Locked Nailing Research Articles

Initial construct stability of long cephalomedullary nails with superior locking for a complex trochanteric fracture model AO31A2.2– a biomechanical study

BackgroundComplex fractures of the trochanteric region, as well as fractures located in the directly subtrochanteric region, are controversially discussed around the world regarding the nail type to be used. A long nail is recommended by manufacturers but requires longer surgical and fluoroscopy times. A possible solution could be a nail with an appropriate length which can be locked in a minimally invasive manner by the main aiming device. We aimed to determine if such a nail model (DCN SL nail, SWEMAC, Linköping, Sweden) offers similar structural stability on biomechanical testing on artificial bone as a standard long nail when used to treat complex trochanteric fractures and compared it to long nails usually used in this setting.MethodsAn osteoporotic bone model was chosen. The Swemac Hansson DCN Nail System was used as osteosynthesis material. Two types of nails were chosen: a superior lock nail which can be implanted with a singular targeting device, and a long nail with distal locking using free-hand technique. AO31A2.2 fractures were simulated in a standardised manner. Axial height of the construct, varus collapse, and rotational deformity directly after nail insertion were simulated. A Universal Testing Machine was used. Measurements were made with a stereo-optic tracking system.FindingsThere was a detectable difference in the axial fracture movement resulting in narrowing of the fracture gap. There was no difference in varus collapse or rotational deformity between the nail variantsConclusionWe conclude that there are small differences which are clinically insignificant and that a superior locking nail can safely be used to manage complex trochanteric fractures.

Outcome Comparison of Multidirectional Locked Nailing and Plating for Distal Tibial Fractures: A Comparative Analytical Study

Introduction: This comparative analytical study explores the functional outcomes of treating distal tibial fractures using multidirectional locked nailing and plating. Distal tibia fractures, resulting from high-energy trauma, pose challenges due to soft tissue damage, infection risks, and potential unfavorable outcomes. Our study seeks to evaluate and contrast the functional results of treating distal tibial fractures using multidirectional locked nailing versus plating techniques. Materials and Methods: Conducted at Saveetha Medical College and Hospital from August 2022 to October 2023, the study involved 20 cases meeting specific criteria. Adult patients (18-70 years) with closed fractures and grade I compound fractures of distal tibia (AO type 43-A1, 43-A2, and 43-A3) were included. The cases were evenly divided between multidirectional locked nailing and plating groups. Subsequent evaluations, comprising both radiographic and clinical analyses, were performed at 6, 12, and 24-week intervals. Results: The study encompassed various parameters, including age distribution, causes of fractures, weight-bearing protocols, and joint movements. Multidirectional locked nailing demonstrated a shorter fracture union time, promoting earlier weight-bearing and functional exercises. Ankle and knee scores in this group indicated successful joint function restoration but with a higher malunion rate. Plating exhibited a lower malunion rate but a prolonged time to union. Complications, including superficial infections and wound dehiscence, were observed, emphasizing the importance of postoperative monitoring. Despite challenges, the plate group achieved satisfactory functional outcomes, highlighting fair to good ankle scores and full knee movement in all cases. Conclusion: In conclusion, the study underscores the distinctive advantages and considerations of each treatment approach. Multidirectional locked nailing facilitates faster union and joint function restoration but carries a higher malunion risk. Plating, with a lower malunion rate, requires meticulous postoperative care. The choice between the two methods should be individualized, considering patient-specific factors, fracture characteristics, and the surgeon's expertise. This research contributes valuable insights for informed decision-making in distal tibia fracture treatment.

