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Objective To study the stability of plate-assisted intramedullary nailing for fixing proximal third tibiafractures, compare and observe biomechanical characteristics of anterolateral or posteromedial plate-assisted intramedullary nailing after fixation of proximal third tibia fractures. Methods Eight artificial tibia of 4th-generation sawbones were divided into two groups based on location of the assisted plate, namely, anterolateral plate group and posteromedial plate group, with 4 specimens in each group. Each two locking bolts were fixed to theintramedullary nail proximally and distally, and each three bicortical screws were fixed to the plate proximally and distally. The specimens were osteotomized with a 10-mm defect which located 0. 5 cm to the proximal locking bolt of intramedullary nail or 5-6 cm distally to the knee joint line, in order to simulate an AO/ OTA 41-A2 type proximal third tibia fracture after fixation of intramedullary nail. After osteotomy was finished, axial compression test, three point bending test, cyclic loading and overstress test were conducted by mechanical testing machine. The results of axial stiffness and three-point stiffness between two groups were compared and analyzed. Results Axial compression test showed that the average axial stiffness in posteromedial plate group was lower than that in anterolateral plate group, but no significantly statistical differences were found between the two groups. Three point bending test showed that the average bending stiffness in posteromedial plate group was significantly higher than that in anterolateral plate group when stimulating either varus stress (plate located at pressure side of the fracture, t = 3. 679, P<0. 05) or valgus stress (plate located at tension side of the fracture, t = 8. 975, P<0. 05). Conclusions Plate-assisted intramedullary nailing for fixation of proximal third tibia fractures can minimize the angulation malalignment, improve the stability of nailed proximal tibial fragment and allow the early weight bearing. Both anterolateral and posteromedial plate-assisted intramedullary nail can provide satisfactory axial stability for proximal third tibia fractures, while posteromedial plate-assisted intramedullary nail shows better bending stability than anterolateral plate in countering varus or valgus stress deformity. This study provides an essential basis for clinical decision making about plate-assisted intramedullary nailing for fixing proximal third tibia fractures.
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PURPOSE@#Intramedullary implants are well accepted fixation of all types of intertrochanteric (IT) fractures, both stable and unstable types. Intramedullary nails have an ability to effectively support the posteromedial part, but fail to buttress the broken lateral wall requiring lateral augmentation. The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures, which was fixed to the femur through hip screw and anti-rotation screw nail.@*METHODS@#Of 30 patients, 20 had Jensen-Evan type III and 10 had type V fractures. Patients with IT fracture of broken lateral wall and aged more than 18 years, in whom satisfactory reduction was achieved by closed methods, were included in the study. Patients with pathologic or open fractures, polytrauma, prior hip surgery, non-ambulatory prior to surgery, and those who refused to participate were excluded. The operative time, blood loss, radiation exposure, quality of reduction, functional outcome, and union time were evaluated. All data were coded and recorded in Microsoft Excel spread sheet program. SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.@*RESULTS@#The mean age of patients in the study was 60.3 years. The mean duration of surgery (min), mean intra-operative blood loss (mL) and mean number of exposures were 91.86 ± 12.8 (range 70 - 122), 144.8 ± 3.6 (range 116 - 208), and 56.6 (range 38 - 112), respectively. The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.@*CONCLUSION@#Lateral trochanteric wall in IT fractures is significantly important, and needs to be reconstructed adequately. Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment, fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.
