Intramedullary Nailing Group Research Articles

Curative effect study of Multiloc nailing and Philos locking plate on the treatment of proximal humerus fracture

Objective To compare the clinical effect of Multiloc nailing and Philos locking plate for treating proximal humerus fracture. Methods A retrospective analysis of 34 surgery treated proximal humeral fractures patients in Department of Orthopedics, Beijing Haidian Hospital and Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University from January 2015 to June 2016, in which 3 cases of high-energy injury and multiple fractures andonecase of humerus head replacement and onecase of non-surgical treatment were excluded.Finally, 29 patients were included and clinical followed up to 12 months after surgery. The 29 patients were divided into the locking plate group (n=13) and intramedullary nail group (n=16), The operative time, volume of intraoperative blood loss, preoperative to postoperative 24 patients were compared between the locking plate group and intramedullary nail group underwent open reduction and internal fixation with philos locking plate hemoglobin changes, 24 h postoperative visual analogue scale and 3, 6, 12 months postoperative Constant-Murley shoulder function score. SPSS13.0 statistical software was used to analyze the data. Measurement data were expressed as (±s). Comparison of groups used independent samples t test, repeated measurement data used repeated measures analysis of variance. Results The age of the locking plate group was (65.7±9.3) years, and the age of the intramedullary nailing group was (65.6±11.1) years. In the locking plate group, the operation time was (150±17) minutes, the intraoperative blood volume was (300±53) ml, the change of blood pigment between before surgery to 24 hours after surgery was (26±8) mg/L, and the vision algetic standard of 24 hours after surgery was (3.4±0.8) scores. In intramedullary nailing group, the operation time was (119±13) minutes, the intraoperative blood volume was (130±25) ml, and the change of blood pigment between before surgery to 24 hours after surgery was (11±5) g/L, the vision algetic standard of 24 hours after surgery was (2.3±0.5) scores. No serious postoperative complications occurred in either group, including infection, internal fixationfailure, and humeral head necrosis. In locking plate group, for the Constant-Murley shoulder joint function score, 3 months after surgery was (76.0±11.6) scores, 6 months was (78.0±13.4) scores, 12 months was (88.0±12.1) score. In intramedullary nailing group 3 months was (85.0±9.7) scores, 6 months was (87.0±8.9) scores, 12 months was (89.0±10.3) scores. There were no statistical difference between the two groups at incidence of serious complications after surgery, postoperative 12 months Constant-Murley shoulder joint function score. Multiloc intramedullary nailing group was better than Philos locking plate group in the operation time, the intraoperative blood volume, etc. Conclusion Multiloc intramedullary nail is an effective method for treating proximal humerus fracture, and it has the advantages of less surgical injury and early postoperativesatisfactory than the locking plate. Key words: Humeral fractures; Fracture fixation, internal; Comparative study

Frequency of Infection After Immediate Intramedullary Nailing Versus External Fixator in Open Tibial Shaft Fractures

Objective: The purpose of this study was to have a comparison of frequency of infection between two procedures i.e immediate intramedullary nailing and external fixation in the treatment of type II open fracture of shaft of tibia. Study Design: The study design was a randomized controlled trial. Place and Duration of Study: The study was done at the Department of Orthopedic Surgery, Sir Ganga Ram Hospital Lahore over 1-year period from January 2017 through December 2017. Methodology: This included 40 patients of both genders aged between 19-51 years with type II (Gustilo and Anderson) open fracture of shaft of tibia. These patients were randomly divided in two groups with draw methods with AB p=0.759). Similar insignificant difference was observed across various age and gender groups. Conclusion: Frequency of infection was lower in intramedullary nailing group as compared to external fixation group so immediate intramedullary nailing is preferred method in type II open tibial fractures.

