Treatment Of Diaphyseal Fractures Research Articles

Emergency Traumatology at the N.V. Sklifosovsky Research Institute for Emergency Medicine: History and Modernity

The purpose of this work was to study the history of the development of traumatology-orthopedics at the N.V. Sklifosovsky Research Institute for Emergency Medicine.Traumatology as an independent discipline began to form at the N.V. Sklifosovsky Research Institute for Emergency Medicine during the reign of Professor S.S. Yudin (chief surgeon since 1928), who invited the famous Argentinean traumatologist-orthopedist Professor Lelio Zeno to work at the institute.In 1932, the trauma department of the N.V. Sklifosovsky Research Institute for Emergency Medicine was headed by Professor V.V. Gorinevskaya. She organized a 100-bed trauma clinic for the treatment of injuries to the head, spine, limbs, chest and abdominal cavity. She is rightfully considered one of the founders of trauma science in the USSR.With the development of traumatology and orthopedics as an independent specialty in 1961, two clinics were formed at the institute. The first trauma clinic was run by Dr. med. sciences professor I.I. Sokolov. The second clinic was headed by Dr. med. Sci. P.N. Petrov.In 1971, Dr. med. Professor, Honored Scientist of the Russian Federation, Academician of the Russian Academy of Medical and Technical Sciences of the Russian Federation V.P. Okhotsky was appointed the head of the traumatological service of the institute and the chief traumatologist of Moscow (from 1971 to 2001). With his active participation in Moscow, the reorganization of outpatient care was completed, work was widely launched on the medical aspects of the prevention of road traffic injuries and the introduction into practice of the most rational methods of diagnosis and treatment of patients with injuries of the musculoskeletal system. In the N.V. Sklifosovsky Research Institute for Emergency Medicine A.G. Suvalyan introduced the method of intramedullary osteosynthesis of long tubular bones (humerus, femur and tibia). Under the guidance of prof. V.P. Okhotsky the dissertation researches of A.G. Suvalyan, M.A. Suvalyan and S.S. Myakota were carried out. The expediency of early surgical intervention on the extremities in case of combined traumatic brain injury and multiple trauma of the extremities has also been proven, new functional methods of treatment of diaphyseal fractures of the shoulder, lower leg, spine and intra-articular injuries have been developed.In close scientific cooperation with scientists from other clinics of the institute, a comprehensive method of treating open injuries of the limbs has been developed (dissertation researches of I.F. Byalik, I.Yu. Klyukvin, O.P. Filippov, M.V. Zvezdina, R.S. Titov). Much scientific work has been carried out to improve the diagnosis and treatment of intra-articular injuries of the knee joint (dissertation researches by M.A. Malygina, O.P. Filippov, A.Yu. Vasa).From 2001 to 2016 the head of the department of emergency traumatology of the musculoskeletal system was a student of prof. V.P. Okhotsky – Dr. med. sciences, Professor, Academician of the Academy of Medical and Technical Sciences of the Russian Federation I.Yu. Klyukvin. Since 2016 the department is headed by Dr. med. sciences Alexey M. Fine.The scientific developments of the employees of the Department of Emergency Traumatology have a practical orientation. Every year, the department’s employees successfully perform more than 2500 surgical interventions using advanced low-traumatic techniques, making extensive use of the achievements of biotechnology.

Застосування зовнішнього черезкісткового остеосинтезу в практиці спеціалізованого травматологічного відділення міської лікарні (на прикладі міської лікарні № 3 м. Краматорська)

