Nail Fixation Research Articles

Poor radiological outcomes and associated factors among tibial shaft fracture patients treated with intramedullary nail fixation at Addis Ababa Burn, Emergency and Trauma Hospital, Ethiopia

BackgroundTibial shaft fractures account for the majority of operatively treated long bone fractures and have the greatest prevalence of open wounds. For both open and closed injuries, intramedullary fixation has become the standard of therapy. At Addis Ababa Burn, Emergency, and Trauma (AaBET) Hospital, the rates of poor radiological outcomes for tibial shaft fractures treated with intramedullary fixation are unknown.MethodsA retrospective health facility-based cross-sectional study design was conducted among patients with tibial shaft fractures treated with intramedullary nails at AaBET Hospital. Data were collected by reviewing medical records and x-rays. The study was conducted on a sample size of 160 using a simple random sampling technique. Descriptive statistics such as frequency and percentage were used to summarize the results. Binary logistic regression was used to describe the associations between variables. A P-value < 0.05 was considered statistically significant.ResultsThis study included 122 (76.3%) men and 38 (23.8%) women with a mean age of 36.3 ± 13.9. The magnitude of poor radiological outcomes among the tibial shaft fracture patients treated with intramedullary nail fixation was 23.1%, with factors including include the presence of medical comorbidity [adjusted odd ratio (AOR) (95% confidence interval, CI): 16.5 (2.524–108.69)], having diabetes mellitus [AOR (95% CI): 3.85 (1.07–14.08)], Gustilo–Anderson type III (GA III) open fractures [AOR (95% CI): 17.4 (3.11–97.72)], and post-operative infection [AOR (95% CI): 13.9 (5.8–33.16)] identified as being significantly associated with poor radiological outcomes.ConclusionThe magnitude of poor radiological outcomes in this study is comparable to other similar studies. The study found that factors including Gustilo–Anderson type III open fractures, diabetes mellitus, and post-operative infections increase the odds of poor radiological outcomes in patients with tibial shaft fractures after intramedullary nailing. Therefore, surgeons should improve their assessment and evaluation of patients with infection signs and use negative wound pressure for GA III fractures.

Late fracture-related infections in HIV-positive patients : a prospective cohort study.

HIV and musculoskeletal injuries both disproportionately affect individuals living in low- and middle-income countries (LMICs), leading to a significant number of fractures in HIV-positive patients. Despite this, little is known about the long-term outcomes for these patients. This prospective cohort study investigated whether HIV infection is associated with fracture-related infections (FRIs). All adult patients between September 2017 and December 2018 who received intramedullary nail fixation of lower limb fractures in two tertiary referral hospitals in Cape Town, South Africa, were deemed eligible. In total, 358 participants were recruited for this study, 33 of whom were lost to follow-up. Of the 325 participants, 37 (11.4%) developed a total of 39 FRIs over the study period; 25 were early FRIs (64.1%) and 14 were late FRIs (35.9%). Participants were followed up for a minimum of 24 months. Throughout follow-up, participants were monitored for FRIs. These were categorized as early FRIs (< 90 days) and late FRIs (> 90 days). Overall, 71 participants (21.8%) were HIV-positive and 254 participants were HIV-negative (78.2%). In the HIV-positive population, 15 participants (21.1%) suffered 16 FRIs: seven early FRIs (9.9%) and nine late FRIs (7.0%). In the HIV-negative population, 22 participants (8.7%) experienced 23 FRIs, 18 were early FRIs (7.1%), and five participants experienced late FRIs (2.0%). On univariate and multivariate regression, being HIV-positive increased a participant's likelihood of suffering late FRIs, and FRIs overall. HIV status made no significant difference to early FRI rates. Contrary to recent evidence, this study demonstrates an association between HIV and an increased risk of a patient developing late FRIs. However, there was no significant difference in early FRI rates.

A Comparison of Wound Related Complications Between Intramedullary and Lateral Plate Osteosynthesis After Fibula Osteotomy in the Lateral Approach Total Ankle Replacement.