Comparing the Intramedullary Nail and Extramedullary Fixation in Treatment of Unstable Intertrochanteric Fractures

Treatment options for unstable intertrochanteric fractures include intramedullary nail and extramedullary fixation, although evidence regarding the most appropriate treatment for such fractures remains controversial. Our hypothesis was that there would be no obvious differences in mortality rates, functional outcomes and complications between the two groups. We therefore conducted a meta-analysis to compare the relative advantages of intramedullary nail and extramedullary fixation. A total of 10 randomized controlled trials including only patients with unstable intertrochanteric fractures were included in the final analysis. We found that no statistically significant difference in one-year mortality was observed between the two groups (RR: 0.78, 95% CI: 0.55–1.10, p = 0.160). Analysis of exact p values from five included studies indicated that functional outcomes were markedly better for patients of the intramedullary nail group when compared with those of the extramedullary fixation group (p = 0.0028), although evidence remains controversial. Higher incidences of all complications were noted for extramedullary fixation (RR:1.48, 95% CI: 1.12–1.96, p = 0.006). However, no significant differences in implant-related complications were observed between the two groups (RR:1.20, 95% CI: 0.73–1.97, p = 0.475). Therefore, comparing with extramedullary fixation, the intramedullary nail method would be more reliable and should be encouraging for unstable intertrochanteric fractures.

A comparative study on the fixation of fracture shaft of humerus in adults by compression plate and intramedullary interlocking nail

The aim of the present study was to evaluate comparative analysis of two series in patients with diaphyseal fractures of humerus in the adults operated with dynamic compression plating and intra-medullary interlock nailing with focus on their functional outcome results using DASH score and complications. The present study was conducted in the Department of Orthopaedics, Osmania Medical College and Hospital, Hyderabad, Telangana, India for a period of one year. The study subjects consisted of n = 28 adult patients of fracture shaft of humerus with indications for surgical management. Among n = 28 subjects, n = 15 (53.57%) cases showed excellent results, n = 8 (28.57%) good, n = 3 (10.72%) fair and n = 2 (7.14%) poor results. Among n = 15 subjects with excellent results, n = 9 (60%) were of plating group and 6 (46.15%) interlocking nailing. In intramedullary nailing group, 4 (30.77%) patients showed good results, 2 (15.38%) fair and 1 (7.69%) poor results. In patients treated by plate fixation, 5 (33.33%) cases showed good results, 1 (6.67%) fair and 1 (6.67%) poor results. For all the subjects, DASH scoring was in the range of 21-30 in 50% subjects followed by 10 - 20 in 32.14%, 51 - 60 in 10.72% and 31 - 40 in 7.14% cases. In this series, both the methods of treatment i.e. dynamic compression plating and interlocking nailing showed good functional outcome results. We prefer dynamic compression plating method as the complications are less compared to the interlocking nailing method and also with respect to pain and function of the shoulder joint.

Interlocking Intramedullary Nailing Versus Locked Dual-Plating Fixation for Femoral Shaft Fractures in Patients with Multiple Injuries: A Retrospective Comparative Study

ABSTRACTPurpose: Intramedullary nailing (IMN) is a popular method in the management of femoral shaft fractures (FSFs). However, whether the association of IMN with pulmonary fat emboli can compromise the pulmonary and nervous systems is debatable. The purpose of this study is to compare IMN with the locked dual plating (LDP) method by assessing the clinical outcomes of FSF patients with head or chest injury. Method: A total of 126 FSF patients were included in this study between January 2010 and July 2016 and divided into LDP and IMN groups. Patient demographic characteristics, operative time, blood loss, Harris Hip Score, Lysholm Knee Score, radiological outcomes, and systemic complications were collected and compared between the two treatment groups. Patients were followed up for at least 12 months. Results: The LDP group performed better than IMN in terms of operative time, estimated blood loss amount, and malunion rate. Differences in function scores, fracture union rate, overall pulmonary complication rate, and in-hospital mortality between the two groups were not significant. Average radiographic union time was significantly longer in the LDP group (36.3 weeks) than in the IMN group (32.5 weeks). One case of fixation failure occurred postoperatively in the LDP group, whereas one case of fracture nonunion took place in the IMN group. Conclusion: Our findings suggest that dual-plating fixation is a promising method for FSFs with multiple injuries. However, the retrospective nature of this study necessitates high-quality trials to be performed to assess the clinical efficiency of dual plating.

Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement.