Актуальність. При лікуванні переломів у деяких випадках з’являється можливість вибору способу остеосинтезу, що відображено в «Клінічних рекомендаціях з лікування переломів», затверджених Пленумом асоціації ортопедів-травматологів України 15.05.2013 р. З урахуванням цього важливо знати, яке місце займає кожен із варіантів остеосинтезу, зокрема зовнішній черезкістковий остеосинтез (ЧКО), у практиці травматологічних відділень. Мета дослідження: встановити частоту застосування ЧКО та його співвідношення з внутрішнім остеосинтезом у практиці травматологічного відділення міської лікарні. Матеріали й методи. Проведено ретроспективне дослідження за матеріалами травматологічного відділення КМУ «Міська лікарня № 3» м. Краматорська (лютий 2015 р. — січень 2017 р.). Здійснено тотальну вибірку операцій ЧКО (72 спостереження), досліджено співвідношення зовнішнього та внутрішнього остеосинтезу. Результати. Як основний варіант остеосинтезу при лікуванні переломів ЧКО застосовано в 53 випадках (73,6 %). При наслідках травм його використано в 11 (15,3 %) спостереженнях, як спосіб тимчасової фіксації — у 8 (11,1 %). ЧКО становив 31,9 % серед втручань на аналогічних сегментах (72 із 226, співвідношення — 1 : 2,14). Він виявився домінуючим при діафізарних переломах кісток гомілки (26 із 47, 1,24 : 1), переважав при переломах дистального епіметафізу променевої кістки (2 : 1) та п’яткової кістки (2,5 : 1). Співвідношення ЧКО та внутрішнього остеосинтезу при пошкодженнях надп’ятково-гомілкового суглоба становило 1 : 2,93 (14 проти 41). При лікуванні наслідків травм найбільш часто ЧКО застосовували при наслідках переломів діафіза стегнової кістки (6 спостережень — 8,3 %). Висновки. Зовнішній черезкістковий остеосинтез становив 31,9 % серед усіх операцій остеосинтезу. Як основний вид остеосинтезу ЧКО застосовано у 88,9 % випадків, в 11,1 % — як спосіб тимчасової фіксації. Найбільш часто ЧКО використовували при діафізарних переломах кісток гомілки, ділянки надп’ятково-гомілкового суглоба, дистального епіметафізу променевої кістки.

До питання застосування консервативного та оперативного методів лікування діафізарних переломів довгих кісток

Піддано аналізу сучасний стан застосування консервативного й оперативного методів лікування діафізарних переломів. Розглянуто роль репозиції, оперативних і консервативних методів лікування діафізарних переломів, виділені фактори впливу на зрощення кісткових фрагментів.

Лiкування дiафiзарних переломiв плечової кістки за допомогою блокуючого iнтрамедулярного металоостеосинтезу в умовах Обласної лікарні інтенсивного лікування м. Маріуполя

Проведено аналiз лiкування 38 хворих з діафізарними переломами плечової кiстки та їх наслідками. 32 з них оперовані методом блокуючого iнтрамедулярного остеосинтезу. Результати лiкування простежені в термiни вiд 4 до 24 мiсяцiв пiсля оперативного втручання. Встановлено, що метод блокуючого iнтрамедулярного остеосинтезу дозволяє оптимiзувати термiни консолiдацiї, покращити результати та якiсть життя пацiєнтiв пiд час лiкування i може бути рекомендований як метод вибору для оперативного лiкування дiафiзарних переломiв плечової кістки.

Лечение диафизарных переломов костей нижней конечности методом БИОС при политравме

