Open Nailing Research Articles

Lassa fever presenting as a cause of post-operative pyrexia following open femoral interlocking nailing.

We report a case where Lassa fever was diagnosed in the search for post-operative pyrexia. Protective measures may have prevented any transmission to the attending medical staff.

Comparison of Open and Closed Nailing for Femoral Shaft Fractures: A Retrospective Analysis.

IntroductionOpen and closed nailing are the two reduction methods used for the fixation of femoral shaft fractures. The study aims to assess the clinical and functional outcomes of open and closed nailing for closed femoral shaft fractures.MethodologyA total of 398 patients who underwent intramedullary nailing fixation of nonpathological femoral shaft fracture between January 2016 to December 2019 were reviewed retrospectively. Two hundred seventy-four underwent closed nailing, and 124 were considered for open nailing.ResultsThe primary outcome reviewed was the union rate of fracture. Other outcomes analyzed were complications, intraoperative blood loss, time to union, and the duration of the procedure. Patients in the open group had a union of fracture in 15.71 weeks, closed nailing group had a union in 15.53 weeks (p-value 0.495). Patients with open nailing had a mean Radiological union scale in tibial (RUST) fracture score of 11.435, whereas the closed nailing group had a mean of 11.664 (p-value 0.187). Operative time was higher in the open group when compared to the closed nailing group (p-value 0.000). However, intraoperative blood loss was more in open nailing in comparison to closed nailing. Furthermore, 15 patients with closed nailing had non-union, whereas 11 had non-union after open nailing (p-0.204). Superficial infection and deep infection requiring debridement were equally observed among the two treatment groups.ConclusionFixation of femoral shaft fractures with open nailing has similar outcomes in union rates, time to union, and rates of significant complication similar to those of close nailing.

Is open bone graft always necessary when treating aseptic subtrochanteric nonunion with a reamed intramedullary nail?

BackgroundThis study aimed to compare the radiological results between closed nailing without bone graft (BG) and open nailing with BG for aseptic subtrochanteric nonunion and to determine when an open procedure with BG should be considered.MethodsIn this retrospective study, we investigated patients who underwent surgical intervention for subtrochanteric nonunion between January 2008 and March 2018 in two institutions. Patients with infection, large bone defect, pathologic fracture, open fracture, previous surgery using plate, and follow-up of less than 1 year were excluded. We compared the demographic details and radiological results between patients who underwent the open procedure with BG (BG group) and the closed procedure without BG (non-BG group) as a historical control, and risk factors for the failure of revision surgery were evaluated.ResultsThirty-seven patients met the criteria and were divided into the following two groups: the BG group (n=19) who underwent open nailing with BG and the non-BG group (n=18) who underwent closed reamed nailing without BG. The mean degrees of correction of varus and flexion deformity were significantly different (p=0.001, respectively), 6.2° and 2.9° in the BG group and 4.1° and 0.6° in the non-BG group, respectively. Bony union was observed in 17 cases (89.5%) in an average of 7.4 months in the BG group and in 16 cases (88.9%) in 7.6 months in the non-BG group, with no significant differences. The factors that were significantly associated with failure of revision were atypical fracture, two or more previous surgeries, and varus and sagittal anterior angulation.ConclusionsThe radiological results of closed reamed nailing without BG for subtrochanteric nonunion were satisfactory. In the effort of percutaneous realignment, gap reduction, and intramedullary reaming, the radiological results of closed nailing without BG were not different from those of open nailing with BG; therefore, closed procedure without BG may be an acceptable option in appropriately selected patients.

A comparison of anterior knee pain, kneeling pain and functional outcomes in suprapatellar versus infrapatellar tibial nailing.

