Russell-Taylor Reconstruction Nail Research Articles

Complications Of Treatment Of The Subtrochanteric Fractures Of The Femur By Russell-Taylor Reconstruction Nail

Thirty cases of closed subtrochantric fractures were treated in adults by Russell –Taylor Reconstruction nail between March 2004 and September 2005. Complications of this modality of treatment are described. Complications were divided intointraoperative and postoperative complications. Difficulty in the placement of proximal locking screw was the most common complication in the first group followed by difficulty in close reduction of the fracture. Amongst the postoperative complication proximal thigh pain and limb length discrepancy were the main complications. None of these complications, however, contributed adversely to the final outcome of results. The findings of this study revealed that Russell-Taylor Reconstruction nail is the preferred treatment for complex proximal femoral fractures and complications associated are minor and do not significantly contribute towards the final outcome. Moreover these complications decline as the learning curve progresses.

Biologic Plating Versus Intramedullary Nailing for Comminuted Subtrochanteric Fractures in Young Adults: A Prospective, Randomized Study of 66 Cases

Published reports about treatment of comminuted subtrochanteric fractures in young patients are few. This study compared the effectiveness of biologic plating and intramedullary nailing in the treatment of such fractures. A prospective, randomized, and nonblinded study was conducted. Closed reduction and fracture osteosynthesis were performed with either a dynamic condylar screw (DCS) or a Russell-Taylor reconstruction nail (RTRN) in all 66 patients. The average age of the patients was 36.1 years. The average follow-up period was 28.1 months. All but two patients had uneventful bone union and the average time to union was 15.1 weeks. One implant failure in the RTRN group and one delayed union in the DCS group required additional surgery to achieve bone union. Shorter fluoroscopic time, reduced blood loss, and fewer patients requiring blood transfusion were found in the DCS group, though the DCS group had a higher hip pain score 2 years postoperatively. Otherwise, the surgical results and functional outcomes were comparable between groups. With the enhanced fixation properties demonstrated in the present study, the DCS proved to be a feasible fixation device for comminuted subtrochanteric fractures in young patients. Our results indicated that intramedullary nailing by a RTRN revealed no advantages over biologic plating by a DCS for treatment of such fractures.

Complex proximal femoral fractures in the elderly managed by reconstruction nailing – complications & outcomes: a retrospective analysis

BackgroundUnstable proximal femoral fractures and pathological lesions involving the trochanteric region in the elderly comprise an increasing workload for the trauma surgeon as the ageing population increases. This study aims to evaluate use of the Russell-Taylor reconstruction nail (RTRN) in this group with regard to mortality risk, complication rates and final outcome.MethodsRetrospective evaluation of 42 patients aged over 60 years who were treated by reconstruction nailing for proximal femoral fractures over a 4 year period.ResultsOver two-thirds of patients were high anaesthetic risk (ASA > 3) with ischemic heart disease the most common co-morbidity. 4 patients died within 30 days of surgery and 4 patients required further surgery for implant related failure. Majority of patients failed to regain their pre-injury mobility status and fewer than half the patients returned to their original domestic residence.ConclusionFavourable fixation of unstable complex femoral fractures in the elderly population can be achieved with the Russell-Taylor reconstruction nail. However, use of this device in this frail population was associated with a high implant complication and mortality rate that undoubtedly reflected the severity of the injury sustained, co-morbidity within the group and the stress of a major surgical procedure.

Complex femoral fracture treated with Russell-Taylor reconstruction nail

Although the Russell-Taylor reconstruction nail (RTRN) was primarily used to treat diaphyseal and cervical femoral fractures its configuration permitts its use also in difficult subtrochanteric comminuted fractures with diaphyseal involvement.

