Nailing Of Diaphyseal Fractures Research Articles

Prognostic factors for surgical site infection following intramedullary nailing of diaphyseal fractures of the femur and tibia in adult patients at a tertiary hospital in Lusaka, Zambia.

Our study aimed to identify prognostic factors for surgical site infection following long bone fracture intramedullary nailing at a tertiary hospital in a low-resource setting. This was a longitudinal observational study involving 132 participants enrolled over a one-year period with femoral and tibial diaphyseal fractures scheduled for ORIF. Participant median age was 30 years (range: 26 - 42). The prevalence of surgical site infection was 16%. Male sex (AOR=0.26, 95% CI [0.70-0.98]; p = 0.047) was associated with lower odds of surgical site infection while associated non-musculoskeletal injuries were associated with higher odds of developing surgical site infection. Our study confirms a higher surgical site infection rate than normally accepted. However, intramedullary nailing in our setting is justified as it allows an early return to a pre-injury state. These interventions must be carried out in the best possible circumstances. Future studies could explore alternative methods of fracture fixation.

Role of Elastic Stable Intramedullary Nailing in Diaphyseal Fractures in Children

Background: All femoral or tibial fractures regardless of associated injuries, intramedullary nailing (IMN) has its more advantages in rapid rehabilitation, good effects on the child and his family and strong fixation. Objective: To assess the role of elastic stable IMN in union of diaphyseal fractures of long bones in children. Patients and Methods: A prospective and retrospective analytical study on ten children with isolated femoral or tibial fractures who were admitted to Orthopedic Department, Zagazig University Hospitals. They were divided equally into group I that included 5 patients with femoral shaft fracture managed with IMN and group II, which included 5 patients with tibial shaft fracture managed with IMN. Their mean age was 4.7 years old. Results: When the groups compared, the spica cast group was found to have a shorter duration of hospital stay compared to elastic nail group. The knee range of motion of the spica cast group was found to be better compared to the elastic nailing group. The elastic nailing group was found to have started walking earlier both with and without support. Patients with intramedullary nailing started to walk with aid after one month and independently after 2 weeks. Patients with spica cast started to walk with aid after 2 months and independently after 12 weeks. Conclusion: None of the available treatment tools to fix diaphyseal long bones fractures in preschool children is perfect because each method has its own set of complications. However, constitute the motive for developing new techniques or changing the design of currently available devices.

COMPARATIVE STUDY BETWEEN THE DYNAMIC COMPRESSION PLATING (DCP) AND THE INTRAMEDULLARY INTERLOCKING NAILING IN DIAPHYSEAL FRACTURES OF THE HUMERUS IN ADULTS

AIMS: The aim of our study was to nd the difference between the mean duration of union and functional outcome between the dynamic compression plating (DCP) and the intramedullary interlocking nailing in diaphyseal fractures of the humerus in adults. MATERIALS AND METHODS: From May 2019 to October 2019, 34 patients with diaphyseal fractures of the humerus were treated with compression plating using dynamic compression plate or with intramedullary interlocking nail. The time taken for radiological union in the two groups was compared. After satisfactory radiological union, the functional outcome was assessed by the “Disabilities of Hand, Shoulder and Elbow (DASH) Questionnaire”. RESULTS: All fractures united and a marginal difference was noted in the time taken for union. The functional outcome was better in DCP group compared to interlocking nailing group which was statistically signicant (P= 0.010). The complication associated with interlocking group was more than the DCP group. We are of the opinion that when surgery is opted as a choic CONCLUSION: e of treatment, both the modalities of treatment i.e. dynamic compression plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the number of complications and functional outcome, we opine that dynamic compression plating offers better result than antegrade interlocking nailing with respect to pain and function of the shoulder joint.

A study of clinicoradiological and functional outcomes of intramedullary nailing in diaphyseal radius ulna fractures

<p class="abstract"><strong>Background:</strong> The aim of this study was to evaluate the results of intramedullary nailing in diaphyseal fractures of radius and ulna in age group of 10 to 49 years and to understand its clinicoradiological and functional results.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective case series study of forearm bone fractures and the selected management for the same over a period of 3 years. We chose the cases in which intramedullary nailing was the treatment modality which were followed up over a period of minimum 6 months. Patients with galeazzi variety, monteggia variety, pathological fracture or non-union after previous surgery were excluded. The outcomes were then evaluated with disabilities of the arm, shoulder and hand (DASH) score, Green and O’Brien score, and Grace and Eversmann functional outcome score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Of the 22 patients, 10 patients had excellent functional outcome according to Grace and Eversmann score, 7 patients had good outcome, 4 patients had acceptable while 1 was unacceptable. Green and O’Brien also had similar results, except that patients among fair category were 3 and poor category were 3. The mean DASH score was 16.2.</p><p><strong>Conclusions:</strong> This study shows that closed method for fixation by intramedullary nailing of both bone forearm fractures leads to excellent to good functional outcomes (according to DASH score, Green and O Brien, and Grace and Eversmann score) with less complications. In 6 months follow up x ray there is radiological union in all cases with no angulation, malunion or non-union. </p>

A biomechanical analysis of intramedullary nailing for humeral shaft fractures using 3D-finite element method

