Intramedullary Nailing For Treatment Research Articles

System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture

To systematically evaluate the clinical efficacy of reamed and nonreamed intramedullary nailing in treatment of closed tibial fractures with Cochrane systematic review methods. According to the Cochrane systematic review methods, literatures were retrieved from Cochrane library, PubMed, EMbase and other database. Randomized controlled trials (RCTs) and quasi-randomized controlled clinical trials about reamed and nonreamed intramedullary nailing in the treatment of closed tibial fractures were collected and RevMan 5.0 was chosen for meta-analysis. A total of seven studies were included in this meta-analysis. Reamed intramedullary nailing was better than nonreamed intramedullary nailing in nonunion rate [P = 0.02, RR = 0.46, 95% CI: (0.24, 0.91)] and implant failure rate [P <0.0001, RR = 0.36, 95% CI: (0.22, 0.57)]. No statistically significant difference was observed in malunion rate, compartment syndrome rate, postoperative infection [P = 0.18, RR = 0.50, 95% CI: (0.18, 1.383); P = 0 43, RR = 0.77, 95% CI: (0.40, 1.48); P = 0.27, RR = 0.38, 95% CI: (0.01, 7.87)]. Compared with the nonreamed intramedullary nailing, reamed intramedullary nailing can lead to better outcome in the treatment of closed tibial fractures.

The comparison of effect of dynamic hip screw and proximal femur interlocking intramedullary nail in treatment of intertrochanteric fractures

Objective To compare the effect of dynamic hip screw(DHS) locked intramedullary nail and the proximal femur with (PFN) in the treatment of intertrochanteric fracture.Methods 88 patients with femoral intertrochanteric fracture were selected.According to the patients' intention and economic status,they were divided into two groups.43 cases in group A were treated by DHS internal fixation,45 cases in group B were treated by PFN internal fixation.The clinical efficacy,the healing time and complications were observed.Results The excellent and good rate in group A and group B were 95.35％,97.78％,there was no significant difference between the two groups (x2 =0.394,P ＞ 0.05).In group B,the healing time,intraoperative bleeding volume and the incidence rate of complications were significantly lower than those in A group (t =3.824,4.017,x2 =4.552,P ＜ 0.05).Conclusion DHS and PFN in treatment of femoral intertrochanteric fractures can achieve better efficacy,however,PFN can significantly reduce postoperative complications,and shorter healing time,which is worth to be widely applied in clinical. Key words: Bone nails; Fracture fixation, intramedullary; Femoral fractures; Aged

Comparative study of external fixation device and interlocking intramedullary nail in treatment of tibiofibular fractures

Objective To compare curative effect of tibiofibular fractures treated by external fixation device and interlocking intramedullary nail.Methods A total of 121 patients with tibiofibular fractures were included in the study and were divided into external fixator group (56 patients) and interlocking intramedullary nail group (65 patients),according to diverse surgical approaches.The two groups were compared in indices of postoperative good-excellent rate,intraoperative blood loss,operation time,subsided time of postoperative swelling,hospital stay,fracture healing time,time of fixation removal and incidence of postoperative complications.Results The postoperative excellence rate in external fixator group and interlocking intramedullary nail group was 88％ and 89％,respectively (P ＞ 0.05).Compared with interlocking intramedullary nail group,the intraoperative blood loss was reduced more in external fixator group,with more evidently shortened operation time,subsided time of postoperative swelling and hospital stay (P ＜ 0.01).Fracture healing time and time of fixation removal,however,were significantly shorter in the interlocking intramedullary nail group than those in the external fixator group (P ＜ 0.01).Incidence of postoperative complications was 11％ in the external fixator group and 28％ in the interlocking intramedullary nail group (P ＜0.05).Conclusions External fixation device and interlocking intramedullary nail are both effective in treatment of tibial and fibular fractures.External fixation device with less damage to tissue is relatively more helpful to postoperative recovery.On the contrary,the interlocking intramedullary nail is relatively more conducive to fracture healing. Key words: External fixators ; Fracture fixation, intramedullary ; Tibiofibular fractures

KN-F2 Intramedullary nailing for treatment of complications

KN-F2 Intramedullary nailing for treatment of complications

L-F3.3 The patellofemoral kinematics following locked intramedullary nailing treatment for femur shaft fracture

L-F3.3 The patellofemoral kinematics following locked intramedullary nailing treatment for femur shaft fracture

