Nail Group Research Articles

Comparison of calcareous replacement hemiarthroplasty and proximal femoral nail in elderly ıntertrochanteric femur fractures

Background: In this study, a retrospective evaluation was made of patients aged 70 years and over who were applied with proximal-femoral nail (PFN) or calcareous replacement cemented hemiarthroplasty in respect of early and late-stage morbidity and mortality and functional personal independence. Methods: The study included a total of 77 patients aged over 70 years with an AO type 31-A1 or 31-A2 fracture. The patients were separated into two groups as those applied with proximal femoral nailing and those applied with calcar replacement hemiarthroplasty. Statistical comparison was made of the groups in respect of preoperative age, comorbidities, type of anaesthesia, ASA score, and fracture type, and postoperative amount of blood loss, albumin decrease, wound complications, other complications, Harris hip functional scores, Barthel daily living activity index, mortality rates. Results: The two groups were found to be similar in respect of age, gender, comorbidities, AO fracture type and type of anaesthesia. The operating time was shorter in the proximal femoral nailing group. The Harris hip scores and the Barthel daily living activity ındex values were similar in both groups. Rates of wound infection were higher in the hemiarthroplasty group. Mortality rates at one month, six months and one year were similar in both groups. Conclusions: Proximal femoral nailing can be one of the primary treatment options for intertrochanteric hip fractures in the elderly. Furthermore, although functional results and mortality rates are similar, as cemented calcar replacement hemiarthroplasty has serious life-threatening complications, it should not be the first choice of treatment method.

Comparison of suprapatellar intramedullary nailing versus minimal invasive locked plating for proximal tibia fractures.

To compare the radiological alignment, union time, union rate, and complication rate between suprapatellar intramedullary nails and minimally invasive locking plate fixation in the treatment of proximal tibial fractures. We retrospectively analyzed 103 patients who underwent plate fixation (n = 50) or suprapatellar intramedullary nailing (n = 53) for proximal tibial fractures involving the meta-diaphyseal junction between November 2015 and October 2020 at our institution. The union rate, union time, radiologic alignments, and complications, such as malalignment, nonunion, and deep infection, were investigated. The demographic data did not differ between the plate and suprapatellar intramedullary nail groups. The alignment of the coronal plane was 0.24 ± 3.19 in the plate group and - 0.49 ± 2.22 in the intramedullary nail group (p = 0.196). Sagittal plane alignment was - 0.29 ± 4.97 in the plate group and 0.24 ± 4.12 in the intramedullary nail group (p = 0.571), and coronal malalignment (p = 0.196), sagittal malalignment (p = 0.57), deep infection (p = 0.264), nonunion (p = 0.695), union time (p = 0.329), and final union rate (p = 0.699) were not significantly different between groups. Compared with the minimally invasive locking compression plate group, the suprapatellar intramedullary nail group yielded comparable results in terms of radiological alignment and complications. Considering that proximal tibial fractures are associated with high-energy trauma and severe soft tissue damage, we believe that a suprapatellar intramedullary nail may be a good alternative. Level III.

Evaluation of Humeral Shaft Fracture Outcomes by Treatment Method: A Systematic Review and Meta-analysis Based on Comparison Studies.