Anterior knee pain and kneeling pain are some of the most common complications following intramedullary nailing of tibial shaft fractures. With the increased uptake of suprapatellar nailing at our institution, we undertook a service evaluation to assess anterior knee pain and kneeling pain in patients who underwent the suprapatellar tibial nailing technique compared with the infrapatellar approach. Data from all consecutive intramedullary tibial nailing operations between January 2014 and July 2017 were analysed from a prospectively collected database. All acute diaphyseal fracture nailing procedures were included. All patients were reviewed between six-month and four-year post-operation. Each patient was asked to complete a standardised questionnaire with three main outcome measures: pain on kneeling, presence of anterior knee pain and the severity of pain. After exclusions, a total of 148 patients were identified. A total of 102 responses were received, 41 in the infrapatellar group (73.2%) and 61 in the suprapatellar group (66.3%). A longer time from surgery to telephone follow-up response was noted in the infrapatellar group: 32.4months (interquartile range, 16.1) vs. 19.3months (interquartile range, 17.4), p < 0.001. A trend towards lower reported anterior knee pain was noted in the suprapatellar group (67.9% VS 53.7%). Most patients reported mild or no pain on kneeling, with no significant difference between the two groups. There was also no significant difference in severity of knee pain between the two groups and no significant effect on the Kujala score. With the comparable pain outcomes between the two groups, our analysis supports the continued use of the suprapatellar tibial nailing technique for tibial shaft fractures at our institution.

Comparison of Different Dynamization Techniques Applied in Cases of Tibial Fractures with Fracture Healing Problem after İntramedullary Nail Operation

Çalışmamızda intramedüller çivi (İMÇ) uygulanan tibia kırığı vakalarında dinamik kilitleme ve kaynama gecikmesi nedeniyle ikincil dinamizasyon uygulanan vakaları kaynama süreleri yönünden karşılaştırmak amaçlanmıştır. Mayıs 2002 ile Eylül 2019 tarihleri arasında tibia kırığı nedeniyle İMÇ kullanılarak kapalı redüksiyon internal fiksasyon uygulanan 95 hasta çalışmaya alındı. Hastalar dinamizasyon tekniklerine göre 3 gruba ayrıldı. Birinci grup dinamik kilitleme yapılan hastalar, ikinci grup dinamizasyon amacıyla sadece statik vida çıkarılan hastalar, 3. grup dinamizasyon amacıyla dinamik ve statik tüm vidalar çıkarılan hastalardı. Gruplar; demografik bilgiler, sigara kullanımı, kırık tipi ve kaynama süresi açısından karşılaştırmalı olarak değerlendirildi. Çalışmaya dahil edilen 95 hastanın 61’i erkek, 34’ü kadındı. Hastaların yaş ortalaması 35 (19 – 63) idi. Hastaların ortalama takip süresi 21,3 (12 – 30) hafta idi. Grup 2’de kaynama süresinin diğer gruplara göre daha uzun olduğu görüldü. Tüm hastalar ve ayrı ayrı gruplar arasında yaş ve cinsiyet ile kırık kaynama süresi arasında anlamlı istatistiksel bir ilişki saptanmamıştır (p&gt;0.05). Tüm gruplar için sigara kullanan hastalarda kırık kaynama süresinin daha uzun olduğu saptanmıştır (p0.05). Gruplar, 12. haftadan tam kaynama gerçekleşene kadar geçen süreler açısından incelendiğinde grup 2’de istatistiksel olarak grup 3’ten daha uzun bir kaynama süresi olduğu saptandı (p

Hip fracture among elderly people: a single cohort study from Kurdistan of Iraq

Background: Hip fracture is considered a major health problem worldwide. The current study aimed to investigate hip fracture characteristics among older people in Iraq and factors involving postoperative mortality.Method: A single cohort study was carried out in Sulaimani and Shar Teaching hospitals in Sulaimani from the 1st of July 2018 to 30th of June 2019. Hip fracture was diagnosed by a specialist physician using an X-Ray. The data was collected by the researcher through direct interviews and filling a prepared uniform questionnaire. The data analyzed by SPSS and p-value&lt;0.05 was significant.Results: From the total of 100 hip fracture patients included, the average age of patients was 74.45±8.18 years. Fifty-nine patients aged 60 to 75 years, while the rest were older than 75 years. Female consisted of 59.0% of the total samples. Non-mechanical falls accounted for (84%) of all falls. Most patients had intertrochanteric fractures (65%), while 35% had femoral neck fractures. The Proximal femoral nail (PFN) operation was the primary type of operation (77%) performed. Most patients (94%) were discharged after two days. There was a significant association between gender and postoperative mortality; female patients had worse prognosis and higher mortality, relative risk (95%CI) 0.18 (0.0424 to 0.7788). Older patients aged 75 and more had a remarkably poorer prognosis than younger patients, relative risk (95%CI) 0.30 (0.10 to 0.93). There was a strong relationship between poor cognitive function (moderate to severe depression) and postoperative mortality rate with relative risk (95%CI) 0.04 (0.006 to 0.36). Finally, patients on three or more medications also had an outstanding worse prognosis, relative risk (95%CI) 0.022 (0.001 to 0.37). Conclusion: Hip fracture was more common among women and people aged above 75 years. The prevalence of intertrochanteric fractures was nearly double the femoral neck fractures. Age, female, depression, and polypharmacy had a statistically significant association with three-month mortality in hip fracture patients.