Tibial Malrotation after Intramedullary Locked Tibia Nailing and its Computed Tomography-Based Assessment

Objectives To assess the incidence and degree of malrotation of tibia after fixation with intramedullary nail for tibial shaft fractures and its measurement by computed tomography (CT). The study also aims to assess the value of CT-based torsion angle in such cases. Material and Methods In this prospective study, fifty patients with closed/open fracture of tibia shaft (proximal 1/3, middle 1/3 or distal 1/3) with or without fracture of fibula were chosen and operated with closed/open reduction internal fixation with reamed intramedullary locked nail. Torsion angle calculated by post-operative CT and revision done for selected cases when tibial malrotation was more than 10 degrees than the control (normal side). Results The range of malreduction was from 43 degrees of external rotation to 12 degrees internal rotation. 15 of the 50 (30%) tibia operated showed malrotation and 5 (10%) were above 20 degrees. The repetition of torsion angle showed a variation of 3.2 to 4.3 degrees. Some injury patterns showed more malrotation than the others. Conclusion Assessment of tibial malrotation following intramedullary nailing has shown higher incidence of malalignment than previously reported in the literature. CT-based torsion angle calculation can be used as a reliable indicator of malrotation.

Assessment of Intraoperative Rotational Alignment of Closed Locked Intramedullary Nailing for Humerus Fractures.

Intramedullary nailing of humerus fractures has evolved over the past half century and has grown in popularity especially for the polytraumatized patient. The importance of restoring appropriate rotational alignment is equivalent to that of restoring sagittal and coronal alignment to decrease the risk of shoulder degenerative changes and limit range of motion discrepancy from the contralateral limb. This technique is designed to introduce an intraoperative fluoroscopic method to obtain adequate rotational alignment of humeral shaft fractures treated with closed antegrade humeral locked nailing.

FUNCTIONAL OUTCOME OF ANTEGRADE AND RETROGRADE INTRAMEDULLARY INTERLOCKING NAIL FOR THE TREATMENT OF SHAFT OF HUMERUS FRACTURE - A PROSPECTIVE COMPARATIVE STUDY

Background: Antegrade or retrograde locked intramedullary nailing are both effective treatments for humeral shaft fractures; however, these two techniques have not been sufciently compared. In this study, mid humeral shaft fractures treated with these two strategies using the identical locking nails were evaluated for efcacy and potential risks. 50 fractures in 50 Methodology: patients with humerus mid-shaft fractures were randomly assigned to get either antegrade or retrograde locked nailing using sealed-envelope method in this prospective comparative research. Clinical outcomes including fracture healing time, complications, functional recovery of the elbow and shoulder, and time for functional recovery were evaluated. There was no statistically signicant difference in the time of union i Results: n this trial, with an average of 13.6 weeks in the Antegrade group and 14 weeks in the Retrograde group. The two treatment groups in the current research were similar in terms of demographics, fracture patterns, surgical indications, and treatment. The antegrade nailing patients regained functional recovery faster while comparing to retrograde nailing patients. Antegrade nailing is advised for patients with proxima Conclusion: l fractures, young age and patients with tiny medullary canal whereas retrograde nailing is advised for fractures which are distal with broad medullary canal or prior shoulder issues. Due to less complications of elbow stiffness , shortened surgery duration, early functional recovery and since humerus generally tends to have narrow medullary canal we conclude that antegrade nailing is favoured over retrograde nailing for patients with humerus shaft fractures.

Locked intramedullary nailing of open fractures in resource-poor settings: a prospective observational study of challenges and functional outcomes in 101 fractures at Ogbomoso, Nigeria