The purpose of this systematic review and meta-analysis was to evaluate various outcomes of humeral shaft fractures treated with different treatment methods, which included functional bracing, open reduction and internal fixation, intramedullary nailing, and locked compression plate. A systematic review was performed using research databases including PubMed, EMBASE, and Google Scholar. Keywords relating to treatment of humeral shaft fractures were used, and comparison studies that reported patient characteristics and outcomes, including nonunion, malunion, function scores, and complications, were included. One hundred fourteen records were screened, with 18 studies ultimately included in the meta-analysis. Treatment groups were consolidated into brace or surgery and then further categorized into subgroups based on surgical technique used. Postoperative events, complications, and functional scores were compared among the treatment groups. Statistical analysis for this study was conducted using Review Manager 5.3, with a standard p-value of ≤0.05 for statistical significance. Eighteen studies were included in this review with a total of 706 patients. Z-tests showed that risks of revision, nonunion, and malunion were higher in the brace treatment group compared with the surgical treatment group (p < 0.0001, <0.0001, 0.004, respectively). Risk of infection was expectedly higher in the surgical group compared with the brace group (p = 0.04). Radial nerve injury rates were also higher in the unspecified surgical group compared with the brace group (p = 0.01). In the surgical group, the mean Constant shoulder score was also significantly higher than that in the brace group (p = 0.004). When comparing the nail and plate groups, Z-tests revealed higher risks of delayed unions and other complications in the nail group (p = 0.04 and 0.001, respectively) but higher risk of infection in the plate group (p = 0.05). The conservative treatment of humeral shaft fractures with functional braces may be associated with a lower incidence of infection and nerve injury when compared with operative treatment methods. However, nonoperative treatment may also come with higher risks of revision, nonunion, and malunion than the many available surgical modalities. Operative management with either intramedullary nail or plate has shown to be a reliable method of management with reasonable outcomes for humeral shaft fractures. While the nail group had higher risk of delayed unions and other complications, the plate group had higher risk of infections. Both nail and plate surgical treatments have shown to result in high union rates and should be considered by the surgeon on a case-by-case basis when treating humeral shaft fractures. Level I. See Instructions for Authors for a complete description of levels of evidence.

Hindfoot nailing for displaced ankle fractures in the elderly: A case-control analysis

IntroductionManagement of fragility ankle fractures in the elderly poses a surgical dilemma. An alternative to open reduction and internal fixation (ORIF) with screw and plate construct in selected elderly patients who may be significantly frail and comorbid is a tibio-talo-calcaneal (TTC) or hindfoot nail. Hindfoot nailing potentially reduces the risk of wound infection and increases likelihood of earlier return to function by allowing earlier weightbearing. The aim of this study was to examine the outcomes and complications of patients who received a hindfoot nail compared to patients who underwent an ORIF. MethodsA retrospective review identified patients who underwent hindfoot nailing from Jan 2010 to Dec 2021. Patients aged >65-years who underwent ORIF in the same time period were concurrently identified. The patients in the ORIF group were matched with patients in the hindfoot nail group by age, gender, comorbidity according to their Charlson Comorbidity Index (CCI) and their pre-injury function by Karnofsky Performance Scale (KPS). Clinical Frailty Scale (CFS) was also collected as part of patient demographics. Outcomes examined include mortality, length of stay, operation time, return to previous mobility, wound complications, metalware failure and infections. ResultsTwenty-six patients were identified in the hindfoot nail group and matched to 26 patients who underwent ORIF. Mean age was 84 and 83 years in the nail and ORIF group respectively. Overall, there were 12 and 11 complications from the hindfoot nail and ORIF group respectively with seven and two requiring return to theatre in the nail group and ORIF group (P = 0.07). The hindfoot nail group waited an average of 22 days after the operation for weightbearing compared to 59 days in the ORIF group (P < 0.001). There were no significant differences in length of stay (P = 0.58) and operation time (P = 0.19). ConclusionHindfoot nailing was associated with an increased risk of complications and higher risk of return to the operating theatre. Despite the potential attraction of earlier weightbearing, surgeons and patients need to be aware of these potential pitfalls.

A Comparison of the Outcomes Between Suprapatellar and Infrapatellar Approaches of Intramedullary Interlock Nailing in Patients With Extra-Articular Tibial Fractures.

Background and objective Intramedullary nailing can be considered the current gold standard for the treatment of diaphyseal tibial fractures. Nailing ensures good fracture stability, protection against malalignment, and quick mobilization. The suprapatellar (SP) approach of tibial nailing in the semi-extended position has recently been recommended as a safe and effective surgical technique; it has been gaining significant attention in the orthopedic literature, with fewer complications and reoperations. The approach has been shown to facilitate a reduction in fractures around the knee jointin the semi-extended position, and the extended position of the lower leg allows for easier fluoroscopic imaging. In this study, we aimed to compare the outcomes between SP and infrapatellar (IP) approaches of intramedullary nailingin patients with extra-articular tibial fractures. Method A randomized control trial was conducted over a period of 1.5 years at our tertiary care hospital after obtaining approval from its institutional ethics committee. A total of 60 patients with extra-articular tibial fractures were included in the study, with 30 patients each in the SP nailing groupand the IP nailing group, based on randomized sampling and with the help of radiological exposure in SP and IP nailing as per a previous study. The groups were then compared in terms of KUJALA patellofemoral knee score, operative time, radiation exposure, and time of union. Results When comparing both groups, those treated with the SP approach had better outcomes, including reduced radiation exposure, less pain, decreased operative time, better KUJALA patellofemoral knee score, and faster union. Conclusion Based on our findings of the comparison between SP and IP nailing approaches of extra-articular tibial fractures,the former leads to better and safer outcomes than the latter.