The treatment of difficult proximal femoral fractures with the Russell–Taylor reconstruction nail

The outcome of 30 proximal femoral fractures and pathological lesions in 29 patients treated with the Russell–Taylor reconstruction nail are reported. Four patients had fractures involving both the femoral neck and shaft (segmental). Fifteen patients had extensive comminuted fractures of the proximal femur and ten patients underwent nailing because of pathological fractures (one bilateral). In nineteen operations there were technical difficulties, nail insertion and proximal interlocking being the commonest. In the elderly there was a high post-operative complication rate. Three nails needed to be revised for failure of fixation. On review, all patients under sixty years of age regained full mobility and returned to their pre-fracture level of activities. Patients with per-trochanteric fractures over the age of sixty had less favourable results. No cancer patient returned to their pre-fracture mobility level. The Russell–Taylor reconstruction nail proved to be useful in the treatment of segmented and, in a lesser degree, pathological fractures. However, the surgical technique is demanding and there is a high incidence of post-operative complications in the patients over the age of sixty.

Ipsilateral Femoral Neck and Shaft Fractures

Ipsilateral, concomitant femoral neck and shaft fracture is a rare fracture pattern encountered by orthopaedic surgeons. We review 11 cases of this fracture pattern. Treatment was by reduction and stabilization of the femoral neck fracture with one or more cannulated screws, followed by fixation of the femoral shaft using a Russell-Taylor reconstruction nail or a Russell-Taylor Delta reconstruction nail. When properly sequenced, this has proven to be a successful treatment method in these dual fractures, resulting in a low complication rate. No avascular necrosis of the femoral head or nonunion of either fracture site occurred. In our series, one patient with delayed union had varus angulation of 120 degrees of the femoral neck. Good functional outcome based on patients' ability to perform activities of daily living was achieved.

同側大腿骨頚部・骨幹部骨折の治療経験

We reviewed seven cases of ipsilateral fractures of the femoral neck and shaft treated at our hospital since 1989. There were four males and three females. Their ages ranged from 19 to 69 years (average, 44.9 years). All injuries resulted from high energy trauma.There were two intracapsular femoral neck fractures and five extracapsular fractures (three were trochanteric and two were subtrochanteric fractures). There were no open fractures.Two patients were treated with plate fixation for the shaft and compression hip screw fixation for the femoral neck, two were treated with an intramedullary nail for the shaft (Ender nail or Russell-Taylor nail) and pinning for the neck, and three were treated with Russell-Taylor reconstruction nail. One case had non-union and nail failure (Ender nail), so reoperation with plate fixation and an autobone graft was performed. The average follow-up was 19 months.At follow-up, all patients had achieved a good result and all fractures were followed to union. There was no case of avascular necrosis of the femoral head.Ipsilateral fractures of the femoral neck and shaft should be stabilized by internal fixation as early as possible. Russell-Taylor reconstruction nail is useful providing superior stabilization with a single implant.

Fixation of segmental subtrochanteric fractures. A biomechanical study.

Segmental subtrochanteric fractures have been associated with high rates of malunion, nonunion, and implant failure. Although the use of second generation intramedullary nails with proximal interlocking in the femoral head has been advocated for these fractures, shaft fractures at the tip of short second generation intramedullary rod nails in clinical studies raise concerns about the mechanical suitability of these implants. No biomechanical data are available on the strength of fixation and mode of failure of these newer implants. This study compares the strength and failure mode of segmental subtrochanteric fractures stabilized with 3 current implants. Eighteen anatomic specimen femurs were obtained. The 3 implants tested were the Russell-Taylor reconstruction nail, a short intramedullary hip screw, and a long intramedullary hip screw. Each femur was instrumented and a segmental subtrochanteric fracture was created. The femurs were loaded in a Materials Testing System. The strength of the reconstruction nail group (2869 +/- 210 N) was significantly greater than for the short intramedullary rod hip screw (2330 +/- 490 N), and the long intramedullary rod hip screw (2181 +/- 244 N). The failure modes for the implants were: screw cut out of the femoral head for the reconstruction nail; fracture of the femoral shaft for the short intramedullary hip screw, and implant bending for the long intramedullary hip screw. This study suggests that the reconstruction nail is the superior implant for segmental subtrochanteric fractures of those tested. Implant bending and shaft fractures at lower loads make the 2 intramedullary rod hip screw implants less suitable.

