Comparative Study of External Fixator versus Internal Fixation Using Interlocking Nail in Open Diaphyseal Fractures of Tibia: An Hospital Based Prospective Study

Background: External fixation and internal fixation usingintramedullary nails are two well-accepted and effectivemethods, but each has been historically related tocomplications. We therefore performed a prospective study tocompare the early functional recovery and overall results withthese two methods of management.Materials & Methods: This prospective randomized study wascarried out on the patients admitted in the Department ofOrthopaedics, Dr S.N. Medical College, Jodhpur. The studyincluded 30 patients of Open Diaphyseal Fractures of Tibia. Ofthese, 15 patients were treated by intramedullary interlockingnailing and the remaining 15 patients by External Fixator asprimary fixation method. Patient able to walk without supportwithout pain were considered union clinically. Johner AndWruhs Criteria, 1983 were used to evaluate functionaloutcome.Results: Our study showed that the mean age was 32.4 yearsin ILN group and 34 years in external fixation group. The maleto female ratio was approximate 4:1. In present study showedthat the road traffic accident were most of the injury (80%) ingroup A as compared to group B (93.33%). The farmer & laborwas higher incidence of tibial fractures, which are higherdemanding activity and lower incidence of fractures wasoccurred in low demanding activity occupation. The outcome ofour study showed that excellent in 73.33% cases in group A ascompared to 53.33% in group B. Poor outcome maximum ingroup B was 20% cases as compared to 6.66% in group A.Conclusion: We concluded that in open tibial shaft fractureintramedullary interlocked nailing is excellent modalities,leading to accepted union with a mild delay but permissibleearly weight bearing and low patient morbidity

Management Of Comminuted Tibial Diaphyseal Fractures By Means Of Interlocking Nails

Introduction:This study assesses the outcome of interlocking tibia nail in comminuted fractures of tibial diaphysis. Objectives: To study the functional outcomes of interlocking tibia nail in comminuted tibial diaphyseal fractures, with respect to time to bony union, mobility achieved, complications of the procedure and secondary procedures. Material and Methods: The present prospective study included 25 patients of comminuted fracture shaft of tibia admitted to the Department of Orthopaedics at MMIMSR, Mullana and at Civil Hospital, Rajpura who were managed with interlocking tibia nail. Results:All 25 cases united with interlocking nailing. 1 case needed additional exchange nailing and bone grafting. 3 cases had a malunion but had an acceptable functional outcome. Conclusions: Due to the simple surgical technique, good healing rate and minimum complications, it is recommended that interlocking tibia nail should be used in comminuted fractures of tibial diaphysis

Haste intramedular bloqueada em comparação com placa de compressão dinâmica na estabilização de osteotomia intertrocantérica varizante em cães: estudo ex vivo / Interlocking nail system in comparison with dynamic compression plate in the stabilization of intertrochanteric varus osteotomy in dogs: study in cadavers

Tendo em vista as vantagens das hastes intramedulares bloqueadas (HIB) em relação às placas ósseas na estabilização femoral, o presente estudo objetivou avaliar a exequibilidade e eficácia da aplicação da HIB pós osteotomia intertrocantérica varizante (OIV). Submeteu-se 10 cadáveres caninos à OIV. Nos antímeros esquerdos obteve-se a estabilização por meio de HIB (grupo HIB) e, nos direitos, com placas de compressão dinâmica (grupo placa). Foram comparados os ângulos de Norberg e de inclinação da cabeça e colo femoral (ICF) antes (T0) e após (T1) a OIV. O tempo dispendido para a colocação dos implantes e resultados de resistência biomecânica à compressão e torção também foram confrontados entre os grupos. Houve aumento do ângulo de Norberg entre T0 (106,84®5,55o) e T1 (111,22o®3,89), apenas no grupo HIB (p<0,05). No entanto, redução do ângulo de ICF após OIV (T1) foi observada tanto no grupo placa (T0=127,6®4,70o e T1=110,06®10,61o, p<0,05) quanto no grupo HIB (T0=126,43®5,87o e T1=116,87®8,62o, p<0,05). Os tempos de colocação dos implantes não diferiram estatisticamente e apenas o teste biomecânico de compressão revelou diferença entre os grupos, com maior resistência (P=0,033) do grupo placa (863,3®74,46N/mm) em relação ao grupo HIB (586,7®44,10N/mm). Deste modo, a estabilização por meio de HIB foi factível e eficaz. Embora o resultado biomecânico de compressão tenha demonstrado maior fragilidade da HIB em relação à placa de compressão, seus valores estão acima das forças atuantes, reportadas na literatura, na deambulação normal de cão.(AU)

