Reconstruction Nail Research Articles

Study of management of subtrochanteric fractures of femur with reconstruction nail

<p class="abstract"><strong>Background:</strong> Subtrochanteric fractures of femur are the fractures occurring from the inferior aspect of the lesser trochanter to 5 cm distally. They represent a challenge for surgeons due to the deforming forces acting on the region and the high rates of complications like non-union. This study evaluates the fixation of subtrochanteric fractures of femur with reconstruction nail which is a specialized antegrade intramedullary nail for femur.</p><p class="abstract"><strong>Methods:</strong> A prospective study conducted between October 2017 to May 2019 where 20 cases of subtrochanteric fractures of femur were treated with reconstruction nail and were followed up serially till 24 weeks radiologically and clinically.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average time of union for patients was 5.15±1.14 months with 3 patients whose fractures didn’t unite where one went for frank non union, one had a refracture and one patient had reverse z effect. The functional outcome was excellent in 45% patients and good in 30% patients while poor in 3 (15%) patients.</p><p class="abstract"><strong>Conclusions:</strong> Reconstruction nail is a good device for subtrochanteric fractures of femur providing rigid fixation with low complication rates.</p>

Clinical treatment of humerus fracture using intramedullary humerus nailing system

<p class="abstract"><strong>Background:</strong> The clinical results of intramedullary humerus nailing system of humeral fracture is controversial variation in implants, and follow up factor and operative technical studies. Humerus fracture is the third long fracture after femoral and tibia bone fracture.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, 45 patients (24 female and 21 male) between the age group of 18-75 years with humerus fracture were taken who did not get conservative management. Type of fracture was categorized according to AO classification. Intramedullary humeral nailing system (compression intramedullary humerus nail, reconstruction nail and reconstruction intramedullary humerus nail) manufactured at Auxein Medical Pvt. Ltd., was used to treatment of humerus fracture. Patient physical fitness was observed according to American Society of Anesthesiologist. Pain scale and outcomes was record from the patients using visual analog scale. Follow up of the patients were taken on 3-week, 8-week, 16-week, 1-year and 2-year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At 2 years follow up, bone consolidation was present in 44 cases. Only one case has reported of mortality but that was not due to implant related. No clinical and biomechanical complications were reported. Proper healing of implant was achieved.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary humeral nailing system is the best treatment option to treat the humerus fracture. Compression intramedullary humerus nail can minimize the gap and increase the biomechanical stiffness.</p>

Outcome of intramedullary nailing treatment for intertrochanteric femoral fractures

IntroductionThe OTA/AO type 31 A3 intertrochanteric fracture has a transverse or reverse oblique fracture at the lesser trochanteric level, which accentuates the varus compressive stress in the region of the fracture and the implant. Intramedullary fixation using different types of nails is commonly preferred. The purpose of this study is to evaluate intertrochanteric femoral fractures with intramedullary nail treatment in regard to surgical procedure, complications, and clinical outcomes.MethodsFrom one level 1 trauma center, 216 consecutive adult intertrochanteric femoral fractures (OTA/AO type 31 A3) were retrospectively identified with intramedullary nail fixation from 2004 through 2013. Of these, 193 patients (58.5% female) met the inclusion criteria. The average age was 70 years (range 19–96 years).ResultsCephalomedullary nails were utilized in 176 and reconstruction nails in 17 patients. After the index procedure, 86% healed uneventfully. Nonunion development was observed in 6% and 5% had an unscheduled reoperation due to implant or fixation failure. Active smoking was reported in 16.6%. Current smokers had an increased nonunion risk compared to those who do not currently smoke (15.6% vs. 4.3%; p = 0.016). The femoral neck angle averaged 128.0° ± 5°. Fixation failure occurred in 11.1% of patients with a neck-shaft-angle < 125° compared to 2.6% (4/155) of patients with a neck-shaft angle ≥125° (p = 0.021). Patients treated with a reconstruction nail required a second surgical intervention in 23.5%, which was no different compared to 25.0% in the cephalomedullary group (p = 0.893). In the cephalomedullary group, 4.5% developed a nonunion compared to 23.5% in the reconstruction group (p = 0.002). Painful hardware led to hardware removal in 8.8%. All of them were treated with a cephalomedullary device (p = 0.180). During the last office visit, two-thirds of the patients reported no or only mild pain but most patients had reduced hip range of motion.ConclusionIntramedullary nailing is a reliable surgical technique when performed with adequate reduction. Varus reduction with a neck-shaft angle < 125° resulted in an increase in fixation failures. Patient and implant factors affected nonunion formation. Smoking increased nonunion formation. Utilization of a cephalomedullary device reduced the nonunion rate, but had higher rates of painful prominent hardware compared to reconstruction nailing.

