Retrograde Intramedullary Nailing Research Articles

Periprosthetic distal femoral fractures after total knee replacement treated by ORIF. Mid to long-term follow-up study in 12 patients.

Periprosthetic fractures following total knee arthroplasty are a quite uncommon traumatic lesion that often are present in elderly patients with osteoporosis and comorbidities. The most common periprosthetic fracture affects the distal femur. The main internal fixation techniques are ORIF with a locking plate and retrograde intramedullary nailing. In the present study, we report the medium-long term results in 12 patients with a distal femoral periprosthetic fracture stabilized with a locking plate. We reviewed 12 patients affected by a periprosthetic distal femur fracture surgically treated between 2010 and 2016 by ORIF using a locking compression plate after an average follow-up of 5.75 years. The average age of the patients at diagnosis was 78 years. The mean interval time between knee arthroplasty and distal femoral fracture was 8.25 years. Clinical results were assessed using the WOMAC score, while radiographic results according to Beals and Tower's criteria. All fractures of our series were type II according to the Rorabeck and Taylor classification. At follow-up, the WOMAC score ranged from 40.5 to 76.5 points (average 53.92). Radiographic results, according to Beals and Tower's criteria, were excellent in 5 patients and good in 7. All patients returned to their previous daily activities. We believe that reduction and internal fixation with a locking plate is a surgical option of treatment that provides satisfactory clinical and radiological results in Rorabeck type II periprosthetic distal femoral fractures.

A Single-Center Comparative Study: Outcome Analysis of Fixation Techniques for Tibiotalocalcaneal Arthrodesis.

Introduction Tibiotalocalcaneal arthrodesis (TTCA) is a well-known and accepted surgical technique for end-stage ankle osteoarthritis. The aim of this study is to compare the postoperative clinical and radiological comparison of retrograde intramedullary nailing (RIMN) and plate/cannulated screw (P/cS) fixation methods in patients undergoing TTCA. Methods Patients with end-stage ankle osteoarthritis due to traumatic causes or rheumatic diseases between December 2012 and March 2019 were included in the retrospective study. Patients who underwent isolated tibiotalar or isolated subtalar arthrodesis were not included in the study. Functional scores of patients with bone fusion were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form-36 (SF-36) quality of life score surveys, administered either in person or by phone. From the radiological point of view, it was evaluated whether the union was achieved with the two-view ankle radiograph. There were 48 patients who underwent ankle arthrodesis in the clinical archive. A total of 31 patients were excluded from the study due to failure to attend follow-up, inability to be reached, or non-compliance with study criteria. The mean age of the patients participating in the study was 44.12 ± 12.95 years, the follow-up time was 40.06 ± 27.31 months, the union time was 5.19 ± 3.17 months, and the AOFAS score was 53.12 ± 13.87. SF-36 scores were evaluated among their own subunits. Results A total of 17 patients were enrolled in the study, of whom 13 were male (76.47%) and 4 were female (23.53%). There was no significant effect of the fixation methods (RIMN or P/cS) selected for TTCA on union times (p>0.05). However, there were significant differences in some parameters of the SF-36 when compared by gender. According to this, the scores of men in physical function (PF), mental health (MH), and general health perception (GHP) were higher than those of women. When AOFAS and SF-36 scores were compared by fixation type, no statistically significant difference was found (p>0.05). Conclusion This study investigated the impact of the fixation method on clinical and radiological outcomes in TTCA. We found that both methods were clinically similar in terms of bone union time and surgical efficacy. However, men had better physical function, mental health, and general health perception after TTCA than women.

Intramedullary Fibular Strut Allograft and a Small Fragment Nonlocking T-plate for Periprosthetic Lateral Femoral Condyle Fracture: A Case Report

Intramedullary Fibular Strut Allograft and a Small Fragment Nonlocking T-plate for Periprosthetic Lateral Femoral Condyle Fracture: A Case Report

Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients

PurposeThe aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups.MethodsBetween January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12–120 months).ResultsOut of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18–99) and 70.1 (18–100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6–48, SD 7.3) versus 28.4 (3–48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01.ConclusionWhile the rate of non-union was higher in the LP group and the functional results were superior in the plating group.