Considering the advantages of the interlocking intramedullary nail (IN) in relation to bone plates in the femoral stabilization, this study aimed to evaluate the feasibility and effectiveness of IN application post intertrochanteric varus osteotomy (IVO). For this purpose, 10 canines cadavers were used. On the left femurs, the fixation was obtained with IN (IN group) and rights fixed with dynamic compression plates and screws (plate group). Was compared the angles of Norberg and inclination of the head and femoral neck (IHF) before (T0) and after (T1) IVO. The results of time spent for placement of implants and biomechanical resistance to compression and torsion were also confronted between groups. There was an increase of the Norberg angle between T0 (106.84®5.55o) and T1 (111.22o®3.89), only in IN group (p<0.05). However, reduction of IHF angle after IVO (T1) was observed in both, the plate group (T0=127.6®4.70o e T1=110.06®10.61o, p<0.05) and IN group (T0=126.43®5.87o e T1=116.87® 8.62 o, p<0.05). The placement times of the implants did not differ statistically and only the compression biomechanical test revealed differences between groups, with greater resistance (P=0.033) of the plate group (863.3®74.46N/mm) compared to IN group (586.7®44.10N/mm). Thus, stabilization through IN was feasible and effective. Although the compression biomechanical results has demonstrated a higher fragility of IN in relation to the compression plate, their values are above the forces, reported in literature, acting in normal dog gait.(AU)

Incidence of Varus Malalignment Post Interlocking Nail in Proximal Femur Shaft Fractures Comparing Two Types of Entry Points

Introduction: Osteosynthesis of the femur using an interlocking nail is the gold standard for treating diaphyseal fractures of the femur. There are two established entry points for the antegrade interlocking nails which is the piriformis fossa or the greater trochanter. It has been reported that varus malalignment was frequently seen in proximal femur fracture which were treated with interlocking nail utilizing the greater trochanter entry point. The study was done to find out if the problem was of significance. Materials and Methods: This was a retrospective study which included 179 patients with femur fractures which were treated from January 2013 till September 2015 in one Hospital. They were treated with interlocking nail either by utilizing the piriformis fossa (PF) or the greater trochanter (GT) entry points. Post-operative radiographs of the femur were used to measure the varus deformity. Results: Out of 179 patients, there were 5 patients who were reported to have unacceptable varus malalignment (2.79%). These 5 patients were out of the 88 (5.68%) patients utilizing the greater trochanter as the entry point. The same 5 patients were out 90 patients that were diagnosed with proximal femur shaft fractures (5.55%). Analysis with logistic regression was statistically not significant. Conclusion: There was higher rate of varus malalignment seen in proximal femur shaft fractures treated with interlocking nails utilizing the greater trochanter entry point. The incidence of varus malalignment was not significant statistically. Key Words: interlocking nail; greater trochanter entry point; varus deformity; femur shaft fracture

Mechanical flexural ex vivo study of osteotomized swine femurs stabilized with two types of polyamide 12 rods / Estudo mecânico de flexão, ex-vivo, de fêmures suínos osteotomizados, estabilizados com dois tipos de haste de poliamida 12

