before inclusion in the study, which was approved by the hospital’s ethics committee. Patients who agreed to participate in the study were randomized using the technique of stratified randomization by minimization.17 This method ensures that the treatment groups are similar as regard to the percentage of patient factors that are considered of major prognostic importance. The aim is to balance the marginal treatment totals for each level of each patient factor. Using a computer minimization program, each patient was allocated according to high-energy, soft-tissue injury (closed), age (under or over 50 years), smoking (yes or no), alcoholism (yes or no), and occupation (sedentary, mobile, heavy, unemployed). Fractures caused by traffic accident or a fall from a height of at least 3 meters were classified as highenergy trauma.18 Patients in each stratum were randomly allocated for treatment by unreamed intramedullary nailing or plaster cast. Seventeen patients were randomized to have an intramedullary nail (group I), and 17 patients were randomized to have a plaster cast (group II). All fractures were unilateral. Nineteen involved the right leg and 4 patients were injured by falling accidents. Traffic accidents caused the injuries in 26 patients, 11 of them were pedestrians, 2 were automobile drivers, and 13 were motorcycle drivers. Two patients were injured in sporting accidents and 2 others were injured at work. The severity of the closed injuries was classified according to (Table 1).19 Eight fractures were caused by low-energy trauma, while 26 fractures were caused by high-energy trauma (Table 1). The type of fracture was classified according to the AO system (Table 2). Seven fractures involved the proximal third of the tibia, 21 the middle third, and 6 the distal third. Twentynine patients had an associated fibula fracture, 8 at the same level as the tibia fracture, and 21 at a different one (Table 2). The median time of delay to operation was 5 days for group I and no days for group II. Gender, smoking habits, age, type of trauma, severity of soft-tissue damage, and degrees of comminution of the fractures were similar in the 2 groups. Closed tibial nailing was performed with the patient lying supine. A calcaneal pin was used if traction was required. We used a longitudinal medial parapatellar incision and approach to the Prospective comparative study of functional outcome of treatment of tibial shaft fracture in adult by cast versus intramedullary nailing

Ipsilateral femoral neck and shaft fractures: a retrospective analysis of intramedullary reconstruction nailing versus retrograde intramedullary nailing plus lag screw fixation

Objective To compare the outcomes and indications between intramedullary reconstruction nailing and retrograde intramedullary nailing plus lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures.Methods From January 2001 to May 2010,21 patients with ipsilateral femoral neck and shaft fractures were treated in our division.Ten of them underwent intramedullary reconstruction nailing(Group Ⅰ)and 11 underwent retrograde intramedullary nailing plus cancellous lag screw fixation(Group Ⅱ).There were no significant differences between the 2 groups with respect to gender,age,associated injury,anatomical location and type of fracture(P ＞ 0.05).The patients were evaluated at 1,3,6,9,12 months after surgery,and then every year postoperatively.Fisher exact test and t-test were performed to compare their rates of union and complications.Results The average follow-up was 27.1months(range,from 12 to 48 months)for the 21 patients.An unpaired t-test showed no significant differences with respect to follow-up time,operation time,intraoperative blood loss,postoperative drainage,time for radiographic union,time for clinical union and Friedman-Wyman score between the 2 groups(P ＞ 0.05).The hospitalization cast was significantly higher for Group I than for Group Ⅱ(t =16.710,P =0.016).There were no significant differences in either the rate of femoral shaft union(9/10 vs.10/11)or the rate of femoral neck union(9/10 vs.11/11)(P ＞ 0.05).Four postoperative complications occurred in Group I and 7 in Group Ⅱ.Conclusions The treatment choice for ipsilateral femoral neck and shaft fractures should depend on specific cases.Intramedullary reconstruction nailing should not be preferred in subcapital fractures or irreducible femoral neck fractures,while retrograde intramedullary nailing plus cancellous lag screw fixation may be an excellent choice for subcapital neck fractures and for distal femoral shaft fractures associated with distal femoral supracondylar or proximal tibial fractures. Key words: Femoral fractures; Femoral neck fractures; Fracture fixation, internal

Treatment of humerus surgical neck fracture with interlocking intramedullary nail versus locking plate