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Humans , Middle Aged , Bone Nails , Treatment Outcome , Retrospective Studies , Hip Fractures/surgery , Bone Screws , Fracture Fixation, Intramedullary/methodsABSTRACT
PURPOSE@#Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures, especially in osteoporotic patients. The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.@*METHODS@#A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017-2019 by distal locked or unlocked long PFNA-II fixation were included in this study. Patients who had multiple injuries or open fractures were excluded. There were 40 female and 18 male patients, with 33 affecting the left side and 25 the right side. Of them, 31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B). Surgical procedures and implants used in both groups were similar except for the distal locking of the nails. General data (age, gender, fracture side, etc.) showed no significant difference between two groups (all p > 0.05). The intraoperative parameters like operative time, radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared. Statistical tests like the independent samples t-test Fischer's exact and Chi-square test were used to analyze association.@*RESULTS@#The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study. All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year. The operative time (mL, 107.1 ± 12.6 vs. 77.0 ± 12.0, p < 0.001) and radiation exposure (s, 78.6 ± 11.0 vs. 40.3 ± 9.3, p < 0.001) were significantly less among the patients in group B. Fracture consolidation, three months after the operative procedures, was seen in a significantly greater proportion of patients in group B (92.6% vs. 67.7%, p = 0.025). Hardware irritation because of distal locking bolt was exclusively seen in group A, however this was not statistically significant (p = 0.241).@*CONCLUSION@#We conclude that, in fixation of stable intertrochanteric fractures by long PFNA-II nail, distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation, and hence is not required.
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Humans , Male , Female , Fracture Fixation, Intramedullary/methods , Bone Nails , Treatment Outcome , Retrospective Studies , Hip Fractures/etiology , Femoral Fractures/etiologyABSTRACT
@#Femoral shaft fractures are increasingly common due to various traumatic injuries. Intramedullary nail (IMN) is considered the gold standard treatment for these fractures, but comorbidities often require thorough trauma life support and intensive care. The primary goal of treatment is rigid fixation, early mobilisation, and long-term functional recovery. This article reviews current concepts in the treatment of femoral shaft fractures, including the effects of early or delayed operation, differences between antegrade or retrograde intramedullary nailing, alternative methods to using a fracture table, methods to predict nail length before operation, assessing femoral rotation during an operation, and complications.
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@#Introduction: Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. Material and methods: A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. Results: The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. Conclusion: This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limbsalvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.
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Objective:To compare the short-term effects of proximal femoral bionic nail (PFBN) and proximal femoral nail antirotation (PFNA) in the treatment of intertrochanteric fracture.Methods:Retrospectively analyzed were the data of 56 patients with intertrochanteric fracture of the femur who had been admitted to Department of Orthopedic Trauma, The People's Hospital of Juye County and Trauma Center, Central Hospital Affiliated to The First Medical University of Shandong from August 2020 to April 2022. The patients were divided into 2 even groups according to their internal fixation methods ( n=28). In the PFBN fixation group, there were 12 males and 16 females with an age of (70.4±7.8) years; by AO classification, there were 4 cases of type 31-A1, 16 cases of type 31-A2, and 8 cases of type 31-A3. In the PFNA fixation group, there were 10 males and 18 females with an age of (73.0±8.9) years; by AO classification, there were 2 cases of type 31-A1, 16 cases of type 31-A2, and 10 cases of type 31-A3. The operation time, intraoperative blood loss, fracture reduction, fracture healing time, Harris hip score, and complications were compared between the 2 groups. Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing comparability ( P>0.05). The follow-up time was (7.3±0.9) months for the PFBN group and (7.4±1.1) months for the PFNA group, showing no significant difference ( P>0.05). There was no significant difference either between the 2 groups in operation time, intraoperative blood loss or quality of fracture reduction ( P>0.05). The PFNA group had significantly shorter fracture healing time [(3.9±0.9) months] than the PFNA group [(4.7±1.1) months], and a significantly higher Harris hip score at the last follow-up [(83.9±4.3) points] than the PFNA group [(81.0±3.4) points] (both P<0.05). Fixation failed in one patient in the PFNA group due to cut-out of the head and neck screws while no complications were observed in the PFBN group. Conclusion:In the treatment of intertrochanteric fracture of the femur, PFBN fixation may result in stronger fixation to effectively avoid cut-out of the head and neck screws, and faster fracture healing and functional recovery of the hip than PFNA fixation.