Total ankle replacement (TAR) has evolved in the last decade from a procedure rife with complication and failure to a promising alternative to arthrodesis. The ability to maintain ankle joint range of motion is showing great promise in patient-reported outcomes, postsurgical pain, as well as long-term sequalae of joint fusion. Although TAR can be performed via either an anterior or lateral approach both with their own sets of benefits and potential complications, the consensus seems to be that one is no better than the other when performed by high-volume surgeons. Data were gathered over a 6-year period looking at an age- and gender-matched cohort of lateral approach TARs with either plate osteosynthesis or fibula nail fixation in the management of the fibula osteotomy and compared reoperation and infection rates with the working hypothesis that nail fixation would afford better outcomes. Secondary outcomes including rates of fibula union, tourniquet time as an adjunct to procedure length, and patient-reported outcome measures (PROMs) in the form of FAOS Quality scores were included. A total of 234 TARs were analyzed. Forty-five of these used intramedullary nail fixation (IM), and a control group of 45 plate osteosynthesis (PO) fixation cases was correlated. The Foot and Ankle International guidelines on reporting for complications arising from total ankle arthroplasty that resulted in reoperation were applied to the data set, and it was noted that 13 of 19 reoperations were noted in the PO group, which was statistically significant. Also of note, 12 of 16 patients treated with antibiotics, which included all those cases within the reoperation group, were noted to come from the PO group. This was also of statistical significance. Interestingly, the rate of fibula nonunion in the PO group was lower (8.88%) than that of the IM group (23.25%). Our results confirmed that the rates of reoperation and infection were statistically significantly improved with the use of nail fixation over plate fixation. This was tempered by a concerningly high nonunion rate. This article shows promising results for the use of a simple technique in improving long-term outcomes in ankle arthroplasty.

Exploring the Efficacy of Computer-Assisted Navigation in Improving Lag Screw Placement and Preventing Cut-Out in Intramedullary Nail Fixation of Femoral Fractures: A Meta-Analysis

Exploring the Efficacy of Computer-Assisted Navigation in Improving Lag Screw Placement and Preventing Cut-Out in Intramedullary Nail Fixation of Femoral Fractures: A Meta-Analysis

Optimal timing of stabilization and operative technique for extremity fractures in polytrauma patients: a systematic review and meta-analysis

PurposeIn polytrauma patients, injuries involving the extremities are frequently seen. Treatment concepts vary from early definitive care to temporary fixation and delayed definite stabilization. This analysis therefor aims to illuminate the impact of timing for operative stabilization of extremity fractures on outcome factors in adult polytrauma patients.MethodsWe searched PubMed and Cochrane CENTRAL to identify studies from inception of each database to 14 September 2022. We included systematic reviews and RCTs comparing immediate versus delayed operative fracture stabilization and early definite care versus primary external fixation in adult polytrauma patients.ResultsFive randomized controlled trials were included, with a total of 335 patients. The analysis found no statistically significant difference in overall mortality or improvement in ICU admission between early (< 24 h) and late fracture stabilization. Comparing femoral nailing and external fixation, findings showed that femoral nailing reduce ICU length of stay and duration of invasive mechanical ventilation.ConclusionThe results indicate that immediate surgical treatment by nailing is superior to delayed treatment or a staged surgical approach in stable polytrauma patients with long-bone fractures. As there is a lack of clear evidence regarding the optimal timing for definitive operative stabilization of extremity fractures in polytrauma patients, further high-quality studies are essential to enhance the certainty of evidence and provide more conclusive treatment algorithms.

Different treatment for humeral shaft fractures: A network meta-analysis.

The main treatment methods for humeral shaft fractures include minimally invasive plate osteosynthesis (MIPO), intramedullary nailing (IMN), open reduction and internal fixation (ORF), and non-operative treatment (NonOP). However, the optimal treatment plan remains unclear. This article utilizes a network meta-analysis to compare the therapeutic effects of MIPO, IMN, ORF, and NonOP for the treatment of humeral shaft fractures. We searched electronic databases, including the PubMed, Embase, The Cochrane Library, and the Web of Science Databases, from inception to June 1, 2024. The "Risk of Bias Assessment" tool recommended by the Cochrane Collaboration was used to evaluate the quality of the included literature. RevMan 5.4 software and R software with gemtc package was used for the graphical representation and data analysis of the network meta-analysis. A total of 23 randomized controlled trials were finally included. The results indicated that the efficacy of disabilities of the arm, shoulder and hand score was significantly higher in the MIPO group than in the open reduction and internal fixation (ORIF) group (weighted mean difference = 4.7, 95% confidence intervals, 1.8-7.75). IMN was associated with a decrease of the constant-Murley scores score than NonOP (weighted mean difference = -4.4, 95% confidence intervals, -8.7 to -0.068). IMN, MIPO, and ORIF was associated with a decrease of the fracture healing time than NonOP. The difference for nonunion rate and iatrogenic radial nerve injuries between any 2 groups was not statistically significant (P > .05). The evidence from current meta-analysis indicated that ORIF provides the best recovery effects for upper limb and shoulder joint function after the treatment of humeral shaft fractures, with the drawback of a relatively higher incidence of complications. To ensure the reliability of this study's results, more high-quality randomized controlled trials are needed in the future to verify these findings.