The safety and accuracy of the fluoroscopic imaging during proximal femoral fixation: A computerized 3D reappraisal of the joint penetration risk.

To assess the success of proximal cephalomedullary nailing operations for treating trochanteric fractures, surgeons utilize 2D fluoroscopy to observe the relative positions of the femoral head and the implant. One distance-based risk parameter, observed from the AP and Lateral projections, is the Tip-Surface Distance(TSD) that dictates how close to the outer cortex should the implant tip be residing to avoid post-surgical complications such as cut-out or joint penetration. In this study, the safety and the accuracy of the orthogonal fluoroscopic imaging were evaluated. A femoral head model was created and the risk zone was defined as a hemispherical shell of 5mm thickness beneath the subchondral cortex, which should not be violated during screw insertion. The remaining hemisphere beneath the risk zone was designated as the safe zone. To assess the effect of head size, each simulation was conducted for 34, 47, and 60mm diameter(Dfemur) femoral heads. The rate of safe zone violation was calculated for all possible screw endpoints with a TSD of at least 5mm on fluoroscopic orthogonal views (TSDAP and TSDLat). The minimum risk of joint penetration was achieved when the TSDAP/TSDLat ratio was 1. For Dfemur of 34mm there was a risk of 91.7% of the safe zone violation when each TSDAP and TSDLat were 5mm and 0% for 9mm. For Dfemur of 47mm, the risk was 92.2% for 5mm and 0% for 11mm. For Dfemur of 60mm, the risk was 92.3% for 5mm and 0% for 13mm. Safety maps were constructed for all possible TSD combinations for 34, 47, and 60mm femoral heads. Depending solely on the orthogonal fluoroscopic images is not a safe and accurate technique for assessing joint penetration risk during proximal femoral fixation due to the spherical geometry of the femoral head. The screw tip can lie completely outside of the femoral head even when it appears inside, in both orthogonal fluoroscopic views. Evidently, when using TSD, more stringent distance limits should be chosen, contrary to the recommended 5mm limit. Our safety maps for TSD combinations may be used to check the security of the implantation.

Open intramedullary nailing using ‘Greens Instrumentation’ in the treatment of femoral and tibial shaft fractures: a 5 years review of cases in a private health facility in the Niger Delta region of Nigeria

Background: Open reduction and intramedullary locked nailing using external jig (usually without intra-operative imaging) is gaining widespread popularity in developing and resource-poor countries for the management of lower limb long bone shaft fractures. I share our experience using the “Greens” instrumentation in the treatment of femoral and tibial shaft fractures in a private health facility in Delta State, Nigeria. Methods: This was a retrospective review of patients who had lower limb long bone shaft fractures seen and treated with open intramedullary nailing at a private health facility in Warri, Delta state Nigeria, over a five year period. Results: There were 20 patients with 21 lower limb long bone shaft fractures made of 13 males and 7 females (M:F = 1.5:1). Average age of patients was 42±18 years. Fifty per cent of the fractures were caused by RTA. The femur was affected in 19 fractures (90.5%) and 2 fractures affected the tibia (9.5%). Three of the fractures were open. Sixteen patients presented fresh (within 2 weeks of fracture) while the rest 4 presented at an average of 7.8±1.5 months post fracture with various complications after treatment elsewhere. All patients except 1 had open nailing. Average length of hospital stay was 19.0±9.3 days. The average time between surgery and partial weight bearing was 10.0±6.7 weeks while mean time to full weight bearing was 18.5± 6.7 weeks. Complications included deep infections in 2 patients, distal screw displacement due to early weight (against instruction) in 1 patient, delayed union in 1 patient and death of 3 patients. Conclusion: Open IM nailing of femoral and tibial shaft fractures with the “Greens” instrumentation is an effective treatment method in resource-poor settings like ours where intra-operative imaging is not readily available.