ABSTRACT: Long bone fractures are commonly in surgery routine and several bone imobilization techniques are currently available. Technological progress has enabled to use low cost materials in surgical procedures. Thus, the aim of this study was to evaluate the applicability of polyamide 12 rods, solid and hollow in swine femurs, comparing them through flexion strength. This study had as second aim to fix the locking errors, commom place in interlocking nails, once polyamide 12 allows perforation in any direction by orthopaedic screw. Six groups were used: G1 - eight whole swine femurs; G2 - eight whole swine femurs with drilled medullary canal; G3 - two solid polyamide 12 rods; G4 - two hollow polyamide 12 rods; G5 - eight osteotomized drilled swine femurs with a solid polyamide 12 rod implanted in the medullary canal and locked by four 316L stainless steel screws; and G6 - similar to G5 but using hollow rods instead of solid ones. No significant differences were observed for the modulus of rupture between solid and hollow rods, demonstrating that both rods had similar performances. These results led to the speculation that the addition of other polymers to the hollow rods could increase their strength and thus the bone-implant system. Furthermore, the comparison between G1, G5 and G6 could be analyzed using the finite element method in future. New polymeric materials may be developed based on the data from this study, strengthening the bone-implant system and making possible screws to be placed in any direction, nullifying the detrimental forces on the fracture site.

RESUMO: Fraturas em ossos longos são comumente encontradas na rotina cirúrgica e várias técnicas de imobilização óssea estão disponíveis. Com o avanço tecnológico, tornou-se viável utilizar materiais de baixo custo nos procedimentos, portanto esse estudo objetivou avaliar a aplicabilidade de hastes de poliamida 12, sólidas e vazadas, implantadas em fêmures suínos, comparando-as segundo as forças de flexão e aos erros de bloqueio, corriqueiros nesse implante, uma vez que a poliamida 12 permite sua perfuração em qualquer direção por meio de parafusos ortopédicos. Seis grupos foram usados: G1 - oito fêmures suínos íntegros; G2 - oito fêmures suínos, fresados intramedularmente; G3 - duas hastes maciças de poliamida 12; G4 - duas hastes vazadas de poliamida 12; G5 - oito fêmures suínos osteotomizados e fresados, com haste de poliamida 12 maciça implantada no canal medular e bloqueada com quatro parafusos de aço inoxidável 316L e G6 - diferente de G5 apenas por utilizar hastes vazadas. Não foram observadas diferenças significativas no módulo de ruptura entre hastes sólidas e vazadas, demonstrando que ambas apresentaram o mesmo desempenho. Estes resultados levaram à especulação de que adicionar outros polímeros às hastes vazadas aumentaria sua força e, portanto, do sistema osso-implante. Além disso, a comparação entre G1, G5 e G6 poderia no futuro ser analisada utilizando o método dos elementos finitos. Novos polímeros podem ser desenvolvidos baseando-se nos dados deste estudo, reforçando o sistema osso-implante e também possibilitando o uso de perfurações para o bloqueio no transoperatório em qualquer direção, anulando as forças deletérias atuantes no sítio de fratura.

Análise biomecânica ex vivo de um modelo de haste intramedular de polipropileno para osteossíntese em úmeros de bezerros / Ex vivo biomechanics assay of a model of polypropylene intramedullary nail for calf humeral osteosynthesis

Foram utilizados 12 pares de úmeros obtidos de bezerros machos da raça Holandesa, com idades entre 15 e 30 dias. Os úmeros esquerdos foram mantidos íntegros, e os direitos foram fraturados de forma oblíqua em sua diáfise, na transição entre os terços médio e proximal. A redução da fratura foi feita pela aplicação intramedular de haste de polipropileno, bloqueada por dois parafusos corticais de aço inoxidável, dispostos transversalmente em cada fragmento ósseo. Seis pares de ossos foram submetidos ao teste de compressão, e seis ao teste de flexão, utilizando-se uma máquina universal de ensaios. Nos testes de compressão, as cargas médias de ruptura foram 738,3N e 473,3N, e nos testes de flexão 322,4N e 117,9N, para os ossos íntegros e fraturados, respectivamente. Comparando-se o grupo de ossos fraturados com o grupo de ossos íntegros, verificou-se que o sistema proposto foi capaz de resistir a 66,4 por cento das cargas médias quando submetido à compressão, e a 36,6 por cento quando submetido à flexão. Úmeros fraturados e tratados com haste intramedular de polipropileno apresentaram resistência limitada se comparados aos ossos íntegros.