Isolated Continuous Lumbar Plexus Block Infusion for Hip Fractures: Their Role as Sole Analgesic and Anaesthetic Modality—A Retrospective Observational Study

Background and Aims: India is one of the advancing ageing societies of the world; with this, the country’s demographic structure also changes. The incidence of lower limb fractures is high in this population, and it threatens their health both physically and mentally. Therefore, an effective anaesthesia and analgesia regimen is crucial for smooth and stable surgery and perioperative care. Methods: In this retrospective study, we aimed to describe the use of lumbar plexus block with an indwelling catheter as a sole anaesthetic technique intra-operatively and for providing peri-operative pain relief for 54 patients with intertrochanteric fracture posted for proximal femoral nailing or dynamic hip screw fixation from October 2020 to October 2023. Results: It was found that pain scores remained less than 1 for the majority of the study duration. Most patients underwent surgery within the first day of admission in our hospital and surgery lasted for one to two hours. All patients were discharged within five days of hospitalisation. There were no failures of the blocks before and during the surgical procedures. There were no records of any complications related to the technique. No supplement opioid was used during the procedure. Conclusion: With adequate monitoring, expertise, knowledge and familiarity with the procedure, lumbar plexus block with continuous infusion via a perineural catheter supplemented with periprocedural sedation can be used as a safe and effective anaesthetic technique for hip and proximal femur fracture reduction surgeries.

Short-term effectiveness of Gamma 3 U-Blade system for osteoporotic intertrochanteric fractures in the elderly

To compare the short-term effectiveness between Gamma 3 intramedullary nails and Gamma 3 U-Blade system in the treatment of osteoporotic intertrochanteric fractures in the elderly. A retrospective analysis was conducted on the clinical data of 124 elderly patients with osteoporotic intertrochanteric fractures, who were admitted between February 2020 and February 2023 and met the selection criteria. The fractures were fixed with Gamma 3 intramedullary nails in 65 patients (control group) and Gamma 3 U-Blade systems in 59 patients (UB group). The differences between the two groups were not significant in age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, bone mineral density, time from injury to operation, fracture classification, and affected side ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and fracture healing time were recorded; the tip-apex distance, fracture reduction quality, and lag screw position were evaluated on X-ray films at immediate after operation; the lag screw sliding distance and change value of neck-shaft angle were measured on X-ray films at last follow-up. Harris hip score at 1 year after operation and the occurrence of internal fixation-related complications were compared between the two groups. The operation time, intraoperative blood loss, and hospital stay in the UB group increased compared to the control group, but the differences were not significant ( P>0.05). All patients in both groups were followed up 12-24 months (mean, 17.1 months). At 12 months after operation, there was no significant difference in the Harris hip score between the two groups ( P<0.05). Radiological examination showed that there was no significant difference between the two groups ( P>0.05) in terms of tip-apex distance, fracture reduction quality, and lag screw position. Fractures healed in both groups, and there was no significant difference in healing time ( P>0.05). At last follow-up, the change value of neck-shaft angle and lag screw sliding distance in the UB group were significantly lower than those in the control group ( P<0.05). During follow-up, no related complications occurred in the UB group, while 6 cases (9.2%) in the control group experienced complications, and the difference in the incidence was significant ( P<0.05). For the osteoporotic intertrochanteric fractures in the elderly, the Gamma 3 U-Blade system fixation can achieve good short-term effectiveness, with better imaging results compared to Gamma 3 intramedullary nails fixation.