Tibiotarsal Arthrodesis with Retrograde Intramedullary Nail and RIA Graft: A Salvage Technique.

Ankle arthrodesis is a commonly used salvage procedure in the management of post-traumatic ankle fractures, which often result in severe disability and may require the amputation of the distal third of the leg. Successful ankle arthrodesis relies on a thorough assessment of local and systemic risk factors to ensure optimal results. Failure to accurately assess these factors may lead to unsatisfactory results. High-energy trauma causing bone defects and soft tissue necrosis often results in osteomyelitis, a condition that poses a significant threat to the success of the arthrodesis procedure. It is important to apply a standardised surgical protocol to minimise the possibility of superficial and deep infection and limit damage to the neighbouring soft tissues. Therefore, it is critical to undertake surgical lavage and debridement and administer systemic and local antibiotic therapy, along with the use of a spacer, to eradicate infection prior to performing arthrodesis. In this study, we present our experience in the recovery of limbs with post-traumatic complications via tibio-astragalic or tibio-calcaneal arthrodesis using a retrograde intramedullary nail technique. The approach involves a multi-step procedure using a previous antibiotic spacer implant and an autologous bone graft (RIA). This study spanned a period from January 2014 to December 2021 and included 35 patients (12 women and 23 men) with a mean age of 47.8 ± 20.08 years (range: 22-85 years). Among the patients, 18 had osteomyelitis following AO 43 C3 fractures, and 9 of them had previous exposure and bone loss at the time of injury. The remaining cases included 10 patients with AO 44 C fracture outcomes and 7 patients with AO 44 B fracture outcomes. Our results emphasise the importance of the meticulous management of local and systemic risk factors in ankle arthrodesis procedures. The successful eradication of infection and subsequent arthrodesis can be achieved via the implementation of surgical lavage, debridement, and systemic and local antibiotic therapy using spacers. This surgical protocol implemented by us has yielded excellent results, saving affected limbs from post-traumatic complications and avoiding the need for amputation. Our study contributes to the existing knowledge supporting the use of retrograde arthrodesis with intramedullary nails in severe cases where limb salvage is the primary goal. However, further research and long-term follow-up studies are needed to validate these results and evaluate the effectiveness of this technique in a larger patient population.

The Impact of Supratrochlear Foramen on Humeri's Medullary Canal Diameter and Its Surgical Implications.

Introduction Supracondylar elbow fractures are prevalent in the pediatric age group, and retrograde intramedullary nailing of the humerus is a common treatment approach. The anatomy of the medullary canal and the presence of the supratrochlear foramen (STF) significantly influence the stabilization of the nail. This study aimed to determine the incidence and morphology of the STF and compare the width of the medullary canal in humeri with and without the STF. Methods We examined 40 humeri bones with fused humeral epiphyses for the presence of the STF obtained from the Department of Anatomy's osteology collections. We studied the morphology and measured the dimensions of the foramen. We then compared the morphometric characteristics of humeri bearing the STF with those without it. We also took radiographs of all bones and measured the medullary canal width at three levels. We compared the measured width of the medullary canal in humeri between those with an STF and those without. This analysis was performed using IBM SPSS Statistics version 27.0 (Armonk, NY: IBM Corp.) for Windows and an unpaired t-test. We considered p-values of less than 0.05 as statistically significant. Results We found the STF in six bones (15%) as follows: four on the left side and two on the right. Humeri with the STF had smaller mean head circumference, length, and shaft circumference than those without the foramen. However, this difference was not statistically significant (p>0.05). The mean width of the medullary canal in humeri with the STF was significantly smaller (p<0.05) than in bones without the STF. Conclusions Our study revealed that humeri with an STF present a significantly smaller diameter of the medullary canal, which can impact surgical procedures like retrograde intramedullary nailing. Clinicians should consider this when planning surgeries to avoid iatrogenic fractures and enhance procedural efficiency. Our data also suggest that larger humeri are less likely to have an STF, potentially influencing pre-surgical planning and fracture risk assessment.

Retrograde intramedullary nailing of the femur: identifying the true anatomic axis for the ideal start point.