BackgroundTrauma is now one of the fastest growing epidemics globally but low and middle-income countries (LMICs) are more severely affected in terms of cost, disability and death. The high-energy trauma of road traffic accidents and violence often produces open fractures which can be difficult to manage in resource-poor settings. Adequate stabilization, such as provided by locked nails, has been found to ensure better outcome for open fractures. There is dearth of published studies on the use of locked intramedullary nail in the treatment of open fractures in Nigeria.MethodsThis is a prospective observational study of all the 101 open fractures of the humerus, femur and tibia treated over a period of 92 months with Surgical Implant Generation Network (SIGN) nail. Fracture severity was classified according to the modified Gustilo-Anderson system. The intervals between fracture and antibiotics administration, débridement and definitive fixation, as well as surgery duration and method of fracture reduction were noted. Outcomes measured at follow-up included infection, ongoing radiographic healing, knee flexion/shoulder abduction beyond ninety degrees (KF/SA > 900), full weight bearing (FWB), painless squatting (PS&S)/shoulder abduction-external rotation (SAER).ResultsMost of the patients fall between ages 20 and 49 years; 75.5% of them were males. There were more Gustilo-Anderson type IIIA fractures than other types but nine type IIIB tibia fractures were also nailed. The overall infection rate was 15%, contributed mostly by the type IIIB fractures. By the 12th post-operative week, at least 79% had ongoing radiographic healing and had achieved all of KF/SA > 900, FWB, and PS&S/SAER.ConclusionThe SIGN nail’s solid construct reduces the risk of infection and allows earlier use of the limb, making it particularly suitable in LIMCs where socioeconomic functioning often requires an unhindered use of the limbs.

A Comparative Study of Management of Closed & Comminuted Distal TibialFractures with Intramedullary Inter Locking Nail V/S MIPO

A Comparative Study of Management of Closed & Comminuted Distal TibialFractures with Intramedullary Inter Locking Nail V/S MIPO

Antibiotic cement-coated rigid locked nails in infected femoral and tibial nonunion. Reoperation rates of commercial versus custom-made nails

IntroductionThe objective of this study is to assess bone union, infection control, and reoperation rates in a series of patients with infected femoral or tibial nonunion treated with antibiotic-cement-coated rigid nails and to compare the results obtained with custom-made nails versus commercial nails. MethodsWe retrospectively analyzed a series of consecutive patients with infected nonunion of the femur or the tibia treated with antibiotic-cement-coated rigid nails between January 2010 and 2020. We assessed patients’ distinctive characteristics, initial injury, type of nail used (custom-made nail with vancomycin or commercial nail with gentamicin), success rate (bone union + infection control), reoperation rate, and failure rate. Comparative analyses were conducted between reoperated and non-reoperated patients regarding the type of nail used. A multivariate regression analysis was performed to assess the risk variables that impacted reoperation rates. ResultsWe included 54 patients with 22 (40.74%) infected femoral nonunions and 32 (59.25%) tibial nonunions, who were treated with 38 (70.37%) custom-made antibiotic-cement coated nails and 16 (29.62%) commercial nails. Bone union and infection control were achieved in 51 (94.44%) cases. The reoperation rate was 40.74% (n = 22), and the failure rate was 5.55% (n = 3). The use of custom-made nails was associated with a higher risk of reoperation (Odds Ratio 4.71; 95% Confidence Interval 1.10 - 20.17; p = 0.036). ConclusionAntibiotic-cement-coated nails reached a 94.44% success rate. Nails manufactured in the OR coated with vancomycin cement were associated with a higher risk of reoperation than commercial nails loaded with gentamicin cement. Level of evidenceIII comparative, observational, non-randomized.

Solid locked intramedullary nailing for expeditious return of bone-setting-induced abnormal fracture union victims to work in South-western Nigeria

Wage earning in low- and middle-income countries (LMICs) is predominantly through physical labour. Consequently, limb-related disabilities caused by abnormal fracture unions (AFUs) preclude gainful employment and perpetuate the cycle of poverty. Many AFUs result from traditional bone-setting (TBS), a pervasive treatment for long bone fractures in LMICs. The objective of this study was to accentuate the expediency of solid locked intramedullary nail in the early restoration of victims of TBS-induced abnormal fracture unions (AFUs) to their pre-injury functioning, including work. One hundred AFUs in 98 patients treated with a solid locked intramedullary nail in our center over a period of 7 years were prospectively studied. We found the mean age to be 47.97 years. Males constituted 63.9% of the patients’ population. Atrophic non-union accounted for 54.1% of the AFUs. The mean fracture-surgery interval was 21.30 months. By the 12th post-operative week, more than 75% of the fractures had achieved knee flexion/shoulder abduction beyond 90°, were able to squat and smile (or do shoulder abduction-external rotation), and were able to bear weight fully. The study demonstrated the expediency of solid locked nail in salvaging TBS-induced abnormal fracture unions in a way that permitted early return to pre-injury daily activities and work, thereby reducing fracture-associated poverty.