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Objective:To explore the clinical efficacy of a retrograde pubic ramus intramedullary nail (RPRIN) in the treatment of anterior pelvic ring fractures.Methods:A retrospective study was conducted to analyze the 14 patients with anterior pelvic ring fracture who had been treated and followed up at Department of Traumatic Surgery, Tongji Hospital From June 2020 to February 2021. There were 10 males and 4 females with an age of (44.8±12.5) years. By the AO/OTA classification for pelvic fractures, 5 cases were type 61-A, 4 cases 61-B, and 5 cases type 61-C; by the Nakatani classification, 1 case belonged to unilateral zone Ⅰ fracture, 5 cases to unilateral zone Ⅱ fracture, 2 cases to unilateral zone Ⅲ fracture, 3 cases to right zone Ⅱ and left zone Ⅲ fracture, 2 cases to zone Ⅲ fracture on both left and right sides, and 1 case to zone Ⅱ fracture on both sides. The time from injury to operation was (7.8±1.8) days. All the anterior pelvic ring fractures were fixated with a RPRIN. The time and fluoroscopic frequency for placement of every single RPRIN, quality of fracture reduction, and pelvic function and incidence of postoperative complications at the last follow-up were recorded.Results:A total of 18 RPRINs were placed in the 14 patients. For placement of each RPRIN, the time was (35.9±8.6) min, and the fluoroscopic frequency (22.8±1.9) times. No complications such as infection occurred at any surgical incision after RPRIN placement. According to the Matta scoring, the quality of postoperative fracture reduction was assessed as excellent in 7 cases, as good in 5 cases and as fair in 2 cases. The 14 patients were followed up for (18.1+1.5) months. Their X-ray and CT images of the pelvis at the last follow-up showed that the fractures healed well and the intramedullary nails were placed in the cortical bone of the anterior ring of the pelvis. According to the Majeed scoring at the last follow-up, the pelvic function was assessed as excellent in 10 cases, as good in 3 cases and as fair in 1 case. One patient reported discomfort during squatting 2 months after operation but the symptom improved 3 months later without any special treatment. No patient experienced such complications as displacement or slippage of RPRIN, or pain at the insertion site.Conclusion:RPRIN is effective in the treatment of anterior pelvic ring fractures, showing advantages of small surgical incision, limited intraoperative fluoroscopy and short operation time.
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Resumen: Introducción: el estándar de oro de tratamiento para la mayoría de las fracturas diafisarias de tibia está representado por el clavo endomedular (CEM). El objetivo de este estudio fue analizar la importancia del diámetro del CEM sobre la consolidación de fracturas diafisarias de tibia. Material y métodos: se realizó un estudio retrospectivo en pacientes con fracturas cerradas de tibia 42 OTA/AO, tratados con un CEM fresado y acerrojado, entre Enero de 2014 y Diciembre de 2020. Las variables analizadas fueron género, edad, comorbilidades, cantidad de cerrojos utilizados, relación clavo/canal (diferencia entre el diámetro del canal medular y clavo), el índice clavo/canal (razón entre diámetro del clavo y el canal medular), en relación con la tasa de consolidación y falla (retardo de consolidación y seudoartrosis). Resultados: la serie final se conformó por 96 pacientes y la tasa de consolidación fue de 91.7% (n = 88). Se observó un diámetro de clavo significativamente mayor en los pacientes que consolidaron respecto a los que fallaron (p = 0.0014), incrementando la posibilidad de consolidación 5.30 (p = 0.04) veces, por cada milímetro que el clavo aumentó su diámetro. Se observó un incremento de probabilidad de consolidación de 13.56 (p = 0.018) veces utilizando un clavo > 10 mm de diámetro. El índice clavo/canal ≥ 0.80 aumentó la posibilidad de consolidación 23.33 veces (p = 0.005). Conclusión: nuestros hallazgos sugieren que los CEM fresados y acerrojados en fracturas diafisarias de tibia deben colocarse del mayor diámetro posible (> 10 mm y con un índice clavo/canal ≥ 0.80) para favorecer la consolidación.
