Dynamic Nail Research Articles

Impact of Surgical Timing on Fracture Healing in Tibial Shaft Injuries: A Comparative Review of Intramedullary Nailing Techniques.

Tibial shaft fractures are a prevalent and challenging orthopedic injury, often resulting from high-energy trauma. Optimal management of these fractures is crucial to prevent complications such as nonunion, malunion, and prolonged functional impairment. Intramedullary nailing (IMN) is widely regarded as the gold standard for treating these injuries due to its ability to provide stable fixation, preserve soft tissues, and enable early mobilization. However, the timing of surgical intervention remains a topic of ongoing debate. Early surgical intervention, defined as surgery within 24-48 hours of injury, is advocated for its potential to reduce hospital stay, facilitate early mobilization, and decrease the risk of secondary complications such as compartment syndrome. Conversely, delayed intervention allows for patient stabilization and reduction of soft tissue swelling, potentially lowering the risk of infection and other complications. This comprehensive review aims to evaluate the impact of surgical timing on fracture healing outcomes in tibial shaft fractures treated with IMN. It explores the benefits and limitations of early versus delayed surgery, emphasizing their influence on union rates, healing time, and complication rates. Furthermore, the review examines different IMN techniques, including reamed versus unreamed and static versus dynamic nailing, to determine their role in optimizing fracture healing. By synthesizing current evidence, this review provides critical insights into the optimal timing and technique for IMN in tibial shaft fractures, ultimately aiming to guide clinical decision-making and improve patient outcomes. Future research should focus on randomized controlled trials to establish standardized surgical timing and technique selection guidelines in this patient population.

Study of the Healing of Tibial Fractures Treated with Dynamic Intramedullary Nailing

Background: Dynamic nailing by placing only one screw on one side of the nail shortens the surgical time and reduces the complications during surgery and secondary dynamization. This study aimed to investigate the healing of dynamic intramedullary nailing (IMN) of tibial fractures. Methods: This cross-sectional study was done on 67 patients with dynamic IMN in 5th Azar Hospital, Gorgan, Iran, in 2015-2018. Complications, union time, Radiographic Union Score of Tibia Fracture (RUST) score, and Johner-Wruhs criteria were analyzed based on their grouping in AO classification. Results: The average age of the patients was 33.2 ± 13.0 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62 ± 4.38 weeks and RUST score was 8.90 ± 1.26. There was no significant difference between locations of fracture and the healing time or RUST score (P > 0.05). The healing time in the comminuted fractures (e.g., type C) and open tibial fractures was statistically longer than the simpler type (e.g., type A or B) and the mean radiological score in type C fractures was significantly lower (P < 0.05). The mean Johner-Wruhs criteria score of fractures was 46.31 ± 4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results. Conclusion: Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g., type A or B) have faster healing. Nevertheless, it is better to be more cautious for fixation of open or comminuted fracture (e.g., type C).

Nonunions after intertrochanteric and subtrochanteric femoral fractures

The overall frequency of proximal femoral fractures means that we are repeatedly confronted with failed healing and implant failure, despite arelatively low nonunion rate especially in intertrochanteric fractures (< 5%). The aim of this paper is to present our approach to treating these nonunions of the proximal femur and discuss the treatment results. Between 2009 and 2023, patients with nonunion of the proximal femur were retrospectively identified and analyzed. Age, gender, time to revision, the Weber-Cech classification of pseudarthrosis and radiographic imaging before and after revision were analyzed. Atotal of 66patients were analyzed. The mean age was 58years (range 25-88years). The overall healing rate was 88% with amean consolidation time of 8months (range 2-29months). The main osteosynthesis procedures were plate osteosynthesis (n = 45, of which 44 were blade plates), and nail replacement (n = 12). Other procedures included augmentative plate osteosyntheses (n = 4), isolated cancellous bone graft (n = 2), nail dynamization (n = 2), and the use of adynamic hip screw (n = 1). The analysis of our treatment data as well as the current literature, revealed atrend towards intramedullary revision procedures. Implants that can be used to correct the CCD angle, such as the blade plate, remain apredictable option to achieve correction, especially in nonunions with an increased degree of varus. Particularly in the subtrochanteric region, fractures can also be treated in atargeted manner by acombination of mechanical and biological methods with areamed nail change to alarger caliber implant.

Effect of intramedullary nail stiffness on load-sharing in tibiotalocalcaneal arthrodesis: A patient-specific finite element study.

Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails can be manufactured with multiple materials and some feature the ability to dynamize the arthrodesis construct. However, the impact of IM nail material and nail dynamization on load-sharing and in the setting of bone resorption have not been quantified. This work utilized a patient-specific finite element analysis model of TTC arthrodesis to investigate IM nails with differing material moduli and the impact of nail dynamization on load-sharing and intersegmental compression in the setting of bone resorption. Each nail was virtually inserted into a patient-specific model of a hindfoot, which was segmented into the three bones of the TTC complex and assigned material properties based on the densitometry of the bone. Compression, amount of load-sharing, and stress distributions after simulated bone resorption were quantified and compared between the varying IM nails. Simulations revealed that bone segments were only subjected to 17% and 22% of dynamic gait forces in the titanium and carbon fiber nail constructs, whereas the pseudoelastic NiTi nail constructs allowed for 67% of the same. The titanium and carbon fiber nails lost all initial compression in less than 0.13mm of bone resorption, whereas the NiTi nail maintained compression through all simulated values of bone resorption. These data highlight the poor load-sharing of static nail TTC arthrodesis constructs and the ability of a pseudoelastic IM nail construct to maintain intersegmental compression when challenged with bone resorption.

Fusion Rates in Tibiotalocalcaneal Arthrodesis with Tantalum Coated Metal Cup Augmentation

Category: Ankle Arthritis; Ankle Introduction/Purpose: Tantalum coated metal spacers (TCMS) have recently been utilized to fill and provide structure to large bony defects in the hindfoot. TCMS have a porous structure and elastic modulus similar to cancellous bone, increasing resistance to collapse, as well as osteoconductive properties that allow for bony ingrowth. At this time, there is still a paucity of literature assessing the use and outcomes of TCMS in foot and ankle surgery, more specifically as bridging structures for large bony defects when performing tibiotalocalcaneal (TTC) arthrodesis. This study serves to assess clinical outcomes and fusion rates of patients who underwent TTC arthrodesis utilizing intramedullary nailing with tantalum coated metal cup augmentation for large bony defects. Methods: We retrospectively reviewed the charts of 20 patients who underwent TTC fusion with TCMS augmentation at our local tertiary care center between 2015-2021. The CT scans at the six-month post-operative window were reviewed by one orthopaedic surgeon to determine the presence of bony fusion, which was defined as having at least 50% fusion mass. From the initial cohort, we collected the following modified foot function index scores for 13 patients: PROMIS Physical Health (0-20), PROMIS Mental health (0-20), Foot Function Index (0-170), Activity Limitation Scale (0-30), Pain Scale (0-50) and Disability Scale (0-90). Results: The mean age of our cohort was 53.9 (± 12.9) with a mean CCI of 1.54 (± 1.127) and mean follow up of 451.5 days (± 353.3). Mean modified foot function index scores included: PROMIS Physical Health 12.15 (± 3.34), PROMIS Mental health 12.23 (± 4.82), Foot Function Index 91.08 (± 47.59), Activity Limitation Scale 15.00 (± 10.42), Pain Scale 25.00 (± 14.77) and Disability Scale 51.00 (± 25.06). The post-operative complication rate was 30.8% in which 3 patients required a revision surgery via nail dynamization and one patient required a below knee amputation due to an infected nonunion of the TTC arthrodesis. The overall fusion rate at the 6-month postoperative visit was 69.2%. Conclusion: Unlike prior studies, we were able to obtain 6-month post-operative CT scans to delineate successful fusions with a larger number of patients (n=13). Given the paucity of literature looking at TCMS augmented fusions in foot and ankle surgery, our data will contribute to our understanding and efficaciousness of this relatively new use of TCMS in foot and ankle surgery. Further studies are needed to evaluate the efficacy of TCMS augmented fusions as a viable surgical approach as well an alternative to standard nail dynamizations with structural grafts.

Retrograde Nailing for Extremely Proximal Fractures of the Femoral Shaft.