System integration of a fluoroscopic image calibration using robot assisted surgical guidance for distal locking process in closed intramedullary nailing of femur

&lt;span&gt;Distal locking procedure is one of the most complex tasks in close intramedullary nailing operation which requires fluoroscopic image to interpret 2-D distal locking position on image related to 3-D distal locking position on the patient site. Hence the surgeon has to perform the distal locking process by using multiple fluoroscopic images which causes a lot of x-ray exposure to the patient and surgeon and is a time consuming task. This paper presents the system integration of a fluoroscopic image calibration using robot assisted surgical guidance. The system integration consists of three parts; distal locking recovery, fluoroscopic calibration and tracking, and robot assisted surgical guidance. The distal locking-hole recovery algorithm is based on characteristic information of the major and minor axes of distal locking hole. The fluoroscopic calibration and tracking is modeled as pin-hole projection model to estimate a projection equation based on optical tracking system. The robot-assisted surgical guidance is developed to overlay a trajectory path using a laser beam for reducing the problem of hand – eye coordination on most surgical navigation system. We integrate each part to complete a surgical navigation system for distal locking process. The experiment of system integration is conducted to validate the accuracy of distal locking axis position and orientation. The results of the system integration shows a mean angular error of 1.10 and mean Euclidean distance in X-Y plane error of 3.65 mm.&lt;/span&gt;

Pre-planning of intramedullary nailing procedures: A methodology for predicting the position of the distal hole

Inserting the distal locking screws is a challenging step of the intramedullary nailing procedures due to the nail deformation that makes the proximally mounted targeting systems ineffective. A pre-planning methodology is proposed, based on an analytical model of the nail–bone construct, to predict the nail deformation during surgery using orthogonal preoperative radiographs. Each of the femoral shaft and the nail was modeled as a curved tubular Euler–Bernoulli beam. The unknown positions and forces of the nail–bone interaction were found using a systematic trial and error approach, which minimized the total strain energy of the system while satisfying the force and geometrical constraints. The predictions of the model for the nail deformation were compared with the experimental results of five cadaver specimens in 15 test conditions. Relatively large displacements (up to 13 mm) were found for the distal hole in sagittal plane only. The model predictions were in close agreement with the experimental results, with a root mean square error of 1.2 mm. It was concluded that the proposed pre-planning methodology is promising for practical clinical use in intramedullary nailing operations, in order to provide the compensatory information that is required for tuning of proximally mounted targeting systems.

Early outcome of open locked intramedullary nailing of femoral diaphyseal fractures in a resource – poor setting

Background: Closed locked intramedullary nailing is largely considered the preferred treatment option for fractures of the femoral diaphysis, owing to its associated high union and low complication rates. In resource poor regions where intraoperative imaging is not readily available, most of these injuries are treated by open locked intramedullary nailing and plate osteosynthesis. This study was designed to assess the outcome of open locked intramedullary nailing of femoral diaphyseal fractures. Methods: Medical records and radiographs of all adult patients who had open locked intramedullary nailing of fractures of the femoral diaphysis between January 1, 2013 and July 31, 2017 were retrieved. A total of 45 patients with 46 fractures of the femoral diaphysis were retrospectively studied. Each patient was followed up for at least 12 months. Early outcome of treatment was assessed using the Thorresen's criteria. Results: A total of 45 patients (24 male; 21 female) with 46 femoral diaphyseal fractures were studied. The age range of the patients was 18 years to 80 years, with a mean age of 33.56 (SD=12.87) years. Forty two (91.3%) cases were closed fractures. Twenty four (53.3%) patients had right femoral diaphyseal fracture. The overall union rate was 95.7%. The range of time to fracture union was 12 weeks to 34 weeks, with an overall mean time to fracture union of 13.65 ± 3.57 weeks. Ipsilateral knee joint stiffness (n=4, 8.7%) and osteomyelitis (n=3, 6.5%) were the commonest complications recorded. Overall infection rate was 10.8%. Using the Thoresen's criteria, the overall outcome of treatment in this study was excellent in 37 (80.4%) patients. Conclusion: There is no significant difference between the outcome of open nailing compared to closed nailing of femoral diaphyseal fractures Keywords: Locked intramedullary nailing, femoral diaphyseal fractures

Clinical analysis of application of antibiotic bone cement spacer combined with membrane induction technology in treatment of osteomyelitis after femoral intramedullary nail operation - A case series.

