Minimally invasive fixation of diaphyseal fractures of the long weight bearing bones using ender nailing

The effect and result of 115 semirigid Ender nails in 98 patients suffered either closed or open diaphyseal fractures of the long weight-bearing bones, and followed for a minimum of 2 years were reviewed and analyzed. The patients included 67 males and 31 females, ranging in age from 08-to-68 years, with a mean of 37 years. All patients sustained their fractures as a result of a significant high-velocity injury, 76 in a motor vehicle accident, 14 during sport activities - but in 8, the fractures were due to direct blow and heavy object impact at work. Of the 115 fractures, 21 were open injuries and 25 out of the 98 patients had additional injuries and fractures of other bones. The geometry of most fractures were met the criteria that ensured good mechanical effect after Ender nailing, mainly, the maintenance of axial stability. We did not include cases with established instability, except for the 4 cases with segmental tibial shaft fractures. 61[53%] fractures including open injuries and segmental fractures were treated within 8 hours after injury. On the basis of the results of the current study, open fractures did not considered to be a contraindication for primary nailing. Delayed nailing was performed within 7 days of the onset of trauma for the rest of cases. All cases followed a similar therapeutic regimen, in addition to the initial debridement for open fractures. Most patients experienced pain relief in the early post-operative period and many could resume their activities of the daily living. Rapid restoration of bone continuity with no significant mal-alignment was the early positive finding in the majority of cases in the series. In the course of follow-up, we collected sufficient data to rate patients according to Thoreson, et al., scoring system [18]. At final up, an excellent result was obtained in 91.3% of cases and good in the remaining 8.7%. On conclusion, this method proved to be safe and effective with minimal complications - this is particularly true when the procedure is carried out under the right circumstances with careful attention to its indication and its technical aspects, and then, the chances for the success of the fixation can be greatly improved

Vastus medialis obliquus advancement in association with patellectomy in cases of highly comminuted patellar fractures

The results of 13 total patellectomy, combined with vastus medialis obliquus [VMO] advancement in 13 patients followed-up for 9-to-40 months were analyzed. The patients included 9 [69.2%] males, and the other 4 [30.8%] were females. Their ages ranged from 20-to-40 years old. The indication for patellectomy was severely comminuted fracture of the patella. A direct blow to the patella was the causative trauma for all cases; 9 [69.2%] fractures were closed, and 4 [30.8%] were opened. Associated injuries were reported in 3 [23.1%] patients: Colles' fracture, forearm bones fracture, and open intercondylar-supracondylar fracture femur. Functional assessment of the patients was carried out using the scoring scales described by Marshall, et al., 1977; and Levack, et al., 1985 [18-21]. The overall results according to Marshall, et al., were scored 7.5/8 points which considered excellent - and scored 8.2/9 points according to Levack, et al., which considered good. This technique appears to give better functional results as regards pain, discomfort, range of knee movements, quadriceps function and functional activities including: walking, running jumping, and squatting

Primary non-reamed locked nailing in acute open: segmental tibial shaft fractures [high-risk tibial shaft fractures]

From November, 1999, to April 2004, 23 open segmental tibial shaft fractures were treated by primary non-reamed intramedullary locked nailing after appropriate wound debridement. Most patients were active labor men, the youngest was 27 years old and the oldest was 68 years, with an average of 46 years. The mechanism of injury was high energy trauma; road traffic accidents were responsible for the majority of fractures 15[65.2%]; 9[39.1%] patients had been struck by a motor vehicle as a pedestrian, 4[17.4%] were occupants of a motor vehicle that was involved in an accident; one [4.3%] as a driver, and the other 3[13.1%] as passengers - 2[8.7%] were motorbike accidents Industrial accidents due to blunt trauma represented the remaining 8[34.8%] fractures; 6[26.1%] had a fall from a considerable height, and in two patients [8.7%] the tibiae were crushed by a heavy object. Concomitant fractures of other bones had occurred in approximately half of the cases 11[47.8%], three [13%] had in addition, head injury. For all cases, prophylactic antibiotics were started on admission. Surgery was done immediately post-injury, the average time from injury-to-surgery was 4 hours. Delayed nailing after primary debridement was performed between 3-and-8 days in 5 [21.7%] fractures. No post-operative plaster was needed. Additional bone grafting operation was done in 3 [13%] cases, and pedicle muscle flap to cover the exposed bone in another 3 [13%]. Secondary procedures; plastic reconstructive surgery including delayed wound coverage, bone-marrow injection, fibular osteotomy, Illizaroy application, and nail exchange using 1-2 mm larger diameter nail were done in 9[39.1%] patients. Dynamization of the static locked nailing was needed after 3-to-6 months in 11[47.8%] cases to enhance consolidation and corticalization of the formed callus. After dynamization shortening up to 2 cm was observed in 7[30.4%] patients, 4 of the 7, in addition, developed varus and external rotation malalignment. These deformities did not show further change or progression in the course of follow-up. The patients were allowed partial weight-bearing with crutches as tolerated as soon as they were comfortable and as the other injuries had allowed Patients were evaluated clinically - and radiologically until healing of the fractures. Most of the patients 19[82.6%] achieved clinical union in 9-to- 11 weeks after nailing, however, osseous union had occurred in less than 4 months in 5[21.7%] fractures, and between 4-to-8 months in 14[60.9%]. Only 4[17.4%] fractures were not united after 8 months, that needed further surgical intervention to achieve union