Objective To compare efficacy between the interlocking intramedullary nail and the locking plate in the treatment of humerus surgical neck fractures.Methods From January 2003 through June 2008,36 patients with humerus surgical neck fracture were randomized into an interlocking intramedullary nail group (21 cases ) and a locking plate group ( 15 cases).They were 11 males and 25 females,with an average age of 60.3 years (range,26 to 78 years).According to the Neer system,there were 6 cases of type Ⅱ,13 cases of type Ⅲ and 2 cases of type IV in the nail group,while there were 4 cases of type Ⅱ,8 cases of type Ⅲ and 3 cases of type IV in the plate group.The data of wound length,operative time,intra-operative blood loss,fracture healing time and functional recovery were recorded and analyzed statistically.Results The follow-up periods ranged from 6 to 24 months (average,15.3 months).There were significant differences between the 2groups( P ＜ 0.05 ) in wound length,operative time and intra-operative blood loss,but the average fracture healing time was not significantly different between the groups( P ＞ 0.05).The functional recovery was better in the intramedullary nail group than in the locking plate group but with no significance( P ＞ 0.05).Conclusion Although both theinterlocking intramedullary nail and the locking plate are similarly effective in the treatment of humerus surgical neck fractures,the former has an advantage in operative invasion and manipulative simplicity. Key words: Hurneral fractures, proximal; Fracture fixation, internal; Treatment outcome

Clinical analysis of some serious bone fractures limbs

Objective To investigate the clinical treatment of multi-severe of long bone. Methods To observe 145 fractures of 76 patients with multi-severe comminuted fracture of long bone,and apply expandable intramedullary nailing, interlocking intramedullary nail fixation, plate fixation, external fixation, artificial joint replacement on these subjects respectively. Results The followed-up period were from 6 months to 21 months after operation, fracture union occurred in two to twelve months. Among all the 145 fractures, bone healing 122 (86. 2％), nonunion 8(5.5％) ,inalunion in 12 cases(8.3％ ). The average healing time:closed fractures (5.5 ± 1.5) months,and open fractures(6.8 ± 1.2 ) months. Expandable intramedullary nailing group, only 1 case of malunion. Interlocking nail group,only 2 cases of nonunion and malunion, and the incidence of nonunion malunion was significantly lower than that of external fixation group and the plate fixation group(P ＜0.05 ) ;In the external fixation group, the healing rate was significantly lower than plate fixation( P ＜ 0. 05) ,but the impact on the adjacent joints in external fixation group was much larger than the intramedullary nail group and the plate fixation group( P ＜ 0.05 ). Conclusion There was no uniform standard of how to select the treatment of long bone fracture currently, surgery should be selected according to the specific injuries of different treatment methods. Expandable intramedullary nailing, interlocking intramedullary nailing were new type of internal fixation material which developed in recent years, and there were fewer complications of the application of interlocking intramedullary nail fixation in fracture healing, and it worths further clinical application in the long bone fracture. Key words: Fractures ; Intramedullary pin; Fixation

Intramedullary Nailing Versus Percutaneous Pin Fixation of Pediatric Proximal Humerus Fractures

Surgical treatment is often advocated for unstable or severely displaced proximal humerus fractures in older children. The purpose of this study is to compare the early radiographic results and complications of 2 common methods of internal fixation, percutaneous pinning (PP), and flexible intramedullary nailing (IMN), used to treat these fractures. Fifty skeletally immature patients who underwent surgical reduction and PP or IMN of proximal humerus fractures between 2000 and 2009 were reviewed. Radiographs were assessed for maximum angular deformity and Neer-Horowitz classification on preoperative, immediate postoperative, and final follow-up radiographs. t test, χ, Wilcoxon, and Cochran-Armitage trend test analyses were used to determine statistical significance. Average age at injury was 13.7 years with average follow-up of 9 months. There were no statistically significant differences in age, sex, side of injury, reduction method, preoperative Neer-Horowitz classification or preoperative maximum angulation between the PP and IMN groups. Patients treated with both PP and IMN achieved significant improvements in both radiographic angulation and Neer-Horowitz classification. Patients treated with IMN had a slightly lower average angulation on final radiographs. Patients treated with IMN had higher average estimated blood losses (EBLs) and longer surgical times than patients treated with PP. The complication rate was higher in the PP group than in the IMN group. There were no differences in rates of loss of reduction. More patients in the IMN group underwent a second surgical procedure for implant removal. Both IMN and PP techniques are effective at stabilizing severely displaced proximal humerus fractures in the older pediatric population. IMN has the advantage of fewer complications but involves longer surgeries, increased EBL, and a second surgery for implant removal. PP has shorter surgeries, decreased EBL, and lesser need for operative implant removal, though complication rates are higher. Ultimately both patient and surgeon factors should be used to determine which treatment is best in a given situation. III: retrospective comparative study.