Retrograde femoral intramedullary nailing (IMN) is commonly used to treat distal femur fractures. There is variability in the literature regarding the ideal starting point for retrograde femoral IMN in the coronal plane. The objective of this study was to identify the ideal starting point, based on radiographs, relative to the intercondylar notch in the placement of a retrograde femoral IMN. A consecutive series of 48 patients with anteroposterior long-leg radiographs prior to elective knee arthroplasty from 2017 to 2021 were used to determine the femoral anatomic axis. The anatomic center of the isthmus was identified and marked. Another point 3cm distal from the isthmus was marked in the center of the femoral canal. A line was drawn connecting the points and extended longitudinally through the distal femur. The distance from the center of the intercondylar notch to the point where the anatomic axis of the femur intersected the distal femur was measured. On radiographic review, the distance from the intercondylar notch to where the femoral anatomic axis intersects the distal femur was normally distributed with an average distance of 4.1mm (SD, 1.7mm) medial to the intercondylar notch. The ideal start point, based on radiographs, for retrograde femoral intramedullary nailing is approximately 4.1mm medial to the intercondylar notch. Medialization of the starting point for retrograde intramedullary nailing in the coronal plane aligns with the anatomic axis. These results support the integration of templating into preoperative planning prior to retrograde IMN of the femur, with the knowledge that, on average, the ideal start point will be slightly medial. Further investigation via anatomic studies is required to determine whether a medial start point is safe and efficacious in patients with distal femur fractures treated with retrograde IMNs.

Retrograde Nailing for Extremely Proximal Fractures of the Femoral Shaft.

ObjectivesTo report the results of retrograde intramedullary nailing (RIMN) for the treatment of extremely proximal femur fracturesDesignRetrospective cohortSettingLevel I trauma centerPatients/ParticipantsSixty-three femoral shaft fractures involving the anatomic region within ten centimeters of the inferior border of the lesser trochanter that were treated with RIMNInterventionRetrograde intramedullary femoral nailMain Outcome MeasurementsTime to union, nonunion, malunion, and unplanned reoperationResultsBetween 2009 and 2020, sixty-three fractures were followed to fracture union, reoperation, or a minimum of one year clinically. Mean follow-up was 32 months and 48 (76%) of the patients were followed beyond one year clinically. The mean patient age was 34 years (range 18-84 years) and the mean BMI was 27 (range 14-45). Forty (64%) patients were polytraumatized. Clinical and radiographic union was achieved in 59 (94%) fractures after index operation at a mean time to union of 22 weeks (range 9-51 weeks). Delayed union requiring nail dynamization occurred in one (2%) instance. Malreduction was noted in one (2%) patient with a 12° flexion deformity that resulted in nonunion. In total, there were three (5%) nonunions requiring revision surgery, one treated with retrograde exchange nailing and two revised to cephalomedullary nails; all united after revision.ConclusionsRIMN can be an effective treatment strategy for extremely proximal femur fractures when necessary. Our series demonstrated a high rate of union and a low rate of malalignment and complications.

Ideal entry point and direction of retrograde intramedullary nailing of the tibia

PurposeTo determine the ideal entry point and direction of retrograde intramedullary nailing of the tibia.MethodsThe imaging data of patients with distal tibial fractures from June 2020 to December 2021 in our hospital were collected, and computer-aided design was performed. The relevant data were imported into the software for processing, so as to obtain a distal tibial fracture model and simulate the retrograde intramedullary nail placement in the tibia. The entry points and angles at which the intramedullary nail could be inserted successfully and the fracture could be maintained in good alignment were overlapped and counted to obtain the safe entry range and angle. The center of this safe range is the ideal entry point for retrograde intramedullary nailing of the tibia, and the mean value of the angle is the ideal direction of entry.ResultsThe ideal entry point of the retrograde intramedullary nailing was located at the midpoint of the medial malleolus in the C-arm fluoroscopic anteroposterior (AP) and lateral view. The ideal nail entry direction was located at the anatomic axis of the medial malleolus in the AP position and at the anatomic axis of the distal tibial metaphysis in the lateral position.ConclusionThe ideal point and direction of nail insertion for retrograde tibial intramedullary nailing is a "double midpoint, double axis" approach.