Functional Outcome of Pediatric Subtrochanteric Fractures Treated With a Titanium Elastic Nailing System (TENS) Versus Plating.

Introduction Uncertainty exists regarding the ideal course of therapy for subtrochanteric fractures in children of intermediate age. These fractures arechallenging to treat, with scarce literature-based evidence to support a definitive implant. The ideal course of treatment should consider the patient's weight, age, femoral canal size, associated injuries, fracture stability, and surgeon's experience. A subtrochanteric femoral fracture in a child between the age of 5-12 is difficult to treat. For these patients, there is debate concerning the optimal internal fixation, hence this study was conducted to try and determine the superior mode of treatment for these fractures. The objective of this study is to compare functional outcomes of subtrochanteric fractures in the paediatric age group operated on with titanium elastic nail and plate fixation and the complications associated with both treatment modalities. Materials and methods Thisis a retrospective observational study of 40 cases that were admitted and operated on in the hospital of the current study from May 2007 to November 2021. Twenty patients underwent titanium elastic nailing system (TENS)nailing and the other 20 patients underwent plating for subtrochanteric fractures. The surgeries were conducted at our institute and patients were followed up at one-, three-, and six-month intervals. The final functional results were calculated with the help of the Flynn scoring system. Results Out of 40 patients involved in the present study, 17 were female while 23 were male. Twenty patients received treatment with titanium elastic nails, and the remaining twenty received plating. The majority of the patients were males around 9.6 years of age on average in the plating group and 8.9 years in the nailing group. In comparison to 75% of participants in the plating group, 40% of patients who received nailing showed excellent results. Results were satisfactory for five patients who received titanium elastic nails and one who received plating. The only poor outcomes were noticed in six people (30%) in TENS and three people (15%) in the plating group who went through unplanned surgery for complications. In comparison to the plating group, the overall rate of complication was much greater in the TENS group. Conclusion We would like to conclude our study that, in accordance with Flynn's score, both elastic nailing and plating stabilization can produce positive functional outcomes. Both groups have a similar percentage of excellent and good results.We also conclude that the overall complication rate is slightly higher for patients treated with TENSwhen compared to plating for subtrochanteric fractures.

Locking plate fixation versus intramedullary nail fixation for the treatment of multifragmentary proximal humerus fractures (OTA/AO type 11C): a preliminary comparison of clinical efficacy

BackgroundThis study aimed to compare the clinical efficacy of locking plate and intramedullary nail fixations in the treatment of patients with OTA/AO type 11C proximal humerus fractures.MethodsWe retrospectively analyzed the data of patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures who underwent surgery at our institution from June 2012 to June 2017. Perioperative indicators, postoperative morphological parameters of the proximal humerus, and Constant–Murley scores were evaluated and compared.ResultsSixty-eight patients with OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures were enrolled in this study. Overall, 35 patients underwent open reduction and plate screw internal fixation, and 33 patients underwent limited open reduction and locking of the proximal humerus with intramedullary nail internal fixation. The total cohort had a mean follow-up duration of 17.8 months. The mean operation time of the locking plate group was significantly longer than that of the intramedullary nail group (P < 0.05), while the mean bleeding volume was significantly higher in the locking plate group than that in the intramedullary nail group (P < 0.05). The initial neck–shaft angles, final neck–shaft angles, forward flexion ranges, or Constant–Murley scores did not show significant differences between the two groups (P > 0.05). Complications, including screw penetrations, acromion impingement syndrome, infection, and aseptic necrosis of the humeral head, occurred in 8 patients (8/35, 22.8%) in the locking plate group and 5 patients in the intramedullary nail group (5/33, 15.1%; including malunion and acromion impingement syndrome), with no significant difference between the groups (P > 0.05).ConclusionsSimilar satisfactory functional results can be achieved with locking plates and intramedullary nailing for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures, with no significant difference in the number of complications between these two techniques. However, intramedullary nailing has advantages over locking plates for OTA/AO type 11C1.1 and 11C3.1 proximal humerus fractures in terms of operation time and bleeding volume.