Changes in the anatomical position of the superficial and deep femoral arteries during internal fixation of intertrochanteric fractures

Fixation for intertrochanteric proximal femoral fractures are increasing globally, one of the risks with surgical treatment is injury to the deep and superficial femoral arteries (DFA and SFA, respectively). The anatomic path of these vessels has been previously described, though the effect of reduction techniques, such as traction over a perineal post has not been well defined. This study addresses the question of: do closed reduction maneuvers on an orthopaedic trauma traction table affect the anatomical relationship of superficial and deep femoral arteries to the proximal femur in intertrochanteric proximal femoral fractures? Prospective observational single centre study of seventeen patients with pertrochanteric femoral fractures examined before and after applying traction for closed reduction. Doppler ultrasound was used to determine the proximity of these arteries to the proximal medial femoral cortex at three different levels. Our data demonstrates that internal rotation of the injured limb during reduction draws the arteries statistically closer to the medial cortex of the proximal femoral shaft at 3.5cm and 10.5cm distal to the lesser trochanter (SFA: 3.5cm - 38.0mm vs 34.7mm p 0.004, 10.5cm – 30.4mm vs 21.0mm p 0.02; DFA: 3.5cm – 26.4mm vs 22.3mm p 0.003, 10.5cm - 21.5mm vs 14.1mm p 0.007). No significant change in the artery position was noted in patients who did not require internal rotation to achieve fracture reduction. Surgeons performing these internal fixation procedures need to be aware of the anatomical changes to ensure patient safety and avoid complications including intramuscular haematomas and pseudoaneurysms. • Internal rotation laterally displaces the femoral artery during fixation on an orthopaedic traction table. • Care should be taken to avoid drill plunge beyond the medial femoral cortex. • Deep femoral artery is most ‘at risk’ of injury when using plate or distal locked nail constructs.

Subtrochanteric fractures in elderly people: functional and radiographic outcomes after intramedullary locked nail fixation with or without cerclage.

Sub-trochanteric fractures are among the most challenging for trauma surgeons. The purpose of this study was to analyze our own experience about subtrochanteric fractures. We focused on functional and radiographic outcomes after intramedullary locked nail fixation with or without cerclage assist. A retrospective analysis on subtrochanteric fractures managed from January 2016 to April 2021 was conducted. Patients treated by closed reduction and intramedullary nail fixation were enrolled in Group A, while Group B included those patients who underwent wire-assisted intramedullary nail fixation. All patients performed clinical and radiological follow-up and complications were analyzed. The significance was established for a value of p < 0.05. 80 patients were included in the present study. The mean age was 74.2 (+/-19.2) years. The mean surgical time was 84.7 (+/-24.6) and 254.7 (+/-80.2) minutes in Group A and Group B, respectively. The mean blood loss was 87.3 (+/-18.3) ml in Group A and 224.4 (+/-37.8) ml in Group B. Quality of reduction was mainly superior in Group B. The mean time of union was 4.2 (+/-1.4) months in Group A and 3.4 (+/-2.1) months in Group B. Statistical differences were observed in Visual Analogue Scale (VAS) and in the Short Form 12 (SF-12) after 6 and 12 months of follow-up with better results in Group B. The complication rate was 18.2% in Group A and 12.2% in Group B. We recommend the use of wires when acceptable closed reduction cannot be obtained because its use may be useful for medial wall stability. For elderly patients, closed reduction may be more appropriate as the quality of life and functional recovery between the two methods is almost overlapped.