Traitement des fractures fémorales périprothétiques supra-condyliennes par enclouage centro-médullaire rétrograde versus plaque fémorale distale : revue systématique et méta-analyse de la littérature actuelle

BackgroundSupracondylar periprosthetic fractures, when amenable to fixation, can be treated by either retrograde intramedullary nailing (RIMN) or plating. There is paucity of evidence regarding the superiority of one fixation method over the other. This review aims to determine which fixation method leads to better functional outcomes and perioperative complications. HypothesisSuperiority of intramedullary nailing in terms of fracture healing and surgical complications when compared to distal femoral plating. Materials and MethodsUsing PRISMA guidelines, a systematic search was performed. Studies which reported comparative outcome data following the two interventions were included. Qualitative data analysis and narrative synthesis were reported. Pooled comparisons were conducted when similar quantifiable outcomes were reported in a minimum of three studies. ResultsA total of 151 records were generated by the search. Eight studies met the eligibility criteria so were included in the final analysis. The studies comprised a total of 407 cases, with a follow up period ranging from 1 to 15 years. Two-hundred and fifty-two cases were treated with plate fixation and 155 with RIMN. All studies were mitigated by heterogeneity and methodological limitations. The review showed marked variation in descriptive fracture classifications. Narrative data synthesis was conducted. Although guarded by the methodological limitations of individual studies, outcomes showed that mean time to union was equivalent; 5.88 months for RIMN compared to 6.75 months in plating, standardised mean difference=0.28 (95% CI –0.02–0.58). Similarly, no statistically significant differences were reported between RIMN and plating for deep infection (OR:1.41 95% CI 0.40–5.00) and revision surgery (OR: 0.74, 95% CI 0.39–1.41). DiscussionClinical outcomes showed a tendency that favours intramedullary nailing; however, generalisation of results was not possible. Future priority must be awarded to higher quality research in the form of a collaborative multicentre observational studies to delineate appropriate major diagnostic categories, ultimately informing a large comparative trial using condition specific validated outcome measures. Level of evidenceIII, meta-analysis.

Prebent Steinmann Pin to Remove the Broken Retrograde Intramedullary Nail After Tibiotalocalcaneal Arthrodesis

A retrograde intramedullary nail is an implant option for tibiotalocalcaneal arthrodesis because it provides mechanical strength and compression at the fusion site, while being less invasive to soft tissue. However, some fusion failures result in implant overloading, resulting in implant failure. The accumulated stress at the level of the subtalar joint will most likely cause implant breakage. It is challenging to remove the broken tibiotalocalcaneal nail’s proximal part. Several surgical procedures for removing the broken tibiotalocalcaneal nail have been reported. In this article, we present a surgical technique for removing a broken tibiotalocalcaneal nail by punching out the proximal part of the broken nail using a prebent Steinmann pin. It has the advantage of being less invasive and not requiring any specific tools to punch out the nail.

Retrograde intramedullary nailing for distal femur fracture after total knee arthroplasty

Abstract Periprosthetic fractures over the total knee arthroplasty (TKA) are increasing in aged population. When open reduction is considered as a treatment option there is excessive soft tissue insult causing reduction of periosteal blood supply resulting in delayed union and weight bearing. Patient of the case of postosteoarthritis TKA with periprosthetic supracondylar fracture treated with retrograde intramedullary nailing. The patient after 12 months of follow-up gained a comparable range of motion with early weight bearing and union. Retrograde intramedullary nail, through compatible TKA component, is a feasible option and has numerous advantages over other conventional methods being less invasive, less time-consuming, less blood loss, preservation of fracture hematoma, and periosteal blood supply.