Endoprosthetic replacement (EPR) and intramedullary nailing (IMN) are the two most commonly applied surgical methods used to treat proximal metastatic lesions; however, indication of the above procedures remains controversial. The aim of the present study was to evaluate the clinical, functional and oncological outcomes of patients who underwent EPR compared to IMN for the treatment of proximal femur metastases to investigate the surgical indication for patients. The records of patients (n=88) with pathological fractures secondary to metastatic tumors of the proximal femur admitted between January 2005 and December 2014 to West China Hospital, Sichuan University (Chengdu, China) were retrospectively studied. A total of 57 patients were treated with EPR (34 males and 23 females; mean age, 62.5 years) and 31 patients were stabilized with IMN (19 males and 12 females; mean age, 60.2 years). Patients were analyzed regarding surgery time, blood loss, hospital stay, Musculoskeletal Tumor Society (MSTS) score, survival, recurrence and complications. The median follow-up period was 12.9 (range, 3-98) months. The median survival time in EPR was 10.0 months and 7.5 months in IMN. The surgery time was 142.6±22.7 min in the EPR group and 98.7±19.5 min in the IMN group (P=0.001). Significantly less blood loss was observed in the IMN group (345.2±66.4 ml) than in the EPR group (631.5±103.6 ml; P=0.001). The median hospital stay in the EPR group was 8 (quartile range, 7-9) days and 5 (quartile range, 5-6) days in the IMN group (P=0.001). Local recurrence rate was 10.5% (6/57) in the EPR group and 25.8% (8/31) in the IMN group (P=0.074). The complication rates were 10.5% (6/57) in the EPR group and 29.0% (9/31) in the IMN group (P=0.038). MSTS-93 score was higher in IMN compared with EPR at 6 weeks postoperatively (P=0.001), while the EPR group demonstrated a higher score at 6 months postoperatively (P=0.001). EPR has the advantage of better functional outcomes and higher life quality in the long term, with lower complication rates in treating metastatic lesions of the proximal femur with pathological fractures. EPR is recommended for patients with relatively good general condition and prognosis. IMN is best indicated when the patient's life expectancy is extremely limited.

Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis

To compare the clinical outcome and complications of locking plates versus intramedullary nails in patients with displaced proximal humeral fractures. Our hypothesis was that there would be no difference between these two implants with regard to clinical outcome and complications. We performed a systemic review of PubMed, EMBASE, Clinical Trials Registry, Cochrane Central Register of Controlled Trials and Google Scholar to identify all relevant randomized controlled trials, prospective and retrospective comparative studies on April 26, 2017. The studies of locking plates compared to intramedullary nails in patients with displaced proximal humeral fractures were included. We conducted a meta-analysis of shoulder functional scores, range of motion, pain scores, and complications. This meta-analysis included 13 comparative studies with 958 patients (529 in the locking plate group and 429 in the intramedullary nail group). A significantly greater external rotation (MD =9.67; 95% CI, 4.22-15.12; P=0.0005) and a significantly higher penetration rate (RR =1.75; 95% CI, 1.11-2.77; P=0.02) were observed in the locking plate group compared with the intramedullary nail group. Constant-Murley scores, DASH scores and total complication rate were comparable between the two groups. Moreover, there were no significant differences in forward elevation, VAS scores, and other complications. Current evidence indicates that locking plates and intramedullary nails have similar performance in terms of the functional scores and total complication rate. No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures.

Comparative investigation of percutaneous plating and intramedullary nailing effects on IL-6 production in patients with tibia shaft fracture

ObjectiveThe aim of this study was to analyze the effect of intramedullary nailing (IMN), open plating and percutaneous plating on the induction of IL-6 in patients with tibia fractures. MethodsA total of 30 patients with tibia shaft fracture underwent either intramedullary nailing (IMN, n = 15; 14 males and 1 female; mean age: 32.1 ± 15.6), ORIF plating (n = 8; 5 males and 3 females; mean age: 60.0 ± 17.8), or percutaneous plating (n = 7; 6 males and 1 female; mean age: 43.1 ± 21.4). Serum IL-6 cytokine levels were measured prior to, and 6 and 24 h after the surgery, using a special ELISA kit. ResultsThe IL-6 concentration increased to peak levels at 6 h in both IMN and percutaneous plating groups, and at 24 h in ORIF plating group (p < 0.001). The mean IL-6 concentration of percutaneous plating group was significantly lower than that of the IMN group at 6 h following the surgery (p = 0.022). In addition, the mean IL-6 concentration of ORIF plating group was significantly higher than that of the percutaneous plating group at 24 h post operation (p = 0.009). ConclusionOur results suggest that percutaneous plating compared to the IMN has lower effects on IL-6 production in patients with tibia fracture. Level of evidenceLevel III, therapeutic study

A comparison study of phlios plate and multiloc nail in treatment of proximal humerus fractures

Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures. Methods From February 2013 to December 2015, data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed. In group one (Phlios plate), there were 10 males and 8 females, with an average age of 56.3±5.8 years, including 7 cases of Neer 2-part surgical neck fracture, 6 cases of Neer 3-part fracture, 4 cases of Neer 4-part fracture, and 1 case of fracture-dislocation. In group two (Multiloc nail), there were 8 males and 11 females, with an average age of 57.2±7.4 years, including 8 cases of Neer 2-part surgical neck fracture, 9 cases of Neer 3-part fracture, 1 case of Neer 4-part fracture, and 1 case of fracture-dislocation. Operation time, range of motion of shoulder joint, visual analogue scale (VAS) pain score, American Shoulder & Elbow Surgeon (ASES) score and Constant-Murley score were collected. Results All 37 patients were followed up for an average period of 15.5 months (range, 12-36 months). The average bone healing time were 2.5±0.5 months (range, 2-3 months) and 2.2±0.5 months (range, 1.5-3 months) in the plate and nail group respectively. At the latest follow-up, average VAS score was 0.4±0.6 (range, 0-2), the ASES score averaged 85.4±6.8 points (range, 73-96), Constant-Murley score averaged 83.4±7.3 points (range, 71-94), and external rotation averaged 30.8°±10.0° (range, 10°-50°) in plate group, while average VAS score was 0.2±0.4 (range, 0-1), ASES score averaged 89.7±5.6 points (range, 80-98), Constant-Murley score averaged 88.5±6.8 points (range, 76-98), and external rotation averaged 40.3°±7.9° (range, 20°-50°) in the intramedullary nailing group. One case had partial necrosis of humeral head in the plate group, while 1 case suffered absorption of the greater tuberosity in the nail group, with the complication rate of 5.6% (1/18) and 5.3% (1/19) respectively, without significant difference. The internal and external rotation degrees, ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures, while the forward elevation and abduction degrees were similar. Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail. The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures. Key words: Shoulder fractures; Internal fixators; Fracture fixation, intramedullary

Middle third humerus fractures in adults: Intramedullary nails vs. locking compression plates

Background: 2 to 3% of all traumatic fractures in adults encountered by orthopaedic surgeons are humerus fractures. Operative management for these fractures has now gained popularity among surgeons to allow patients an early recovery and return to premorbid conditions. We compared the two commonly used implants for treating humerus shaft fractures, that is, locking compression plates and intramedullary nails in terms of complications associated and range of movements. Materials and methods: 40 patients were allotted into 2 groups, with 20 undergoing treatment with locking compression plates and 20 undergoing intramedullary nailing. The 2 groups were comparable when pre-operative demographics were analysed. Post-operative follow up showed the following results. Results: Axillary nerve injuries were noted in 4 out of the 20 patients in the nailing group and radial nerve palsy was note in 1 patient in the plating group after surgery. 2 cases of superficial wound infection and 1 case of deep wound infection were recorded in the plating group. 1 patient in each group were found to have delayed union. A significantly higher incidence of shoulder stiffness was recorded in the intramedullary nailing group. A significant difference in the DASH score was recorded, in favour of the plating group. This could be attributed to the pain free movements at shoulder joint. A significant difference in the Rodrigues Merchan outcome was seen, in favour of the plating group, with 70% patients having achieved good to excellent outcome, as opposed to 25% in the nailing group. A higher incidence of poor outcomes was seen in the nailing group due to shoulder related complications. Conclusion: We concluded that Open reduction and internal fixation with locking compression plates gave a better outcome to patients when followed up after surgery as compared to closed reduction and internal fixation with interlocking nails, primarily due to the shoulder related complications associated with intramedullary nailing.