Non cannulated intramedullary nailing in treatment of nonunited tibial fractures

Background and objectives: Nonunion following diaphyseal tibial fractures is still a challenging problem facing orthopaedic practice , different approaches used to tackle this problem , the aim of this study was to evaluate the outcome of treatment by non cannulated intramedullary nailing as regards union and complications Method: Eighteen patients with non-united diaphyseal tibial fractures their age ranged between 19 –60 years (mean of 33.5 years) were studied and treated by non cannulated intramedullary nailing between 2005 to 2010. Initially all these patients underwent multiple surgeries including wound excisions , revision of fixation and bone grafting All underwent fixation by non cannulated intramedullary nailing , in 14 patients , the site of the non-union wasexplored to correct alignment by osteotomy , while closed intramedullary nailing were performed in the remaining 4 patients Results: In seventeen cases ( 94.4 % ) union was achieved between 5 – 9 months with an average of 7.5 months , complications included refracture and failure of fixation in 1 patient ( 5.6 % ) and superficial wound infection occurred in 3 cases ( 16.6 % )Patients with nonunited diaphyseal fractures were followed post-operatively for 1 – 6 year( average 4 years ) , eventually healing was successful with full weight bearing without support and pain , fracture line was not visible on radiographs Conclusion: Non-cannulated intra-medullary nailing appears to be very helpful procedure to promote union in these cases with relatively less significant complications .

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.

Elastic stable intramedullary nail treatment for lower limb fractures in childhood

In order to treat femoral and tibial midshaft fractures in children we have several options: closed reduction and Paris cast, external fixation and internal fixation, such as the elastic stable intramedullary nail (ESIN). ESIN respects bone healing and allows a fast weight-bearing restoring and a quick return to normal activities. For these reasons it seems to be an optimal treatment, with few complications. In this paper, we report our experience with this method.

Clinical research of the femoral shaft fractures treated with self-locking intramedullary nail

Objective To explore the clinical efficacy of self-locking intramedullary nail treatment on femoral shaft fracture.Methods Retrospectively analyzed 80 femoral shaft fracture patient from our hospital; randomly divided them into experimental group and control group,experimental group were fixed with self-locking intramedullary nail,while the control group were fixed with intramedullary nail.Scored both groups' hip function score before and after treatment.Results The surgery time,healing time,and hospital stay time of the experimental group were significantly less than that of the control group (P＜ 0.05 ).There were no significant differences between these two groups in hip function score,clinical efficacy,and complication incidence ( P ＞ 0.05 ).Conclusion Both self-locking- and intramedullary nail have good curative effect on femoral shaft fracture.In contrast to intramedullary nail, selflocking intramedullary nail has simpler operation,less operation time,faster fracture healing,which is worth to apply on the clinical treatment of femoral shaft fracture. Key words: Self-locking intramedullary nail; Femoral shaft fractures; Clinical research

Pre-bend elastic stable intramedullary nail fixation for distal radial shaft fractures in children

Objective To investigate the functional and radiographic outcomes of pre-bent elastic stable intramedullary nail in treatment of distal radial shaft fractures in children. Methods From January 2006 to December 2008, 18 children with distal radial shaft fracture were treated by close reduction and internal fixation with a pre-bent elastic stable intramedullary nail. The age range was from 5 years to 15 years,with an average of 9 years and 8 months. All the cases were closed fractures, and followed up at least 12 months. The time interval from injury to surgery were 1 to 9 days. Fracture sites were located at the distal radial shaft. Among them, 15 cases suffered ipsilateral ulnar fracture, and the others for solitery radial fracture. Closed reductions were performed under C-arm fluoroscopy. All affected arms were immobilized in the functional position postoperatively by the plaster cast beyond elbows. Results The average time of fracture complete union was 5 months (ranged from 3 months to 7 months). The average preoperative angulation of the fractures: anteroposterior view 16.2±7.5 degrees, lateral view 26.2±13.1 degrees. The average postoperative angulation of the fractures: anteroposterior view 2.7±1.5 degrees, lateral view 1.4±1.2 degrees. All fractures maintained good alignment postoperatively, and 94.4% (17/18) of the patients regained a full range of rotation of the forearm. One patient suffered limitation of rotation in forearm less than 10°, and this had improved by final follow-up. Complications included soft tissue irritation at the site of nail insertion in one patient and transient scar hypersensitivity in another. Conclusion Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children. Key words: Child; Radius fractures; Fracture fixation, intramedullary

Pre‐bent elastic stable intramedullary nail fixation for distal radial shaft fractures in children

To investigate the functional and radiographic outcomes of pre-bent elastic stable intramedullary nail in treatment of distal radial shaft fractures in children. From January 2006 to December 2008, 18 children with distal radial shaft fracture were treated by close reduction and internal fixation with a pre-bent elastic stable intramedullary nail. The age range was from 5 years to 15 years, with an average of 9 years and 8 months. The minimum follow-up was 12 months. All fractures maintained good alignment postoperatively, and 94.4% (17/18) of the patients regained a full range of rotation of the forearm. One patient has limitation of rotation to less than 10°, this had improved by final follow-up. Complications included soft tissue irritation at the site of nail insertion in one patient and transient scar hypersensitivity in another. Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children.