Актуальность. Переломы диафизов большеберцовой и бедренной костей достаточно распространены. Их доля среди травм опорно-двигательного аппарата при политравматических повреждениях достигает 15,3 %. Лечение больных с политравмой требует применения малоинвазивных методов стабилизации костных отломков с целью ранней активизации пострадавших и обеспечения удобства в проведении дополнительных обследований в случае необходимости. Цель исследования: провести анализ результатов оперативного лечения диафизарных переломов большеберцовой и бедренной костей у пострадавших с политравматическими повреждениями методом блокирующего интрамедуллярного остеосинтеза. Материалы и методы. Проведен анализ результатов лечения 51 больного с переломами бедренной и большеберцовой костей методом блокирующего интрамедуллярного остеосинтеза. Переломы бедренной кости получили 25, а переломы большеберцовой кости — 26 пострадавших. Средний возраст пациентов составил 34 года. Согласно классификации АО, переломы бедренной кости типа А были у 5 пострадавших, типа В — у 15, а переломы типа С — у 5. Переломов большеберцовой кости типа А было 6, типа В — 16, типа С — 4. Оперативное вмешательство методом блокирующего интрамедуллярного остеосинтеза проводили в срок от 1 до 7 суток после травмы, руководствуясь принципами damage control. Все операции выполняли с помощью ЭОП фирмы Philips. Использовали антеградный способ введения интрамедуллярного фиксатора. Внешнюю иммобилизацию после операции не применяли. Активизацию больных с переломами бедренной кости начинали с 4–7-х суток, а при переломах большеберцовой кости — на 2-е — 3-и сутки после операции. Полную нагрузку позволили через 10–12 недель после операции. Удаление металлических конструкций осуществляли не ранее 14–18 месяцев после операции при наличии рентгенологических признаков консолидации перелома. Результаты. Критериями оценки результатов лечения были: своевременная консолидация перелома, деформация сегмента, укорочение сегмента, перелом или миграция металлоконструкции, ограничение движений в суставах, нейротрофические расстройства, инфекционные осложнения. За результатами лечения наблюдали до 24 месяцев после операции. У 47 пациентов удалось достичь хороших результатов. У 5 пациентов результат лечения был расценен как удовлетворительный. У 3 пациентов результат лечения был расценен как неудовлетворительный. После замены методов лечения на чрескостный остеосинтез по методике Г.А. Илизарова удалось достичь консолидации перелома, устранить деформацию сегмента. Гнойно-инфекционное осложнение удалось ликвидировать после удаления металлоконструкции и проведения фистулонекрэктомии. Выводы. Использование метода блокирующего интрамедуллярного остеосинтеза позволяет оптимизировать срок начала реабилитации больных с политравмой и позволяет достичь в 94 % случаев хороших и удовлетворительных результатов.

Atypical use of pediatric flexible nails in the treatment of diaphyseal fractures in adults.

Background and aim of the work:Elastic intramedullary nails are commonly used for the treatment of diaphyseal fractures in adolescents and children. The major advantages are the minimally invasive nature of the technique, the short operation time, and the preservation of the growth plate and periosteum thus allowing bone healing within a closed and intact biological environment. Elastic nails are rarely applied to the adult fractures.Methods:Five selected adult patients affected by diaphyseal fractures were treated using paediatric flexible nails T2 Kids (Stryker®, Mahwah, NJ, USA) as consequence of their poor clinical conditions, high risk of neurovascular injuries and skin/soft tissues problems. All patients were monthly clinically and radiographically evaluated after surgery until fracture healing.Results:Radiological and clinical outcomes were satisfying. All fractures healed after a mean period of 3 months. No losses of reduction as well as mobilization/breakage of implant were observed. Conclusions: Use of pediatric elastic nails is a valid surgical option in treatment of diaphyseal fractures in selected adult patients who request fast and minimally invasive surgery as consequence of precarious clinical or soft tissues conditions. (www.actabiomedica.it)

Fracture management in growing animals

There are important differences to consider when fractures are encountered in growing animals, particularly those under six months of age, rather than in mature animals. Physeal fractures are common and must be diagnosed promptly if satisfactory results following reduction and stabilisation are to be achieved. When physeal fractures are encountered, closed reduction and stabilisation using Kirschner wires applied in various configurations is generally recommended. Careful adherence to the principles of physeal fracture repair will reduce the risks of postoperative complications, including the development of growth deformity. Treatment of diaphyseal fractures in juvenile patients also differs to that in the mature animal. External coaptation may lead to serious complications if inappropriately applied or managed, and must be monitored closely if used. While intramedullary pins are often appropriate in skeletally immature patients, caution is recommended when considering use in the femur. Elastic plate osteosynthesis was developed specifically for use in growing animals and may offer an advantage, particularly for management of femoral fractures. For both physeal and diaphyseal fractures, minimally invasive techniques may be beneficial in skeletally immature patients where case presentation allows.