Abstract: Introduction: the gold standard for tibial diaphyseal fracture treatment is represented by the intramedullary nail (IMN). This study aimed to assess the relevance of nail diameter in bone healing of tibial diaphyseal fractures. Material and methods: a retrospective study was conducted analyzing patients with closed 42 OTA/AO tibial fractures, treated with a reamed and locked IMN between January 2014 and December 2020. The variables assessed were gender, age, comorbidities, number of bolts used, canal/nail index (difference between the diameter of the medullary canal and nail), nail/canal ratio (ratio between nail diameter and medullary canal), related to consolidation and failure rates (delay - and non-union). Results: 96 patients were included. The consolidation rate was 91.7% (n = 88). Patients with consolidation had a significantly larger nail diameter than those who failed (p = 0.0014), increasing the chance of consolidation 5.30 (p = 0.04) times for each millimeter that the nail increased its diameter. Using a nail > 10 mm increased the chance of consolidation 13.56 times (p = 0.018). A nail/canal ratio ≥ 0.80 increased the chance of consolidation 23.33 times (p = 0.005). Conclusion: our findings suggested that reamed and locked IMN in tibial diaphyseal fractures should be implanted with the largest possible diameter (> 10 mm and with a nail-to-canal ratio ≥ 0.80) to promote bone healing.
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Las fracturas de húmero proximal (FHP) son una de las fracturas más frecuentes en la población anciana. La reducción abierta y fijación interna (RAFI) generalmente está indicada para pacientes con una FHP desplazada en jóvenes o pacientes mayores con alta demanda funcional y buena calidad ósea. No se ha llegado a un consenso sobre la técnica de fijación ideal. La RAFI con placas ha sido la más utilizada, pero se han reportado altas tasas de reintervenciones y complicaciones globales en la literatura. La necesidad de agregar técnicas de aumentación a la RAFI con placas bloqueadas en fracturas complejas puede resultar en un tiempo quirúrgico más largo, abordajes extensos y mayores costos. Debido a esto, se hace necesario considerar otras opciones para la osteosíntesis de FHP. Con una mayor comprensión de los mecanismos de falla de la osteosíntesis, la fijación intramedular se ha convertido en una opción de tratamiento aceptada para las FHP con ventajas biomecánicas y biológicas. La fijación intramedular para las FHP ha demostrado menor tiempo quirúrgico, sangrado intraoperatorio, tiempo hasta la unión ósea y menores tasas de infecciones, que las placas bloqueadas. La fijación intramedular es una opción válida para que las fracturas complejas se resuelvan con un implante que por sí solo puede satisfacer en gran medida todas las necesidades de aumento requeridas por una placa bloqueada
Proximal humeral fractures are one of the most frequent fractures in the elderly population. Open reduction and internal fixation (ORIF) is generally indicated for young patients and older patients with high functional demands and good bone quality. No consensus has been reached regarding the ideal fixation technique. Although ORIF with plates is the most widely used technique, high re-intervention rates and global complications with locked plate fixation have been reported in the literature. Addition of augmentation techniques to locked plate fixation in complex fractures may result in longer surgical times, extensive approaches, and higher costs. Therefore, considering other options for ORIF is necessary. With a greater understanding of the mechanisms of fixation failure, intramedullary fixation has become the accepted treatment option for proximal humeral fractures considering the specific biomechanical and biological advantages. Compared with ORIF with locked plates, intramedullary fixation for proximal humeral fractures has low surgical time, intraoperative bleeding, time to bone union, and rate of infections. Intramedullary fixation is a valid option to resolve complex fractures with an implant that may largely supply all the augmentation requirements of a locked plate.
