Medullary Nailing Research Articles

The Second Decade of Experience with the K??ntscher Medullary Nail in the Femur

The Second Decade of Experience with the K??ntscher Medullary Nail in the Femur

Medullary Nailing of Infected Fractures of the Femur

Medullary Nailing of Infected Fractures of the Femur

Primary Medullary Nailing of Open Fractures of the Lower Extremity

The Journal of Trauma: Injury, Infection, and Critical Care: March 1968 - Volume 8 - Issue 2 - p 305

15 Medullary Nailing of the Wrist to the Radius as a Mechanical Guide to Ensure Optimum Position for Wrist Arthrodesis

15 Medullary Nailing of the Wrist to the Radius as a Mechanical Guide to Ensure Optimum Position for Wrist Arthrodesis

Osteosynthesis with a Thick Medullary Nail in non-union of Long Bones

Osteosynthesis with a Thick Medullary Nail in non-union of Long Bones

Fracture healing with intra medullary nail fixation of the long bones. An experimental study.

Fracture healing with intra medullary nail fixation of the long bones. An experimental study.

Further progress in the area of medullary nailing

Further progress in the area of medullary nailing

THE MANAGEMENT OF INFECTION AFTER KÜNTSCHER NAILING OF THE FEMUR

1. Seven cases of infection following medullary nailing of the femur have been studied. 2. Points in the diagnosis of nail track infection are emphasised, especially periosteal reaction. 3. It is felt that a sinograph is an essential part of the investigation and can be useful to assess progress. 4. The principles of treatment of established nail track infection are: adequate drainage of the fracture site; dependent drainage of the whole track by draining the pocket at the lower end; the use of instillation tubes to irrigate the nail track with antibiotics. Once the fracture is stable and the nail track adequately treated by local and general antibiotics the nail should be removed. It is not considered necessary to wait for bony union before removal of the nail.

LATE THROMBOSIS OF THE FEMORAL ARTERY COMPLICATING FRACTURE OF THE FEMUR

1. A case of femoral artery occlusion after fracture of the femur occurring several days after internal fixation with a medullary nail is described. 2. Arterial reconstruction was undertaken seventeen days after the internal fixation, twenty-seven days after the injury, with restoration of flow and recovery of the limb.

Treatment of delayed or nonunion fractures of the tibia by a medullary nail.

Treatment of delayed or nonunion fractures of the tibia by a medullary nail.

Medullary nailing for fracture of the shaft of the tibia.

1. A method of medullary nailing of fractures of the shaft of the tibia with a straight clover-leaf nail of large calibre is described. The nail is introduced, without exposure of the fracture, through the deep infrapatellar bursa. No external splint is used and the patient is usually allowed to walk as soon as the wound is healed. The technique is essentially that of Küntscher. 2. The results obtained in the first fifty patients so treated are described. The average period of absence from work for those twenty-five whose treatment was satisfactory was eleven weeks. There were no cases of sepsis or non-union; the only difficulties encountered were mechanical ones.

Medullary Fixation of Fractures of the Forearm

The history of medullary fixation, particularly of the forearm bones, is briefly reviewed. Results are reported of a detailed study of the size and contour of the medullary canal of 100 radii from cadavera. Medullary nails triangular in cross section have been devised for the forearm bones. The nail for the radius is prebent in accordance with anatomical data, and is made of a metal tempered to the proper resilience and rigidity. Results are reported for the first fifty patients in whom these nails have been used. Despite some early clinical errors, and despite some serious preoperative complications, there were fewer instances of malunion in this series than we have been able to obtain with closed methods, and fewer instances of non-union than have resulted from other methods of open reduction. The technique of insertion and extraction of the nails is described, and the indications given for their use in diaphyscal fractures. The technique is exacting, and if not properly performed may produce complications.

Air embolism as a complication of medullary nailing.

A case of fatal air embolism after Küntscher nailing of a fractured femur is described. Necropsy indicated that the only possible means of air entry was through the bone marrow. Subsequent discussion between the surgeon and the pathologist indicated that air must have been forced into the venous circulation through the marrow by repeated removal and reinsertion of nails, which allowed air to fill the punched-out marrow space when the nail was removed, the same air being forced into the marrow sinusoids when the nail was reinserted and hammered into position. This danger may be overcome 1) by allowing the site of operation to flood with blood by placing the patient in a "head up" position; 2) by flooding the operation site with saline; or 3) by assessing the calibre of nail required by radiological means rather than by trial and error.

