Percutaneous Intramedullary Nailing Research Articles

Nursing intervention in geriatric intertrochanteric femoral fracture with percutaneous intramedullary nail fixation.

Nursing intervention in geriatric intertrochanteric femoral fracture with percutaneous intramedullary nail fixation.

Humeral shaft fracture: Outcomes of percutaneous antegrade intramedullary nailing using the long Telegraph® nail with dynamic distal locking

IntroductionAntegrade intramedullary nailing (IMN) in humeral shaft fracture (HSF) has been abandoned by certain orthopedic surgeons due to rotator cuff injury caused by curved nails, and to unreliable anatomical results. The purpose of this study was to report outcomes of straight percutaneous intramedullary nailing with dynamic distal locking in HSF. HypothesisPercutaneous antegrade intramedullary nailing using a long straight nail with dynamic distal locking improves radiological and functional outcome in HSF. Material and methodsA retrospective study was carried out, between january 2008 and june 2018, about 76 consecutive patients undergoing straight percutaneous antegrade IMN with dynamic distal locking for isolated closed displaced HSF. Eighteen patients were excluded; 36 were reviewed in June 2018 to assess Constant score. ResultsThere were 35 women and 23 men, with a mean age of 53years. All fractures were closed: 36 type A, 16 type B and 6 type C according to the AO/OTA classification. Healing was achieved in 97% of cases, at a mean 13±3weeks. There were no cases of infection or secondary nerve injury. The mean Constant score was 78±13. DiscussionSurgical treatment of humeral shaft fractures is a subject of discussion, without any consensus. Based on our experience, percutaneous antegrade IMN with dynamic distal locking improves anatomical and functional outcomes, provided that the surgical technique is mastered, which requires a learning curve. Level of evidenceIV, retrospective study.

Factors affecting healing following percutaneous intramedullary fixation of metacarpal fractures.

Although percutaneous intramedullary nailing of metacarpal fractures is a straightforward and reliable technique, it is not without complications, and patients experience different outcomes. This study analyzed factors affecting fracture healing time and complication rates in patients who underwent percutaneous intramedullary fixation of metacarpal fractures.This study was a retrospective review of the 25 patients who underwent retrograde percutaneous Kirschner wire (K-wire) nailing for fracture of the metacarpal shaft or neck at a military hospital between May 2016 and October 2018. Correlation study and multiple regression analysis were performed to evaluate variables (age, smoking history in pack-years, body-mass index, fracture site, number of K-wires used) that affect time to bone union. Clinical features of patients with metacarpal neck fractures and those with metacarpal shaft fractures were also compared.The metacarpal shaft fractures (as opposed to metacarpal neck fractures) and higher number of K-wire used were associated with longer time to bone union. Mean union time was significantly longer for metacarpal shaft fracture (8.6 weeks) than for metacarpal neck fracture (6.1 weeks) and for patients who received more K-wires than for those who received less (regression coefficient 1.307). One patient suffered fixation failure and required revision operation, and another experienced superficial infection which was treated with intravenous antibiotics.Percutaneous intramedullary nailing is an effective technique for metacarpal fractures, but fracture site and number of K-wire used affect time to achieve bone union.

Study on Percutaneous Intramedullary Nailing In Adult Diaphyseal Humeral Fractures