Comparison of Contact and Damage to Anatomic Structures in the Fixation of Zone II Fifth Metatarsal Fractures with an Intramedullary Screw or an Intramedullary Nail

Category: Sports, Trauma Introduction/Purpose: Percutaneous intramedullary screw fixation of Zone II fifth metatarsal fractures has become commonplace. The potential for injury to the important surrounding anatomy has not been well documented, though some authors have reported unexplained postoperative pain and paresthesia over the lateral aspect of the foot despite hardware removal. The purpose of this study was to determine the contact and injury rate of surrounding anatomic structures with either the use of the traditional intramedullary screw (IMS) inserted “high and inside” or a novel intramedullary nail (IMN) inserted “low and outside” through a relative “safe-zone.” Methods: Zone II fifth metatarsal fractures were created in ten cadaver matched-pairs using a 1 mm thick saw through a small incision. Fractures were randomized to receive either an IMS or an IMN. The surgical technique was performed in accordance with the manufacturer’s instructions. For the IMS group, the guide pin was inserted percutaneously according to the “high and inside” starting point on the base of the fifth metatarsal using fluoroscopy; followed by insertion of the 3.5 mm drill, tissue protector, tap, and screw. For the IMN group, the guide pin was inserted percutaneously “low and outside,” positioned slightly medial and dorsal to the tip of the tuberosity of the fifth metatarsal; followed by the 5.2 mm reamer, tissue protector, and IMN. Dissection was performed to identify damage or contact to the peroneus brevis tendon (PB), peroneus longus tendon (PL), sural nerve (SN), lateral insertion of the plantar fascia (PF) and cuboid-fifth metatarsal jointspace. Results: There were significantly more episodes of PB injury, PL contact, SN contact, and presence in the cuboid-fifth metatarsal jointspace for the IMS group. There were significantly more episodes of contact of the PF with the IMN group but no episodes of damage. The results are summarized in Table 1. Images of contact and damage are shown in Figure 1. Fluoroscopic images of the IMN inserted through the “low and outside” position are shown in Figure 2. Conclusion: We have demonstrated significant contact and injury to surrounding structures with the placement of a “high and inside” IMS for the fixation of Zone II fifth metatarsal fractures. We believe there is a relative safe zone at the “low and outside” position that affords less potential damage to the important surrounding structures. Consideration should be given to the development of implants inserted through the relative safe zone.

Operative Treatment of 2-Part Surgical Neck Fracture of the Humerus: Intramedullary Nail Versus Locking Compression Plate With Technical Consideration

To compare the outcomes of patients who underwent either open reduction internal fixation with a locking plate and screws or closed reduction internal fixation with an antegrade intramedullary nail (IMN) for displaced surgical neck fracture of the humerus. Retrospective comparative study. Single institute, Level-I academic trauma center. Sixty-nine patients with 2-part surgical neck fracture of the humerus underwent either an IMN (38 patients group A) or a locked plate fixation (31 patients group B). Pain on a visual analog scale, University of California Los Angeles (UCLA) Shoulder Score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM). At the 2-year follow-up, there were no significant differences in the visual analog scale pain score (1.3 in group A; 0.9 in group B), ASES score (90.2 in group A; 91.9 in group B), and UCLA Shoulder Score (30.7 in group A; 31.8 in group B) between groups. Active ROM did not differ significantly between groups. There were 3 complications in the IMN group, 1 nonunion requiring autogenous iliac crest bone graft, and 2 cases of screw loosening. For displaced surgical neck fractures of the humerus, both IM nailing and locked plate fixation in patients yielded satisfactory outcomes at the 2-year follow-up with no significant differences in pain or ROM between groups. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of intramedullary nail and retrograde intramedullary nail combined with hollow lag screw fixation for treatment of ipsilateral femoral neck and shaft fractures

