Rush Nail Research Articles

Antegrade Rush nailing for fractures of humeral shaft- an analysis of 200 cases with an average follow up of 1 year

Background : The incidence of humeral fracture has significantly increased during the recent times due to the rising age of the population and the number of automobile accidents. In order to achieve a stable fixation and early mobilization, numerous surgical implants have been devised. Method : We carried out a prospective analysis of the data of 200 consecutive patients who had closed fractures of the humeral shaft treated with ante-grade closed Rush nails at our institute. Patients with preoperative radial nerve injury were excluded from this study. In 186 patients we achieved close to anatomic reduction of the fracture fragments. In 14 patients we had to resort to limited open reduction. Results : Fracture united in 186 of 188 patient followed up for one year. Complications occurred in 26 patients. We strongly advise a careful surgical technique and modification as per the individual fracture pattern to reduce the complications. Conclusion : Osteosynthesis with multiple Rush nails features the advantages of rotational stability of the head-neck fragment to the diaphysis, an unreamed implantation technique without any special instruments, the speed of execution and minimal economic burden so important for the developing country like ours.

A flexible intramedullary nails for fractures in children.

©2004 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.86B7. 15273 $2.00 J Bone Joint Surg [Br] 2004;86-B:947-53. Over the past few years there has been a marked increase in the use of intramedullary fixation in the management of fractures of long bones in children. To some extent this reflects a more interventionist attitude among paediatric orthopaedic surgeons but is also due to technical developments, notably that of the elastic stable intramedullary nail (ESIN). The use of intramedullary devices to stabilise fractures is not new. In the mid-19th century, ivory pins were used for this purpose and were then gradually supplanted by various metal devices.1 These were generally rigid implants, although more flexible ones were introduced in in the 1930s. The school of rigid intramedullary fixation was typified by the Kuntscher nail, which achieved great stability in all planes by occupying the entire medullary cross-sectional area of the bone.2 However, its use in growing children was limited by the difficulties encountered in trying to avoid the physes. The Rush nail was introduced at about the same time as the Kuntscher nail.3 It was the forerunner of modern elastic intramedullary fixation in that the objective was to achieve three-point fixation on the inner aspect of the cortex. Unlike the stiff Kuntscher nail, the Rush nail was slightly flexible and it was intended that it should be pre-bent to the appropriate configuration before insertion.3 Rotational stability was poor, however, and in most situations the flexibility was insufficient to allow insertion points in the metaphysis which were well away from the active physis in children. Others, such as Hackethal4 and Marchetti,5 used bundles of thinner wires which filled the medullary cavity but with stabilisation achieved by splaying the ends of the wires within the bone well beyond the fracture. Ender6 developed this further with his nails, which were the first to feature adaptations to both ends of the nail in order to improve both control of insertion and quality of fixation. These nails could be safely inserted into the metaphysis which made them suitable for consideration in paediatric fractures. In the early 1980s, surgeons in Nancy, France, developed an elastic stable intramedullary nail based on a theoretical concept by Firica.7 Previous experience had suggested that elasticity and stability were not easily combined in one construct. However, working from the concept of three-point fixation used with a single Rush nail, these surgeons were able to improve stability significantly by using two pre-tensioned nails inserted from opposite sides of the bone. Metazieau, Ligier and their colleagues7 were able to show that titanium nails which were accurately contoured and properly inserted could impart excellent axial and lateral stability to diaphyseal fractures in long bones. Rotational stability was also better than had previously been experienced, although this was to remain the weakest point of the technique. The use of titanium nails allowed greater elasticity than was available in the steel nails of the Ender system. Most contemporary work on flexible intramedullary nailing in children’s fractures is based on the Nancy experience, although there remain pockets of Ender and Marchetti enthusiasts. For the purposes of this review, flexible intramedullary nailing is taken to mean elastic stable intramedullary nailing using the concepts espoused by the Nancy group.

The Hastings experience of the Attenborough springs and Rush nail for fixation of olecranon fractures

A study was done of 70 patients who had internal fixation of an olecranon fracture with an Attenborough spring and Rush nail at the Royal East Sussex Hospital (now called Conquest Hospital), Hastings. This method has been in use since 1970. The age-sex distribution showed more men in the younger age group and more women in the older one. A subjective evaluation was done of all patients. The results were recorded for pain, activities, range of movement, further operations and re-referral after discharge. In the series more than 90 per cent of the patients were satisfied in terms of pain relief, daily activities and range of movements. There were four dissatisfied patients and seven complications. This method provides a quick, safe and effective method of fixing olecranon fractures and appears to give a high level of patient satisfaction.