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

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

Effects of Closed Reduction and Interlock Nailing of Femoral Shaft Fractures by Traction Table Vs Modified NA Fixator

Background: Femoral fractures are common fractures in orthopedics. Aim: To study the outcomes in patients with fracture shaft of femur, managed by close reduction and Inter Locking nail by traction table versus modified Naseer Awais fixator. Study design: Non randomized clinical study. Methodology: One hundred patients (50 in each group) were included in present study. Inter Lock femoral nailing was done in group A by TM distractor. Traction table was used in group B for the same procedure. Number of fluoroscope images per procedure, operation duration/time, contact between fracture fragments after reduction, limb rotation, limb length discrepancy, union time (radiological) and frequency of infection occurrence was noted and compared between the above said two groups. Results: Number of images per-operatively were 38.55±19.087, in group A 43.08±23.67, in group B 34.02±11.56 (P=0.017). The operative time in group A was 81.40±25.95 mins. The limb length discrepancy after surgery was 0.17±0.49 cm. The time of radiological union was 5.62±2.29 months in group A, versus 5.44±3.32 months in group B (P=0.753). Conclusion: We concluded that TM distractor group has comparable outcome with traction table group because there was no statistically significant difference in terms of operation duration/time, contact of major fracture fragments after reduction, limb length discrepancy (LLD), union (radiological), non-union and frequency of infection. However numbers of images in a procedure were less in traction table group in our study. Keywords: TM Distractor, Femoral Nail, Traction Table, Modified NA Fixator and Inter Lock Nail.

Management of Non-Prosthetic Peri-Implant Fracture in a Case of Broken Intramedullary Locking Nail - A Rare Case Report and Review of Literature

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail, NPPIFs are mostly reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but they represent a separate clinical entity with different conceptual and practical considerations1. Our case is a 72-year male with a broken humerus intramedullary Nail in right upper limb who was managed with implant removal and bridge plating with locking plate. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case.

Studying the strength of the tibia during the replacement of a post-resection defect with a segmental allograft using locked intramedullary nailing (experimental clinical study)

Background. To achieve success in the incorporation of allografts and bone of the recipient, many factors are taken into account, which can be divided into two main groups: those related to sterilization and processing of the bone allograft and factors affecting the reliability of implant fixation in the bone of the recipient. The second important factor is the method for fixing the allografts and the bone of the recipient. The purpose was to determine the mechanical properties of bone after segmental bone alloplasty. Materials and methods. Female patient Sh., 30 years old, diagnosed with osteosarcoma of the left distal tibia T2N0M0 GIII, degree II, clinical group II, underwent polychemotherapy courses, surgical intervention according to the developed method. The tumor was removed en block, a post-resection defect was replaced with an articulating segmental bone allograft, fixed to the recipient’s bone through a stepped osteotomy and an intramedullary locked nail. Bone autografts were additionally placed into the area of the allograft contact with the recipient’s bone. After 2 years, the patient underwent surgery: amputation at the left third of the thigh. Radiographically, fusion of the allograft and the recipient’s bone was noted. An experimental study of the tensile strength of the tibia after segmental alloplasty of a post-resection defect was carried out using the developed surgical technique and a segmental allograft. Results. To compare the results of an experimental study of the tibia preparation after segmental bone alloplasty, data about the values of the ultimate strength of the bone tissue under compression and bending loads were selected. As shown by the experiment, the ultimate strength of the tibia preparation after its bone alloplasty was 51.82 MPa. This value corresponds to the minimum ultimate strength of a compact bone in bending — 51 MPa. Although this is twice as low as the maximum value of the ultimate strength of a compact bone in bending (133 MPa), it should be borne in mind that all the given reference values were obtained when testing intact preparations of a compact bone. Conclusions. The use of a segmental bone allograft to replace a post-resection defect in a long bone with its fixation to the recipient’s bone through a stepped osteotomy and locked intramedullary nailing with additional bone autoplasty in the area of the allograft contact with the recipient’s bone makes it possible to obtain in the osteotomy zone the bone, the ultimate strength of which corresponds to that of the intact tissue.

Is it Possible to Achieve Satisfactory Results With Intramedullary Locking Nails In Adult Forearm Fractures ?