Clinical analysis of antibiotic bone cement spacer combined with membrane induction technology in the treatment of osteomyelitis after intramedullary nail fixation operation for femoral shaft fracture was retrospectively performed on 12 cases in Department of Orthopaedics Centre, Renmin Hospital, Hubei University of Medicine from February 2013 to November 2016. The healing time of bone defect, infection recurrence and other complications were observed. Membrane induced series treatment scheme was given to all patients. Membrane-induced sequence therapy consisted of the first stage which included complete debridement, removal of the original internal fixation of intramedullary nail, intraoperative preparation of antibiotic bone cement rod into the medullary cavity and full drainage. The second stage included replacement of the interlocking intramedullary nail after infection control and autologous iliac bone graft was then used at the bone defect. Followup visits for bone situations were conducted for all the cases and the duration was 12-35 min (25.75 min on average). Fractures of all patients healed clinically. The healing duration was 4-11 min (7.33 min on average).After treatment, patients had no significant shortening of the limbs and their gait was normal at 12 months follow-up. This study is of femoral shaft fracture with no involvement of the joints and range of movement was not measured. No apparent relevant complications were seen.

Result of Internal Fixation of Femoral Shaft Nonunion with Implant Failure by SIGN Interlocking Nail at Rajshahi Medical College Hospital

This prospective study on result of internal fixation of femoral shaft nonunion with implant failure by SIGN interlocking nail was carried out during the period of January 2009 to December 2016at Rajshahi Medical College Hospital, Bangladesh. Mean age of the patient was 34 years (11-70 years), majority of the patients were male (76%), injury was due to high energy trauma (88%), right side involvement was more (68%).Closed exchange nailing was done in 28 cases (56%) and open nailing was done in 22 cases (44%). In the open cases previous implants were removed, refreshening of the fracture ends was done. Antegrade or retrograde SIGN interlocking nailing depend on the site involvement. Reaming materials were used as internal bone graft in all the cases. Autogenouscancellous bone graft was given in 5 cases due to comminution at fracture site (2 cases) and severe osteoporosis (3 cases). The final outcome satisfactory result was found in 44 (88%) cases and unsatisfactory result in 6 (12%) cases.TAJ 2017; 30(1): 11-16

Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing versus infrapatellar tibial nailing

BackgroundFractures of the tibial shaft are routinely managed with intramedullary nailing. An increasingly accepted technique is the suprapatellar extended leg method. The aim of this study was to investigate whether the suprapatellar tibial nailing technique offers shorter intraoperative fluoroscopy times and lower radiation doses when compared to the traditional infrapatellar technique. Study design and methodsData from 200 consecutive intramedullary tibial nailing operations in our level 1 Major Trauma Centre were retrospectively collected from a prospective database (January 2014–December 2017). Only acute diaphyseal nailing procedures were included. The operations were performed by seven senior trauma consultants experienced in both suprapatellar and infrapatellar tibial nailing. The operations were divided into two groups: infrapatellar and suprapatellar. Intraoperative radiation time and dose data were collected. ResultsA total of 90 cases were included and analysed. The majority of the patients were male (82%). 37 operations were infrapatellar and 53 were suprapatellar. Independent samples t-test revealed lower radiation time and dose for the suprapatellar group. The infrapatellar group had a mean radiation time of 129.7±56.6s versus 94.4±47.9s for the suprapatellar group. The infrapatellar group had a mean radiation dose (Dose Area Product) 53.6±34.2 cGYcm2 versus 38.2±26.7 cGYcm2 for the suprapatellar group. The difference in mean radiation time and mean radiation dose were both significant (p=0.002 and p=0.02 respectively). ConclusionsSuprapatellar tibial nailing is an increasingly accepted technique in the management of tibial fractures. It is shown here that amongst surgeons experienced in both suprapatellar and infrapatellar nailing techniques, the suprapatellar approach trends towards lower use of intra-operative fluoroscopy as measured by time and dose and thus potentially lower radiation exposure to the operating surgeon, assistants and patient.