Comparison of Unstable Per-Trochanteric Fractures Fixed with Proximal Femoral Nail Versus Dynamic Hip Screw Using Harris Hip Score

Objective: To compare the frequency of a good functional outcome in unstable per-trochanteric fractures fixed with a dynamic hip screw and proximal femoral nail using the Harris Hip Score. Methodology: A comparative study was conducted at the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences, Islamabad, from June to December 2021. A total of 80 patients with per-trochanteric femur fractures were selected and divided into two groups based on the surgical procedure performed: dynamic hip screw or proximal femoral nail. A comprehensive history and thorough examination were performed for all patients during scheduled follow-up visits. Patients were called in for follow-up assessments at 1 month and 3 months to evaluate the functional outcomes using the Harris Hip Score. Results: The mean age of all patients was 58.73±6.78 years. At the 3-month follow-up, the mean Harris Hip Score was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (84.64±7.05 vs. 73.9±12.53; p = 0.005). The proportion of patients with good functional outcomes (Harris Hip Score ≥ 70 points) was significantly higher in the proximal femoral nail group compared to the dynamic hip screw group (97.5% vs. 72.5%, p = 0.002). Conclusion: In this study, the proximal femoral nail group demonstrated superior functional outcomes compared to the dynamic hip screw group. The use of proximal femoral nail fixation can provide better outcomes and facilitate an earlier return to pre-injury status for patients.

A PROSPECTIVE COMPARATIVE STUDY OF FUNCTIONAL OUTCOME IN PATIENTS TREATED WITH INTERLOCKING NAILING AND DYNAMIC COMPRESSION PLATING FOR FRACTURE SHAFT OF HUMERUS IN ADULTS

Aims of the Study: The purpose of this study is to compare the functional outcome between patients who underwent intramedullary interlocking nailing treatment and those who had Dynamic Compression plating applied to the fractured shaft of the humerus. Methods: A prospective comparative study involving 30 people who had humeral shaft fractures was carried out. Fractures treated at the Department of Orthopaedics, Pacific Medical College and Hospital, Udaipur, between December 2020 and November 2022 using intramedullary interlocking nailing and Dynamic Compression plating. Results: According to our analysis, there is no appreciable difference in the fracture union times between the two techniques. The incidence of infection was greater in the plating group than in the patients who received closure reduction and an interlocking nail procedure. Conclusion: The interlocking nail group in our study reported higher complications. The majority of them involved excruciatingly poor shoulder function. However, both treatment techniques’ secondary complications a group of interlocking nails were more common than they should have been. I, therefore, come to the conclusion that patients can be treated with dynamic compression plating and interlocking nailing for a fractured humerus shaft. Intramedullary interlocking nailing is a safe and effective alternative therapy of diaphyseal fractures in the humerus. It can be used by those who have osteoporosis segmentation-and polytrauma-affected fractures.

SHORT VERSUS LONG INTRAMEDULLARY NAILS FOR INTERTROCHANTERIC HIP FRACTURE: META-ANALYSIS

To conduct a meta-analysis for intertrochanteric hip fractures comparing in terms of efficacy and safety short versus long intralomedullary nails.A pubmed search of the last 10 years for intertrochanteric fracture 31A1-31A3 according to the AO/OTA classification was performed. Baseline characteristics of each article were obtained, complication measures were analyzed: Peri-implant fracture, reoperations, deep/superficial infection, and mortality. Clinical variables consisted of blood loss (mL), length of stay (days), time of surgery (min) and nº of transfusions. Functional outcomes were also recorded. A meta-analysis was performed with Review Manager 5.4.Twelve studies were included, nine were retrospective. The reoperations rate was lower in the short nail group and the peri-implant fracture rate was lower in the long nail group (OR 0.58, 95% CI 0.38 to 0.88) (OR 1.88, 95% CI 1.04 to 3.43). Surgery time and blood loss was significantly higher in the long nail group (MD −12.44, 95% CI −14.60 to −10.28) (MD −19.36, 95% CI −27.24 to −11.48). There were no differences in functional outcomes.The short intramedullary nail has a higher risk of peri-implant fracture; however, the reoperation rate is lower compared to the long nail. Blood loss and surgery time was higher in the long nail group.