Mini-screw fixation for certain fractures of the phalanges and the metacarpals

68 patients with phalangeal or metacarpal fractures were treated in the emergency department at Bab-Elshareia university hospital and health insurance hospital by open reduction and internal fixation using inter-fragmentary lag screw stabilization technique. Operative stabilization was considered because we failed to restore fracture alignment at closed attempts, or fractures failed to maintain closed reduction in plaster immobilization after conservative trials, Phalangeal fractures were accounted for 45 [66.2%] of the total, the remaining 23[33.8%] were metacarpals. There were 59 [86.8%] males and 9[13.2%] females. The youngest patient was 18 years old and the oldest was 55; the mean age was 27 years. All fractures were unstable. The fracture pattern was displaced spiral in 49 [72.1%] cases and displaced oblique in the remaining 19[27.9%]. There were 39[57.4%] injuries to the left hand, 29[42.6%] to the right, and in no instance was there an injury to both hands. Considering all 68 fractures, direct blow was accounted for 80.9% of the total, whereas indirect forces was instrumental in only 19.1% of the fractures. Most of the injuries 39[57.4%] had occurred in young labor men. Athletic injuries, 20[29.4%] fractures had occurred in young adult students. Indoor injuries, 9 [13.2%] fractures had occurred only in females, most of them were in the 5th decade of life. All injuries were closed single-bone fracture. None of the fractures was pathological none was intra-articular and none of the patients had other additional injuries elsewhere, but one, suffered in addition, ipsilateral fracture distal radius. The overall results at final follow-up were excellent in 61[89.7%] patients, and good in 7[10.3%]

Remote fixation of humeral shaft fractures using ender nailing technique

A fracture of the humeral shaft is defined as one occurring below the surgical neck and above the supracondylar ridge of the humerus [1-24], Remote fixation means that, the fracture site is not interfered with and remains untouched during the operative procedure. Nail insertion is carried out through an isolated and restricted proximal or distal incisions [1-3]. Among many humeral shaft fractures that were seen during the period of the study [2001-2004], 46 fractures in 42 patients were nailed using closed Ender technique. Our opinion, all these fractures were not suitable for conservative treatment There were 29 [69.0%] men and 13[31.0%] women, with an average age of 31.5 years. Direct blow to the arm was the causative trauma in all fractures, of the 42 patients, 18[42.9%] were victims of road traffic accident, the next high incidence, 9[21.4%] patients had injured at work. All fractures were closed, except 6[14.3%] open injuries, the skin wound was about 1 cm long in 2 cases and the other 4 were graded Gustilo type-Il [9]. Associated injuries were reported in 13 [31.0%] patients. The level of the fracture was the middle third in 50% of cases, the upper third in 32.6% and the lower third in 17.4%. Retrograde nailing was done for 38[82.6%] fractures and antegrade for the remaining 8[17.4%]. No external splints were used post-operatively, except in open injuries, just for some days for comfort. Active use of the operated arm was encouraged immediately after the operation. After hospital discharge, patients were reviewed for assessment of functional use of the extremity, range of motion of the shoulder and elbow and for progress of healing. The results obtained confirmed the effectiveness of the procedure with regard to union and function with remarkably low incidence of complications. The average time to return to function was 12 days. The safeness, easiness and simplicity of the technique, in addition, the time saving and the low costly far outweigh other surgical alternatives for all these reasons we recommended this treatment modality when indicated