A total of 12 pairs of humeri from male calves 15 to 30 days old were used. The left humeri remained unchanged and the right ones were fractured in the diaphysis between proximal and middle thirds. The fracture was fixed with a polypropylene intramedullary nail interlocked with two steel bone screws crossed along each segment. Six pairs of bones were subjected to a compression test and the others to a flexural test using a universal testing machine. In the compression tests, the mean rupture loads were 738,3N and 473,3N, and in the flexural tests they were 322,4N and 117,9N for the intact and fractured bones respectively. Fractured bones fixed with the proposed model were able to resist 66.4 percent of the load during compression and 36.6 percent during bending when in comparison to intact bones. Fractured humeri treated with polypropylene intramedullary nail showed limited resistance compared to intact ones.

Sistemas osso-implante ex vivo utilizando haste intramedular polimérica para imobilização de fraturas femorais em bovinos jovens / Ex vivo bone-implant systems using polymeric intramedullary nails for fixation of femoral fractures in young calves

O desenvolvimento de novos aparatos usando materiais disponíveis e de baixo custo pode ser uma alternativa viável para o tratamento cirúrgico de fraturas em ossos longos de bovinos. O objetivo deste estudo foi avaliar a resistência mecânica de fêmures de bovinos jovens com fratura diafiseal, imobilizados com hastes intramedulares bloqueadas, compostas por diferentes polímeros. Para tanto, testes físicos de compressão e flexão, por meio de uma máquina universal de ensaios foram realizados em quatro grupos distintos de seis fêmures obtidos de bovinos jovens. Em um dos grupos, os ossos foram mantidos íntegros (grupo controle), enquanto que os outros os ossos, foram fraturados e imobilizados com uma haste intramedular bloqueada, composta por polipropileno, poliacetal ou poliamida (uma para cada grupo). Independente do polímero utilizado, nenhuma das hastes estudadas ofereceu aos fêmures fraturados resistência comparável ao osso íntegro, quando consideradas em conjunto as forças de flexão e compressão. A concordância desses achados com resultados in vivo previamente publicados, demonstra que a metodologia utilizada para testes ex vivo pode ser útil na seleção de materiais mais resistentes para confecção de novos modelos.

The development of new devices using available and low cost materials may be an useful alternative for the treatment of long bone fractures in large animals. The aim of this study was to evaluate the mechanical strength of young bovine femur with diaphyseal fracture fixed with different polymeric intramedullary nails. Bending and compression tests using a universal machine were carried out in 4 distinct groups of 6 femurs from young calves. In one of the groups bones were intact while in the other three fractured bones were fixed using an intramedullary nail made of polypropylene, polyacetal or polyamide (one for each group). Considering bending and compression tests together, none of the used polymers offered strength to the fractured bones similar to the intact ones. The agreement of this findings with those from previous published in vivo results indicates that the employed ex vivo methods for mechanical assays may be useful in the search of stronger materials to be used in development of new devices.

Falhas na utilização de poliacetal e poliamida em forma de haste intramedular bloqueada para imobilização de fratura femural induzida em bovinos jovens / Failures in the use of polyacetal and polyamide in the form of intramedullary interlocking nail for immobilization of induced femoral fracture in young cattle

Apesar da expressiva evolução da ortopedia veterinária nos últimos anos, as fraturas de ossos longos em grandes animais são constante desafio para o médico-veterinário. O presente estudo é parte da proposta de desenvolvimento de um sistema de haste intramedular polimérica, de baixo custo e fácil aplicação, para uso em bovinos jovens e neonatos. Os objetivos foram avaliar, in vivo, hastes de poliacetal e poliamida para imobilização de fraturas femorais em bovinos jovens. Cinco bezerros machos foram submetidos à anestesia geral e tiveram os fêmures esquerdos fraturados e, em seguida, imobilizados, utilizando-se uma haste cilíndrica de poliacetal ou poliamida inserida no canal intramedular e bloqueada por quatro parafusos corticais de aço inoxidável, inseridos na diáfise em seu sentido lateral-medial e igualmente distribuídos distal e proximal à linha de fratura. Durante um período de 60 dias pós-cirúrgico, os animais foram avaliados por meio de exames clínicos e radiográficos. Houve fratura em quatro das cinco hastes de poliacetal implantadas pela primeira vez e em duas das quatro hastes de poliamida que foram implantadas após a quebra das de poliacetal. Todas as falhas ocorrerem nas primeiras duas semanas de imobilização. Não foram verificados quaisquer sinais de rejeição aos materiais usados. Os resultados demonstram que as hastes de poliacetal e poliamida não apresentaram resistência suficiente para, de acordo com o modelo proposto, promover imobilização precoce de fraturas de fêmur em bovinos jovens.