An Observational Study on the Functional Outcomes of Intramedullary Nailing Versus Dynamic Compression Plating for Humeral Shaft Fractures

Objectives: The purpose of this research is to evaluate and contrast the functional results of Dynamic Compression Plating and Interlock Nailing for Humeral Shaft Fractures. Material and Methods: The design of this study was a prospective observational study. This study was conducted in DHQ Teaching Hospital Gujranwala and the duration of this study was from October 2020 to December 2022. We evaluated a total of 60 cases after receiving ethics committee permission from our institute. In DHQ Teaching Hospital Gujranwala, a study on instances of humeral shaft fractures needing surgical intervention was conducted. Results: In the plating group, 76.7% of the cases had outstanding results, compared to 56.7% in the nailing group. Moreover, the nailing group had a worse overall result (13.4% vs. 10%). Conclusion: Locking plating and intramedullary nailing had statistically similar results for individuals undergoing surgical intervention for humeral shaft fractures. In terms of union and function, both provide excellent and favourable results, but the dynamic compression plating group had a higher percentage of positive results and a propensity for union. Keywords: Humeral Shaft Fracture, Intramedullary Nailing, Dynamic Compression Plating

Ipsilateral proximal and shaft femoral fractures: Results of two treatment strategies

IntroductionIpsilateral proximal and shaft femoral fractures typically occur in young adults after high-energy trauma. No consensus exists regarding the optimal internal fixation device or surgical strategy for these complex fractures. Our main objective is to identify differences on outcomes and complications between patients treated with one or combined implants. Material and methodThis is a single-center retrospective cohort study in patients with associated fractures of the proximal (31 AO) and shaft femur (32 AO). We divided the patients into two groups according to the use of single (Group I) or combined implants (Group II). Demographic, clinical, radiological, surgical data and development of complications were collected. ResultsWe identified 28 patients (19 men and 9 women) with an average age of 43 years. We used an anterograde femoral nail in group I (17 patients) and a retrograde femoral nail or a plate associated with hip lag screws or sliding hip screw in Group II (11 patients). Patients were followed up for 26.28 (9.12–62.88) months. Osteonecrosis of the femoral head, osteoarthritis, infection or nonunion was found in 9 patients (32%). No significant differences (p 0.70) were found in complications between two groups or between definitive surgical fixation before or after the first 24h. ConclusionsNo differences in the development of complications or timing of definitive fixation were found between the use of one or combined implants in ipsilateral proximal femur and shaft fractures. Regardless of the implant chosen, an appropriate osteosynthesis technique is crucial, even so high complication rates are expected.Level of evidence: IV. Grade of Recommendation: C.

Assessment of Modal Characteristics of Steel–Concrete Composite Girder Bridge with V-Shaped Piers

As the standards of bridge design and construction continue to improve, more and more combination bridges are being put into use. The public’s demand for aesthetically pleasing bridges is also increasing, making it necessary to use the special structure of steel–concrete combinations, continuous V-shaped piers, and continuously stiffened bridges. This structure has the structural and mechanical characteristics of both a continuous girder and a V-shaped pier bridge. The span can be reduced to a certain extent because the support of the V-shaped piers can be applied directly to the main girder. The spanning capacity of the bridge is generally greater than that of a combined steel–concrete girder bridge with vertical piers. The whole bridge is continuous, without expansion joints, making it more stable and safe for traffic. At present, research on this structural bridge type is not yet complete. In this paper, the structural system and dynamic characteristics of this bridge are investigated in the context of real-life engineering. Firstly, the self-vibration characteristics of the three structures were analyzed, and their effects on the self-vibration characteristics were studied by varying the height of the crossbeam at the V-shaped piers’ support, the main beam stiffness, and the V-shaped piers’ stiffness in the three structures. The results show that the increase in main beam stiffness can effectively improve the vertical stiffness of the three structures, with the most obvious effect on structure one and the least effect on structure two; the increase in V-shaped pier stiffness causes a huge improvement in the transverse stiffness of the three structures. Subsequently, a two-unit rod system model of the background bridge was established using the finite element method, and the original model was improved by calculating the equivalent shear stiffness of the shear nail group so that it could simulate the shear joints more accurately. The effects of the shear connectors on the self-vibration characteristics of the steel–concrete combined continuous beam–V-shaped piers and continuous rigid-frame bridge were investigated through theoretical analysis and finite element simulation. It was found that due to the existence of flexible shear connectors, the interface between the steel beam and concrete slab in the combined beam has a slippage effect which causes the deformation to become unsynchronized, and there is a certain difference between vibration patterns. The stiffness of the shear connectors has a certain effect on the self-vibration frequency of the bridge. The damage to the local shear connectors does not have a large effect on the self-vibration frequency of the overall structure, but the damage to the shear connectors at the beginning of the connection between the V-shaped piers and the main beam is greater than that of the other areas. Damage to shear joints should be given special consideration in comparison to other areas.