ObjectivesTo report the results of retrograde intramedullary nailing (RIMN) for the treatment of extremely proximal femur fracturesDesignRetrospective cohortSettingLevel I trauma centerPatients/ParticipantsSixty-three femoral shaft fractures involving the anatomic region within ten centimeters of the inferior border of the lesser trochanter that were treated with RIMNInterventionRetrograde intramedullary femoral nailMain Outcome MeasurementsTime to union, nonunion, malunion, and unplanned reoperationResultsBetween 2009 and 2020, sixty-three fractures were followed to fracture union, reoperation, or a minimum of one year clinically. Mean follow-up was 32 months and 48 (76%) of the patients were followed beyond one year clinically. The mean patient age was 34 years (range 18-84 years) and the mean BMI was 27 (range 14-45). Forty (64%) patients were polytraumatized. Clinical and radiographic union was achieved in 59 (94%) fractures after index operation at a mean time to union of 22 weeks (range 9-51 weeks). Delayed union requiring nail dynamization occurred in one (2%) instance. Malreduction was noted in one (2%) patient with a 12° flexion deformity that resulted in nonunion. In total, there were three (5%) nonunions requiring revision surgery, one treated with retrograde exchange nailing and two revised to cephalomedullary nails; all united after revision.ConclusionsRIMN can be an effective treatment strategy for extremely proximal femur fractures when necessary. Our series demonstrated a high rate of union and a low rate of malalignment and complications.

Masquelet's induced membrane technique associated with Reamer Irrigation Aspiration grafting and intramedullary Nailing (MaRIAN) for chronic diaphyseal osteomyelitis of the lower limb

IntroductionMasquelet's induced membrane technique offers a definitive contribution to the treatment of diaphyseal osteomyelitis. To overcome its drawbacks while maintaining its principles, technical modifications have been proposed: antibiotic cement, femoral intramedullary autograft harvested by RIA (Reamer Irrigation Aspiration) and interlocking nails. Material and methodThis retrospective study gathered patients with chronic osteomyelitis of the femur or tibia. The first surgical stage consisted of bone resection in the healthy zone and use of a gentamicin cement spacer to fill the bone defect. The second stage consisted of the placement of a statically locked intramedullary nail associated with a bone autograft using the RIA technique. ResultsAmong this group of 12 men with diaphyseal osteomyelitis; 9 tibial and 2 femoral, and 1 knee nonunion, the mean bone defect was 7.3cm (±6.7). The mean time between the 2 stages was 2.7months (±3) with a mean antibiotic period of 3.25weeks (±3). There was a femoral diaphyseal fracture at the donor site, and a wrong trajectory intraoperatively during the RIA. Two patients with tibial nonunion presented with nail rupture without septic recurrence. A septic recurrence was healed by removal of the nail. At a minimum follow-up of 18months, with an average of 5years, consolidation was complete without infectious recurrence. Despite the statistical weakness related to the size of the cohort, the resumption of early weight bearing (OR=−7.68 95% CI [−13.33 to −2.08] (p=0.01)) and nail dynamization seemed to have an impact on the formation of complete consolidation (OR=−0.86 95% CI [−1.39 to −0.33] (p=0.007)). Discussion and conclusionThis short series, compared to the literature, demonstrated that the proposed technical modifications improved the overall management of this rare and challenging condition while maintaining the reliability of the original technique. Dynamization was also seen to be of particular interest. Level of evidenceIV, retrospective study.

A Comparative Study of Proximal Femoral Nail and Dynamic Hip Screw in the Treatment of Intertrochanteric Fractures of Femur

Aim: The aim of this analysis is the comparison of the functional and radiological results of stable intertrochanteric femoral fractures managed with the dynamic hip screw (DHS) and proximal femoral nail (PFN). Study Design: A Randomized, controlled study. Place and Duration: In the Orthopaedics department of Capital Hospital (CDA), Islamabad for two years duration from January 2020 to December 2021. Methods: All patients with stable intertrochanteric fractures who met the criteria of selection were randomly allocated to group A (DHS) and B (PFN). There were 80 total patients alienated into group A and B. Patients were x-rayed for union evaluation and functional evaluation was done with Harris Hip Score (HHS) was performed, rated as poor (score &lt;70), good (80 to 90), fair (70 to 80) and excellent (90 to 100). The comparison of the results in the two groups was made at the third, sixth and twelfth months, and the P value was calculated using the chi-square test and the independent sample t-test. P &lt;0.05 was measured significant. Results: There were 80 total patients. They were divided equally and randomly into groups A and B of 40 patients each. The PFN group had a shorter operative time, smaller incision and minimum blood loss intraoperatively than the DHS group (p &lt;0.05). The group A mean age was 60.10±4.48 years, and of group B was 59.20±5.71 years. There were 25 men (62.5%) in A group and 23 (57.5%) in B group. Women were 15 (37.5%) in A group and 17 (42.5%) in B group. Mean time of radiological union was 14.2±4 weeks in group A and 12.8±6 weeks in group B (P&gt; 0.05). During the 3-month follow-up period, the Harris Hip Score (HHS) was 54.20 ± 4.20 (poor) and 35.03 ± 4.11 (poor) in Groups A and B, correspondingly (P &lt;0.05). HHS in group A was 90.27 ± 3.80 (good) and in B group, it was 82.27 ± 3.65 (good) (P &lt;0.05) at 6 months and HHS 94.61 ± 2.08 (excellent) and 93.27 ± 2.18 (excellent) 1 year in the group A and B (P&gt; 0.05). Conclusions: Both DHS and PFN gave similar results in terms of radiological union in stable intertrochanteric fractures. The short-term functional score was poor and good for both DHS and PFN at 3 and 6 months, although DHS scored statistically better than PFN. After one year of follow-up, both DHS and PFN had similar excellent functional scores, but had no statistically significant difference in score. Keywords: Harris hip Score, Proximal femoral nail, Dynamic hip screw and Intertrochanteric fracture.

Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

BackgroundLong-bone non-unions after intramedullary nailing can be treated by nail dynamization or focused high-energy extracorporal shock wave therapy (fESWT). The objective of this study was to assess the effect of the combination therapy of nail dynamization and fESWT on long-bone non-unions.Materials and methods49 patients with long-bone non-unions (femur and tibia) after nailing were treated with nail dynamization (group D, n = 15), fESWT (group S, n = 17) or nail dynamization in addition to fESWT (group DS, n = 17). Patients were followed up for 6 months retrospectively. Furthermore, age, sex, Non-Union Scoring System (NUSS) score, time intervals from primary and last surgery until intervention and smoking status were analysed for their correlations to bone union.ResultsUnion rates were 60% for group D, 64.7% for group S and 88.2% for group DS, with a significant difference between group D and DS (p = 0.024). Successful treatment was correlated with high age (OR 1.131; 95% CI 1.009–1.268; p = 0.034), female gender (OR 0.009; 95% CI 0.000–0.89; p = 0.039), low NUSS score (OR 0.839; 95% CI 0.717–0.081; p = 0.028) and negative smoking status (OR 86.018; 95% CI 3.051–2425.038; p = 0.009).ConclusionsData from the present study indicate that the combination therapy of nail dynamization and fESWT leads to a higher union rate than dynamization or fESWT alone.Level of evidenceLevel 3.

Effectiveness of Nail Dynamization in Delayed Union of Tibial Shaft Fractures: Relationship Between Fracture Morphology, Callus Diameter, and Union Rates

Dynamization has already been described as a secondary intervention for delay unions of tibial shaft fractures treated with intramedullary nailing. Although it's a common procedure, it is not widely supported in the literature. The purpose of this study was to determine the union rate of nail dynamization in cases of delayed union of diaphyseal tibial fractures, and assess the effect of fracture morphology on union rates. We retrospectively analyzed a series of 199 consecutive tibial shaft fractures. We recorded the dynamization rate, period from nailing to dynamization, nailing to the union, the fracture pattern (according to AO/ASIF and whether it was closed or open), the callus diameter before dynamization (fracture healing index; FHI) and union/failure rates. Out of a total of 199 fractures treated during the study period, 41 (20.6%) were dynamized. After applying inclusion and exclusion criteria, 39 patients with 39 fractures were included in the study. The mean time from nailing to dynamization was 18.4 ± 7.2weeks. The union rate was 92.3% (n = 36) over a mean time of 14.1 ± 5.6weeks as from dynamization. The overall failure rate was 6.7% (n = 3). There was no significant association between failure and AO/ASIF classification (p > 0.05) or fracture exposure (X 2 = 0.19; p = 0.66). The pre-dynamization FHI of ≥ 1.17 was significantly associated with consolidation (p < 0.05). In cases of delayed union of tibial fractures, dynamization offered a high union rate associated with pre-dynamization FHI, while fracture morphology did not affect the failure rate.

Revision with Locking Compression Plate by Compression Technique for Diaphyseal Nonunions of the Femur and the Tibia: A Retrospective Study of 54 Cases.