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Humans , Male , Female , Shoulder Fractures/surgery , Internal Fixators , Fracture Fixation, Intramedullary/methods , Biomechanical Phenomena , Bone Nails , Bone PlatesABSTRACT
Resumen: Introducción: el alargamiento femoral mediante clavo intramedular es una de las opciones quirúrgicas en el tratamiento de las dismetrías severas de miembros inferiores en la práctica clínica habitual. Material y métodos: se realizó un estudio descriptivo retrospectivo de una serie de cinco pacientes con una media de edad de 15.4 años, intervenidos de alargamiento femoral mediante clavo intramedular Precice®. La etiología en todos los casos fue idiopática. Se midió la dismetría o alargamiento teórico prequirúrgico y el definitivo postquirúrgico, así como la precisión del alargamiento, la tasa y el índice de distracción (mm/día y días/cm respectivamente) y el índice de consolidación (días/cm). Se identificaron las complicaciones intra y postoperatorias en todos los casos. Resultados: la media de seguimiento fue de 21 meses (12-42), sin pérdidas en el seguimiento. La duración media del procedimiento quirúrgico fue de 126 minutos (105-160). La dismetría teórica prequirúrgica fue de 38 ± 2.7 mm. El alargamiento medio final fue de 41 ± 7.5 mm. La precisión media fue de 108% (91-125) y la tasa de distracción de 0.9 ± 0.4 mm/día. El índice de distracción fue de 13.9 ± 5.1 días/cm y el índice de consolidación, de 26.6 ± 9.1 días/cm. La consolidación ósea se observó en la totalidad de los pacientes con una media de 113 ± 58 días. Con respecto a las complicaciones, se encontraron un total de cuatro complicaciones menores de índole muscular. Conclusión: el clavo intramedular Precice® es una buena opción de tratamiento para casos de acortamiento femoral severo aportando buenos resultados clínicos y radiológicos con una baja tasa de complicaciones y fallo del implante.
Abstract: Introduction: femoral lengthening using an intramedullary nail is one of the surgical options in the treatment of severe lower limb dysmetria in routine clinical practice. Material and methods: a retrospective descriptive study was carried out on a series of five patients with a mean age of 15.4 years, who underwent femoral lengthening surgery using a Precice® intramedullary nail. The etiology in all cases was idiopathic. Preoperative and definitive postoperative theoretical lengthening or dysmetry was measured, as well as lengthening accuracy, distraction rate and index (mm/day and days/cm, respectively) and consolidation index (days/cm). Intraoperative and postoperative complications were identified in all cases. Results: mean follow-up was 21 months (12-42), with no loss to follow-up. The mean duration of the surgical procedure was 126 minutes (105-160). The preoperative theoretical dysmetry was 38 ± 2.7 mm. The final mean lengthening was 41 ± 7.5 mm. The mean accuracy was 108% (91-125) and the distraction rate was 0.9 ± 0.4 mm/day. The distraction rate was 13.9 ± 5.1 days/cm and the consolidation rate was 26.6 ± 9.1 days/cm. Bone consolidation was observed in all patients with a mean of 113 ± 58 days. Regarding complications, a total of four minor muscular complications were found. Conclusion: the Precice® intramedullary nail is a good treatment option for cases of severe femoral shortening, providing good clinical and radiological results with a low rate of complications and implant failure.