Elastic stable intramedullary nailing versus nonoperative treatment of displaced midschaft clavicular fractures – a randomized, controlled, clinical trial

Elastic stable intramedullary nailing versus nonoperative treatment of displaced midschaft clavicular fractures – a randomized, controlled, clinical trial

Expandable intramedullary nailing for treatment of atrophic femoral shaft nonunion associated with hypotoxic infection and bone defects: A case report

Expandable intramedullary nailing for treatment of atrophic femoral shaft nonunion associated with hypotoxic infection and bone defects: A case report

Valgus osteotomy combined with intramedullary nail for Shepherd’s crook deformity in fibrous dysplasia: 14 femurs with a minimum of 4 years follow-up

To investigate the effectiveness of valgus osteotomy combined with intramedullary nail in treatment of Shepherd's crook deformity of fibrous dysplasia. A retrospective study was performed in 13 patients (14 femora) of fibrous dysplasia who were treated in our hospital between August 2000 and February 2005. All patients had Shepherd's crook deformity. Six patients had monostotic disease, and seven had polyostotic disease. There were seven males and six females. The four-step procedure was performed orderly as valgus osteotomy, curettage lesion, massive impaction allograft, and insert intramedullary nail with neck cross pinning. All patients were followed up from 4 to 7 years with an average duration of 75.3 months. The average neck-shaft angle was corrected from preoperative 75 degrees (range 55 degrees -100 degrees ) to postoperative 120 degrees (range 95 degrees -130 degrees ). The average extremity lengthening was 3.4 cm (range 2.0-4.5 cm). 19 location of osteotomy showed good union. There were no infection and recurrent fracture and progression of deformity. The valgus osteotomy can correct Shepherd's crook deformity, prevent recurrent fracture, and restore alignment, thus improve functioning of limb. The intramedullary nail with neck cross pinning should be the first consideration of internal fixation. Massive impaction allograft is the key technique to improve full incorporation of allograft and to prevent pathological fracture.

A comparison of 3 intramedullary nails in treatment of intertrochanteric fractures

Objective To compare the clinical results of Gamma nails, proximal femoral nails (PFN) and proximal femoral nail anti-rotation (PFNA) in the surgical treatment of intertrochanteric fractures of femur. Methods From January 2004 to June 2007 in our hospital, 46 cases of intertrochanteric fractures of the femur were treated with Gamma nails, 29 treated with PFN and 51 treated with PFNA. A retrospective study was performed to compare the outcomes of the 3 intramedullary nails by analyzing operative time, blood loss, complications, fracture healing and postoperative Harris hip scores. Results Nine-ty-one cases were followed up successfully with a mean period of 21.6 (11 to 39) months. There were no significant differences between the 3 nails in terms of complication rate, recovery of hip function, and time required for fracture union (P>0.05). However, PFNA had a faster procedure and less intraoperative blood loss than the other 2 nails (P<0.05) . Conclusions All the 3 intramedullary nails can be used ef-fectively for the treatment of intertrochanteric fractures. However, PFNA may be associated with a shorter operative time and less blood loss. Key words: Hip fracture; Fracture fixation, intramedullary nail

Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bones.