Nonunion after diaphyseal fracture of the femur or the tibia is a common but difficult complication for treatment. Currently, the main treatment modalities include nail dynamization, exchange nailing, and bone transport, but revision with compression plating in these nonunions was rarely reported. To evaluate the outcomes of compression plating in the treatment of femur and tibia shaft nonunions, we retrospectively reviewed 54 patients with diaphyseal nonunion of the tibia or the femur treated with locking compression plate (LCP) by compression technique. There were 46 aseptic and 8 septic nonunions in the case series. Patient's history, fracture characteristics, previous interventions, and types of nonunion were recorded. The possible reason which might lead to nonunion was also analyzed for each case. Patients with aseptic nonunions were revised by hardware removal and compression plating with or without bone grafting. For septic nonunions, a two-stage surgery strategy was used. Compression plating with iliac crest bone grafting (ICBG) or free vascularized fibular grafting (FVFG) was used as the final treatment for septic nonunions. The compression technique and bone grafting method were individualized in each case according to the patient's history and architecture of the nonunion. Each patient finished at least a two-year follow-up, and all cases achieved healing uneventfully. Our study showed that compression plating with LCP was an effective method to treat diaphyseal nonunions of the tibia and the femur. It is compatible with different bone grafting methods for both infected and noninfected nonunions and is a good alternative to the current treatment methods for these nonunions.

A novel intramedullary nail to control interfragmentary motion in diaphyseal tibial fractures.

Numerous animal and human studies have demonstrated the benefit of controlled interfragmentary motion on fracture healing. In this study, we quantified interfragmentary motion and load transfer in tibial fractures fixed using a novel intramedullary nail (IMN) that allows controlled axial motion. Fifty composite tibias with various fracture patterns were utilized. For all test conditions, two interlocking screws were used to fix the nail in the proximal metaphysis, and two interlocking screws through the distal metaphysis. The nail allowed either no motion (static mode) or 1 mm (dynamic mode) of cyclic axial motion between the two fracture fragments for every fracture pattern tested. As expected, strain shielding was more prominent under static nail conditions. In contrast, specimens tested under dynamic nail conditions transferred axial load between the fracture fragments such that strains near the fracture site were generally similar to those measured on an intact tibia. Maximum shear strains proximal to the fracture were significantly lower in specimens with oblique or butterfly fracture patterns (p < 0.01) compared to intact specimens. This decrease in shear strain indicates that strain shielding effects were likely present due to the implant. However, strain shielding appeared to be reduced in tensile and compressive principal strains. In summary, the novel IMN allowed controlled axial motion between the fragments in a variety of common diaphyseal tibial fracture patterns.Clinical Significance: The present in vitro biomechanical study investigated a novel intramedullary nail capable of controlled axial interfragmentary motion which may potentially enhance fracture healing.

English

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P &lt; 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation

Is Nail Dynamization Useful In Delayed Union of Tibial Shaft Fractures? A Systematic Review and Meta-Analysis

Is Nail Dynamization Useful In Delayed Union of Tibial Shaft Fractures? A Systematic Review and Meta-Analysis

Comparative study between dynamic compression plating versus interlock nailing in treatment of fracture of shaft of humerus

Comparative study between dynamic compression plating versus interlock nailing in treatment of fracture of shaft of humerus

The Application of Henna (Lawsonia inermis) in Orthopedics

Background: Many orthopedic procedures require skin marking as part of preoperative planning. The markings obtained from commercially available permanent pens may fade away after vigorous skin preparation before surgery. We describe the use of Henna (Lawsonia inermis) paste as a durable, readily available, and cost-effective material for preoperative skin marker in various orthopedic surgeries. Patients and Methods: We performed a retrospective review of prospectively collected data of 50 cases with various indications of preoperative localization of skin incision and divided them in 2 groups: Group A (n=25) were the patients where Henna was to be used as marker and group B (n=25) were the ones where permanent skin marking pen was decided to be used for the purpose of skin marking. The groups were compared for the instances of mark fading after bathing, after scrubbing of surgical part, the need for intraoperative fluoroscopy, and complications because of marking substance. Results: Of the 25 cases where henna was used for markings (group A), none had fading of mark after routine bath with soap on the morning of surgery (0 of applicable 11) or after surgical scrubbing (0 of 25). However, for the permanent marker (group B), 3 patients (of applicable 6) had fading of mark beyond recognition after routine bath with soap and additional 10 cases (of applicable 22) had fading of mark beyond recognition after surgical scrubbing (P&lt;0.05). Four cases (of applicable 23) from group A still required intraoperative fluoroscopy, whereas this figure was 15 (of 25 cases) for group B (P&lt;0.05). There was no suggestion of rash/allergy/wound infection in either group. Conclusions: Henna paste may reliably be used in various orthopedic procedures like foreign body removal, vertebral-level identification, nail dynamization, marking growth plate in children, identification of sequestrum in nondischarging chronic osteomyelitis, and marking the course of blood vessels in tumor surgery.