Induced membrane technique combined with a retrograde intramedullary nail for the treatment of infected bone defects of the ankle

In this study, we treated infected ankle bone defects with the induced membrane two-stage technique. The ankle was fused with a retrograde intramedullary nail in the second stage, and the aim of this study was to observe the clinical effect. We retrospectively enrolled patients with infected bone defects of the ankle admitted to our hospital between July 2016 and July 2018. In the first stage, the ankle was temporarily stabilized with a locking plate, and antibiotic bone cement was used to fill the defects after debridement. In the second stage, the plate and cement were removed, the ankle was stabilized with a retrograde nail, and tibiotalar-calcaneal fusion was performed. Then, autologous bone was used to rebuild the defects. The infection control rate, fusion success rate and complications were observed. Fifteen patients were enrolled in the study with an average follow-up of 30 months. Among them, there were 11 males and 4 females. The average bone defect length after debridement was 5.3 cm (2.1–8.7 cm). Finally, 13 patients (86.6%) achieved bone union without recurrence of infection, and 2 patients experienced recurrence after bone grafting. The average ankle-hindfoot function score (AOFAS) increased from 29.75 ± 4.37 to 81.06 ± 4.72 at the last follow-up. The induced membrane technique combined with a retrograde intramedullary nail for the treatment of infected bone defects of the ankle after thorough debridement is an effective treatment method.

Knee Pain After Retrograde Intramedullary Nailing with Surgical Implant Generation Network of Femur Shaft Fractures at Public Hospitals in Bahir Dar City, Ethiopia: Analysis of 6-Months Follow-Up Results.

The incidence of femur fractures in young and elderly people has increased, particularly in countries with limited resources like Ethiopia. Intra-medullary nailing (IM) has been an effective and cost-effective method of treating long bone shaft fractures, but it can lead to complications such as knee pain. This study aimed to evaluate knee pain and its associated factors following retrograde intramedullary nailing for femur fractures. The study followed 110 patients diagnosed with femur fractures and treated with retrograde SIGN Standard Nail or Fin Nail from January 2020 to December 2022 at two hospitals in Ethiopia. The patients were followed up for at least 6 months, and data were collected from medical charts, patient interviews, and phone calls to patients who did not attend the follow-up appointment. Binary logistic regression analysis was used to identify factors associated with knee pain. The study showed that 40 patients reported knee pain at 6-months follow-up, making a prevalence of 36.4%. Factors significantly associated with knee pain were a time of injury to nailing (AOR=4.23, 95% CI: 1.28-13.92), use of a screw to the medial cortex (AOR=9.30, 95% CI: 2.90-12.74), and fracture site (AOR= 2.67, 95% CI: 14.01-7.03). Specifically, the longer the time from injury to nailing, the higher the risk of knee pain. The use of a longer screw to the medial cortex and a fracture site were also positively associated with knee pain. This study concludes that although retrograde intramedullary nail fixation is an effective method for femur fractures, it often results in knee pain. Approximately 4 of 10 patients suffered from knee pain in this study. Avoiding delayed surgical management and minimizing the use of prominent metalwork may reduce knee pain.

Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail for Charcot neuroarthropathy of foot - A prospective observational study

Background: Surgical treatment is often needed for Charcot neuroarthropathy (CN) of foot. Even though good outcomes were reported with tibiotalocalcaneal arthrodesis (TTCA) in CN patients, the choice of implant is still an issue. The aim of the study was to evaluate the outcomes of TTCA with retrograde intramedullary nail, in patients with CN. Materials and methods: A prospective observational study was done with 41 consecutive patients treated with TTCA with hindfoot retrograde IM nail. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used for the outcome evaluation, one year after surgery. Results: The mean age was 67.4(±8.7) years, with 63.5% females. Most common cause was diabetes mellitus (75.6%), followed by post-traumatic CN (19.5%) and chronic alcoholism (4.9%). Eleven (26.8%) had good score at the end of 1 year compared to five (12.2%) pre-op and twenty (48.8%) had fair score compared to fifteen (36.6%). The AOFAS score increased one year after surgery (p value 0.001). In twenty (48.8%) patients, the time taken for union was more than 6 months; and in 15 (36.6%) union occurred within 6 months of surgery. Six (14.6%) patients had non-union. Two (4.9%) had deep infection along with non-union. Hardware failure was seen in 3 (7.3%) patients. Hardware failure with non-union was reported in one (2.4%). Four (9.8%) patients had superficial wound infection and amputation done in one (2.4%) patient. Conclusion: Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail is an acceptable and safe procedure with good clinical outcomes in patients with Charcot arthropathy which obviates the need for amputation. Keywords: Charcot neuroarthropathy; tibiotalocalcaneal arthrodesis; intramedullary nail; amputation