Internal fixation with elastic intramedullary nail versus plate-screw system for treatment of fibular diaphyseal fracture

Objective To compare elastic intramedullary nail (EIN) and plate-screw (P+S) system in the treatment of fibular diaphyseal fractures. Methods From January 2014 to April 2017, 48 tibiofibular fractures were treated with internal fixation using EIN (21 cases) or plate-screw (27 cases) . The 2 groups were compared in terms of intraoperative blood loss, operative time, fibular healing time, fibular union rate, ankle function and postoperative complications. Results All the patients were followed up for 3 to 24 months (average, 14.0 months) .The intraoperative blood loss (17.9±4.9 mL) , operative time (23.2±5.8 min) and fibular healing time (10.3±1.8 weeks) for the EIN group were significantly less than those for the plate-screw group (28.9±9.6 mL, 30.0±10.7 min and 11.6±2.0 weeks) (P 0.05) . The AOFAS ankle-hindfoot scoring revealed 12 excellent, 8 good and one fair cases (91.0±5.3 points on average) in the EIN group, and 14 excellent, 10 good and 3 fair cases (90.1±6.1 points on average) in the plate-screw group, showing no significant difference between the 2 groups (P=0.594) . Conclusions Compared with plate-screw system, elastic intramedullary nail for fibular diaphyseal fractures may be in line with the biomechanical characteristics of the fibula and with the basic principles of minimally invasive surgery. It may be advantageous in blood loss, operative time and fracture healing but not in fibular union rate or functional recovery of the ankle. An appropriate way of internal fixation for a fibular diaphyseal fracture should be chosen according to the specific conditions of the patient. Key words: Fibula; Fractures, Bone; Fracture fixation, internal; Bone nails; Bone plate

Biomechanical study in vitro on the use of self-designed external fixator in diaphyseal III metacarpal fractures in horses

Diaphyseal fractures of the III metacarpal bone represent 22% of all fractures of the long bones in horses. Treatment of such cases is difficult. The most popular solution used in these types of fractures is two plates applied directly to the bone surface, but they are not applicable on contaminated and infected fractures. External fixators are quite commonly used in human medicine, although in veterinary practice there is no typical stabilizer designed for the treatment of diaphyseal fractures of the III metacarpal bone so far. In this study, an external semicircular fixator of our own design was used and in vitro strength tests were conducted to determine the maximum force which would lead to the destruction of non-fractured bone and fractured bone treated with the stabilizer. On the basis of the strength tests, we can conclude that the stabilizer can be strong enough to allow the horse to stand up after surgery. It also has many favorable features which make it easy to assemble and to take care of a wound, while being safe enough for the animal at the same time.

Osteosynthesis of mid-distal humeral diaphyseal fracture with an anatomically precontoured extra-articular distal plate system

Objective To evaluate the clinical outcomes of internal fixation with extra-articular distal humerus locking compression plate (LCP) for the treatment of mid-distal humerus diaphyseal fracture. Methods From December 2012 to December 2016, a cohort of 22 patients with mid-distal humerus shaft fracture were treated by open reduction and internal fixation using extra-articular distal humerus LCP. They were 14 males and 8 females with an average age of 42.7 years (range, from 18 to 86 years). According to AO classification, there were 13 cases of type 12-A, 7 cases of type 12-B, and 2 cases of type 12-C. The surgical time, intra-operative blood loss and hospital stay were recorded. The clinical outcomes were evaluated by the Mayo elbow performance score (MEPS) at the last follow-ups. Results Surgical time ranged from 46 to 95 minutes with an average of 57 minutes. The average blood loss was 220 mL (range, from 150 to 400 mL). The average hospital stay was 10.5 days (range, from 9 to 13 days). The mean follow-up was 23.8 months (range, from 6 to 48 months). Bone union was achieved in 21 cases after an average of 4.6 months (range, from 3 to 9 months), and one patient experienced bone non-union which was uneventfully healed after secondary auto platelet rich plasma (PRP) graft management. The average MEPS elbow performance score was 88.2, resulting in 16 excellent, 4 fine and 2 fair cases (excellent and fine rate: 90.9%). Conclusions Since extra-articular distal humerus LCP can provide stable internal fixation, facilitating early postoperative rehabilitation, it may be considered an effective alternative osteosynthesis for mid-distal comminuted humeral diaphyseal fractures. Key words: Elbow joint; Humeral fractures; Fracture fixation, internal; Treatment outcome

Do osteoporotic fractures constitute a greater recalcitrant challenge for skeletal regeneration? Investigating the efficacy of BMP-7 and zoledronate treatment of diaphyseal fractures in an open fracture osteoporotic rat model