Objective: The objective of this research was to evaluate close fixation techniques for fractures of humerus via percutaneous intramedullary nailing.
 Methodology: This was a prospective study, carried out in Suleman Roshan Medical College Tando Adam Pakistan from January 2019 to January 2020. About 60 patients with humeral shaft fractures were made part of this study with a follow-up period of about 1 to 2 years. The inclusion criteria were humeral fractures that were of less than 7 days prior to surgery, the displacement of fracture >20° in sagittal as well as coronal plane, and the distance measuring >2cm between the two fragments. All patients were treated via the closed fixation technique. Multiple nails that were slender as well as flexible (3-5) were used in the close fixation technique including rush nails (45 patients) and ender nails (15 patients). All the patients within their follow-up periods were evaluated for ROM, pain, or any kind of deformity, and all the patients were assessed radiographically to check the process of bone union.
 Results: The outcome was analyzed before implant i.e at six months and after the implant was removed. About 86% patients (n= 52) revealed satisfactory outcomes at six months. About 5 patients revealed non-union or delayed union that was healed after 2nd surgery of bone grafting in 3 patients and injections associated with bone marrow in 2 patients. Stiffening of the shoulder was found to be a frequent complication that decreased significantly when the position of nail insertion was changed during the research.
 Conclusion: The technique of intramedullary nailing displayed many benefits including minimum tissue stress, a quick surgery time, decreased period of hospital stay, and rapid bone union.

Rotator cuff integrity and shoulder function after intra-medullary humerus nailing

IntroductionAntegrade percutaneous intra-medullary nailing (IMN) has a poor reputation in the treatment of humerus fractures. The aim of the present study was to assess rotator cuff integrity and shoulder function after IMN in humerus fracture. HypothesisThird-generation humeral nails (straight, small diameter, with locked screws) conserve rotator cuff tendon integrity and avoid the shoulder stiffness and pain incurred by 1st generation (large diameter, without self-blocking screw) and 2nd generation nails (curved, penetrating the supraspinatus insertion on the greater tuberosity). MethodsForty patients (26 female, 14 male; mean age, 60 years (range, 20-89 years)) with displaced humeral fracture (23 proximal humerus, 17 humeral shaft) underwent IMN using a 3rd generation nail (34 Aequalis™ (Tornier–Wright), 6 MultiLoc™ (Depuy-Synthes)). Mean clinical, radiologic and ultrasound follow-up was 8 months (range, 6-18 months); 22 patients agreed to postoperative CT scan. ResultsThere were no revision surgeries for rotator cuff repair or secondary bone displacement. Mean Adjusted Constant Score (ACS) was 93±22% and the Subjective Shoulder Value (SSV) 77±18%. Elevation was 140±36°, external rotation 48±22° and internal rotation was to L3. Ultrasound found: 5 supraspinatus tendon lesions (12.5%) (2 full and 3 deep partial tears) without functional impact (ACS) 91% without vs. 107% with tear; (p=0.12); 2 of the deep partial tears involved excessively lateral and high nail positioning. Eight patients (20%) had painful tendinopathy of the long head of the biceps (LHB) tendon associated with significantly impaired functional scores (ACS 65% vs. 100%; p<0.001); and 4 cases of technical error: 3 of anterior LHB screwing in the groove, and 1 of LHB irritation due to an excessively long posterior screw. ConclusionSupraspinatus tendon lesions following IMN with a 3rd-generation humeral nail were rare (12.5%) and asymptomatic; prevalence was not higher than in the general population in the literature (16%). LHB tendinopathy was frequent (20%) and symptomatic, and due to technical error in half of the cases. Level of evidenceIV, retrospective study.

Functional And Neurological Outcomes Of Closed Reduction And Percutaneous Pinning In Pediatric Monteggia Fracture