AO Tubular External Fixation vs. Unreamed Intramedullary Nailing in Open Grade IIIA-IIIB Tibial Shaft Fractures: A Single-center Randomized Clinical Trial

Although the intramedullary nailing is thought to be the method of choice for treatment of closed tibial shaft, there is ongoing debate on the optimal surgical approach in patients with open types of these fractures. In addition, choosing between the reamed and unreamed intramedullary nailing is still an issue for the orthopedic surgeons. In present study, we aimed to compare the outcome and consequences of OA tubular external fixation vs. unreamed intramedullary nailing in open grade IIIA-IIIB tibial shaft fractures. In a randomized clinical trial, 50 patients with open tibial shaft fractures (grades IIIA-IIIB) were recruited in Tabriz Shohada teaching centre in a 2-year period of time. They randomized in two equal groups underwent either AO tubular external fixation or unreamed intramedullary nailing. These 2 groups were matched for sex, age and fracture-grade. The follow-up time was one year. Union time, surgical outcome, postoperative complications and the ambulation time were compared between the two groups. Twenty five patients, 20 males and 5 females with a mean age of 30.80 +/- 5.24 years were allocated in unreamed intramedullary group and 25 other patients, 22 males and 3 females with a mean age of 28.92 +/- 8.88 years were studied in the external fixation group (p = 0.70 and 0.37, respectively). The two groups were matched for sex (p = 0.70) and age (p = 0.37). The time of union was 3, 4, 5 and 6 < or = weeks after operation in 28, 12, 32 and 28% of the cases in unreamed intramedullary group vs. 4, 12, 48 and 36% of the cases in external fixation group, respectively (p = 0.14). Post-operative infection, soft tissue injury, malunion and nonunion were documented in 16, 8, 0 and 4% of the cases in unreamed intramedullary group vs. 32, 12, 24 and 8% of the cases in external fixation group, respectively (p = 0.19, 0.50, 0.02 and 0.50, respectively). The mean ambulation time after operation was 2.92 +/- 2.43 weeks in the unreamed intramedullary nailing group vs. 2.68 +/- 2.14 weeks in the external fixation group (p = 0.71). Our results are in favor of unreamed intramedullary nailing against external fixation in treatment of open tibial shaft fractures.

Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter

Background and purpose In recent years, intramedullary nails (INs) for the treatment of pertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws (SHSs). There is little empirical background for this development, however. A previous series of ours suggested that the use of SHS was not adequate in situations with fragile or fractured lateral femoral walls, where it often led to lack of healing in a maximally telescoped position. We hypothesized that INs would be the superior implant in these specific circumstances.Methods We retrospectively examined 311 consecutive patients treated in our department between 2002 and 2008, with either an IN (n = 158) or an SHS (n = 153) mounted on a 4-hole side-plate, for an AO/OTA type 31A1–2 pertrochanteric fracture with a detached greater trochanter. The status of the lesser trochanter was assessed preoperatively and the integrity of the lateral femoral wall, fracture reduction, and position of the implants were assessed postoperatively. Reoperations due to technical failure were recorded for one year postoperatively.Results Multivariate logistic regression analysis showed that the groups were similar regarding demographic and biomechanical parameters. The lateral femoral wall was more frequently fractured during SHS implantation (42 patients) than in the IN group (9 patients) (p < 0.001). 6 (4%) of the 158 patients operated with IN had to be reoperated, as compared to 22 (14%) in the SHS group of 153 patients (p = 0.001).Interpretation IN had a lower reoperation rate than SHS in these pertrochanteric hip fractures with a detached greater trochanter. IN left more lateral femoral walls intact.