Treatment options for aseptic tibial diaphyseal nonunion: A review of selected studies.

In aseptic tibial diaphyseal nonunions after failed conservative treatment, the recommended treatment is a reamed intramedullary (IM) nail.Typically, when an aseptic tibial nonunion previously treated with an IM nail is found, it is advisable to change the previous IM nail for a larger diameter reamed and locked IM nail (the rate of success of renailing is around 90%).A second change after an IM nail failure is also a good option, especially if bone healing has progressed after the first change.Fibular osteotomy is not routinely advised; it is only recommended when it interferes with the nonunion site.In delayed unions before 24 weeks, IM nail dynamization can be performed as a less invasive option before deciding on a nail change.If there is a bone defect, a bone graft must be recommended, with the gold standard being the autologous iliac crest bone graft (AICBG).A reamer-irrigator-aspirator (RIA) system might also obtain a bone autograft that is comparable to AICBG.Although the size of the bone defect suitable to perform bone transport techniques is a controversial issue, we believe that such techniques can be considered in bone defects > 3 cm.Non-invasive therapies and biologic therapies could be applied in isolation for patients with high surgical risk, or could be used as adjuvants to the aforementioned surgical treatments.Cite this article: EFORT Open Rev 2020;5:835-844. DOI: 10.1302/2058-5241.5.190077

Application of Henna as a Durable Skin Marker in Orthopedic Surgery.

BackgroundMany orthopedic procedures require skin marking well before surgery. Marks made with most conventional marking pens fade with vigorous skin preparation required before orthopedic procedures, whereas marks with henna may safely last almost up to three weeks. Thereby, we intend to describe applications of henna, a readily available, cost-effective material, as a durable skin marker for various indications in orthopedics.MethodsA total of 120 patients with varied indications for skin marking were randomized into two equal-sized groups of 60 each. Group A patients were marked with henna and group B patients with a permanent skin marker before the intended surgery. All patients had a routine pre-operative bath one day before surgery and vigorous skin preparation using chlorhexidine and ethanol-based scrubs just before surgery in the operating room. The two markers were compared for the following variables: photographic record to determine fading of the mark after scrubbing, in terms of successful execution of the procedure, patients’ acceptability of the mark, any allergy or infection, and final time of disappearance of the mark.ResultsMarking with henna was clearly visible during all but one surgical procedure even after vigorous pre-operative skin preparation, thereby ensuring minimal use of fluoroscopy in henna-marked patients. The fading of the mark and use of fluoroscopy was significantly low in group A (p<0.05). There was no complication associated with marking with either marking method. Marks with henna disappeared on an average nine days later than with permanent marker. In terms of acceptability of mark, henna was preferred by almost all patients.ConclusionsHenna paste is an ideal substance for use as a skin marker in conditions, such as foreign body removal, vertebral level identification, nail dynamization, marking tibial physis in children, and sequestrum in non-discharging osteomyelitis, and in marking blood vessel course in tumor surgery or in volar ganglion removal. Pre-operative skin marking with henna ensures minimal use of fluoroscopy, and it is particularly efficacious when ultrasound is used for localization as it can be directly applied over gel film.

Poller blocking screw augmentation to treat delayed union of proximal tibial shaft fracture after locked IM nailing.

Cases:We present the cases of two adult male patients with painfully delayed union of proximal tibia diaphyseal fracture after intramedullary nailing. Patients underwent to nail dynamization and Poller blocking screw augmentation at 3 and 5 month, respectively, after the index surgery. Both patients were pain-free after the surgery and bone-union were radiographically evident after 3 months. At 12-month follow-up, patients returned to their previous activities.Conclusions:Although nail dynamization is the choice treatment to obtain fracture compression for delayed union of tibial shaft fractures, augmentation with Poller blocking screw could provide additional mechanical stiffness in unstable supra-isthmic shaft fractures of the tibia and favour bone union. (www.actabiomedica.it)

A Comparatives Study of Unstable Intertrochanteric Fracture of Femur Treated with Dynamic Hip Screw Versus Proximal Femoral Nail

A Comparatives Study of Unstable Intertrochanteric Fracture of Femur Treated with Dynamic Hip Screw Versus Proximal Femoral Nail