Use of intramedullary implants in adult diaphyseal fracture both bone forearm

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Fractures of the forearm bones are very common. The most common form of stabilization is plate and screw fixation. The role of Intramedullary nailing of fractures of the shafts of the adult radius and ulna is still to be defined. This study was perform to analyze anatomical and function outcome of the patients treated by Talwarkar square nail.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;We evaluated 46 patients (29 males and 17 females) had fracture both bone forearm treated by intramedullary nail. We analyzed patients in two broad group one with close fracture or grade I, II open fracture (34 patients) and other have open fracture grade IIIA or IIIB (12 patients). First group patients further analyzed weather close (22 patients) or open reduction (8 patients) required. Functional outcome was calculated by Grace and Eversman system&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Out of 32 patients of close fracture or open grade 1 or 2 fracture, 29 (90.62%) have excellent or acceptable result. All the patients (100%) in whom close reduction succeeds achieved excellent result. 22 (64.70%) patients close nailing possible.12 patients in whom open reduction required 9 (75%) goes into union. Close nailing have overall success rate is 90.62% where it fail and open nailing require success rate bring down to 75%.. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;IM nailing gives satisfactory results. Advantages of close nailing are- early union, low incidence of infection, small scars, less blood loss, short operating time with minimal surgical trauma, easier implant removal. Even though plate and screw fixation is the gold standard for stabilization of both bone forearm fracture but intramedullay implant can be used in selected cases with good result. To achieve acceptable result – early surgery, proper selection of the case, pre-operative planning, proper assessment of diameter, length and radial bowing of the nail, is required.&lt;/span&gt;&lt;/p&gt;

Tratamento de fraturas patológicas tumorais diafisárias do úmero com haste intramedular rígida bloqueada estática – Experiência de 22 anos

ObjectiveRetrospective observational study in patients submitted to fixation with intramedullary nail after established or impeding pathological humerus‐shaft tumoral fracture in the context of disseminated tumoral disease alongside 22 years experience in the same institution. MethodsSample with 82 patients and 86 humeral fixations with un‐reamed rigid interlocking static anterograde or retrograde intramedullary nail. ResultsThe most prevalent primary tumors were breast carcinoma (30.49%), multiple myeloma (24.39%), lung adenocarcinoma (8.54%), and renal cell carcinoma (6.10%). The average nailing operation time was 90.16 ± 42.98minutes (40‐135). All patients referred arm pain improvement and there was a MSTS mean score rise from 26% in the preoperative to 72.6% in the evaluation performed in the still living patients three months after the surgery. The survival rate showed an overall survival of 69.50% at three months after surgery, 56.10% at six months, 26.70% at one year, and 11.90% at two years. None of the deaths were related to the surgery or its complications. There were only four complications related to the operation, one intraoperative and three late, corresponding to a 4.65% complications risk. ConclusionClosed un‐reamed static interlocking intramedullary nailing (anterograde or retrograde) of the humerus is a fast, safe, effective, and low morbidity procedure in the treatment of pathological fractures of humerus shaft, guaranteeing a stable arm fixation and consequently improving function and life quality of these patients during their short life expectation.

Randomized controlled trial comparing open versus closed interlocking nail for closed fracture shaft of femur in Adults