Intramedullary Nailing of a Periprosthetic Intertrochanteric Fracture in the Setting of Prior Hip Resurfacing: A New Technique for Fracture Fixation

We report the case of a 61-year-old male individual with a history of left hip resurfacing arthroplasty who sustained a left intertrochanteric fracture after a mechanical fall. While prior reports have described internal fixation with a femoral reconstruction nail or small frag locking compression plate for periprosthetic intertrochanteric fractures sustained around a Birmingham resurfacing prosthesis, our case is unusual in that the fracture extended into the lesser trochanter as well as the basicervical femoral neck. We present our technique for fracture fixation with a lateral entry femoral reconstruction nail and a derotation screw for this unstable injury as an alternative to currently available treatment options, which are limited to revision total hip arthroplasty.

Mechanical comparison of reconstruction nail and dynamic condylar screw in the treatment of unstable Subtrochanteric fracture in vitro study

Background: Subtrochanteric femur fractures are severe injuries that are often associated with high-energy trauma in young age and a trivial fall in osteoporotic patients. These fractures constitute a major bulk of hip fractures and are difficult to treat. Objective of this study was to determine the rigidity and strength of fixation and ultimate load of failure of certain composite femur models designed to simulate unstable subtrochanteric femur fractures fixed with DCS and Reconstruction nail. Methods: Paired femora were osteotomized to produce like models of an unstable subtrochanteric femur fracture in vitro. The femora were fixed with the Reconstruction nail and a 95 degree dynamic condylar screw plate (DCS). Materials testing machine was used to apply compression to the femoral head through an adapter plate. Stiffness values were calculated from the load-deformation curves obtained. Results: The Reconstruction nail-femur model was stiffer than the 95 degree DCS. The Reconstruction nail also had the highest ultimate load-to-failure than the 95 degree DCS. Conclusion: Our findings suggest that the Reconstruction nail has greater stiffness and strength than the 95 degree dynamic condylar screw when tested in this model of an unstable subtrochanteric femur fracture.

Outcome analysis of subtrochanteric fractures fixed with dynamic condylar screw, dynamic hip screw and reconstruction nail

To determine the rate of union, complications, operative risks and Functional outcome in subtrochanteric fractures treated with DCS, DHS and RECONSTRUCTION NAIL. To create an algorithm for surgery of choice in various Subtrochanteric fracture patterns. To determine the complications involved in the management of Subtrochanteric fractures.

Ipsilateral Femoral Neck and Shaft Fracture Management Single Implant versus Multiple Implants

Introduction: Fracture of shaft and ipsilateral neck of femur is a challenging problem to orthopaedics surgeons. The treatment is often difficult, and there are many protocols for the management of these fractures. Objectives: To assess the efficiency of multiple implants method for management of ipsilateral fracture neck and shaft femur using plate and screws or retrograde nail for femoral shaft fractures and cannulated screws or sliding hip screw for femoral neck fracture, evaluate the efficiency of reconstruction nail as a single implant method for management of fracture both neck and shaft femur as well as to compare the results of two management methods. Material and Methods: A total of 20 adult patients with ipsilateral femoral neck and shaft fractures were included in our study. Standard radiographs were obtained. Patients were divided into single implant group (Group I; 10 patients) and multiple implants group (Group II; 10 patients). All patients were followed prospectively for a minimum of 1 year. Fracture union was confirmed radiologically, and functional evaluation was done as per Harris Score. Results: 70% of both groups achieved successful fracture union with the remaining 30% with either nonunion, malunion or necrosis of the femoral head but with non- significant difference between both groups. Conclusion: Upon comparing single versus multiple implants methods, equivalent results, were clinically and radiologically obtained with both techniques. However, it is difficult to draw a definite conclusion as the number of cases is relatively small. A study with a larger population scale probably gives a definite conclusion.