High Fixation Failure Rate of Cephalomedullary Nail Fixation in Patients with Low-Energy Basicervical Femoral Fractures: Do We Need Extramedullary Reduction?

Background and Objectives: A basicervical femoral fracture is a relatively uncommon type of proximal femoral fracture. However, as the proportion of proximal femoral fractures rises in conjunction with the aging of society, the absolute number of patients with basicervical femoral fractures is also increasing. Nevertheless, the optimal surgical methods for the treatment of basicervical femoral fractures remain a topic of debate. The aim of this study is to evaluate the failure rates of cephalomedullary nail fixation in basicervical femoral fractures based on reduction types. Methods: A retrospective analysis was conducted on 22 patients (22 hips) with AO/OTA 31-A1.2 hip fractures who had undergone treatment with a cephalomedullary nail (PFNA-II or Gamma-3) between March 2007 and February 2018. They were classified into three groups based on the reduction types: extramedullary (E), anatomical (A), or intramedullary (I). The intramedullary group included cases where the basicervical component was impacted into the medullary canal, while the extramedullary group comprised cases where the component was displaced beyond the medullary canal. The anatomical group consisted of specimens that exhibited complete anatomical reduction. This was determined by both the anteroposterior (AP) view and the lateral view using simple radiographs. Results: There were 13 patients (59.1%) in Group E and 9 patients (40.9%) in Group A. No patients were classified in Group I. Fixation failure occurred in four patients (18.1%, 4/22). In Group E, no patients exhibited fixation failure (0%, 0/13). In contrast, four patients in Group A demonstrated fixation failure (44.4%, 4/9). Group A exhibited a significantly higher incidence of fixation failure (0% vs. 44.4%, p =0.037) compared to Group E. Conclusion: In the treatment of low-energy basicervical femoral fractures with cephalomedullary nails, extramedullary reduction demonstrated a lower rate of fixation failure compared to anatomical reduction in this study. While definitive conclusions regarding its superiority cannot be drawn due to the limited sample size, extramedullary reduction may serve as a promising alternative to reducing the high fixation failure rate associated with this challenging fracture type.

Between Consecutive Fractures: Time and Sex as Dominant Factors in Type and Severity Concordance of Contralateral Hip Injuries.

Background/Objectives: Hip fractures present a global public health concern, with a forecasted rise in incidence and having associated increased mortality rates. This study aimed to investigate whether the AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification of a first hip fracture can predict the location and severity of a subsequent contralateral fracture. Methods: We retrospectively evaluated patients with non-simultaneous bilateral hip fractures between January 2000 and February 2021 and analyzed the type and severity of each fracture using the AO/OTA classification system, interval between fractures (TI), and patients' characteristics, including sex, age at time of each fracture, and radiographic measurements of hip morphology. Results: The study included 182 fractures in 91 patients (68% women, mean age: 79.5 and 82.2 years at first and second fractures, respectively; mean TI: 975 days). A strong association (lambda = 0.437, p < 0.001) was demonstrated between the first and second fracture classifications, which was higher in men (lambda = 0.60, p < 0.001) and for TI < 3 years (lambda = 0.625-0.688, p < 0.001). The mean TI was significantly shorter between the first and subsequent identical fractures than between different fracture types. However, mean hip morphological features did not significantly differ between groups. Conclusions: The initial hip fracture classification significantly predicted the type and severity of a subsequent contralateral fracture, particularly within 3 years and in men. Providing appropriate patient guidance and preventive measures is crucial, particularly for those with primary fractures that are associated with higher morbidity and mortality. Specific fracture-focused interventions, such as preventive intramedullary nail fixation, should be considered.

Clinical and Functional Outcomes of Peri-Implant Fractures Associated with Short Proximal Femur Nails: Prevention Strategies and Key Insights.