In spite of the expressive development of veterinary orthopedics in the last years, long bone fractures in large animals remains a challenge for veterinary surgeons. This study is part of a proposal for development of a low-cost and easy-to-use polymeric interlocking nail designed to be used in newborns and young cattle. The objectives were to evaluate, in vivo, polyacetal and polyamide nails for immobilization of femoral fractures in calves. Five calves were submitted to general anesthesia and the left femur was fractured and then fixed using polyacetal or polyamide rods (nails) interlocked with four cortical screws (stainless steel) equally applied to the distal and proximal fracture line. In the postoperative period, calves were clinically assessed during 60 days by clinical and radiographic exams. Fractures occurred in four of the five polyacetal nails implanted in the first time and in two of the four polyamide nails implanted after the polyacetal nail failures. All failures occurred in the first 14 days after implantation. No rejection signs against the polymers were observed. In conclusion, polyacetal and polyamide did not have enough resistance to be used as intramedullary interlocking nails in this system designed to promote early femoral fractures immobilization in young calves.

The curative effects of intramedullary interlocking nailand small incision for the treatment of tibial shaft fracture / 中国基层医药

Objective To evaluate the clinical applied effects of tibial shaft fracture with intramedullary interlocking nail and small incision. Methods From November 2004 to October 2005,47 cases of tibial shaft fracture were treated with intramedullary interlocking nail, all the cases were adopted with small incision and intramedullary interlocking nail, and analysed the curative effects Results 47 cases were followed-up ranged 8 ～ 27 months. All cases resumed normal knee function 6 to 12 weeks after operation,without nonunion and malunion. Conclusion Treatment of tibial shaft fracture with intramedullary interlocking nail and small incision had the advantages of little trauma,good stability, high rate of fracture union and rapid functions recovery. It is worthy deserveed to be put into application and populatization in clinics.

13 Year Old Exposed Interlocking Nail: A Case Report

We are reporting a case of post traumatic chronic osteomyelitis of the tibia with an open wound exposing an intra medullar nail implant for 13 years. The patient presented with fresh ipsilateral tibia plateau fracture. He was treated by removal of the implant, debridement and local placement of Gentamicin impregnated PMMA beads according to guidelines of the two stage Belfast technique. After five months of wound treatment, the exposed bone was covered by healthy granulation tissue and the patient was able to fully bear weight.

Avaliação do uso de haste bloqueada e bloqueio transcortical no reparo de fraturas diafisárias de fêmur em felinos / Evaluation of the use of interlocking nail and transcortical blockade for the repair of diaphyseal fractures of the femur in cats

