ABSTRACT
The subtrochanteric area is the place where mechanical stress is most concentrated in the femur. When a fracture happens, bone union is delayed and nonunion often occurs. The recommended treatment for atypical fractures is an anatomical reduction of the fracture site as the frequency of nonunion is higher than that of ordinary fractures. Various reduction methods have been suggested, and good results have been obtained. On the other hand, the occurrence of posterior displacement of the distal fragment during the insertion of an intramedullary nail is often overlooked. This is probably because the bone marrow of the femur tends to form an elliptical shape in the anteroposterior direction. The author attempted to insert a blocking screw into the distal part of the fracture to prevent posterior displacement of the distal fragment while performing intramedullary nailing of the femur fracture and achieved a good reduction state easily.
Subject(s)
Bone Marrow , Femur , Fracture Fixation, Intramedullary , Hand , Stress, MechanicalABSTRACT
PURPOSE: To evaluate the usefulness of blocking screws in distal tibial metaphyseal fractures treated with intramedullary nailing. MATERIALS AND METHODS: A total of 18 patients with distal tibial metaphyseal fractures, who underwent intramedullary nailing treatment with blocking screws between January 2012 and December 2014 and had a minimum follow-up of 1 year, were retrospectively reviewed for analysis. There were 7 patients with open fracture and 4 patients with intra-articular fracture. The location of the blocking screws was previously determined according to the fracture pattern. Moreover, the preoperative and postoperative angular alignment was measured. Patients received regular postoperative radiographic check-up, and the time-to-bone union and the incidence of nonunion were recorded. The clinical outcome was evaluated using the modified functional Kalstrom-Olerud score. RESULTS: All fractures healed completely without nonunion at an average of 17.7 weeks. The mean coronal/sagittal alignment improved from 6.4/4.8 degrees preoperatively to 2.5/1.9 degrees postoperatively. The alignment was maintained until complete union. There were 3 cases of anterior knee pain but no complications related to the blocking screw and wound infection. Using a modified functional Karlstrom-Olerud score, the outcome was considered good to excellent in 83.4% of the patient cohort. CONCLUSION: We conclude that the blocking screws may help the maintenance of reduction and alignment in distal tibial metaphyseal fractures treated with intramedullary nailing.
Subject(s)
Humans , Cohort Studies , Follow-Up Studies , Fracture Fixation, Intramedullary , Fractures, Open , Incidence , Intra-Articular Fractures , Knee , Retrospective Studies , Wound InfectionABSTRACT
OBJETIVO: Definir una zona segura, usando como referencia la línea intercondílea anterior (LCA) del codo para realizar los bloqueos anteroposteriores durante el enclavijado endomedular retrógrado humeral (CEMR). MÉTODOS: Estudio experimental ex-vivo. Trece húmeros humanos fueron analizados. Se tomaron fotografías registrando la porción distal de los húmeros paralelos a la LCA, elevando el húmero distal 10cm. Tres evaluadores independientes realizaron las siguientes mediciones: ángulo del surco bicipital (SB) a la altura del cuello quirúrgico humeral (S, formado por las paredes medial y lateral del SB; zona de peligro) y el ángulo complementario lateral (formado por el límite lateral de la tróclea y la pared lateral del SB a la altura del cuello quirúrgico humeral; zona segura). RESULTADOS: Valor promedio de S: 3,1±0,5° (3,3-4), coeficiente de correlación intraclase: 0,057 (p=0,057). Valor promedio del ángulo complementario lateral: 87,5±3,3° (81,3-92,5), coeficiente de correlación intraclase: 0,304 (p=0,217). Considerando 3 desviaciones estándar del promedio de los ángulos medidos (para aumentar los parámetros de seguridad) la zona segura se enmarcó entre los 0° y los 80° con relación a la LCA. CONCLUSIÓN: En este estudio la zona de seguridad del bloqueo cefálico anteroposterior para evitar el daño del tendón bicipital durante el enclavijado endomedular retrógrado humeral se localizó entre los 0° y 80° con relación a la LCA.
OBJECTIVE: To define a safe zone, using the anterior intercondylar line (AIL) of the elbow as a reference to perform anterior-posterior (AP) cranial blocks during retrograde intramedullary humeral nailing (RIHN). METHODS: An ex-vivo experimental study was performed by analysing 13 human humeri. Photographs were taken, recording the distal portion of the humeri parallel to the AIL, elevating the distal humerus 10cm. Three independent evaluators made the following measurements: Bicipital groove (BG) angle at the level of the surgical neck of the humerus (S, formed by the medial and lateral walls of the BG; danger zone) and the Lateral Complementary Angle (LCA, formed by t5he lateral trochlear limit and the lateral wall of the BG at the level of the surgical neck of the humerus; safe zone). RESULTS: The mean value of S: 3.1±0.5° (3.3-4), intraclass correlation coefficient (ICC): 0.057 (P=.057). The mean value of the AIL: 87.5±3.3° (81.3-92.5), ICC: 0.304 (P=.217). Using 3 standard deviations from the mean of the angles measured (in order to increase the safety parameters), the safety zone is located between 0° and 80° in relation to the AIL. CONCLUSION: In this study, the safety zone of the AP cranial block, in order to avoid damage to bicipital tendon during RIHN, is situated between 0° and 80° in relation to the AIL.
Subject(s)
Humans , Bone Screws , Fracture Fixation, Intramedullary/methods , Humeral Fractures/surgery , Humerus/anatomy & histology , Bone Nails , CadaverABSTRACT
Objective To introduce minimally invasive fixation of lower tibial fractures with ex- tra-distal interlocking intramedullary nail combined with blocking screw and evaluate itS clinical outcome. Methods Five patients with lower tibial fracture received the fixation with extra-distal interlocking in- trainedullary nail combined with blocking screw.Their clinical data were analyzed.Results They were followed up for a mean time of 22.2 weeks.All patients got normal wound healing,satisfactory reduction andstable fixation.No infection or any other soft tissue complications occurred.Condusion Fixation with extra-distal interlocking intramedullary nail plus blocking screw for lower tibial fractures has advantages of minimal invasion,shorter operative time,stronger fixation and better softtissue protection over traditional open reduction and buttress plate fixation.
ABSTRACT
PURPOSE: To evaluate the effectiveness of a blocking screw in intramedullary nailing at the tibia proximal shaft fracture. MATERIALS AND METHODS: 63 tibia proximal shaft fractures from January 2000 to December 2002 treated with only intramedullary nailing were referred to as group I, and 8 fractures from January 2003 to December 2003 treated with both intramedullary nailing and the blocking screw were referred to as group II. Retrospective studies were done for group I and II. The incidence of nonunion and the postoperative angular alignments were compared. Malalignment was defined as an angle of 5 degrees anteroposteriorly or mediolaterally. RESULTS: There were 7 nonunion (11%) in group I in compare with none in group II. There were 21 angular malalignments (33%) in group I and 1 in group II (12%) and most of them had valgus deformity or anterior anglulation. No complications were directly due to the use of the Blocking screw. CONCLUSION: The technique of the blocking screw used to be one of the option for proximal tibial nailing at tibial proximal shaft fracture helps to overcome angular malalignments of bones.