Background: Hip fractures are prevalent among the elderly and impose a significant burden on healthcare systems due to the associated high morbidity and costs. The increasing use of intramedullary nails for hip fracture fixation has inadvertently introduced risks; these implants can alter bone elasticity and create stress concentrations, leading to peri-implant fractures. The aim of this study is to investigate the outcomes of peri-implant hip fractures, evaluate the potential causes of such fractures, determine the type of treatment provided, assess the outcomes of said treatments, and establish possible improvement strategies. Methods: We conducted a retrospective observational study on 33 patients with peri-implant hip fractures (PIFs) who underwent surgical management at Río Hortega University Hospital from 2010 to 2022. The collected data included demographics, initial fracture characteristics, the peri-implant fracture classification, implant details, surgical outcomes, functional scores, and complications. Functional capacity was evaluated using the Parker Mobility Score (PMS). Results: The cohort (91% female, mean age 87.6 years) included 34 peri-implant fractures. The mean time from the initial fracture to the PIF was 47.2 months (nine patients developed PIFs within 2 months). Most fractures (76%) were managed with implant removal and the insertion of a long intramedullary nail, with cement augmentation in 31% of cases. The mean surgical time was 102 min, and the average hospital stay was 9.6 days. Postoperative complications occurred in 27%, with a perioperative mortality rate of 9%. Functional capacity showed a significant decline, with an average PMS loss of 4.16 points. Mortality at one year post-PIF was 36%, rising to 83% at five years. Radiographic consolidation was observed in 72% of cases at an average of 6.04 months, though 24% of patients died before consolidation. Statistically significant correlations were found for PMS pre-index fracture (PMS1: r = 0.354, p < 0.05), pre-PIF (PMS2: r = 0.647, p < 0.001), and post-PIF (PMS3: r = 0.604, p < 0.001). Conclusions: Peri-implant hip fractures present complex challenges due to their surgical difficulty and impact on patient mobility and survival. Successful management requires individualized treatment based on fracture type, implant positioning, and patient factors. These findings underscore the need for preventive measures, particularly in implant choice and techniques like overlapping and interlocking constructs, to minimize the secondary fracture risk.

An overview of patients with intertrochanteric femoral fractures treated with proximal femoral nail fixation using important criteria

BackgroundThis study aimed to assess important criteria, including osteoporosis, fracture type, implant position within the bone, fracture reduction, and radiographic union, in patients with intertrochanteric femoral fractures treated with proximal femoral nail (PFN) fixation and to show their effect on clinical outcomes.MethodsPFN fixation was applied in 73 patients (41 females, 32 males; mean age: 64.5 ± 6.2). The T score, fracture type according to the AO Foundation and Orthopedic Trauma Association (AO/OTA), implant-related complications (IRCs), Harris hip score (HHS), Jensen social function (JSF) score, and Parker-Palmer mobility score (PPMS), postoperative reduction classification, screw position according to the Cleveland zone, Radiographic Union Scale for the Hip (RUSH) score, and tip-apex distance (TAD) were recorded.ResultsMost screws were in central-central (n = 42) and inferior-central (n = 11) positions. IRCs were seen mostly in cases of screws placed in peripheral zones (n = 10) and were not observed in almost any patient with a TAD ≤ 25 mm (n = 52) (p < 0.001). Most of the patients with acceptable or good fracture reduction did not have IRCs (n = 11 and 50, respectively) (p < 0.001). Half of type 3A1 (n = 13) and most type 3A2 (n = 20) fractures showed radiographic union at 3 months, and most type 3A3 (n = 9) fractures showed radiographic union at 5 months (p < 0.05). At 12 months, type 3A2 fractures had the highest HHS (79.2 ± 5.3) and PPMS (3.9 ± 1.5), while type 3A3 fractures had the lowest HHS (70.3 ± 4.6) and PPMS (0.6 ± 2.8) (p < 0.05). At 12 and 24 months, type 3A3 fractures had higher JSF scores (2.8 ± 0.4 and 3.5 ± 0.5, respectively); at 3 months, type 3A1 fractures had higher JSF scores (3.1 ± 0.3) (p < 0.05). The radiographic bone union time was prolonged in patients with a T score ≤ -2.5 standard deviation (SD) (p < 0.05). The HHS and PPMS increased while the RUSH score, considered as the radiographic union, was going towards the 4th month and decreased after the 4th month (p < 0.05).ConclusionsConsidering the criteria (osteoporosis, fracture type, implant position within the bone, fracture reduction, and radiographic union) examined in this study, satisfactory results can be obtained with PFN fixation in the treatment of patients with intertrochanteric femoral fractures.

Hindfoot Nailing for Surgical Management of Open Ankle Fractures in the Elderly: A Systematic Review.