Objective To compare the effect of proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures. Methods Data of 42 patients with ipsilateral femoral neck and shaft fractures who were admitted in our hospital from January 2007 to January 2016 were retrospectively analyzed. According to different fixation methods, the patients were divided into two groups: single intramedullary nail group (SIN group) (20 cases, treated with single proximal femoral intramedullary nail, 15 males and 5 females with an average age of 39.4); combined internal fixation group (CIF group) (22 cases, treated with femoral distal intramedullary nail combined with femoral neck hollow lag screw, 17 males and 5 females with an average age of 42.2 years). In the SIN group, 4 cases were type A, 9 cases type B, 7 cases type C according to AO classification. And 14 cases belonged to I or II (stable fracture), 6 cases of type III or IV (unstable fracture) according to Garden classification. In the CIF group, 3 cases were type A, 10 cases type B, 9 cases type C according to AO classification. And 16 cases belonged to type I or type II, 6 cases type III or IV according to Garden classification. The incision length, operation time, intraoperative blood loss, fracture healing time, postoperative weight time, stability of internal fixation, hip function score, pain in the knee and postoperative complication rate were compared between the two groups. Results There was no significant difference in gender, age and fracture classification between the two groups. The operation time (75.0±10.2 min), intraoperative blood loss (150.6±80.4 ml), hip Harris score excellent rate (80%) of incidence of knee pain in postoperative 3 months (10.0%) of the SIN group were significantly lower than those of the CIF group (105.2±18.4 min, 180.0±56.8 ml, 86.4% and 31.8%). The length of incision (8.3±1.4 cm) in the SIN group was significantly longer than that in the CIF group (4.0±0.6 cm). There was no significant difference in fracture healing time (SIN group 20.0±4.0 weeks, CIF group 19.6±4.2 weeks) and postoperative weight time (SIN group 8.2±4.0 weeks, CIF group 8.0±4.2 weeks) between the two groups. The main complications of the two groups were delayed union (3 cases of SIN group and 1 case of CIF group), nonunion of fracture (1 case of SIN group) and, coxa vara (1 case of SIN group). The complication of SIN group (30%) was significantly higher than that of CIF group (4.5%), which occurred mainly in unstable femoral neck fracture cases. Conclusion Both proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw can effectively treat femoral ipsilateral femoral neck and shaft fracture. Femoral retrograde intramedullary nail combined with hollow lga screw has more therapeutic advantages for unstable femoral neck fractures (Garden III and IV). Key words: Femoral fractures; Femoral neck fractures; Fracture fixation, intramedullary; Bone screws

Comparative study between biologic plating and intramedullary nailing for the treatment of subtrochanteric fractures: Is biologic plating using LCP-DF superior to intramedullary nailing?

BackgroundThe objective of this study is to evaluate the outcome measures of subtrochanteric fractures between biologic plating and intramedullary nailing and determine if biologic plating is superior to intramedullary nailing. MethodsBetween March 2009 and December 2015, 81 patients with subtrochanteric fractures were enrolled (52 males and 29 females; 31 treated with biologic plating and 50 with intramedullary nailing). Biologic plating was conducted consecutively between May 2011 and March 2013 and intramedullary nailing was performed for the rest of period. Perioperative outcomes including operation time and blood loss during the operation; postoperative radiologic outcomes including union, time to union, coronal alignment, and shortening of the femur; and clinical outcomes including walking ability and pain were evaluated. The biologic plating group was compared with the intramedullary nailing group as a historical control. ResultsNo significant differences were identified for bony union and time to union between the two different fixation methods Coronal alignment was significantly better in the biologic plating group than in the intramedullary nailing group (p<0.016). Postoperative coronal alignment was the only risk factor associated with the nonunion of subtrochanteric fractures (unadjusted OR: 1.915, 95% CI: 0.190 − 19.273; adjusted OR: 0.042, 95% CI: 0.000 − 21.517; p=0.320). ConclusionSurgical outcomes using LCP-DF are comparable to those using intramedullary nailing. Further clinical studies with a larger sample size are required to show the advantage of biologic plating for the treatment of subtrochanteric fractures.

Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures

IntroductionThe three currently used methods of treatment: namely open reduction plate osteosynthesis (ORPO), Minimally invasive plate osteosynthesis (MIPO), antegrade intramedullary nailing(IMN) are all reported as satisfactory procedures for treatment of humeral shaft fractures. However none of the published reports have a comparison of superiority of one procedure over the other. We evaluated the clinical, radiological and functional outcome of the three procedures. Materials and methodsWe studied adult patients with humerus shaft fractures over a period of 2 years from May 2014 to May 2016 in a level 1 trauma center. Forty-four were treated with IMN, 34 treated with ORPO, and 34 with MIPO. The null hypothesis tested in this study is that there is no difference between IMN, ORPO, MIPO with respect to union time, surgical time, complication rate, non-union rate and functional outcome. Functional outcome was studied by comparing the UCLA shoulder and MEP scores in the three groups. Results112 patients were studied consisting of 83 males and 29 females with mean age of 39 years (range 18-70). IMN group showed early union with mean of 12.73 weeks compared to MIPO (14.45 weeks) and ORPO(13.58 weeks), (p<0.05). MIPO had no events of non-union, as compared to ORPO (5 non-unions) and IMN (10 non-unions), (p=0.04).The range of movement at the shoulder with the UCLA score was significantly better with a score of 32.26 in MIPO as compared to 27.54 in IMN and 28.82 in ORPO (p<0.05). The difference in MEPS score in the three groups was not significant (p=0.31). IMN required a mean of 117.95 minutes intraoperatively as compared to 131 and 150.58 mins in MIPO, ORPO respectively. ConclusionMIPO is overall better with respect to non-union, functional outcome and complications rate. The surgical time depends on the surgeons’ skill and learning curve. Thus considering the advantages and risks involved in the various procedure and surgical acumen, each case should be individualized to have a good outcome. We advocate that MIPO can be safely used as an alternative in treating these fractures.

Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis.

This study aims to compare the outcomes of intramedullary nail (IMN) and volar locking plate (VLP) fixation for treatment of extra-articular or simple intra-articular distal radius fractures. PubMed, Embase, Medline and Cochrane Collaboration Central databases were searched for studies that compared the results of IMN and VLP fixation for the treatment of distal radius fractures up to March 2016. Stata 11.0 was used to perform the meta-analysis. Six randomized controlled trials (RCT) and two retrospective studies were included in this review, including 463 patients. No significant differences were found between two treatment methods in terms of any functional score, radiographic parameters and motion range in the late post-operative period (6, 12 and 24months). However, IMN did better than VLP at the post-operative sixweeks and threemonths, no matter which functional scoring system was used. The incidence of carpal tunnel syndrome (CTS) was 8.7% in the VLP group, significantly higher than that (0.8%) in the IMN group (OR, 0.183; 95%CI, 0.045-0.74). But for other complications, such as infection (OR, 0.449; 95%CI, 0.095-2.114), tendious damage (OR, 0.931; 95%CI, 0.238-3.648), tenosynovitis (OR, 0.806; 95%CI, 0.209-3.108), algodystrophy (pain) (OR, 0.795; 95%CI, 0.291-2.173) and radial nerve paraesthesia (OR, 1.8143; 95%CI, 0.834-3.942), no significant differences were found (P > 0.05). Compared to VLP, IMN could provide better early postoperative functional outcomes and reduce the incidence of carpal tunnel syndrome, which could be of particular help in restoring confidence for workers with specialized manual skills to return to their prior jobs. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and large samples are required to verify this conclusion.

Ilizarov External Fixator Versus Retrograde Intramedullary Nailing for Ankle Joint Arthrodesis in Diabetic Charcot Neuroarthropathy

Charcot neuroarthropathy of the ankle joint is a destructive process that leads to instability and significant morbidity that can end with amputation. Surgical arthrodesis in Charcot neuroarthropathy has a high failure rate. The aim of the present prospective study was to compare the outcomes of an Ilizarov external fixator and retrograde intramedullary nailing (IMN) for tibiotalar arthrodesis in Charcot neuroarthropathy. From February 2010 to October 2013, 27 patients (16 males and 11 females) with Charcot neuropathy of the ankle joint were treated in our department. Their ages ranged from 32 to 75 (average 54) years. Of the 27 patients, 14 received an Ilizarov external fixator and 13 underwent IMN. A preoperative clinical and radiologic assessment of all patients was performed. The outcomes were measured for bone union, development of complications, and clinical follow-up. The mean score of modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale was 80 ± 2.7 points in the Ilizarov group and 75 ± 1.9 points in the IMN group. In the Ilizarov group, 12 of 14 patients achieved union, and in the IMN group, 10 of 13 patients achieved union. The complication rate was significantly greater in the external fixator group than in the IMN group. The complications in the Ilizarov group included nonunion in 2 patients (14%), pin tract infection in 8 (57%), pin tract loosening in 3 (21%), surgical wound infection in 3 (21%), and wound breakdown in 1 patient (7%). In the IMN group, nonunion occurred in 3 patients (23.1%), back-out of a distal locking bolt in 2 (15.4 %), and a superficial wound infection that resolved with antibiotics in 1 patient (7.7%). In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. The Ilizarov external fixator resulted in a greater union rate than IMN but the complications with external fixation were significantly greater than those with IMN.