SummaryOsteoporotic fractures may pose a challenge for skeletal regeneration. This study investigates if pharmaceutical interventions such as bone morphogenetic protein 7 (BMP-7) alone or in combination with Zoledronate have equivalent efficacy in osteoporotic bone? Our findings suggest they do and that an osteoporotic bone environment may increase sensitivity to BMP-7.IntroductionOsteoporosis is thought to contribute to delayed or impaired bone healing. Bone morphogenetic protein 7 (BMP-7) alone or synergistically combined with zoledronate (ZA) has proven effective in augmenting the regenerative response in healthy young male rats. Yet their comparative efficacy in an osteoporotic bone environment is unknown. Our study aimed to answer the following questions using the ovariectomized (OVX) rat model of osteoporosis: Do osteoporotic fractures pose a greater challenge for skeletal regeneration? Are interventions with BMP-7-alone or combined with ZA of equivalent efficacy in osteoporotic bone?MethodsSham operations (n = 33) or ovariectomies (n = 34) were performed in 12-week-old female Sprague-Dawley rats. Mid-diaphyseal open femoral osteotomies were created at 24 weeks of age and the rats allocated to either (i) untreated, (ii) BMP-7-only or (iii) BMP-7 + ZA treatment groups. At 6 weeks post-osteotomy, fracture healing was evaluated by radiography, μCT and 3-point bending mechanical tests.ResultsCumulatively, radiological, micro-structural and mechanical measures were equivalent in both healthy and osteoporotic environments. A reduced response to BMP-7-alone was observed in healthy rats that may be age/gender- or protocol/fracture-model dependent. Conversely, the BMP-7-only treated OVX group attained 100 % union in addition to significantly increased measures of mineralized bone volume, total callus volume, peak force and absorbed energy relative to untreated OVX fractures.ConclusionsOur findings refute the hypothesis that osteoporotic fractures constitute a greater recalcitrant challenge for skeletal regeneration. Furthermore, our results suggest that an oestrogen-deficient environment may in fact cause an increased sensitivity to BMP-7.

Bone fragments displacement in the treatment of diaphyseal fractures and their importance to the process of bone regeneration

Methods of fixation are used for the treatment of diaphyseal fractures, which produce structure « fragments – fixation device » with various mechanical properties and the displacement range of fragments. Purpose: to justify the concept of the effect of the displacement of bone fragments in the process of formation of the regenerate in the treatment of diaphyseal fractures with orthosis or external rod device (ARD). Methods: dislocation of the bone fragments using ultrasonography studied in 18 patients with diaphyseal fractures of humerus (9), femur (5) and tibia (5). Eight patients out of them with acute humeral fractures were treated conservatively with orthosis, in 5 patients with acute femoral and tibial fractures ARD was used, 6 patients had nonunion after osteosynthesis. Results: it is found that bone fragments have a multidirectional path of movement in space. In patients with acute humeral fractures treated with orthosis, linear displacement of the fragments end ranged 1 . 1–6 mm (10–40 % of initial distance), angular amplitude was 2°–8°. In ARD fixation linear fragment displacement (2 mm — 13 %) found only in patients with femoral fractures. In a cases of nonunion angular skeletal deformation appeared and increased under the axial load (apical deformity angel 13–40 %). The mobility of bone fragments in the first three weeks after diaphyseal fracture causes deformation and strain blastema, which results in the future structure of the high-grade periosteal bone regenerate. Nonunion of diaphyseal fracture fragments mobility does not provide a stimulating and shaping effect.

Stress-strain state of fibrin-blood clot and periosteum in the area of diaphyseal fracture under different conditions of fracture fragments fixation and its impact on the structural organization of regenerate