PROSPECTIVE STUDY TO EVALUATE FUNCTIONAL OUTCOME OF PAEDIATRIC RADIAL NECK FRACTURES TREATED BY METAIZEAU TECHNIQUE

Background: Radial neck fractures in children are a rare injury, and the timing of surgery as well as the surgical technique will determine how well they respond to treatment. When the tilt surpasses 60 degrees, radial neck fractures in children are signicant injuries with frequent after effects. In these situations, conservative treatment is frequently insufcient, and open reduction may result in iatrogenic consequences. Retrograde intramedullary nailing of the radius is one method of treating dislocated radial neck fractures in children (the Metaizeau technique). Aim: The purpose of this study was to evaluate the functional outcome of Metaizeau technique. Methodology: After taking proper consent and ethical clearance a prospective study was conducted in 16 cases of closed radial neck fractures in children aged 6-12 years without any neurovascular decit. Patients were treated by Metaizeau technique at Jorhat medical college and Hospital from 2021-2022 and were followed up at 2 weeks, 4 weeks, 6 weeks, 10weeks and 12 weeks. Result: In this study, it is found that this technique is safe and effective in treating radial neck fracture in children. The fracture should be reduced within 7 days of injury. Later on, fracture reduction will be difcult because of brosis and fracture healing. In our study, average age was 9 years. Males were affected more than females and the common mode of injury was fall on outstretched hand. All cases achieved radiological and clinical union by 6 weeks. All cases achieved comparable exion-extension of elbow, supination-pronation of the forearm (as compared to healthy side). Average MEPS was 82.19 which was quite remarkable. Only one patient developed entry site pressure necrosis by cut end of TENS nail. The other disadvantage of this technique was need of second surgery for tens removal. Metaizeau technique is a minimally Conclusion: invasive technique with easy learning curve, minimal tissue damage, and reduced chance of elbow stiffness and osteonecrosis of radial head. Our results are within the acceptable range of satisfactory outcomes, if not more towards the better end of the outcomes quoted in literature.

The application of a hollow trephine in femoral retrograde intramedullary nailing technique

PurposeThe purpose of this study was to describe and evaluate the use of a specially designed hollow trephine to create the entry point through the femoral condyle during retrograde interlocking intramedullary nailing for femoral fractures.MethodsFrom June 2019 to December 2021, we treated 11 patients (5 men, 6 women; mean age, 64 years; age range 40–77 years) with mid-distal femoral fractures by retrograde intramedullary femoral nailing using a self-designed hollow trephine for femoral condyle reaming and cancellous bone harvesting. The mode of all the nails is static. Patients were followed up at 1, 4, 8, and 12 weeks and for at least 6 months after surgery. The healing process and heterotopic ossification were evaluated by imaging. Partial weight bearing was permitted during the recovery period and complete weight bearing was permitted after clinical healing of the fracture displayed by X-ray.ResultsThe operation was successful in all patients. Over mean follow-up of 9.3 months (range, 6.0–12.0 months), all patients achieved clinical healing within three months. There were no complications such as knee joint infection, heterotopic ossification, knee joint adhesion and wedge effect.ConclusionThe use of the hollow trephine during femoral retrograde intramedullary nailing helps avoid postoperative complications such as heterotopic ossification, knee joint adhesions, and wedge effect. It also facilitates bone graft harvesting.