Ipsilateral Femoral Neck and Shaft Fracture Management Single Implant versus Multiple Implants

Introduction: Fracture of shaft and ipsilateral neck of femur is a challenging problem to orthopaedics surgeons. The treatment is often difficult, and there are many protocols for the management of these fractures. Objectives: To assess the efficiency of multiple implants method for management of ipsilateral fracture neck and shaft femur using plate and screws or retrograde nail for femoral shaft fractures and cannulated screws or sliding hip screw for femoral neck fracture, evaluate the efficiency of reconstruction nail as a single implant method for management of fracture both neck and shaft femur as well as to compare the results of two management methods. Material and Methods: A total of 20 adult patients with ipsilateral femoral neck and shaft fractures were included in our study. Standard radiographs were obtained. Patients were divided into single implant group (Group I; 10 patients) and multiple implants group (Group II; 10 patients). All patients were followed prospectively for a minimum of 1 year. Fracture union was confirmed radiologically, and functional evaluation was done as per Harris Score. Results: 70% of both groups achieved successful fracture union with the remaining 30% with either nonunion, malunion or necrosis of the femoral head but with non- significant difference between both groups. Conclusion: Upon comparing single versus multiple implants methods, equivalent results, were clinically and radiologically obtained with both techniques. However, it is difficult to draw a definite conclusion as the number of cases is relatively small. A study with a larger population scale probably gives a definite conclusion.

Classifications in Brief: The Russell-Taylor Classification of Subtrochanteric Hip Fracture.

Classifications in Brief: The Russell-Taylor Classification of Subtrochanteric Hip Fracture.

Role of PFN in ipsilateral fracture neck and shaft femur: a single solution to double fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern that presents a diagnostic and treatment challenge. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced proximal femoral nails (PFN).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We analysed the retrospective data of 25 consecutive patients who had sustained a high energy trauma who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with PFN between January 2010 and January 2017.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Average follow up period was 1.2 years. All ipsilateral neck and shaft fractures were united with proximal femur nail (PFN). Neck fracture union averaged 4.3 months (range, 3–6 months). Shaft fracture union averaged 5.4 months (range, 4–7 months). Eighteen patients (70%) had a good functional result, five patients (21%) had fair result and in two patients the result (9%) was poor.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We observed although technically demanding, the reconstruction nail is an acceptable, cost effective and minimal invasive alternative for the management of concomitant ipsilateral fractures of the femoral neck and shaft, with a good functional outcome and fewer complications.&lt;/p&gt;

Evolution and principles of intramedullary locked nailing

Key factors for successful osteosynthetic fracture stabilization are anatomical fracture reduction, restoration of axis and torsion alignment as well as tissue-preserving operative techniques. In long bone fractures, the use of intramedullary long bridging nailing offers ideal conditions for bone healing, as axial and rotational stability is provided by canal-filling nails and locking screws. In addition, the tissue in the fracture region is protected as the intramedullary nail insertion is distant from the fracture. The indication spectrum for modern intramedullary locked nailing includes diaphyseal fractures of long bones, metaphyseal fractures and reconstructions, as well as treatment of nonunion, osteotomy and arthrodesis of the lower extremities. Continuous improvements in nail design and instrumentation as well as the introduction of anatomical reconstruction nails will optimize the spectrum and effectiveness of intramedullary osteosynthesis even further.

Role of cephalomedullary nail in proximal femur fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Hip fractures are recognized to be a major public health problem. Key determinants of hip fractures include age, osteoporosis, and falls. In these determinants socioeconomic status, have not been well explored. Under eccentric loading, high bending loads occur, leading to failure of the osteosynthetis anchorage at the center of the femoral head.The introduction of the reconstruction nail has broadened the indications for the intramedullary fixation of difficult femoral fractures. The operative technique is however complicated. Some technical difficulties encountered during its use are presented together with guidance to allow these problems to be avoided.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;This Study had included 47 cases which were operated by single surgeon and use of different implant (cephalomedullary nail) was randomized irrespective of fracture types and pattern. This study was done over a period of 12 months (October 2013 to October 2014) with 1 month, 3 months, 6 months, 12 months follow up. At every visit patient were assessed as per Oxford hip score. Type of implant used was&lt;strong&gt; &lt;/strong&gt;PFNA&lt;strong&gt;,&lt;/strong&gt; Intertan&lt;strong&gt;, &lt;/strong&gt;Sirus Nail&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;The mean age of the patients was 65.68 (±13.55) years. Severe pain was observed among majority of the patients at one month (70.2%) which became mild (40.4%) and moderate (34%) at 3 months. Very mild pain was found in 36.2% patients at 6 months and in 61.7% at 12 months. The limping was all the time among all the patients at one month. However, the limping was found often in 46.8% at 3 months and sometimes in 57.4% at 6 months and 53.2% at 12 months. The hip score was found to be severe among all the patients at one month. However, moderate to severe hip was in 46.8% patients at 3 months, mild to moderate was in 57.4% at 6 months and satisfactory joint function was in 68.1% at 12 months. The comparison of Hip score according to long or short nail at one 3, 6 and 12 months showed no difference. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Cephalomedullary nails with adequate technique so that the lag screws by purchase in the centre-centre or posterior-inferior quadrant combines the benefit of sliding hip screw as well as intramedullary implants. So we recommend the use of cephalomedullary nails in proximal femur fractures especially the unstable fractures.&lt;/span&gt;&lt;/p&gt;