As hastes bloqueadas além de permitirem estabilização rígida de fraturas, possuem vantagens biomecânicas quando comparadas a outras técnicas de imobilização, por atuar ao longo do eixo mecânico central do osso, além de preservar os conceitos de padrões biológicos de osteossíntese . O uso limitado de hastes bloqueadas em gatos se atribui ao fato da cavidade intramedular ser pequena, limitando o tamanho e diâmetro dos pinos. Relatam-se casos de 10 felinos que apresentavam fraturas fechadas simples ou múltiplas da diáfise femoral. Os animais pesavam entre 3,5 e 5 kg, o que permitiu a utilização de hastes de 4,0mm e 4,7mm de diâmetro. Para inserção da haste, adotou-se a via retrógrada ou a normógrada e foram realizados bloqueios com quatro parafusos de titânio de 2,0 mm de diâmetro. Complicações intra-operatórias não ocorreram, entretanto um animal sofreu fratura de colo femoral e fratura transversa distal ao implante, três dias após o ato cirúrgico, devido a novo trauma. Os animais foram submetidos a exames radiográficos até quatro meses após a intervenção, evidenciando-se formação de calo ósseo secundário e consolidação óssea em período de 61-89 dias. Clinicamente, ocorreu esporadicamente alteração na marcha por leve claudicação de apoio definida por escala de claudicação, entretanto os animais iniciaram o apoio adequado entre três e oito dias após o ato operatório. Complicações pósoperatórias ocorreram referentes ao animal que sofreu novo trauma, entretanto notou-se consolidação do foco primário tratado pelo implante com 61 dias e consolidação da nova fratura num período total de 150 dias do início do tratamento conservativo por penso esparadrapado e tala. Conclui-se que o uso de haste bloqueada em felinos foi adequado uma vez que houve consolidação óssea em todos os casos, com retorno precoce da função do membro, permitindo a deambulação.

Interlocking nails allow rigid fracture stabilization and present biomechanical advantages when compared to other immobilization techniques. It acts along the central mechanical axis of the bone and preserves biological concept standards for osteosynthesis. The use of interlocking nail in cats is limited because the intramedullary space is relatively small for the available nail sizes. We reported 10 cases of cats that had simple or multiple closed fractures of the femoral diaphysis. The animals weighed 3.5 to 5 kg , which allowed using nails of 4.0mm and 4.7mm in diameter. For the nail insertion, retrograde and normograde routs were used, and four 2mm titanium screws were used to lock all the perforations. No trans-surgical complication occurred, however, due to a new trauma, one of the animals suffered femoral neck fracture and transversal distal fracture to the nail, three days after surgery. Radiographies were made up to four months after surgery, and in most cases secondary bone formation was seen, showing bone consolidation in 61-89 days, excluding the animal who suffered new trauma, who presented bone healing in 150 days. Clinically, occasional lameness occurred; however, except for the animal that had new trauma, all animals initiated adequate limb support in 3 to 8 days after surgery. In conclusion, the use of 4.0mm and 4.7mm interlocking nails in felines was adequate, with bone healing in all cases, and also return of good limb function after surgery.

Unlocked Nailing vs. Interlocking Nailing for Winquist Type I and II Femoral Isthmus Fractures. Is there a Difference?

Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for noncomminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus unlocked intramedullary nailing in such fractures. Ninety-three cases of noncomminuted femoral isthmus fractures (Winquist I and II) treated with interlocking nailing and unlocked nailing from 1 June 2004 to 1 June 2005 were reviewed; radiological and clinical union rates, bony alignment, complication and knee function were investigated. There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with unlocked femoral nailing is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. We therefore conclude that unlocked nailing is still useful for the management of non-comminuted isthmus fractures of the femur.

Clinical analysis of reconstruction interlocking nail in surgical treatment of femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur / 中国矫形外科杂志

[Objective]To discuss the operative treatments and evaluate the effects of reconstruction interlocking nail(RIN)in treating femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur.[Method]A retrospective study was done on 37 patients with femoral shaft fractures combined with ipsilateral peritrochanteric fractures treated by RIN from September 2002 to Janurary 2009.This study involved 32 males and 5 females,with an average age of 36 years (range,24 to 69 years).Thirty-three patients had high-energy injury (26 of road accident,7 of falling from height),and 4 low-energy injury.Among them,13 patients had fractures in the upper one-third of the femoral shaft,18 in the middle one-third and 6 in the lower one-third.Six patients had open fractures (Gustilo scale Ⅰ in 1,and Ⅱ in 5).According to Garden classification for femoral neck fractures,there were 19 cases of type Ⅱ,9 cases of type Ⅲ and 2 cases of typ Ⅳ.According to AO classification for femoral intertrochanteric fractures,there were 3 cases of type A1.1,1 case of type A2.1.According to Seinsheimer classification for femoral subtrochanteric fractures,there was 1 case of type Ⅰ,and 2 cases of type ⅡA.The mean duration from injury to surgery was 3.7 days (range,4 hours to 13 days).After operation step-by-step functional rehabilitation was encouraged.[Result]The follow-up periods ranged from 14 to 38 months (average,24 months).Bony union was achieved in all patients.The average bony union time was 13 weeks for fractures of femoral shaft,14 weeks for femoral neck,12.6 weeks for intertrochanteric and 15.5 weeks for subtrochanteric fractures.Femoral head necrosis occurred in one case.No such complications as infection,loosening of nails,coxa vara,or malunion was found.According to Harris Scoring system,32 cases (86.5%)were rated as good or excellent.[Conclusion]The treatment of femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur with RIN is a good method because of its advantages of small trauma,stable fixation,high union rate,few complications and good results.It may have fewer internal fixators.Carefully choosing suitable patients,sophisticated operation skills and active functional exercise after operation are keys to success.