Background: Close reduction and intramedullary fixation of fracture shaft femur proposed by Kuntscher, is the most biological way of treating the fracture shaft femur. But an open version of this procedure, by which the fracture is stabilized by opening the fracture site and fixing it by retrograde method, became popular because of less complication and more predictable operating time. With the development and emergence of image intensifier and modification in the technique, the locked intramedullary gained popularity. Locked intramedullary nailing can be inserted in a static or dynamic fashion. Aim and Objectives: To compare outcome of open versus closed interlocking nail for fracture shaft of femur in Adults in term of: union, Blood loss, infection rate, functional outcome, Complications if any. Methods and Materials: It is Randomised Controlled Trial Study. Randamization was done using Excel random number generation technique into two groups, each of size 40. Group A:- Diaphyseal fracture treated with closed methods. Group B:- Diaphyseal fracture treated with open methods. Sample size: 40 in each group Results: A total of 80 patients (49 male and 31 female) were included in the study. 15 patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients between 41-60 age group and 10 patients more than 61 years. Road traffic accident is commonnest mode of injury followed by fall from height. The average blood loss is 119.5 ml in Closed nailing group and 139.5 ml in open nailing group. The procedure time is 71 mins in closed naililng group as comprared to 97 mins in open nailing group. Discussion: A total of 80 patients (49 male and 31 female) were included in the study. 15 patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients between 41-60 age group and 10 patients more than 61 years. Road traffic accident is commonnest mode of injury followed by fall from height. The average blood loss is 119.5 ml in Closed nailing group and 139.5 ml in open nailing group. The procedure time is 71 mins in closed naililng group as comprared to 97 mins in open nailing group. Conclusion: Closed IMIL nailing group needs fracture table and image intensifier. Operating time and blood loss is more in Open nailing group. Cost of treatment and union is comparable in both groups. Infection is more in open group as compared to closed group.

Closed vs open nailing for displaced middle third fracture of clavicle. Does it matter?

Intramedullary nailing for fractures of middle third clavicle has become increasingly popular. Though open nailing has been widely described, closed nailing finds less mention. In this study we compared closed nailing with open nailing in fractures of middle third of clavicle to assess if the former holds any advantage. 34 patients with closed nailing were compared to 31 patients with open nailing in terms of operative time, length of incision, pain, time to union and functional outcome. Only operative time and length of incision were significantly more in open group than in closed group. We believe that closed reduction can be attempted in all patients undergoing nailing for middle third clavicle fracture but surgeon should have a low threshold to open the fracture if closed reduction fails as functional outcome and time to union remains unaffected.

Assessing the impact of fracture pattern on transfusion requirements in hip fractures.

Hip fractures in the elderly represent a major source of morbidity and mortality, with allogeneic blood transfusions (ABTs) associated with increased mortality. This study assesses the ABT requirements between the most common patterns of hip fracture; intertrochanteric (IT) and intracapsular (IC). The impact of operation type on transfusion rates was also assessed. A retrospective study was performed for all patients entered on the national hip fracture database over 1year in a teaching hospital. Records of 559 patients were reviewed and, following exclusion criteria, 474 were evaluated (198 IT, 276 IC). Baseline haematological parameters and ABTs were identified using hospital systems. Analysis was performed in SPSS, using independent samples t tests, one-way ANOVAs and Chi square tests. Patient groups were matched on gender, anaesthetic type, American Society of Anesthesiologist (ASA) grade, cognitive score and coagulation parameters. A significantly greater proportion of IT patients required an ABT during admission (39.4 vs. 22.5%, p<0.001). For IT fractures a greater proportion of patients required an ABT when undergoing an intramedullary nail operation compared with those requiring a dynamic hip screw (67.4 vs. 32.0%, p<0.001). Similarly, for IC fractures transfusion rates in patients undergoing an internal fixation were significantly lower than those undergoing hemiarthroplasty or arthroplasty (9.4 vs. 26.4 vs. 20.8%, p=0.033). Patients with IT hip fractures are significantly more likely to require an ABT than those with IC hip fractures. Patients undergoing an intramedullary nail for IT fractures have significantly higher transfusion rates than for other types of operation.

Treatment of Displaced Mid-Clavicle Fractures by Closed Titanium Elastic Nail

Introduction: Recently, intramedullary nailing for displaced middle third fractures of clavicle has received wide attention. Though open nailing has been widely described, closed nailing finds less mention. This paper therefore aims to study the outcome of closed titanium elastic nailing for displaced mid-clavicular fractures. Material and Methods: This was a prospective study of 34 patients with displaced middle third clavicle fracture who underwent closed intramedullary nailing with titanium elastic nail at a tertiary care centre. The operative time, length of incision, time for radiological union, pain and functional outcome after union were noted. Results: The mean operative time was 34.33 mins. The mean time of discharge was 2.25 days. The average time of radiological union was 10.23 weeks. All the patients achieved full, painless range of motion of the ipsilateral shoulder. The average Constant-Murley score at 12 months was 94.28 indicating excellent result. Conclusion: Closed titanium elastic nailing offers a safe and minimally invasive method of fixation for fractures of middle-third clavicle with excellent functional outcome.