The goal: using mathematical finite-element modeling to calculate the stress-strain state (SSS) of fibrin-blood clot and periosteum around the fracture zone in the conditions of fixation of femur fragments with on-bone plate, intramedullary locking nail and ExFix. The methods: the model represents two fragments of femur with transverse fracture plane joined with spindly fibrin-blood clot enclosed in periosteum and devices mentioned above. The existing data on the Young's modulus and Poisson's ratio of all components of the model were used. The calculations of SSS of clot and periosteum were performed under axial load of 800 N on femur and transverse load of 200 N on the distal femur. The control points on the horizontal section of clot and periosteum were selected for a quantitative comparison of the voltage in various conditions of fragments fixation. Moreover, the area covered by the maximum stress level was compared. The results: The following patterns were revealed. At the same axial load of model the lowest level of stress in periosteal-fibrin spindle was observed when fragments were fixed with intra­medullary locking nail, a little more — with plate, and the biggest one — with ExFix. The ratio of the stress values was 1: 2: 3–4.At the same transverse load of model the lowest level of stress in periosteal-fibrin spindle was observed when fragments were fixed with plate, a little more – with intramedullary locking nail, and the biggest one — with ExFix. The ratio of the stress values was 1: 6: 10–12.The greatest difference in stress levels was noticed in the conditions of transverse load on the segment. Conclusion: The presented data on SSS in tissues around the fracture zone explain the origin of sizes, shapes and structures of periosteal bone regenerate in the treatment of diaphyseal fractures with devices with different modes of mobility of bone fragments.

Treatment of diaphyseal fractures of the metacarpal bones

It was presented the experience of theapplication of stable osteosynthesisby three Kirschner wires on diaphyseal fractures of the metacarpal bones on 74 patients. Indications for osteosynthesiswere opened (6 %), closed (94 %), non-united, mal-unitedfracturesand false joints of metacarpal bonesdiaphysis. Patients were performed intraosseous anesthesia atdistalepimetaphysisarea of radial bone anddescribeda method of operation extramedullaryosteosynthesis using three Kirschner wires. Also, describedmethod of wedge osteotomy for full recovery of hand function. Good results were obtained in 83.1 % of patients, satisfactory at 13.6 %, and unsatisfactory results in 3.4 % of patients.

A paradigm shift of the conventional intramedullary devices to new biological osteosynthetic devices: Bone stents

The intramedullary nailing as a fixation device has a long history, which dates back to the 16th century and has evolved in various aspects. Now, it has become a gold standard for the treatment for diaphyseal fractures, with a good success rate, however the technique still has some drawbacks associated with it, but continued research regarding new mechanisms and devices can overcome these drawbacks. New osteosynthetic devices, such as intramedullary bone stents can be superior to current fixation devices, as they have a modulus of elasticity closer to that of bone, cause minimum soft tissue damage and trauma. Moreover, they can overcome complications posed by conventional devices, such as stress shielding and an inadequate blood supply. This review focuses on an evolutionary perspective of intramedullary devices used surgically for the repair of long bone diaphyseal fractures.

Verrouillage distal des clous fémoraux : une analyse mathématique du champ de tir préférentiel

Summary Background During the last decades, intramedullary nailing has become the standard treatment for diaphyseal fractures of long bones. Numerous innovative techniques and devices have been proposed to simplify distal locking. Each has its own limitations and, as a result, the fluoroscopy-dependent “free-hand technique” remains the most popular method. However, radiation exposure to the patient and operating room staff remains a concern. Methods Before the development of a new radiation-independent, nail-mounted targeting system, we mathematically analyzed the aiming accuracy that such a system has to achieve. The correctness of this mathematical model was evaluated using a mechanical testing apparatus. Findings We found a quite large targeting range for the unimpeded passage of the drill bit through the locking hole of a given nail. Important degrees of nail bending can thereby be compensated. As predicted by the mathematical formula, a 4-mm drill bit passed the distal locking hole of a 320/11 mm femoral nail up to a deflection of ± 13 mm in the coronal plane. Interpretation This mathematical model can be considered to be an additional tool for the development of new targeting devices. Combining our mathematical model with data previously published, not only torsional deformation along the longitudinal axis of the nail but also bending in the coronal plane can approximately be neglected. Hence, the three-dimensional aiming process can be simplified to the determination of the interlocking hole of the nail in the sagittal plane provided that the insertion-induced nail deformation in vivo stays in the range of that observed in vitro. Level of evidence Level III: basic sciences control study.