TIBIAL DIAPHYSEAL NONUNIONS AFTER EXTERNAL FIXATION TREATED WITH NONREAMED SOLID CORE NAILS

Twenty-nine patients with tibial diaphyseal fractures had external fixators applied to treat their initial fractures and underwent nonreamed solid core nailing for nonunion (> 22 weeks). Fifteen Alta, 11 Lottes, and 3 Rush nails were used. The original fracture grades were: 1 closed, 1 grade I, 7 grade II, 3 grade IIIA, and 17 grade IIIB. The duration of nonunion was 51 weeks (average: 22 to 173). The average duration of external fixation was 19 weeks (range: 9 to 47). The average interval from fixator removal to nail was 32 weeks (range: 0 to 156). Twenty-eight patients were seen at > 12 months' follow up (average: 35; range: 10 to 58) and completion of treatment. Twenty-seven patients' fractures united at an average of 14 weeks (range: 6 to 40). One patient required a reamed exchange nailing at 39 weeks and united 58 weeks post-exchange nailing. One patient had a persistent asymptomatic nonunion. One patient developed a stress fracture 49 months post nail requiring an exchange nailing. Eleven fractures had a pre-nail deformity of 10 degrees or more; 9 were corrected. Eight patients had pre-nail wound and five had pre-nail pin tract infections. Except for two cases, all of these infections were treated successfully with surgical debridement and/or antibiotics prior to nail insertion. Two patients had their nail inserted through active infections that could not be controlled with an unstable fracture. One patient healed uneventfully in 6 weeks. One required two subsequent debridements. There were no other infections. The authors conclude that nonreamed solid core nailing is an acceptable treatment for tibial diaphyseal nonunions following external fixation.

Treatment of the Humeral Shaft Fracture by Rush nailing: In the Cases of Multiple Trauma Patient

Treatment of the Humeral Shaft Fracture by Rush nailing: In the Cases of Multiple Trauma Patient

Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines.

Thirty-nine adults and five children with active spinal tuberculosis and resulting kyphosis of the dorsal and lumbar spine who had combined posterior instrumentation and anterior interbody fusion were observed to determine whether the corrected spinal deformity could be maintained until solid fusion. To evaluate the effectiveness of the combined two-stage procedure for treating kyphosis due to active spinal tuberculosis. Until 1970, with all methods of treatment, kyphosis due to active spinal tuberculosis tended to increase during therapy. Most of the patients treated with these methods were not happy with this residual kyphosis, even though their disease was arrested or cured. Kyphosis became their main concern regarding further treatment. A combined two-stage procedure, under the cover of 18 months of triple chemotherapy, was used for all patients. For posterior stabilization, the Harrington distraction system, Rush nails or Steinmann pins and wires, and Texas Scottish Rite Hospital instrumentation were used. The diagnosis of successful interbody fusion was made if there was no loss of correction, no graft resorption or graft bed resorption, and if there was visible graft remodeling, such as trabeculation between the graft beds and graft and the graft hypertrophy. In the 39 adults, average preoperative, immediate postoperative, and last follow-up kyphosis angles were 37 degrees, 16 degrees, and 18 degrees, respectively. In four children, the average preoperative, immediate postoperative, and last follow-up kyphosis angles were 55 degrees, 28 degrees, and 31 degrees, respectively. The loss of correction did not exceed 3 degrees. For one-segment spondylodesis, the average fusion times were 4 months in adults and 3.5 months in children. For a two-segment fusion, the average fusion times were 6 months in adults and 6.3 months in children. Posterior instrumental stabilization and anterior interbody fusion were found helpful in arresting the disease early, providing early fusion, preventing progression of kyphosis, and correcting the kyphosis.

Investigation of fatigue failure of a stainless steel orthopedic implant device

An orthopedic implant (rush nail) fractured in a patient at a location that corresponded to the site of a prior fracture of the bone (right femur). The crack propagation in the implant proceeded from both sides of the nail, and the final fracture occurred by ductile shear in the midsection of the nail. Dimple structures and tear ridges between fatigue striation patches were observed on the fractured surface. Moreover, the device fractured within a short period of use. Contrary to post-procedure instructions, the patient placed the body’s full weight on the implanted leg at least once, perhaps twice, causing overload-induced fatigue failure of the implant.

Closed Intramedullary Pinning of Metacarpal and Phalanx Fractures

The surgical technique for closed intramedullary pinning of metacarpal and phalanx fractures is described. Commonly available 0.045 K-wires are used in a manner similar to Ender or Rush nailing of long bone fractures. This technique avoids impaling soft tissue structures--a drawback to more commonly used percutaneous K-wire techniques--and provides sufficient stability to allow early, protected motion.

Stabilisation of the wrist in rheumatoid disease

Internal splintage was undertaken of fifteen wrists for pain and instability, using an intramedullary Rush nail. The patients were examined at an average of thirty-three months after operation. Spontaneous fusion in a useful position had occurred in all but one. The operation is simple and external immobilisation is unnecessary.

Stabilisation of the wrist in rheumatoid disease.

Internal splintage was undertaken of fifteen wrists for pain and instability, using an intramedullary Rush nail. The patients were examined at an average of thirty-three months after operation. Spontaneous fusion in a useful position had occurred in all but one. The operation is simple and external immobilisation is unnecessary.

Treatment of Fracture of Tibial Shaft with Rush Nails or Ender Nails: Comparative Study

Treatment of Fracture of Tibial Shaft with Rush Nails or Ender Nails: Comparative Study

Comparison Study Between Rush Nailing and Ender Nailing in the Treatment of Fracture of the Tibial Shft

Comparison Study Between Rush Nailing and Ender Nailing in the Treatment of Fracture of the Tibial Shft

The Treatment of Fracture of Tibial Shaft with Rush Nailing and Early Weight Bearing

The Treatment of Fracture of Tibial Shaft with Rush Nailing and Early Weight Bearing

A new method of internal fixation of olecranon fractures

A new method of internal fixation for fractures of the olecranon is described. An Attenborough spring and hooks, together with a Rush nail, are used. The spring and hooks provide compression across the fracture site. The surgical technique is described and the results in 17 patients treated by this method are discussed. Nine patients had an excellent result and 7 a good result. The method required no special instrumentation and early mobilization is encouraged.