Effects of intramedullary nailing versus dynamic hip screwing on hip abduction in the treatment of intertrochanteric fractures

Objective To compare intramedullary nail (IN) and dynamic hip screw (DHS) regarding their effects on hip abduction following fixation of intertrochanteric fractures. Methods From January 2008 to December 2015, 310 patients with intertrochanteric fracture were treated at our department. They were divided into 2 groups depending on the manner of treatment. 198 patients (71 males and 127 females) were subjected to intramedullary nailing, with an average age of 74.7±5.6 years; there were 50 cases of 31-A1, 134 ones of 31-A2 and 14 ones of 31-A3 according to the AO classification. 112 patients (35 males and 77 females) were subjected to dynamic hip screwing, with an average age of 74.1±6.7 years; there were 24 cases of 31-A1, 78 ones of 31-A2 and 10 ones of 31-A3. The 2 groups were compared in terms of time for weight-bearing ambulation and stand on one leg, gait, pelvic tilt, range of hip active abduction, muscle strength of the abductor and hip function at the final follow-up. Results Of this series, 284 patients were followed up for 1.5 to 8.5 years (average, 3.6 years) and 26 patients died. The IN group achieved significantly better outcomes in terms of time for weight-bearing ambulation (37.6±4.9 d), time for stand on one leg (60.1±9.5 d), cases of normal gait and normal pelvic tilt (171 and 179), muscle strength of the abductor (62.3±4.4 N·m), and range of hip active abduction than the DHS group (53.0±8.4 d; 71.0±12.0 d; 67 and 85; 56.6±3.3 N·m, respectively) (P 0.05). Conclusion Compared with dynamic hip screwing, intramedullary nailing has a limited effect on hip abduction so that the patients may benefit from quicker functional recovery and faster improvement in quality of life. Key words: Hip fractures; Fracture fixation, internal; Bone nails; Abductor

Are clinical and functional results of MIPPO and IMN for treatment of extraarticular distal tibia fractures similar?

Aim: Controversy still exists on whether intramedullary nailing (IMN) or minimal invasive percutaneous osteosynthesis (MIPPO) is better for treatment of extra-articular distal tibia fractures. In this study, our aim was to retrospectively compare the clinical and functional results of patients with distal tibia fractures that were treated f by plate or nail. Materials and Methods: This study included 46 patients with a mean age of 40,3 (range, 18-63 years). All had closed extra-articular distal tibia fractures within 4 to 10 cm away from the tibial plafond and two senior trauma surgeons operated them with either MIPPO (n=27) or IMN (n=19) technique. Patients were followed up until full bony union occurred and also hospitalization time, union time, malunion criteria; complication rates and AOFAs were evaluated. Results: Mean follow up was 12.5 (range, 10-16 months) months and no major vessel injury or deep infection was observed in either group. Full bony union time was similar in two groups (15±12.7 weeks in MIPPO and 16±11.3 weeks in IMN group; p=0.062). Also, there was not statistically significant difference in MIPPO and IMN groups for nonunion rates [3 (11%) vs. 1 (5.3%)] and malunion rates 3 (11.1%) vs. 2 (10.5%)] (p>0.05). However, secondary surgical intervention was performed in two patients (7.4%) of MIPPO group for severe wound dehiscence (p=0.04). Conclusion: The two surgical techniques are equivocal for nonunion or malunion rates. However, wound problems may be seen after MIPPO technique and surgeon must be cautious for applying plate when patient has apparent wound problem.

ESIN and K-wire fixation has similar results in both bone pediatric forearm fractures

The purpose of this study was to compare short-term radiographic and clinical results of pediatric both-bone diaphyseal forearm fractures treated with intramedullary nail fixation using titanium nails or K-wires. This was a prospective comparative trial. In total, 43 patients with both-bone open or closed forearm fractures who underwent surgical treatment with intramedullary fixation were randomly classified into two groups. Three patients did not return for the follow-up and were excluded from the study. Twenty of the 40 patients were assigned to the elastic stable intramedullary nail group and 20 were assigned to the K-wire group. Demographic data suggested no difference between the two groups except for the side of injury. Perioperative data and radiological and clinical outcomes were evaluated. The cohort comprised 5 girls and 35 boys whose mean age was 11.60 ± 2.69 years. Except the proportion of patients who were conservatively followed up preoperatively, all perioperative data were similar between the groups. Radiographic and functional results were similar. There were two delayed unions; one pin track infection and one re-fracture. Intramedullary fixation of forearm fractures in children with titanium nail or K-wire does not affect radiological and clinical results. Both elastic stable intramedullary nail and K-wire fixation were effective in stabilizing pediatric diaphyseal forearm fractures.