Objectives Plate osteosynthesis is the most commonly used surgical method in the treatment of diaphyseal forearm fractures in adults. Intramedullary nailing (IMN) is an easy surgical alternative for treating these fractures. In the present study we discussed the minimum 2 year follow up results of intramedullary nailing for the management of forearm fractures in a secondary trauma center. Methods A retrospective analysis of patients operated for adult forearm fractures, using intramedullary locking nails, between 2013 and 2015 in a secondary trauma center was performed. Patient demographics and clinical characteristics were retrieved from the hospital database. The union rates and complications were also recorded. Results Twenty nine patients (22 M 7 F) with mean age 29.4 years (range: 19 and 51) were included into the study. Mean follow up time was 26.8 months (range: 24 and 36). Twenty one patients had fracture of both bones, 4 had isolated ulna and 4 had isolated radius fractures. There were 2 open fractures. Average clinical healing time was approximately 20 days and radiologic healing time was 40 days. One patient with an open fracture underwent revision with plate screw fixation due to union delay. Patients improved in terms of health related quality of life questionnaire scores. Conclusion The intramedullary locking nail is a suitable treatment method for the surgical treatment of forearm fractures, and can be an alternative to open reduction and internal fixation with plate screw constructs when the patients can not undergo open surgery due to different factors.

Assessment of Shoulder Function after Internal Fixation of Humeral Diaphyseal Fractures in Young Adults: A Prospective Comparative Study.

Background Humeral shaft fractures are commonly encountered in casualties. There are different methods of operative internal fixation with no consensus on the best technique. The objective of this study was to assess shoulder function and rate of complications among two different options of fixation, intramedullary nailing, and minimal invasive plate osteosynthesis (MIPO) in young adults. Methods Forty-two patients with humeral shaft fractures were included in the study and divided into two equal groups: group A treated with antegrade intramedullary locked nails (IMN) and group B with MIPO. Fracture union was evaluated with serial X-rays, and shoulder function was assessed in both groups using the scale of the American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles Shoulder Scale (UCLA), and visual analog score (VAS). The mean differences between groups were recorded and considered significant if the P value was ˂0.05. Results The results were reported prospectively with no significant differences in mean age, sex, side of injury, type of fracture, mechanism of injury, and the follow-up period between the groups studied. Group A had shorter operative time and minimal blood loss than group B. Regarding shoulder function scores (ASES, UCLA, and VAS), the results in the MIPO group were better than the IMN group with shorter time of union and fewer complications. Conclusion Despite a shorter operative time and lower blood loss during locked intramedullary nail fixation in the management of humeral shaft fractures, MIPO enables more superior shoulder function with better fracture healing and lower morbidities.

Study to Determine the Outcomes of Closed Tibial Shaft Fractures Treated with Reamed Inter Locking Nails

Aim: The aim of the study is to evaluate the results of treatment of a closed reamed interlocking in the treatment of closed fractures of the tibial shaft. Study design: A Descriptive observational study Venue and Duration: This study was conducted in the Orthopedic department of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Patients and methods: The study included 43 patients over 19 years of age. The patients were taken to the emergency and Orthopedic department for surgery of Ayub Teaching Hospital, Abbottabad for six months duration i.e from September 2020 to February 2021. Written approvals were granted from all selectees. Detailed history was asked and each patient was assessed clinically and radiographically. The reamed intramedullary nailing performed according to the protocol. Patients were followed for 1 year and assessed for infection, union, knee and ankle range of motion, and implant problems. 3 patients were excluded from follow-up, and the study was held in 40 patients. Results: All fractures were having complete union without the need for bone grafting. Simple fractures have union at mean of 14 weeks, comminuted and segmented fractures have union for longer than five weeks, and a mean duration of 18.5 weeks. Superficial infection at the screw site occurred in two patients, and the drainage was done, antibiotics were given and distal screw were removed, respectively. While all patients had a full range of knee motion, 37 patients had a full range of ankle movement. The other three patients had a 15-to-20-degree dorsiflexion loss at the ankle joint. No nail fracture, proximal screw end fracture in one patients and distal screw fracture in two patients were observed. Conclusion: We came to the conclusion that closed intramedullary nailing in the case of a closed shaft fracture of the tibia is a safe and satisfactory technique with a high rate of union and a relatively low complication rate and early return to activity. Keywords: Fracture, Internal, Fixation, Interlocking nail.