Introduction: The aim of this study was to assess the neurological and functional recovery of children with Monteggia fracture following closed reduction and percutaneous pinning.&#x0D; Methods: It was a descriptive observational study, patients aged from 3 to 15 years with Monteggia fractures are taken in to consideration during the period between 2074/02/01 and 2074/7/30. Participants were selected on the basis of pre-determined inclusion/exclusion criteria. A total of 33 patients were included in the study. The demographics and pre- and post-operative outcomes were recorded in semi-structured proforma. Data entry, synthesis and descriptive analysis were done using MS EXCEL and SPSS version 16.0.&#x0D; Results: Total of 33 patients met the inclusion and exclusion criteria. The mean age was 8.21±3.4 years, with sex ratio (m: f) of 1.75: 1. Majority of the patients (57.58%) injured their left elbow and the most common mechanism of injury was fall while playing (36.36%). According to modified classification system for children, 60.61% had class C and 39.39% had class B Monteggia fracture. Five patients (15.15%) presented with PIN injury. All patients were treated with closed reduction and percutaneous pinning (IM RUSH nail) within 2.27±1.30 days after injury. The average duration of surgery was 62.42±23.55 minutes. The average duration of fracture healing was 5.39±1.6 weeks. Jupiter’s criteria for the evaluation of elbow function was used and at the time of cast removal, 6 (18.18%) had excellent, 10 (30.30%) had good, 13 (39.39%) had fair and 4 (12.13%) had poor functional recovery.&#x0D; Conclusions: This study concludes that most of the pediatric Monteggia fractures (class B and C) can be treated with closed reduction and percutaneous intramedullary nailing using RUSH pins. This technique has very good functional and neurological outcomes with fewer complications.&#x0D; Keywords: children; functional recovery; Intra-medullary nailing; jupiter’s criteria; Monteggia fractures.

Clinical comparative study of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation for mid-clavicular fractures

To compare the effectiveness of thoracoscopic assisted reduction and traditional manual reduction with percutaneous intramedullary nail internal fixation in the treatment of mid-clavicular fractures. A prospective randomized controlled trial was conducted. Twenty-two patients with mid-clavicular fractures who met the selection criteria between March 2012 and March 2017 were recruited and randomly divided into trial group (7 cases, thoracoscopic assisted reduction and percutaneous intramedullary nail fixation) and control group (15 cases, traditional manual reduction and percutaneous intramedullary nail fixation). There was no significant difference in gender, age, side, cause of injury, fracture classification, interval between injury and operation between the two groups ( P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. The effectiveness was evaluated by Constant-Murley scale at 6 months after operation, which included subjective evaluation indexes (functional activity and pain) and objective evaluation indexes (range of motion of shoulder joint and muscle strength). The operation time of the trial group was significantly longer than that of the control group ( t=5.881, P=0.000). Patients in both groups were followed up 7-20 months, with an average of 11 months. Satisfactory anatomical reduction achieved in all patients, and all incisions healed by first intension. In the control group, 1 patient had difficulty in removing the intramedullary nail, and 1 patient had fracture nonunion. No fracture nonunion or intramedullary nail rupture in the other patients of two groups. There was no significant difference in fracture healing time between the two groups ( t=0.764, P=0.453). At 6 months after operation, there was no significant difference in Constant-Murley scale between the two groups ( P>0.05). The treatment of the mid-clavicular fracture by using thoracoscopic assisted reduction with intramedullary nail internal fixation requires longer operation time, but does not require fluoroscopy. The effectiveness is comparable to that of traditional surgery.

Displaced humeral surgical neck fractures: classification and results of third-generation percutaneous intramedullary nailing

The high rates of complications and reoperations observed with the early designs of first-generation (unlocked) and second-generation (bent design) humeral intramedullary nail (IMNs) have discouraged their use by most surgeons. The purpose of this study was to report the results of a third-generation (straight, locking, low-profile, tuberosity-based fixation) IMN, inserted through a percutaneous approach, for the treatment of displaced 2-part surgical neck fractures. We performed a retrospective review of 41 patients who underwent placement of a third-generation IMN to treat a displaced 2-part surgical neck fracture (AO/OTA type 11A3). The mean age at surgery was 57 years (range, 17-84 years). After percutaneous insertion through the humeral head, the IMN was used as a reduction tool. Static locking fixation was achieved after axial fracture compression ("back-slap" hammering technique). Patients were reviewed and underwent radiography with a minimum of 1 year of follow-up; the mean follow-up period was 26 months (range, 12-53 months). Preoperatively, 3 types of surgical neck fractures were observed: with valgus head deformity (Type A = 8 cases), shaft translation without head deformity (Type B = 19 cases), or with varus head deformity (Type C = 14 cases). At final follow-up, all fractures went on to union, and the mean humeral neck-shaft angle was 132° ± 5°. We observed 2 malunions and 1 case of partial humeral head avascular necrosis. No cases underwent screw migration or intra-articular penetration. At last review, mean active forward elevation was 146° (range, 90°-180°) and mean external rotation was 50° (range, 20°-80°). The mean Constant-Murley score and Subjective Shoulder Value were 71 (range, 43-95) and 80% (range, 50%-100%), respectively. Antegrade insertion of a third-generation IMN through a percutaneous approach provides a high rate of fracture healing, excellent clinical outcome scores, and a low rate of complications. No morbidity related to the passage of the nail through the supraspinatus muscle and the cartilage was observed. The proposed A, B, and C classification allows choosing the optimal entry point for intramedullary nailing.