Surgical Treatment of Extra-Articular or Simple Intra-Articular Distal Tibial Fractures: External Fixation versus Intramedullary Nailing

To compare intramedullary nailing (IMN) with external fixation (EF) in the treatment of tibial shaft fractures located within 5 cm of the ankle. University teaching hospital. Retrospective comparative study. Sixty-seven patients with a mean age of 48 years (range, 16-78 years; 24 women, 43 men). Thirty-three fractures were treated with EF from 1998 to 2004 and 34 fractures were treated with reamed IMN from 2004 to 2007. Olerud-Molander ankle score, RAND-36 Item Health Survey, and the number of secondary interventions. The healing time was 21 weeks in the IMN group and 23 weeks in the EF group (P = 0.53). One fracture in the IMN group and three in the EF group malunited (P = 0.62). Olerud-Molander ankle score was 75 in the IMN group and 74 in the EF group (P = 0.51). There was no difference in any of the RAND-36 subscores measuring physical functioning. More patients in the EF group had secondary intervention resulting from delayed healing (8 versus 1, P = 0.03). The patients in the EF group also needed more secondary interventions as a result of any complication (15 versus 2, P < 0.001). There was one deep infection in the IMN group. Distal extra-articular or simple intra-articular fractures can be treated with modern IMNs or nonbridging EF. Although functional results are similar, EF carries a significant greater risk of secondary interventions; based on these data, IMN is recommended.

Both-bone forearm fractures in children Intramedullary nailing or open reduction with plate fixation?

Six small retrospective cohort studies shed little light on whether intramedullary nailing (IMN) or open reduction internal fixation (ORIF) with plate fixation is more effective in treating both-bone forearm fractures in children. No statistically significant difference between treatment groups was found with regard to functional outcomes or the average magnitude of radial bowing.Small sample sizes may have precluded detection of statistically significant differences. In one study, a statistically significant difference was found in the average radial bow location in the IMN group as compared with both the ORIF group and normative values. Cosmetically,IMN provided significantly better results (ie, smaller incision/scar length) than ORIF as assessed by two studies. For both nonunion/delayed healing and complications, rates varied widely between studies and did not consistently favor one treatment method over the other. Randomized controlled studies with larger sample sizes and longer follow-up periods are needed to determine which treatment option is optimal. Use of validated outcomes measures is recommended. 根据6项小样本回顾性队列研究的结果,在评价髓内钉固定(IMN)和切开复位钢板内固定(ORIF)治疗儿童前臂双骨折的疗效时证据较弱.研究结果显示,在患肢功能和桡骨弓的恢复方面,两种治疗方法差异无统计学意义.由于样本量较小,本身就排除了产生统计学差异的可能性.一项研究显示,IMN组桡骨弓的顶点位置与ORIF组相比差异均有统计学意义.2项研究认为,与ORIF组相比,IMN组术后结果更好(如手术切口、瘢痕更小).在骨折不愈合或延迟愈合和并发症发生率方面,各研究结论不一,无法说明哪种方法更优.综上所述,仍需大样本的随机对照研究并进行长期随访,采用有效的评价方法,以便更好地评价哪种治疗方法更好.……

Locking Intramedullary Nails and Locking Plates in the Treatment of Two-Part Proximal Humeral Surgical Neck Fractures

