ABSTRACT
The intramedullary nailing is one of the most available method in the treatment of femoral shaft fracture. Since the development of Küntscher nail in 1940, new designs such as the Grosse-Kempf interlocking femoral nail, Ressell-Taylor Femoral nial, AO/ASIF universal nail, ACE titanium nail became widely used by more applicable level of femoral shaft fracture. But complication of intramedullary nailing was rarely seen. The authors analyzed the clinical and mechanical factors predisposing to failures of intramedullary interlocking nails in 6 cases whom treated the comminuted fracture of the femoral shaft, at the department of orthopaedic surgery, Sun General Hospital from 1991 to 1995 and the following results are obtained. 1. Initial fracture patterns were comminuted in all 6 cases. 2. The implant nails were AO nail in 4 cases, Grosse-Kempf nail in 1 case, Russell-Taylor nail in 1 case(nail diameter was 10mm to 12mm). 3. The failure sites of the interlocking nail were the initial bone fracture site in 2 cases, distal to the proximal screw hole in 1 case, proximal to the distal screw hole in 2 cases, fracture site and distal to the proximal screw hole in 1 case. 4. The average time to failure of implants were 11.5 months. 5. The average times to partical weight bearing were 6.3 weeks. In the analy of above results, by using diameter of nail more than 13mm and delaying weight bearing on the injured limb until there is clear radiographic evidence of early union of the femur fracture, we may reduce the metal failures of intramedullary interlocking nail in comminuted femoral shaft fractures.
Subject(s)
Extremities , Femur , Fracture Fixation, Intramedullary , Fractures, Bone , Fractures, Comminuted , Hospitals, General , Methods , Solar System , Titanium , Weight-BearingABSTRACT
Inappropriate treatment of the injury of the lateral collateral ligaments of the ankle produce residual instability, which causes serious disability. There is considerable divergence of opinion as to whether fresh rupture of the lateral ligaments of the ankle are best treated by conservative or opreative method. We have conducted a trial to analyze thirty patients, who were treated by immediate open surgical rupair of rupture of the lateral ligaments of the ankle between April 1991 and February 1992. The results were as follows: 1. All patients were active, young men, Injuries to left ankle were three times more than right side. The most common cause of injury is occurred during sports, especially association football. 2. The decision to operate was based on 1)Talar tilt angle of the injured ankle measures 8-10 degrees more than that of the stress uninjured ankle. 2)A positive arthrogram showing contrast leakage into peroneal tendon she-aths & anterolateral aspect of the lateral malleolus. 3. Diagnostic accuracy rate of arthrography is 94.5%, stress radiography 61.1 %. Arthrography is more reliable than stress radiography in the diagnosis of acute injuries to the lateral ligament of the ankle. 4. At operation, isolated rupture of anterior talofibular ligament was in 5 cases, isolated rupture of middle calcaneofibular ligament in 3 cases, concomittant ruptures of anterior talofibular and middle calcaneofibular ligements in 22 cases. 5. Location of tears of anterior talofibular ligament was mostly mid-portion, middle calcaneofibular ligament in mid-portion or distal portion. 6. On radiologic results, average angle of talar tilt was 14.4° preoperatively, 5.2 preoperatively. There was correction of talar tilt angle of average 9.2°. 7. Clinical results of treatment were excellent in 9 patients, good in 6 patients, fair in 4 patients, poor in 2 patients by authors rating system. The satisfactory result was achieved in 15 patients(71.4%). 8. Postoperative complication was reduced mobility in 4 cases, functional instability 1 case, neuroma in operation scar in 2 cases, minor sensory loss in 4 cases. 9. Primary surgical repair gave good results in the aspect of radiologic & fun ctional instability, but clinical results were not satisfactory, due to high incidence of postoperative complication.