Treatment for long bone metastases based on a systematic literature review.

To provide treatment guidelines for patients with long bone metastatic disease based on a systematic review of the literature and to propose an algorithm to guide orthopedic surgeons in decision-making for these patients. We performed a computerized literature search in MEDLINE, EMBASE and Scopus for studies on patients with long bone metastases. We used the key words "long bones", "metastasis" and "treatment" for published studies that evaluated any treatment for long bone metastases. The articles found were then studied to determine the accuracy of surgical treatments for long bone metastases in every anatomic location, regardless of cancer type, stage and grade of the oncologic disease. Guidelines inferred from this literature review were collected, and an algorithm was proposed. There was no clear evidence to support excision of a long bone metastatic lesion at the same surgical setting with internal fixation or prosthetic reconstruction. However, en bloc resection of an isolated bone metastasis may have a beneficial effect on survival. The life expectancy of the patients should be considered for any surgical treatment. Internal fixation preferably with reconstruction nails is indicated for meta-diaphyseal lesions; their rate of mechanical failure and complications ranges from 2 to 22%. Prosthetic reconstruction is indicated for extensive lytic lesions or pathologic fractures in a meta-epiphyseal locations; their rate of mechanical failure and complications ranges from 3.7 to 35%. Most of the internal fixation-related complications occur more than 1year after treatment, in contrast to prosthetic reconstruction-related complications that may occur earlier. Intramedullary nail fixation or prosthetic reconstruction should be chosen on the basis of the location of the lesion, the extent of bone destruction and the stability of the construct to outlast the expected life of the patient. Implant-related complication is similar but may occur earlier with prosthetic reconstructions.

Titanium Reconstruction Nailing For Sub - Trochanteric Fractures of Femur

Introduction: Sub-trochanteric fractures of femur present a challenging situation to the orthopaedic surgeons world-wide. Complications like malunion, nonunion and implant failure are high. Several implants have been designed for fixation of sub-trochanteric fractures. In this study we analyze the functional and radiological outcome of sub-trochanteric fractures treated by Titanium Reconstruction nails. Methods: This is a prospective study. 20 patients with sub-trochanteric fractures treated by Titanium reconstruction nail from June 2012 to December 2014 were included in the study. We analyzed these 20 patients for functional and radiological outcome and complications. Results: The fracture union rate was 100 % and the average union time was 14 weeks. 3 patients had varus malunion and shortening was noted in 4 patients. 85% of the patients had excellent to good functional outcome. Conclusion: We concluded that Titanium Reconstruction nail is an ideal implant for sub-trochanteric fractures with an excellent union rate and a very good functional outcome.

Study of Functional and Radiological Outcome in Subtrochanteric femoral Fractures FIXED with Reconstruction Nail

Sub-trochanteric femoral fractures present a challenging situation to the orthopaedic surgeons. There are many implants for fixation of subtrochanteric fractures. In this study we analyze the functional and radiological outcome of subtrochanteric fractures treated by Reconstruction nails. Irrespective of the implant used, it is important to get a good medial bone support by anatomical reduction, with cortical bone continuity, to prevent varus malunion. We concluded that Reconstruction nail is an ideal implant for Subtrochanteric fractures.