Distal tibial treatment with multidirectional locked nailing and plating: An observational comparative study at Rajasthan based teaching hospital

Background: We Assessed patients with Functional recovery between two treatment modality intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. In high energy distal tibial fractures younger age groups are involved due to road traffic accident and fall from height. Axial loading, compression and torsional forces are involved in the mechanism of injury. Distal tibial fractures are very commonly encountered by orthopaedic surgeons. Aims and Objectives: To study and compare clinical and radiological outcome in extra articular fractures of distal tibia treated by multidirectional interlocking intramedullary nails and anterolateral locking compression plates with reference to rate of healing, functional outcome and complications. Material and Methods: In this study 26 patients with distal tibia extra-articular fractures, AO type 43 A1, 43A 2,43A3 were randomly selected and 13 of them were operated with multidirectional interlocking nailing and remaining 13 with anterolateral locking compression plate. The patients were regularly followed up for a period of one year and were evaluated clinically and radiologically with respect to tenderness at fracture site, abnormal mobility, infection, pain on movement of knee, ankle joints and anteroposterior and lateral radiographs of the leg for union of the fracture. Results: About 42 to 52% complication rate was attributed in internal fixation device and extensive surgical procedure due to soft tissue injury. Therefore ankle spanning external fixation became popular to maintain the articular surface of tibia with minimal internal fixation. In multidirectional Interlocking intramedullary group average time for union was 4.5 months compared to 6.4 months in plating group which was significant (p value

“FUNCTIONAL OUTCOME OF RETROGRADE NAILING IN THE MANAGEMENT OF SUPRACONDYLAR AND DISTAL FEMORAL FRACTURE”

INTRODUCTION: Fractures of the Distal femur are complex injuries that pose a challenge to the orthopaedic surgeon. It constitutes about 6 % of all femoral fractures. It usually occurs during high energy trauma in younger patients and frequently are associated with concomitant injuries. In contrast, elderly patients with severe osteopenia might sustain solitary distal femoral fractures from minor trauma such as a simple fall. Proper diagnosis and treatment leads to early mobilization and rehabilitation of patients. MATERIAL AND METHODS :This prospective study was conducted in Department of Orthopedics at Dr. S. N. Medical College and Associated group of Hospital, Jodhpur ,Rajasthan ,India on 30 patients who underwent the surgery with retrograde intramedullary interlocking nail in the management of extra-articular supracondylar femoral fracture from August 2019 to November 2020. On follow up axial alignment was assessed and functional analysis was quantied using NEERS RATING SYSTEM, Radiographs was analyzed for correction, maintenance of position or loss of reduction. function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients. RESULTS: In our study 30 patients with supracondylar &amp; distal femoral fractures based on AO Classication on MULLER ET AL underwent retrograde supracondylar nail, long term nal result were rated using NEER'S RATING SCORE , which gives point for pain, function, working, joint movement ,gross and radiological appearance. NEER'S RATING SCORE assigned for each patient after 24 weeks of follow up. After accessing this score out of total 30 patients, 10 have excellent score, 10 have good score, 8 have fair score and next 2 have poor score. Function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients,out of 30 patients 9 patients have an excellent result , 8 have good ,12 have fair and only 1 patient have poor result CONCLUSION:The retrograde intramedullary locked nail provides the surgeon with a different option in treatment of specic supracondylar fracture patterns. It offers a practical advantages of simple and efcient technique for patients with polytrauma, oating knee injuries and in elderly. this technique is very useful in distal femur fracture where antegrade nailing does not provide stability and also where plate xation is not suitable due to soft tissue condition.