Comparison of Early Outcome of the Close and Open Technique for the Treatment of Distal Femur Fractures

Objective: To compare the effects of closed and open techniques with its associated complications used for the management of distal femoral fracture in younger to older populations. Methodology: This was a case series study conducted in the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from Sept 2018- March 2019. A total of 66 adult patients were stratified according to treatment technique; closed technique group and open technique group with 33 patients in each group between age 18 - 65 years with fractured close distal 1/3rd shaft of femur distal femur fractures based on AO/OTA classification were included in the study. The Chi-square test was applied to contrast outcomes of closed and open technique and HSS score categories in both procedures. Results: The study findings showed that the mean age of the patient was slightly greater in the open technique group (41.5 + 23.5 years) compared to the closed technique (29.8 + 11.8 years). Most of the patients had type A femur fracture. The postoperative mean HSS knee score was 70.1 + 15.1 in the open technique group compared to 74.5 + 12.5 in the closed technique group with an insignificant difference between the two means (p&lt;0.949). An insignificant difference was observed in postoperative infection, non-union, and implant failure between both groups. Conclusion: This study concluded that superior outcomes such as bony union without infection were achieved in patients with femur fractures treated with closed technique as compared to open technique, although the findings were statistically insignificant. Moreover, the functional outcome of the knee joint was also distinctly improved in the closed technique. Keywords: Â Distal femur fracture, retrograde intramedullary femoral nail, locking compression plate, complications

A retrospective review of the rate of septic knee arthritis after retrograde femoral nailing for traumatic femoral fractures at a single academic institution.

Retrograde intramedullary nailing of the femur is a popular treatment option for femoral shaft fractures. However, this requires accessing the intramedullary canal through the knee, posing a risk of intra-articular infection. The purpose of this study was to examine the rate of intra-articular infection of the knee after retrograde nailing of femoral shaft fractures. All patients who underwent retrograde intramedullary nailing for femoral shaft fractures between June 2004 and December 2017 at a level 1 trauma center were reviewed. Six months of follow-up or documented fracture union was required. Records were reviewed for documentation of septic arthritis of the ipsilateral knee during the follow-up period. A total of 294 fractures, including 217 closed and 77 open injuries, were included. Eighteen had an associated ipsilateral traumatic arthrotomy; 188 cases had an associated ipsilateral lower extremity fracture. No cases of septic arthritis were identified. There were no cases of septic arthritis in 294 fractures treated with retrograde intramedullary nailing. Retrograde nailing appears safe for risk of postoperative septic arthritis of the knee even in the face of open fractures and traumatic wounds.

Is Autograft Necessary in the Treatment of Femur Distal Nonunion with Retrograde Intramedullary Nailing?

Amaç: Distal femur kırıklarında günümüzde sık kullanılan kilitli plaklar sonrasında gelişen nonunion tedavisi için retrograde intramedüller çiviler ile tedavi edilen hastalarda otogreft kullanımının kaynama süresi ve diz fonksiyonları üzerine etkisini değerlendirmek. Gereç ve Yöntemler: Çalışmada reamerize intramedüller çivi ile tedavi edilmiş distal femur kaynaması olmayan 18 hastanın verileri retrospektif olarak incelendi. Çalışmaya femur 1/3 distalinde nonunion olan ve aktif enfeksiyon bulgusu olmayan tüm hastalar dahil edildi. Dokuz ay sonunda kaynama bulgusu olmayan ve implant yetmezliği görülen reamerize intramedüller çivi ile tedavi edilmiş hastalar incelendi. Kaynama değerlendirmesi ve diz fonksiyonları değerlendirildi. Sürekli değişkenler Student t testi kullanılarak karşılaştırıldı. P değeri &amp;lt;0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Hastaların ortalama takip süresi 24.7 (12-36) ay idi. Üç hastada varus deformitesi komplikasyon olarak izlendi. Hastaların Mize skoru esas alınarak 12’sinde iyi sonuç 3 hastada mükemmel, 3 hastada makul sonuç elde edildi. Ortalama kaynama sürelerine bakıldığında 5.2 (4-7) ay idi. Operasyon öncesi maksimum 91.7 (10-120) derece olan diz fleksiyonu, operasyon sonrası ortalama maksimum diz fleksiyonu 106 (70-120) derece bulundu. Otogreft kullanımında kaynama süresi bakımından anlamlı farklılık gözlenmedi. Sonuç: Distal femur nonunionlarda tedavi seçeneği olarak retrograde intramedüller çiviler ile başarılı sonuçlar alınabilir. Otogreft kullanımı kaynama süresi açısından sonucu etkilemese de bu konuda daha fazla çalışma yararlı olacaktır.