Background: Intramedullary nailing by antegrade and retrograde technique was introduced in humeral shaft fractures after interlocking nailing of femoral and tibial fractures achieved excellent results. The aim of this study was to evaluate biomechanical properties of antegrade and retrograde nailing in diaphyseal fractures according to levels of the humerus. Methods: To estimate and compare biomechanical stability of antegrade and retrograde nailing, 3D geometrical and finite element method (FEM) models of the humeral fractures and intramedullary nails were formed using Solidworks software, based on CT scans of the humerus and analyzed with ANSYS 15.0 program. Biomechanical analysis was performed under three types of loads: anterior-posterior (AP) bending, torsion and axial compression. Results: The bending properties of antegrade nailing were higher than those of retrograde nailing in any site of the humeral shaft fractures. During the testing under torsion, antegrade nailing showed that the displacements of fracture sites were lower compared to those retrograde nailing in the proximal and distal diaphyseal fractures. Under axial compression, antegrade intramedullary nailing demonstrated that the stiffness and displacement were found to be lower than those by retrograde nailing in the distal shaft of the humerus and there were no significant differences in stiffness and displacement between antegrade and retrograde nailing in the proximal diaphyseal and midshaft fractures. Conclusions: For the proximal and distal shaft fractures of the humerus, the stability of antegrade nailing was higher than the stability of retrograde nailing. In the midshaft fractures of the humerus, there was no biomechanical difference between antegrade and retrograde technique.

Elastic nailing in diaphyseal fractures of femur in children

Background: Fracture shaft femur in children is conventionally managed by traction followed by hip spica. Prolonged hospitalization, difficulty in maintaining child with traction for 3 weeks, then hip spica makes toileting and personal hygiene difficult. This may cause malunion/limb length discrepancies, rotational deformities, and sometimes psychological problems. Materials and Methods: A total of 32 children in the age group of 4-16years,25 boys and 7 girls having diaphyseal femoral fractures were stabilized with two stainless steel/titanium elastic nail retrograde way under fracture table. The average duration of surgery was 45 min (30–75 min). Patients were assessed clinically and radiologically before and after surgery for 2 years. Early mobilization and weight-bearing allowed. The results were evaluated using the criteria of Flynn et al. Technical problems and complications were also analyzed. Results: Duration of hospitalization was 4 days (3–7 days). The average duration of appearance of bridging callus was 6 weeks. Radiological union in all cases was achieved in a mean time of 8.7 weeks. All children showed sound union at an average 8 weeks without significant complications. Return to school was early with an average 10–12 weeks. Result assessed for range of motion (ROM), irritation at the distal end of the nail, pain, deformity, limb length discrepancies, union, and malunion. Overall results observed were excellent in 24, satisfactory in 5 and poor in 3 patients. The soft-tissue discomfort near the knee produced by the nail ends was the most common problem encountered. Three patients had decreased terminal ROM at the knee. Later, all the 32 patients had full ROM at hip and knee after 3 months. Conclusion: Elastic nailing in pediatrics femoral shaft fracture-simple and effective, small incisions, biological, dynamic fixation, early mobilization, rapid wound healing, rapid functional recovery.

English

AIMS: The aim of our study was to find the difference between the mean duration of union and functional outcome between the dynamic compression plating (DCP) and the intramedullary interlocking nailing in diaphyseal fractures of the humerus in adults. MATERIALS AND METHODS: From January 2007 to December 2008, 34 patients with diaphyseal fractures of the humerus were treated with compression plating using dynamic compression plate or with intramedullary interlocking nail. The time taken for radiological union in the two groups was compared. After satisfactory radiological union, the functional outcome was assessed by the Disabilities of Hand, Shoulder and Elbow (DASH) Questionnaire. RESULTS: All fractures united and a marginal difference was noted in the time taken for union. The functional outcome was better in DCP group compared to interlocking nailing group which was statistically significant (P= 0.010). The complication associated with interlocking group was more than the DCP group. CONCLUSION: We are of the opinion that when surgery is opted as a choice of treatment, both the modalities of treatment i.e. dynamic compression plating and interlocking nailing are good as far as union of the fracture is concerned, but considering the number of complications and functional outcome, we opine that dynamic compression plating offers better result than antegrade interlocking nailing with respect to pain and function of the shoulder joint. INTRODUCTION: Fractures of the diaphysis of the humerus and its complications are a major cause of morbidity in trauma patients. Fractures of the humeral shaft account for 20 % of the humeral fractures1 and about 3-5 % of all fractures2. Humeral fractures have a bimodal pattern in terms of age and sex of patients. The 1st peak is seen predominantly in young males in the age group 21-30 years mainly due to high energy trauma 2 . The 2nd peak in seen in females of age 60-80 years caused primarily due to simple falls 2 . Closed reduction is the mainstay of treatment of diaphyseal fractures of the humerus 3 . Operative treatment is required only if indicated2. Operative treatment commonly involves either plating or intramedullary nailing. The dynamic compression plate (DCP) is commonly used for plating and interlocking intramedullary nail is used for nailing. Closed intramedullary nailing is widely accepted for the stabilization of femur and tibia. Nowadays it is also being applied to the fractures of the humerus. Plate fixation gives high rates of union, but requires extensive open operation with stripping of soft tissues from the bone4. It also provides less secure fixation, especially in osteoporotic bone and if crutch walking is required. Closed intramedullary nailing avoids all these problems. Taking these points in mind, we undertook this study to compare these two modalities in the treatment of humerus fractures with respect to the mean duration for union & the functional

Closed intramedullary nailing of diaphyseal fractures

Closed intramedullary nailing of diaphyseal fractures