Open ankle fractures in the elderly are increasingly common, with significant morbidity and mortality. Management is challenging due to poor soft tissue conditions, comorbidities, and limited functional independence. While traditional surgical options include external fixation or open reduction and internal fixation (ORIF),hindfoot nail (HFN) fixation may offer advantages, including immediate weight-bearing and reduced immobilisation complications. However, no systematic review has assessed the outcomes of HFNs in managing open ankle fractures in this population. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Comprehensive searches of the Medline, CINAHL, Embase, and Cochrane databases were conducted on September 24, 2024, with inclusion criteria focused on studies involving HFNfor open ankle fractures in patients aged ≥60 years. Outcomes included union rates, infection, complications, and functional recovery. Two reviewers independently performed data extraction and quality assessment (using the Newcastle-Ottawa Scale), with narrative synthesis due to study heterogeneity. Five retrospective studies were included where open ankle fractures were treated with HFNs. Across studies, immediate post-operative weight-bearing was allowed in most cases. Union rates ranged from 85% to 100%. Infection rates varied between 6.3% and 17.9%, with implant-related complications noted in 18.7% of cases. Functional outcomes, where reported, were moderate, with scores such as the Olerud-Molander Ankle Score (OMAS) averaging 45-57 (62 preoperatively). Mortality at six to 12 months ranged from 15% to 61%. Compared to ORIF, HFNsdemonstrated no difference in union rates or complications, including deep vein thrombosis (DVT) and pulmonary embolism (PE). HFNs utilised in arthrodesis resulted in increased wound complications, and implant removal reoperations compared to ORIF (10%-20% vs. 5%-10%) in frail patients with compromised soft tissues. HFNs used for fixation only resulted in similar complication rates to ORIF. HFNs appear to be a viable option for managing open ankle fractures in elderly patients. Offering advantages such as immediate weight-bearing and reduced immobilization risks. However, higher rates of implant-related complications and variable functional outcomes warrant caution. Prospective, comparative studies are needed to better delineate the role of HFNs in this complex patient population.

Hip fixation nail (HFN): Amulticentric prospective analysis of 189 cases of trochanteric and proximal femur fractures with a follow up of one year and more

: Encouraging results of final outcome with radiological and clinical function were observed in initial successful pilot study of Hip fixation nail in 43 cases studied in January 2020 to May 2022. This study was done individually by the author Dr Shashikant B Ganjale, who innovated this HFN. Now a Multicentric study was done by group of orthopaedic colleagues residing in different geographical areas. The cases were operated and followed up by studying the radiological, clinical results and functional outcomes were assessed individually and reported. The results were analysed by taking average of all findings of multicentric study and a final clinical results were observed and documented.: To have a multicentric study and assess the radiological and clinical functional outcomes of trochanteric and proximal femur fractures using Hip Fixation Nail operated at different geographical areas by different orthopaedic surgeons and have an unbiased prospective analysis and its mean results using Kyle’s criteria.: A small group of orthopaedic surgeons residing in different places studied individually by treating all intertrochanteric and peritrochanteric fractures along with few subtrochanteric fractures using HFN and long HFN .Trochanteric Buttress plate was also used along with HFN or Long HFN in Lateral wall fractures of proximal femur as per case.: The individual reports of final radiological, clinical and functional outcomes were documented and were grouped in common pool for analysis. An average of all results were documented and were found to be excellent and very much satisfactory using Kyle’s criteria.: The results of Hip Fixation Nail in treating stable and unstable trochanteric pertrochanteric and long HFN in subtrochanteric fractures of femur are promising and excellent.

Clinical application of intramedullary nail fixation assisted by locking plates in segmental tibia fractures: A retrospective study.