Application of reconstruction interlocking nail for treatment of subtrochanteric femoral fracture / 中国矫形外科杂志

[Objective]To investigate the surgical techniques and clinical result of the treatment of subtrochanteric femoral fracture(SFF) with the reconstruction interlocking nail(RIN).[Method]A total of 40 cases(27 males and 13 females,at age ranged from 22 years to 75 years,mean 43.5 years) with SFF were fixed with RIN in our hospital from June 1998 to May 2005.The fractures were classified according to Seinsheimer,the type Ⅱ 5 cases,type Ⅰ 13,type Ⅳ 21 and type Ⅴ 1.33 patients sustained high-energy injury,and 7 low-energy Three cases were open fractures.[Result]The followed-up period ranged from 8 months to 2 years and 6 months with an average of i year and 8 months.The average time for bony union on xray was 4.2 months (from 3.2 to 6.5 months).According to HAN's scoring system there were 26 excellent cases,12 good cases and 2 fair cases.The excellent and good rate was 95%.There was no severe complications,such as incision infection, fixation failure,deformity or ischemic necrosis of femoral head.[Conclusion]RIN is an effective operation for treatment of SFF.This method has obvious advantages of reliable fixation,few complications and the high bone union rate.Meticulous surgical techniques is the key of success for the operation.

Study on limited contact femoral supracondylar interlocking intramedullary nail by finite element analysis / 中国矫形外科杂志

[Objective]A new limited contact femoral supracondylar interlocking intramedullary nail(LCFSIIN) was made,which was part of a new custom-made hemi-knee joint,to improve the results of childrens' limb salvage.[Method]A new LCFSIIN was performed and the stress of bolts,intramedullary nails and bone were analyzed by finite dement analysis(FEA) while the bolts were implanted in different angulafions-0?,15?,30?,45?and 60?.[Result]The results of FEA show that the stress of bolts,bone and nails with 15? insertion angles of bolt was the tiniest and well distributed.Stress of bone with 0? insertion angles was more obvious than that with 15?,30?and 45?.The more the angles,the stress of proximal bolt became more obvious and the stress of distal bolt decreasing.[Conclusion]This new LCFSIIN can reduce destruction of biological environment of bone and is easy in use in limb salvage surgery of allograft.

Two-part and Three-part Fractures of the Proximal Humerus Treated with the Polarus Interlocking Nail: A Comparison of Fracture Types

PURPOSE: To evaluate the radiographic and clinical outcomes of patients with displaced proximal humerus fractures (two-part and three-part) treated with the Polarus interlocking nail, comparing their fractures types. MATERIALS AND METHODS: There were 22 patients with displaced proximal humerus fractures. There were 10 surgical neck (SN) and 1 anatomical neck (AN) two-part fractures and 10 greater tuberosity/surgical neck (GT/SN) and 1 GT/AN three-part fractures. All patients were surgically treated solely with the Polarus interlocking nail using a closed technique. Functional assessment was obtained using the American Shoulder and Elbow Surgeons (ASES) score, which grade outcomes as excellent (>75), satisfactory (50~75), poor (0.05). CONCLUSION: Both displaced two-part fractures and three-part GT/SN fractures can have above satisfactory functional and radiographic outcomes with the Polarus interlocking nail using a closed technique. Even though displaced three-part GT/SN fractures in elderly osteopenic patients (>60 years), we treated successfully with the Polarus interlocking nail.