Proximal femoral nail antirotation for salvage of failed internal fixation of intertrochanteric hip fracture

Objective To evaluate the effect of proximal femoral nail antirotation (PFNA) with autogenous bone grafting for salvage of failed internal fixation of intertrochanteric hip fracture. Methods Between January 2007 and June 2012, 21 cases of intertrochanteric fractures who had failed internal fixation initially were treated with revision open reduction and PFNA internal fixation and autogenous bone grafting. There were 9 men and 12 women with the mean age of 54 years (range, 27-76 years). In the initially failed internal fixation, dynamic hip screw (DHS) was used in 7 cases, locking proximal femoral plate (LPFP) in 8 cases, Gamma nail in 2 cases, proximal femoral nail (PFN) in 2 cases and home-made reconstruction nail in 2 cases. Results Mean operation time was 150 minutes (range, 100-240 minutes) and mean blood loss was 800 ml (range, 400-2, 000 ml). There were no serious complications during operation. Mean follow-up was 26 months (range, 6-66 months). Bone healing was achieved at mean 4 months (range, 3-8 months) in all cases. Harris hip score was (42.1±3.2)points (range, 36-48 points) before operation and (87.2±3.8)points (range, 62-94 points) at the final follow-up, with significant improvement in hip function (P<0.05). At the final follow-up, no avascular necrosis of the femoral head or hip degeneration occurred and mean neck-shaft angle was 130°(range, 110°-142°). Conclusions Once the fracture patients with strong ability of action, massive proximal femoral residuals, and non-serious hip injury, revision PFNA internal fixation with autogenous bone grafting is effective. Complete preoperative evaluation and attention to specific technical details may improve success rate and reduce complications. Key words: Hip fractures; Fracture, ununited; Proximal femoral nails

Treatment for Concurrent Ipsilateral Femoral Neck and Shaft Fractures Using Reconstruction Nail with Temporary K-Wires

23 Copyright c 2015 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received October 8, 2014 Revised October 22, 2014 Accepted November 21, 2014 Address reprint requests to: Sang Hong Lee, M.D. Department of Orthopedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea Tel: 82-62-220-3147ᆞFax: 82-62-226-3379 E-mail: shalee@chosun.ac.kr

Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs

In surgical treatment for atypical femoral fractures (AFFs), reconstruction nail fixation is recommended for both complete and incomplete fractures. Although it has been reported that AFF is affected by many factors, The ASBMR Task Force 2013 Revised Case Definition of AFFs states that a curved femur is often seen in Asian patients. It is sometimes difficult to insert a nail into a femur in incomplete AFF patients with severely curved femurs. We report two incomplete bisphosphonate-related AFF patients with marked femoral curvatures treated by locking plates and teriparatide, showing early bone unions and favorable long-term outcomes.

Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results

Although intramedullary nailing is an ideal treatment for subtrochanteric femoral fractures, it is technically challenging in fractures extending into the nail entry area and/or involving the lesser trochanter. Although the application of circumferential wire may facilitate reduction in these situations, its use remains controversial due to possible blood supply disturbances to underlying bone. In the present study, we evaluated complex subtrochanteric fractures treated by percutaneous cerclage wiring followed by intramedullary (IM) nailing for anatomical fracture reduction and union. Twelve patients (mean age 48.3 years) with an unstable subtrochanteric fracture were prospectively treated. Indications of percutaneous cerclage wiring followed by IM nailing were a fracture extending proximally into the nail entry area deemed difficult to treat by anatomical reconstruction by IM nailing or a fracture with long oblique or spiral component. One or two cerclage wires were percutaneously applied for the temporary reduction of main fragments, and then, a cephalo-medullary or a reconstruction nail was fixed. We assessed radiologic results (union time, alignment), functional results, and complications. All 12 cases healed, without a bone graft, at an average of 19.1 weeks after surgery (range 16-24). In 11 cases, acceptable alignment was achieved (mean, valgus 0.3° extension 0.6°) with minimal leg-length discrepancy; the other exhibited 1 cm of shortening. All patients were able to return to pre-injury activity levels, and median Merle d'Aubigne score was 16.9 (15-18). No infection or implant-related complication was encountered to latest follow-up (minimum 12 months postoperatively). Temporary reduction by percutaneous wiring offers a means of satisfactory nailing in difficult subtrochanteric femoral fractures, and affords anatomical reconstruction and favorable bony union.

Study of Fracture Feature of Titanium Based Alloys for Biocompatible Implants after Removal from Human Body

The study of microstructure and fracture surfaces was performed on specimens of reconstruction plate, reconstruction nail and elastic nail. The composition and phase analysis of microstructure was performed by scanning electron microscope (SEM) JEOL JSM - 6490LV equipped with EDS INCA X - ACT probe. Examination of fracture surfaces by SEM confirmed that damage was not simply due to fatigue but contained evidence of corrosion and mechanical fretting as well.