locking intramedullary nails and locking plates specially designed for proximal humeral fractures are widely used. The purpose of our study was to compare the outcomes between these two types of implants in patients with a two-part surgical neck fracture. The advantages and shortcomings of each method were analyzed. a prospective randomized study was performed. Fifty-one consecutive patients with a fresh two-part surgical neck fracture were randomized to be treated with a locking intramedullary nail (n = 25) or a locking plate (n = 26). Clinical and radiographic assessments were conducted at one year and three years after the surgery. A visual analog scale (VAS) was used to assess shoulder pain. The American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores were recorded to evaluate shoulder function. fracture union was achieved in all patients within three months after the surgery. At one year postoperatively, a significant difference (p = 0.024) was found with regard to the complication rate between the locking plate group (31%) and the locking nail group (4%). The average ASES score, median VAS score, and average strength of the supraspinatus were significantly better in the locking plate group (90.8 compared with 83.6 points [p = 0.021], 1.0 compared with 0.5 point [p = 0.042], and 77.4% compared with 64.3% [p = 0.032]). At three years postoperatively, no significant difference could be found in terms of any parameter between the two groups. Significant improvement in the VAS pain scores, ASES scores, and Constant-Murley scores were found between the one-year and three-year follow-up examinations in each group. satisfactory results can be achieved with either implant in the treatment of two-part proximal humeral surgical neck fractures. There was no difference regarding the ASES scores between these two implants at the time of the final, three-year follow-up. The complication rate was lower in the locking intramedullary nail group, while fixation with a locking plate had the advantage of a better one-year outcome. therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia

We compared the outcome of closed intramedullary nailing with minimally invasive plate osteosynthesis using a percutaneous locked compression plate in patients with a distal metaphyseal fracture in a prospective study. A total of 85 patients were randomised to operative stabilisation either by a closed intramedullary nail (44) or by minimally invasive osteosynthesis with a compression plate (41). Pre-operative variables included the patients' age and the side and pattern of the fracture. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems, the time to union of the fracture, the functional American Orthopaedic Foot and Ankle surgery score and removal of hardware. We found no significant difference in the pre-operative variables or in the time to union in the two groups. However, the mean radiation time and operating time were significantly longer in the locked compression plate group (3.0 vs 2.12 minutes, p < 0.001, and 97.9 vs 81.2 minutes, p < 0.001, respectively).After one year, all the fractures had united. Patients who had intramedullary nailing had a higher mean pain score (40 = no pain, 0 = severe pain), [corrected] but better function, alignment and total American Orthopaedic Foot and Ankle surgery scores, although the differences were not statistically significant (p = 0.234, p = 0.157, p = 0.897, p = 0.177 respectively). Three (6.8%) patients in the intramedullary nailing group and six (14.6%) in the locked compression plate group showed delayed wound healing, and 37 (84.1%) in the former group and 38 (92.7%) in the latter group expressed a wish to have the implant removed. We conclude that both closed intramedullary nailing and a percutaneous locked compression plate can be used safely to treat Orthopaedic Trauma Association type-43A distal metaphyseal fractures of the tibia. However, closed intramedullary nailing has the advantage of a shorter operating and radiation time and easier removal of the implant. We therefore prefer closed intramedullary nailing for patients with these fractures.

Stabilization of Adolescent Both-Bone Forearm Fractures: A Comparison of Intramedullary Nailing versus Open Reduction and Internal Fixation

To compare flexible intramedullary (IM) nailing with open reduction and internal fixation (ORIF) with plates and screws in the treatment of adolescent both-bone forearm fractures. Retrospective comparative study. Level I trauma center. Sixty-one skeletally immature adolescents (mean age, 13.9 years; range, 11.5-16.9 years) treated operatively for both-bone forearm fractures from 1997 to 2007. Patients with Monteggia, Galeazzi, intra-articular, and pathologic fractures were excluded. Forty-six patients (mean age, 14.1 years) underwent ORIF and 15 patients (mean age, 13.3 years) underwent flexible IM nailing. Time to fracture union, forearm rotation, magnitude and location of maximal radial bow, and complications. There was no difference in mean time to union between the IM nailing (8.5 weeks) and ORIF (8.9 weeks) groups, although the study did not have sufficient power to detect a difference. Eighty-three percent of patients in both groups regained full forearm rotation. Although radial bow magnitude was comparably restored in both groups, the mean location of maximal radial bow was translated distally in the IM nailing group (67.2%) compared with the ORIF group (60.1%, P < 0.001) and a previously reported normal value (60.4%, P < 0.001). There were no major complications in the IM nailing group and five major complications in the ORIF group. Flexible IM nailing of both-bone form fractures in adolescents was safe and effective in our small series; we had less complications when compared with conventional ORIF. Although flexible IM nailing results in distal translation of the radial bow, forearm rotation is not compromised.