Interlocking nail and micromovement / 中华创伤骨科杂志

As a main treatment instrument of limb fractures, the interlocking nail is used in two ways: dynamic fixation and static fixation. The former has less stress shielding but lower satiability. The latter is just the opposite. Therefore, static fixation is the main choice in clinic. But because of the higher stress shielding, complications take place frequently. This article is to discuss the relationship between micromovement and fracture healing, and calls for a new kind of interlocking nail which has micromovement function.

Treatment of comminuted femoral shaft fractures with combination of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator / 中华创伤骨科杂志

Objective To observe the clinical outcomes of the treatment of comminuted femoral shaft fractures with combination of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator. Methods 35 cases of comminuted femoral shaft fractures were treated with combined use of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator. Of the 35 cases, 25 were type B and 10 type C according to AO classification. 1 case had bilateral femoral shaft fracture of type B. Results All the fractures were followed up for 12 to 24 months (averaging 18.5 months). By second attention, all the fractures healed except 1 case who had to undergo secondary surgery because his shape memory sawtooth-arm block hoop internal fixator had dropped. The intramedullary interlocking nails were taken out 18 to 24 months postoperatively. The excellent rate was 98.2%according to Klemm grading system. Conclusion In treatment of comminuted femoral shaft fractures, the combined use of intramedullary interlocking nail and shape memory sawtooth-arm block hoop internal fixator can take advantages of the 2 devices so as to secure anatomic reduction and reliable fixation.

211 cases of long bone shaft fracture at lower limbs treated with intramedullary interlocking nails / 中华创伤骨科杂志

Objective To assess the clinical results of the treatment of the 211 cases of long bone shaft fractures at lower limbs with intramedullary interlocking nails. Methods 211 cases of femoral and tibial fractures were treated chiefly with unreamed intramedullary interlocking nails and postoperative functional exercises including continuous passive motion (CPM). Results 189 cases were followed up for an average of 9 months (ranging from 4 to 26 months). All the cases achieved bone union, and no nonunion occurred. Delayed union occurred in 7 cases and limited knee joint function in 4 cases. According to the Johner-wruhs criteria, 178 cases were assessed as excellent, 24 as good and 9 as fair. The total excellent and good rate was 95.6%. Conclusions The intramedullary interlocking nail is a good device for the treatment of long bone shaft fractures at lower limbs. Its indications have become wider. It is correct to pay equal attention to the blood supply of the fractured bone and the reduction of the fracture during the operation.

Is closed reduction and interlocking intramedullary nailing fit for the treatment of fractures of humeral shaft with radial nerve injury? / 中华创伤骨科杂志

Objective To study whether closed reduction and interlocking intramedullary nailing will worsen the injured radial nerve associated with the fracture of humeral shaft.Methods Of the 353 patients with fracture of humeral shaft who received operation from January 2002 to January 2005,63 ones were complicated with preoperative injury to their radial nerve.A retrospective analysis was done of their physical examination records, operative records,X-ray films and results of the treatment.Eleven cases were treated with closed reduction and interlocking intramedullary nailing,and 52 cases with open reduction and internal fixation of plates and screws fol- lowed by exploration to the radial nerve.Chisquare test of PEMS 3.1 system was adopted to analyze the clinical data. Results The radial nerve was embedded by the fracture ends in nine cases(17.3%)of the 52 cases,and con- tused in the other 43 ones.In the 63 cases,The injured nerves recovered spontaneously 2 to 12 weeks postoperatively except in twn cases.All the eases got bony union 3 to 4 months after operation.Closed reduction and interlocking intramedullary nailing has hardly more harmful effects on the injured radial nerve assoeiated with the fracture of humeral shaft than open reduction and internal fixation of plates and screws followed by neural exploration.Con- clusion Closed reduction and interlocking intramedullary nailing is fit for the freatment of fractures of humeral shaft with radial nerve injury.