Background:In cases with infected non-union, the primary step is eradication of the infection before attempting to achieve union. Release of antibiotics from the bone cement at a high concentration and its penetration to the surrounding tissues, including cortical and cancellous bone, prompted the use of antibiotic cement in the control of bone infection. The aim of this study is to summarize our experience with the use of antibiotic cement-impregnated intramedullary nail (ACIIN) for control of infection in cases of infected non-union with bone defect.Materials and Methods:We prospectively studied 25 cases of infected non-union (23 femora and two tibiae). There were 24 males and one female, with the mean age being 33 years (range, 21–58 years). All patients had high-velocity road traffic accidents except one patient who had farmland injury. There were seven closed fractures, one grade I compound, two grade II compound fractures, five grade IIIA compound fractures, and 10 grade IIIB compound fractures. ACIIN was used in all cases after adequate debridement. Patients were classified according to the amount of bone defect present after debridement: group 1 with bone defect <4 cm (n=13), group 2 with bone defect ≥4–<6 cm (n=7), and group 3 with bone defect ≥6 cm (n=5). Infection control was judged on the basis of discharge through the wound and laboratory parameters. All patients were followed-up, with an average follow-up time of 29 months (range, 18–40 months). The mean duration of retention of the intramedullary rod was 8 weeks (range, 6–12 weeks).Results:In group 1, all cases achieved infection control, with three patients achieving bone union without any need of secondary procedure. In group 2, all cases achieved infection control but the time taken was significantly longer than for group 1 (P value 0.0002). All the cases required a secondary procedure in the form of either interlocking intramedullary nailing with iliac crest bone graft or Ilizarov ring fixator application to achieve union. None of the cases in group 3 achieved infection control.Conclusion:ACIINs are useful for infection control in cases of infected non-union with bone defect <6 cm. In cases with defect >6 cm, other alternatives should be used.

The effectiveness of intramedullary nail treatment for proximal humeral fractures in elderly patients

The effectiveness of intramedullary nail treatment for proximal humeral fractures in elderly patients

Retrograde Intramedullary Nailing in Treatment of Bilateral Femur Fractures

The purpose of this study was to evaluate the use of retrograde nailing to treat patients with bilateral femur fractures. A retrospective review of prospectively obtained trauma databases was completed at 9 Level 1 trauma centers. In all, 3767 patients with femur fractures were identified. Of those, 89 (46 males, 43 females) had bilateral femur fractures treated with reamed, retrograde intramedullary nails within 48 hours after injury. The charts were reviewed for pertinent data. The average cohort age was 30 years (16-63 years). The average Injury Severity Score was 21 (9-50). Eighty-five patients (96%) had associated injuries. Thirteen patients (14.6%) developed adult respiratory distress syndrome; 8 had thoracic injuries. There were 4 patients (4%) with fat embolism syndrome, 2 were delayed longer than 24 hours to the operating room. There were 5 deaths (5.6% mortality) in the retrograde nailing group. Thoracic injury was found to be associated with death rate (P < 0.07). Bilateral femur fractures are indicative of severe injuries with mortality rates as high as 40%. There are no specific studies addressing the outcomes of bilateral femur fractures treated with retrograde nailing. In this largest retrospective study to date, the overall death rate of 5.6% was significantly lower than historical controls. The effect of timing and duration of surgery and other injuries is not completely known. In conclusion, retrograde nailing of bilateral femur fractures is an acceptable treatment for bilateral femur fractures.

Long-term Functional Outcomes After Intra-articular Distal Femur Fractures: ORIF Versus Retrograde Intramedullary Nailing

This retrospective study evaluated the long-term clinical, functional, and radiographic outcomes of traditional open reduction internal fixation (ORIF) versus limited open reduction with retrograde intramedullary nailing for supracondylar-intercondylar distal femur fractures (Arbeitsgemeinschaft für Osteosynthesefragen [AO] 33-C type). Twenty-three fractures were followed in 22 patients for a mean follow-up of 80 months. The rate of subsequent bone-grafting procedures (67% vs 9%) and malunion (42% vs 0%) were significantly higher in ORIF compared to the less invasive retrograde intramedullary nailing treatment. A nonsignificant trend was noted for increased infection (25% vs 0%) and nonunion (33% vs 9%) in the ORIF group. The physical function component of the SF-36 was approximately 2 standard deviations below the US population mean, and 50% of patients demonstrated radiographic changes of posttraumatic arthritis. No patient has had a subsequent total knee arthroplasty.

Inflatable intramedullary nails in treatment of fractures of femoral trochanter in aged patients

目的 探讨可膨胀股骨近端髓内钉(PFN)治疗老年股骨转子部骨折的临床疗效.方法 2004年6月～2005年10月,对34例老年股骨转子部骨折患者使用可膨胀PFN固定,骨折按Evans分型:Ⅱ型4例,ⅢA型6例,ⅢB型8例,Ⅳ型16例;其中合并股骨干骨折2例.结果 所有患者获8～52周(平均25周)随访.骨折全部愈合,愈合时间为8～20周,平均12周.无感染、脂肪栓塞、深静脉血栓、骨折不愈合、髋内翻及旋转畸形等并发症发生.结论 可膨胀PFN治疗股骨转子部骨折具有操作简单、创伤小、符合生物学固定原则、骨折固定稳定、并发症少及患者可早期离床负重等优点,尤其适合老年患者。