Mistakes and complications in treatment of diaphyseal fractures of the forearm bones in children

Remote results of treatment of 143 children, aged 3-14 years, with diaphyseal fractures of the forearm bones were analysed in order to reveal the causes of their complications. Mistakes in conservative treatment were made in 18 patients (12.6 %) owing to unqualified assessment of radiograms and underestimation of clinical signs and symptoms. Imperfect immobilization of the fractures resulted in complications in 86 cases (60.1 %), nonobservance of fixation terms in 27 (18.9 %), frequent changes of plaster bandages in 12 (18.9 %), and absence of rehabilitation in 47 (32.6 %).

Cutaneous Complications of Functional Bracing of the Humerus

Patient selection is important when functional bracing is chosen for the treatment of diaphyseal fractures of the humerus. When functional bracing is properly applied to well-selected patients, nonunion rates are low, and skin complications are almost nonexistent. We describe a patient with a closed diaphyseal humeral fracture who experienced skin breakdown and ulceration from the brace with protrusion of the proximal fracture spike, effectively converting a closed fracture into an open one. The patient and her primary caregiver (her daughter) were informed that data concerning the case would be submitted for publication, and they consented. An eighty-seven-year-old woman fell from standing height and landed on the right (dominant) arm. On examination in the emergency department, a varus deformity of the right humerus was evident and radial nerve function was intact. There was some minor bruising over the anterolateral aspect of the arm, corresponding to irritation from the tip of the proximal fragment, but there was no open wound. Radiographs revealed a long spiral AO-OTA 12-A1 diaphyseal fracture extending from the proximal third to the middle of the shaft of the humerus (Fig. 1). The proximal fragment was widely abducted and was pointing laterally. Initial treatment was accomplished by placing the arm in a hanging U-shaped plaster coaptation splint, and the patient was advised against abducting the right arm. Because the fall had not been witnessed, the patient was admitted for additional neurological evaluation. Fig. 1 Radiographs showing the AO-OTA 12-A1 fracture of the right humerus. As the patient had multiple underlying comorbidities, including atrial fibrillation, coronary artery disease, mitral valve prolapse with regurgitation, bronchial asthma, and Alzheimer dementia, a nonoperative course of treatment was chosen. On the second day of admission, a thermoplastic brace was fabricated and applied (Fig. 2). The brace had two components—an anterior shell and a posterior interlocking shell, …

Closed Intramedullar Osteosynthesis in Surgical Treatment of Children with Diaphyseal Femur Fractures

Outcomes of surgical treatment for diaphyseal fractures of the femur were analyzed in 270 (278 interventions) out of 509 patients being admitted to the clinic since 1999. In overwhelming majority of patients (226 children) closed intramedullar fixation of bone fragments (231 operations) was performed. Closed intramedullar osteosynthesis was performed using flexible and rigid rods including the locking ones. Elastic-stable osteosynthesis is indicated for the treatment of under school age children with type A1, A2, A3, B1, B2, B3, C2 fractures as well as junior school age children with type A1, A2, B1, B3, C2 fractures. Presented technique can be considered as a gold standard in this group of patients. Closed intramedullary osteosynthesis by rigid rod without locking is the optimum technique for the treatment of junior and senior school age children in bearing injuries of types A3 and B2. Method of choice in senior school age children with A1, A2, B1, B3, C1, C2 and C3 fractures is closed intramedullar osteosynthesis with locking rod. Preliminary extrafocal fixation in multiple and open injuries creates optimum conditions for delayed intramedullar osteosynthesis.

Effects of interlocking nail on the treatment of femoral fractures

Objective To study the effect of self-locking spinning insertion nail on the treatment of femoral diaphyseal fracture.Methods 60 cases of variant femoral diaphyseal fractures were treated with internaI fixation by self-locking spinning insertion nail.Early function exercise was permitted without weight bearing.Results All cases were followed up for 8 weeks to 3 years.The results were excellent in 39 cases,good in 18 and fair in 3,and the excellent and good rate was 95%.No malunion.or nail breakage was found.The knee function was recovered completely.Conclusion Self-locking spinning insertion nail has advantages of small incision,less trauma,simple manipulation,fast recovery and easy removal in the treatment of femoral diaphyseal fracture,which provides reliable effects. Key words: Fracture fixation; intramedullary; Femoral fractures