Biomechanical comparison of intramedullary nail and plate osteosynthesis for extra-articular proximal tibial fractures with segmental bone defect.

Purpose: Proximal tibial fractures are common, but the current available internal fixation strategies remain debatable, especially for comminuted fractures. This study aimed to compare the biomechanical stability of three internal fixation strategies for extra-articular comminuted proximal tibial fractures. Methods: A total of 90 synthetic tibiae models of simulated proximal tibial fractures with segmental bone defects were randomly divided into three groups: Single lateral plating (LP), double plating (DP) and intramedullary nailing (IN). Based on the different number of fixed screws, the above three groups were further divided into nine subgroups and subjected to axial compression, cyclic loading and static torsional testing. Results: The subgroup of intramedullary nailing with five proximal interlocking screws showed the highest axial stiffness of 384.36 ± 35.00N/mm. The LP group obtained the lowest axial stiffness performance with a value of 96.59 ± 16.14N/mm. As expected, the DP group offered significantly greater biomechanical stability than the LP group, with mean static axial stiffness and mean torque increasing by approximately 200% and 50%, respectively. According to static torsional experiments, the maximum torque of the DP subgroup was 3,308.32 ± 286.21N mm, which outperformed all other groups in terms of torsional characteristics. Conclusion: Utilizing more than four distal screws did not provide improved biomechanical stability in the LP or DP groups, while a substantial increase in the biomechanical stability of DP was obtained when an additional medial plate was used. For the intramedullary nailing group, increasing the number of proximal interlocking screws could significantly improve biomechanical stability, and the intramedullary nailing with three proximal interlocking screws had similar static and cyclic stiffness as the DP group. The intramedullary nailing with five proximal screws had better axial stability, whereas DP had better torsional stability.

A Comparison of Tip-Apex Distance at Various Angles of Fixation Devices in Hip Fractures.

Background Intertrochanteric neck of the femur (NOF) fractures are very common, and the majority are fixed using dynamic hip screws (DHS) or intramedullary (IM) nails with a fixed angle.The aim of this study was to assess which angle of fixation has a better tip-apex distance (TAD) on X-ray and lower complication rates. Methods We included patients with intertrochanteric hip fractures fixed using a DHS or an IM nail. We included patients who had complete radiological and clinical records and a minimum follow-up of 24 months. We measured the TAD and recorded the number of implant cutouts, fracture site nonunions, and periprosthetic fractures. Results A total of 107 patients were included, 35 IM nails and 72 DHS. There were four cases of implant cutouts within the DHS group and none in the IM nail group. All four cutout cases were fixed using 135° angle DHS, and two had TAD of more than 25 mm. Multivariable regression analysis revealed that the implant fixation device (p=0.002) and the angle of fixation (p<0.001) are the most important predictors of TAD. Conclusion Smaller angle (130° or 125°) fixation devices allow better positioning of the lag screw and consequently better TAD, which leads to a lower probability of implant cutout in patients undergoing fracture of the neck of the femur surgery.