It is unclear whether small plates are needed for augment fixation to provide a more stable mechanical environment in segmental fractures of the tibia treated with intramedullary nail. The purpose of this study was to investigate the efficacy of intramedullary nailing combined with locking plates in the treatment of segmental fractures of the tibia. This study included 41 patients with segmental tibia fractures between January 1, 2018 and January 1, 2023. Eighteen patients were treated with an intramedullary nail assisted by a locking plate (combination group), and 23 patients were treated with an intramedullary nail without a plate (nail group). The perioperative parameters of all patients were recorded, and clinical efficacy was evaluated during follow-up. The operation time was shorter but the incision was longer in the combination group (P < .05). The numbers of fluoroscopy procedures and the time to union were shorter in the combination group (P < .05). The rate of malunion in the nail group (4, 17.4%) was significantly greater than that in the combination group (0, 0%). At the last follow-up, no statistically significant differences in walking ability were detected. Our results suggest that a locking plate combined with an intramedullary nail for segmental tibial fractures may require a longer surgical incision, but it has significant advantages such as a shorter operative time and time to union, a shorter fluoroscopy time, and a lower rate of malunion and nonunion. Intramedullary nail fixation assisted by a locking plate is an effective method for treating segmental fractures of the tibia.

Can We Predict 30-day Readmission Following Hip Fracture?

To determine the most common reason for 30-day readmission following hospitalization for hip fractures. Design: A retrospective review. Single academic medical center that includes a Level 1 Trauma Center. Included were all patients operatively treated for hip fractures (OTA 31) between October 2014 and November 2023. Patients that died during their initial admission were excluded. Patient demographics, hospital quality measures, outcomes and readmission within 30-days following discharge for each patient were reviewed. 30-day readmission reason was recorded and correlation analysis was performed. A total of 3,032 patients were identified with a mean age of 82.1 years and 70.5% of patients being female. The 30-day readmission cohort was 2.6 years older (p<0.001) and 8.8% more male patients (p=0.027), had 0.5 higher CCI (p<0.001), 0.3 higher ASA class (p<0.001) and were 9.2% less independent at the time of admission (p= 0.003). Hemiarthroplasty procedure (32.7% vs. 24.1%) was associated with higher 30-day readmission compared to closed percutaneous screw fixation (4.5% vs. 8.8%) and cephalomedullary nail fixation (52.2% vs. 54.4%, p<0.001). Those readmitted by 30-days developed more major (16.7% vs. 8.0%) (p<0.001) and minor (50.5% vs. 36.4%) (p<0.001) complications during their initial hospitalization and had a 1.5 day longer LOS during their first admission (p<0.001). Those discharged home were less likely to be readmitted within 30-days (20.7% vs. 27.6%, (p=0.008). Multivariate regression revealed increasing ASA class (O.R. 1.47, p=0.002) and pre-injury ambulatory status (O.R. 1.42, p=0.007) were most associated with increased 30-day readmission. The most common reason for readmission was pulmonary complications (17.1% of complications) including acute respiratory failure, COPD exacerbation and pneumonia. Thirty-day readmission following hip fracture was associated with older, sicker patients with decreased pre-injury ambulation status. Hemiarthroplasty for femoral neck fracture was also associated with readmission. The most common reason for 30-day readmission following hip fracture was pulmonary complications. Prognostic Level III.

Femoral shaft fractures in preschool children: external fixation and elastic intramedullary nail treatments in clinical practice.

Surgical intervention in preschoolers with femoral shaft fractures has increased due to the evolving lifestyle. This study aimed to analyze and compare the efficacy of elastic intramedullary nailing and external fixation in treating femoral shaft fractures in children aged 2-5. Ninety-nine pediatric patients were categorized into the external fixator (EF) and the elastic intramedullary nail (ESIN) group based on surgical techniques. Data on follow-up, intraoperative parameters, postoperative complications, fracture features, and demographics were gathered and compared. The mean duration of follow-up was 32 months, ranging from 25 to 48 months. All fractures had healed completely and no instances of nonunion were observed. At the latest follow-up, within the EF group, there were instances of malunion, delayed union, and refracture, each occurring once. One case in every group exhibited a leg length difference above 2 cm. The external fixation group had a shorter operation duration (P = 0.04), fewer intraoperative fluoroscopy times (P < 0.01), earlier partial weight-bearing time (P < 0.01), and full weight-bearing time (P < 0.01), while a greater complication rate (29.8 vs. 14.3%, P = 0.07) compared with the ESIN group. The incidence of pin tract infection in the EF group was 21.1% (12/57) compared with 2.4% (1/42) in the ESIN group (P = 0.07). Eighty percent of the patients' families expressed concern about the residual scar after removing the EF. The ESIN group encounters fewer complications and positive aesthetic effects, making it a preferable treatment option in this specific patient population and fracture pattern. Level of evidence: Class III, retrospective comparative study.