Indications and contraindications for medullary nailing of fractures.

American surgeons have now had sufficient experience with medullary fixation to permit them to accept this method as a valuable addition to our armamentarium in the treatment of fractures of long bones. However, the introduction of a suitable nail may require an operative exposure of the fracture site, and this converts a simple fracture into a compound one with its attendant danger of infection and of nonunion. Furthermore, the danger of infection seems to be greater after medullary nailing than after most other clean surgical operations. Consequently, the method should not be used routinely and fractures that can be treated satisfactorily by closed reduction and external fixation, or by traction, should be so treated. The frequency with which medullary fixation is used will and should vary directly with the surgeon's interest and skill in the use of the method and indirectly with his ability to treat fractures by more conservative

BILATERAL TRAUMATIC POSTERIOR DISLOCATION OF THE HIP COMPLICATED BY BILATERAL FRACTURE OF THE FEMORAL SHAFT

The case reported exhibited bilateral posterior dislocation of the hip associated with bilateral frature of the femoral shaft. It is believed to be the only such recorded case. An excellent result was obtained following closed reduction of the dislocated hips and secondary open reduction and medullary nailing of the femoral fractures.

Bridging of bone defects in the forearm with iliac graft combined with intramedullary nailing.

1. A technique for bridging bone defects in the forearm with massive iliac graft and medullary nailing is described. 2. The results of fifteen operations are reviewed.

Medullary Fixation of the Femur

The scope of medullary fixation of the femur is now well defined. Under ideal circumstances, this method can now be accepted as sound therapy, offering many advantages over older and more orthodox forms of treatment. The nail provides internal fixation sufficiently strong and rigid to eliminate the need for casts, splints, or braces. Nursing care is simplified. Early ambulation and weight bearing and mobilization of joints minimize the period of hospitalization and convalescence and decrease the final degree of disability to a minimum. Impaction or coaptation of the fracture surfaces is recognized as a desirable physiological stimulus to union. The medullary nail is a near-perfect mechanical appliance to take advantage of this favorable factor. Over-zealous attempts, however, to capitalize on early mobilization and restoration of function in improperly selected cases can lead only to trouble. Surgeons with the most experience recognize the limitations of medullary nailing, and supplement the nail during p...

The place of medullary nailing in femoral fractures.

The place of medullary nailing in femoral fractures.

Intramedullary fixation of fractures of the forearm: Evaluation of twenty successive unselected cases

TH1 many difficulties attending restoration of function after fracture of the shaft of the bones of the forearm are well recognized by all fracture surgeons . Rush was the first to employ intramedullary pinning in the management of such injuries when in 1936 he treated a compound comminuted Monteggia fracture by fixation with a Steinmann pin and encircling wire loops.'-3 fie later developed a pin to be used for intramedullary fixation of various fractures including the forearm .'' Dickson, 10 Long and Fett, Tordoir and Moeys, Soeur, 13 MacAusland,' Bohler, 13 Westerborn, 16 Stuck and Thompson, 17 Lauritzen, 1 B Knight and Purvis, 10 Schwartz and Harmon, 2U Bush, Vanlerenberghe and Lacheretz, 23 Landelius, 24 Palmer 25 and others have subsequently reported series of fractures of the forearm treated by various intramedullary methods. Watson-Jones and others 22 review the development of medullary nailing and present many of the difficulties and complications likely to be encountered . Personal experience with this method of splinting in the forearm began in 1943 when a Kirschner wire or Steinmann pin was used for intramedullary fixation of the ulna in selected cases of single or both hone fracture which did not respond to closed methods . Use of a single Kirschner wire was abandoned early because of the insecure fixation obtained, but use of the Steinmann pin was continued in cases which were initially considered unsuitable for, or failed to respond to, closed methods . Our first intramedullary splinting of the radius was performed on April 26, 1950, using a hip guide wire for fixation . The last intramedullary fixation in this series was performed August 2, 1951 . Although closed methods of treatment are preferred and are used when satisfactory reduction can be obtained and maintained, many forearm shaft fractures present difficulties which can be met only by open methods . Intramedullary fixation in these problem

CLOSED REDUCTION, PLATE FIXATION, AND MEDULLARY NAILING OF FRACTURES OF BOTH BONES OF THE LEG

CLOSED REDUCTION, PLATE FIXATION, AND MEDULLARY NAILING OF FRACTURES OF BOTH BONES OF THE LEG