Prospective study comparing between plate osteosynthesis and antegrade interlocking nailing its functional and radiological outcome in treating humeral shaft fractures

Humeral shaft fractures are common injuries making upto 1-3% of all fractures. They are widely treated by conservative methods leading to higher rates of non-union. Henceforth surgeons tend to perform operative procedures to treat them. To statistically analyse and compare the functional and radiological outcome of two treatment modalities of humeral shaft fractures, they are plate osteosyntheis and antegrade intramedullary nailing. A total of 22 patients of humeral shaft fractures were operated by either of two methods 12 in plating (P) group ,10 in nailing (N) group and their radiological outcome was assessed by rate of union, time taken for callus formation etc and their Functional outcome was analysed based on Rodriguez Merchan criteria. The commonest age group of patients operated is 21-40 years (70%) majority being males (70%) and road traffic accident being commonest mode of injury. The plate osteosynthesis group stands superior than nailing group in terms of duration of union (20 weeks), rate, percentage of union (100%), least risk of non-union (0). Statistically significant (p&lt;0.05) improvement in shoulder joint function with minimal complications. The plate osteosynthesis method is the most promising surgical procedure for treating humeral shaft fracture due to negligible rates of non-union and early recovery of motion. Though nailing group has minimal need of soft tissue dissection, preserves fracture biology, decreased operative time and early rehabilitation period it still stands inferior when it comes to complications like rotator cuff injury, shoulder impingement pain and restriction of shoulder movements. Ultimately the post operative quality of life is equally good in both techniques.

Comparative study of internal fixation of diaphyseal fractures of both bones of the forearm in adults between intramedullary nailing and plate osteosynthesis

Background: Diaphyseal forearm fracture is one of the most commonly encountered fractures of the upper extremity. The literatures comparing the outcome of plate fixation and intramedullary nailing in adults are scarce and therefore the consensus on superiority of one over the other is lacking. This study was undertaken to compare the outcome of these operative techniques in adults with diaphyseal fracture of both bone forearm. Aims and Objectives: This study was undertaken to compare the outcome of plate fixation and intramedullary nailing in adults with diaphyseal fracture of both bone forearm. Materials and Methods: Patients of 18–70 years of age, with diaphyseal fractures of both bones of the forearm of &lt;21 days old, were recruited. Patients were randomly allocated to two treatment groups: intramedullary nailing and plate osteosynthesis. Patients were followed up at 4th week, 12th week, and 24th week post-operative period. Functional outcome was measured at the end of 24th week based on the Clinical and Radiological parameters by Anderson et al., Score, Grace-Eversman Score, and Disabilities of the Arm, Shoulder and Hand (DASH) Score. Results: This study comprised of 40 cases (n=40) who completed the follow-up period of 24 weeks. Most of the patients treated with plate (80%) demonstrated excellent outcome as per Anderson et al., score while the outcome was unsatisfactory in 50% of those treated with nails. About 90% of the patients of plate group had excellent result in contrast to 50% in case of nail group following Grace Eversman criteria. Considering DASH score, the former group showed mostly excellent (40%) and good (45%) outcome while the latter exhibited mostly fair (55%) and good (30%) result. Conclusion: It may be stated that plate osteosynthesis is a better option in the treatment of diaphyseal fracture of both bones forearm in adults.

A comparison of exchange nailing and plate augmentation over a retained intramedullary nail in aseptic oligotrophic and atrophic femoral shaft pseudoarthrosis.

This study aims to evaluate the success of plate augmentation over a retained intramedullary nail (IMN) against exchange nailing performed with autologous bone grafting in oligotrophic and atrophic pseudoarthrosis of the femoral shaft. Between May 2005 and October 2020, a total of 42 of 56 patients (28 males, 14 females; mean age: 47.3±17.2 years; range, 19 to 84 years) with aseptic atrophic or oligotrophic femoral nonunion were retrospectively analyzed. The patients, 20 were operated with plate over a retained IMN, and the rest (n=22) by exchange nailing. Data including demographic and clinical characteristics of the patients, treatment success, duration of surgery, blood loss during surgery, infection rates, length of hospital stay, time to bridging of the nonunion site, and time to obliteration of the fracture line (solid union) were recorded. The mean follow-up was 23.8±20.4 (range, 12 to 96) months in the plate over an IMN group and 34.7±27.4 (range, 12 to 90) months in the exchange nailing group. At the final follow-up, solid union occurred in all of the patients in the plate augmentation over a retained IMN group, and 21 of 22 (95.45%) patients in the exchange nailing group. Blood loss during surgery was significantly less in the plate augmentation over IMN group (p=0.027). There was no statistically significant difference in the other variables between the two groups (p>0.05). Our study results demonstrate that plate over a retained IMN is effective as exchange nailing in the surgical treatment of oligotrophic and atrophic pseudoarthrosis of the femoral shaft. However, it can be speculated that plate application over IMN is more advantageous in terms of blood loss during surgery.