A comparative study of the role of carbon fibre reinforced polyetheretherketone and titanium intramedullary nails in patients with metastatic bone disease.

Carbon fibre reinforced polyetheretherketone (CFR-PEEK) implants have gained interest because of reported biomechanical advantages and radio-lucent properties. The aim of this study was to evaluate the role of CFR-PEEK nails in patients with metastatic bone disease (MBD). We performed a retrospective cohort study evaluating patients with MBD undergoing intramedullary (IM) nailing for prophylaxis or fixation of pathological fractures using CFR- PEEK or titanium implants. Patient survival, implant failure rates, ability to visualise disease progression on post- operative CT/MRI, and post-operative radiotherapy dose were reported. Fifty patients underwent 56 IM nails (26 CFR-PEEK and 30 titanium). Median survival was 8 months for the entire cohort, 6 months for patients with CFR- PEEK nails and 8 months for those with conventional nails (p=0.691). No implant failures were recorded in either group. There was no correlation between implant type and post-operative radiotherapy dose given (χ 2 = 0.139, p=0.710). Artefact on MRI was less evident with CFR-PEEK nails when hybrid imaging and metal artefact reduction techniques were used. The advantages of CFR-PEEK nails might not be realised in clinical practice for most patients with MBD requiring IM nailing except for in those likely to require prolonged disease surveillance.

Operating room times differ for surgical fixation of metacarpal fractures: An analysis of two principally different techniques.

Time spent in the operating room (OR) has ramifications that impact patient outcomes and the economics of patients, physicians, surgery centers, and insurance industry. For that reason, there is an incentive to seek approaches that allow shorter times to be spent in the OR. To what extent varying routine techniques impact on operating times has not been extensively studied in metacarpal fixation literature, specifically investigating retrograde threaded intramedullary nail fixations (RTNF) and comparing it to open plating fixations (OPF). The present study was designed for the purpose of comparing OR times for different but broadly adopted techniques for internal stabilization of metacarpal shaft fractures. A retrospective chart review was conducted for patients aged 18 and above, who over a 41-month period underwent internal fixation with RTNF or OPF for single, extra articular, closed fractures of the index through little finger metacarpals. We examined anesthesia records, which indicated total operating ("skin-to-skin") times. A total of 81 charts remained for review after exclusions. Statistical analysis of the recorded data showed significantly shorter median OR time values for RTNF (17 minutes, IQR = 14 - 20.75) vs. OPF (36 minutes, IQR = 31.55 - 44; p < 0.001). Statistical analysis of data shows significantly shorter operating times to achieve satisfactory fracture stabilization using RTNF compared to OPF. Since the differences in OR time significantly differ between the two principally different surgical techniques, it should be considered when choosing which surgical technique to use. However, further review of indications and clinical outcomes is necessary to develop definitive recommendations or guidelines on which technique should be preferred, especially when considering specific patient presentations. Retrospective Comparative Study III.

The functional outcomes of tibia fractures treated with intramedullary tibia nail: A retrospective study

Background: The tibia nailing system is a type of implant used to stabilize a broken tibia bone. It is intended for long bone fracture fixation of tibia fractures, which include transverse, oblique, spiral, segmental, comminuted fractures, open and closed fractures etc. There is different nailing system available each with its own advantages and limitation. The type of system that is used will depends on the severity of the fracture, location of the fracture and the patient individual anatomy. In this study the Tibia Nail was to treat the fracture. Materials and Methods: Total 14 patients having age ranging from 26-57 years were treated by Tibia nails. Retrospective analysis of patients who underwent Tibia nail fixation having tibial shaft fractures was performed. Clinical evaluation was done for all patients with a mean follow-up of 1.5 years. Radiological images taken at the follow up after surgery were utilised to assess the outcome. VAS Score was used for analysis. Results: The patients that are included in the current study were available for evaluation after a mean of 12 months of follow-up. Radiological union in all patients were achieved in 6.1-7.2 weeks. Apart from this, the patients stay in clinical hospital for the 12.2 days of mean duration. The result reveals that overall, VAS Score at the final follow up was satisfactory. In addition, the full weight-bearing with low level of pain was reported after 9-12 month of surgery. Conclusion: The tibia nail is an effective treatment of fractures of the tibia bone.