Fractures of the neck of the fifth metacarpal bone, treated by percutaneous intramedullary nailing: surgical technique, radiological and clinical results study (28 cases).

This study report the results in 28 patients affected by closed fractures of the neck of the fifth metacarpal bone (boxer's fracture), treated with percutaneous elastic intramedullary nailing using a single wire, to verify the effectiveness of this surgical treatment. We reviewed the results of 28 patients treated with A single Kirschner wire (K-wire) pre-bent in a lazy-S fashion with a mild bend at approximately 5 millimeters, The K-wire is inserted blunt end first in an antegrade manner and the fracture reduced as the wire is passed across the fracture site The wire is usually removed with pliers post-operatively at four weeks in the fracture clinic. The follow-up period averaged of 20,75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal (MCP) range of motion, and time to union. We opted for this treatment in all cases, regardless volar angulation of the metacarpal head, malrotation of the fifth finger and associated or/no with a severe swelling of the hand. All the patients were reviewed clinically and radiologically at an average of 20,75 months after surgery. At the final follow-up, no patient reported residual pain and All fractures proceeded to bony union but we have one fracture had to be revised for failed fixation and three superficial wound infections needed antibiotic treatment. We recommend that this minimally invasive: percutaneous intramedullary nailing using a single k-wire in all metacarpal neck fracture( boxers’ fractures), especially when severe swelling of the hand is present, with good functional results and low morbidity.

Clinical observation on the different treatments targeted at different types of radial head fracture and radial neck fracture

To assess the effect of the different treatments targeted at different types of radial head fracture and radial neck fracture. A retrospective study was performed in 87 patients from February 2006 to March 2007. Fifty-four patients with radial head fractures included 36 males and 18 females, aged from 18 to 65 years (the average age was 33); Forty of them resulted from crashing, 8 from traffic injury and 6 from falling injury. According to Mason classification system, there were 15 type I, 23 type II and 16 type III. Thirty-three patients with radial neck fractures included 21 males and 12 females, aged from 9 to 17 years (the average age was 13), 29 of them resulted from crashing, 1 from traffic injury and 3 from falling injury. According to O'Brien classification system, there were 8 type I, 14 type II and 11 type III. Type I of radial head fractures and radial neck fractures were immobilization with cast, the patients with type II of radial head fractures were treated with open reduction and micro-screw or T-trapezoid and bridge-shaped plate fixation and type III had operations to fix with bridge-shaped locked plate and repair the broken annular ligament, or replace heads with prosthesis. All patients with type II and type III of radial neck fractures were treated with closed reduction by leverage and percutaneous intra-medullary nailing. The patients were followed up for 4-12 months (mean 7.2 months). The functional recovery degrees were evaluated with Wheeler's evaluation system. In group of radial head fractures, the results were excellent in 26 patients, good in 20, fair in 6 and poor in 2, the excellent and good rate was 85.2%. In group of radial neck fractures, the results were excellent in 20 patients, good in 9, fair in 4 and poor in no patient, and the excellent and good rate was 87.9%. Different types of fractures should choose different surgical methods according to their characters. The excellent functional recovery depend on anatomical reduction, retaining the head of radius, early repairing and protecting the broken annular ligament of radius, and early functional training.