Combined Humeral Head and Shaft Fractures: Outcome Following Intramedullary Nailing and Plating.

Background and Objectives: Combined fractures of the humeral head and shaft (FHS) are rare but frequently involve an intermuscular fracture as its characteristic pattern. The aim of this retrospective study was to investigate intramedullary nailed and plated FHS in terms of outcomes and complications. Materials and Methods: The present study included patients with FHS, treated via either intramedullary nailing or plating within a period of 10 years, with a minimum follow-up of 12 months. Functional outcome was assessed using the age- and sex-adapted Constant-Murley Score (CMS-K). Rates of complications and revision surgeries were registered. Results: Twenty-five patients (18 females, 7 males, age 60.1 ± 14.2 years, range 23-76 years) were included in the study. Nailing was performed in 16 patients (12 females, 4 males, age 62.6 ± 12.4 years), whereas plating was executed in nine patients (6 females, 3 males, age 55.8 ± 17.0 years). Follow-up among all patients was 45.1 ± 26.3 months (range 12-97 months). CMS-K was 70.3 ± 32.3 in the nailing group, with reoperation in four cases, and 76.0 ± 31.0 in the plating group, with one reoperation (p = 0.42). Patients with no metaphyseal fragment displacement (n = 19; CMS-K 76.7 ± 17.3) demonstrated significantly better functional outcomes versus those with secondary displacement of the metaphyseal fragments (n = 6; CMS-K 60.0 ± 17.1), p = 0.046. Conclusions: Comparable acceptable clinical outcome is obtained when comparing nailing with additional open cerclage or lag-screw fixation techniques versus plating with open reduction. However, a higher revision rate was observed after nailing. The correct metaphyseal fragment fixation seems to be crucial to avoid loss of reduction and hence the need for revision surgery, as well as a worse outcome.

Comparison of Cephalomedullary Nails with Sliding Hip Screws in Surgical Treatment of Intertrochanteric Fractures: A Cumulative Meta-Analysis of Randomized Controlled Trials.

The primary objective of the present study was to compare surgical failures of intertrochanteric fractures of the femur through a meta-analysis of randomized controlled trials and to assess the change in surgical outcomes over time in a cumulative meta-analysis. To identify studies evaluating the surgical outcomes of internal fixation using sliding hip screws (SHS) or cephalomedullary (CM) nails for the treatment of intertrochanteric fractures of the femur, all records until August 2021 in the PubMed, Embase, and Cochrane Library databases were searched. Studies with the following characteristics were considered eligible: patients who had an intertrochanteric fracture of the femur (population); patients who received surgical treatment using a CM nail (intervention); patients who received surgical treatment using SHS (comparator); surgical failures that required reoperation, including cut-out or cut-through of lag screws, varus collapse or posterior angulation of proximal fragments, loosening of lag screws or helical blades, and fracture nonunion (outcomes); and two reviewers independently reviewed the titles and abstracts of the randomized controlled trials and selected relevant studies for a full-text review (study design). Twenty-one studies were included in the final analysis consisting of 1,777 cases in the SHS group and 1,804 cases in the CM nail group. The cumulative standard mean difference was 0.87, indicating that CM nails had no significant effect in improving the surgical outcomes. There was no significant difference in surgical failure between SHS and CM nails for all intertrochanteric fractures (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.76-1.49). Pooled data showed no significant difference between the two groups in terms of surgical failure in unstable intertrochanteric fractures (OR, 0.80; 95% CI, 0.42-1.54). Although the use of CM nails has become a current trend in the treatment of intertrochanteric fractures, there is no literature supporting their clinical superiority when compared with SHS.