Use of the Russell-Taylor reconstruction nail in femoral shaft fractures

Of 242 patients with injuries treated by locked intramedullary nailing of the femur, 52 (22 per cent) were considered suitable for insertion of the reconstruction nail. The Russell-Taylor reconstruction nail was found to be useful in a greater variety of fractures than those for which it was originally designed. In addition to ipsilateral neck and shaft fractures, the Russell-Taylor reconstruction nail proved successful in high-energy comminuted subtrochanteric fractures, elderly subtrochanteric fractures and pathological lesions. In two cases, problems were encountered due to the relative straightness of the nail, but in the remaining patients there were no technical problems. In the 43 elderly patients and those with pathological lesions, seven complications occurred: a number which compares favourably with published reports for extramedullary devices. There were no cases of implant failure and in all patients the device supported the fracture to union or death.

Fractured Gamma nail

Fractures of the trochanteric region of the femur are common in the elderly and their operative treatment is controversial. Many devices have been used surgically without any particular method being positively indicated. The sliding screw and plate method is currently the most widely used; the many other systems available include blade plates, flexible intramedullary rods (Enders or Harris) or intramedullary nails such as the Zickel, Kuntscher-Y, Williams-Y and Russell-Taylor reconstruction nail. More recently the Gamma nail has been introduced and many studies have been carried out to compare these various systems (Wolfgang et al., 1982; Carlson et al., 1984; Dobozi et al., 1986; Ruff and Lubbers, 1986; Henry et al., 1988; Wang et al., 1988; Simpson et al., 1989; Boziani and Betelli, 1990; Davis et al., 1990; Lechnez et al., 1990; Bridle et al., ‘1991; Chuan et al., 1991; Coleman et al., 1991). The most controversial of these fractures is that of the subtrochanteric which constitute 5-11 per cent of all fractures of the upper third of the femur and 26.7 per cent of all of those in the peritrochanteric region (Chi-Chuan et al., 1991). For these fractures the same range of devices is suggested together with conventional intramedullary interlocking or compression nails (Papagiannopoulos et al., 1989). One of the commonest is the Zickel nail but this has its own operative complications particularly fracture of the greater trochanter during its insertion (Wang et al., 1988; Calvert, 1992). This makes a number of surgeons sceptical about this technique although it appears to be the strongest in comparison with the Ender rod, the Kuntscher-Y or Harris nail (Carlson et al., 1984; Henry et al., 1988; Wainer et al., 1990). The complications of each device are different but it is well established that for subtrochanteric fractures the rate of non-union is quite high (Ruff and Lubbers, 1986). Subtrochanteric fractures create more problems being classed as unstable as they involve the lesser trochanter (Verghese and Jaffray, 1987) and mechanical failures of the implants are well documented (RL& and Lubbers, 1986; Davis et al., 1990). Davis et al. (1990) reviewed 20 such fractures (9 per cent of their total number of peritrochanteric fractures) and found implant failure in three cases (15 per cent of the subtrochanteric fractures) when using a sliding screw implant of a Kuntscher-Y nail.

The use of the Russell-Taylor reconstruction nail in femoral shaft fractures

The use of the Russell-Taylor reconstruction nail in femoral shaft fractures

A Preliminary Experience with the Russell-Taylor Reconstruction Nail for Complex Femoral Fractures

Eleven cases of complex femoral fractures were seen from November 1987 to November 1989; five ipsilateral femoral neck and shaft fractures and six comminuted subtrochanteric fractures. High-energy accidents accounted for most of these injuries. There were numerous associated injuries, many requiring operative procedures. All of the fractures were treated with Russell-Taylor reconstruction nails. All fractures united, but there were two delayed unions. There was no delay in diagnosis of the femoral neck fractures, and all healed without avascular necrosis. Malalignment occurred in one case, shortening of the femur occurred in two cases, and in two cases only one screw could be placed in the femoral head. In three patients technical errors related to nail insertion led to fracture complications. The use of the Russell-Taylor reconstruction nail is technically demanding. However, we conclude that in complex femoral fractures, this device offers superior stabilization over other currently used methods of internal fixation.

Intramedullary nailing for impending pathological subtrochanteric fractures

We reviewed ten patients with metastatic carcinoma and impending pathological fractures of the subtrochanteric region of the femur who had prophylactic insertion of the Russell-Taylor reconstruction nail. There were no operative complications or long-term mechanical failures. This reconstruction nail has some technical and biomechanical advantages over other implants and is ideal for the management of such cases.