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Objective:To introduce our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate by comparison with conventional bone transport in the treatment of distal tibial osteomyelitis with bone defects involving the articular surface.Methods:The clinical data of 34 patients were retrospectively analyzed who had been treated at Department of Orthopaedics, Honghui Hospital for distal tibial osteomyelitis with bone defects involving the articular surface from September 2014 to September 2019. They were divided into 2 groups according to their way of repairing bone defects. In the modified group of 14 cases subjected to the treatment using the modified hybrid bone transport technique, there were 9 males and 5 females, with an age of (39.4±7.3) years. In the conventional group of 20 cases subjected to the treatment using conventional bone transport technique, there were 12 males and 8 females, with an age of (41.2±6.6) years. The external fixation time (EFT), external fixation index (EFI), self-rating anxiety scale (SAS) were recorded and compared between the 2 groups. Healing of bone defects and function were evaluated at the last follow-up according to the criteria of Association for the Study and Application of the Method of Ilizarov (ASAMI) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-posterior foot score, respectively. Complications were recorded according to the Paley classification.Results:There was no significant difference in the general data between the modified group and the conventional group, showing they were comparable ( P>0.05). Thirty-four patients were followed up for 18 to 32 months (average, 27 months) after operation. The modified group had significantly shorter EFT [(3.9±1.6) months] than the conventional group [(9.8±2.2) months], and significantly lower EFI [(0.48±0.09) months/cm] than the conventional group [(1.42±0.32) months/cm] ( P<0.05). The SAS [(48.1±4.7) points] in the modified group was significantly lower than that in the conventional group [(61.2±6.2) points], and the number of complications per capita in the former [(0.8±0.4)/case] was significantly smaller than that in the latter [(1.42±0.32)/case] ( P<0.05). There were no significan differences in the healing of bone defects or AOFSA ankle-posterior foot score ( P>0.05). In the modified group and the conventional group, respectively, 13 versus 12 patients were satisfied while 1 versus 8 patients unsatisfied, 1 versus 8 patients had grade-Ⅱ infection while 13 versus 12 patients did not, and 1 versus 9 patients had grade-Ⅲ infection while 13 versus 11 patients did not. There were significant differences between the 2 groups in the above indexes (all P<0.05). Conclusion:In the treatment of distal tibial osteomyelitis with bone defects involving the articular surface, compared with conventional bone transport technique, our modified hybrid bone transport technique using hindfoot arthrodesis nails combined with antibiotic-loaded calcium sulfate may lead to better clinical efficacy due to the advantages of shorter external fixation time, lower external fixation index and fewer complications.
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Objective To study the effect of interlocking intramedullary nail on fixing transverse olecranon fracture. Methods Nine pairs of fresh ulna specimens were collected and the transverse fracture model of olecranon was established. Kirschner wire tension band and interlocking intramedullary nail were used to repair the fracture. Cyclic dynamic tension loads with amplitude of 25 N, mean value of 45 N and frequency of 05 Hz were applied to the triceps tendon under simulated elbow flexion conditions of 30°, 45° and 60°, respectively. The fracture displacements of specimens within 300 cycles were recorded in three groups. ResultsAt 30° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.831±0.333) mm and (3.723±2.390) mm, respectively. At 45° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.167±0.374) mm and (2.455±0.609) mm, respectively. At 60° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.407±0.342) mm and (3.112±1.025) mm, respectively. The fracture displacement of interlocking intramedullary nail was smaller. Conclusions The mechanical properties of interlocking intramedullary nail are better than those of Kirschner wire tension band, and the interlocking intramedullary nail is more stable and firmer for fixing transverse olecranon fracture. Moreover, the interlocking intramedullary nail is installed with the operating tool, thus the operation is more accurate and faster, and the operation efficiency is greatly improved.
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@#Introduction: Clavicle fractures are frequently encountered by orthopaedic surgeons. Though multiple treatment techniques have been described in literature, open reduction and internal fixation with plating and intramedullary nailing are preferred in adults. This study analyses the functional outcome, complications, duration of bony union of mid-shaft clavicle fractures treated with plate fixation versus intramedullary fixation. Materials and methods: A quasi- experimental study was conducted on 38 patients with mid-shaft clavicle fracture aged between 18 to 60 years at a tertiary care centre in South India. Nineteen patients were treated by plate fixation and 19 patients underwent intramedullary nail fixation. Every alternate patient with mid-shaft fracture clavicle was treated with plate osteosyntheses or nailing. Results: The average age of presentation was 42 years in plate fixation and 31 years in nail fixation group. Robinson’s classification type 2B1 was the most common type of fracture in both groups. The Visual Analogue Scale (VAS) score reduced significantly from pre-operative to postoperative day 1 in both the groups but there was no significant difference between the two groups. The Disabilities of the Arm, Shoulder and Hand (DASH) score at 6, 12 and 24 weeks reduced significantly in both the groups but showed no statistically significant difference between the two groups. However, intramedullary nail fixation group had a shorter duration of hospital stay and showed an earlier improvement in the DASH score during the first six months after surgery. Complications included implant loosening (three patients) in plating group and implant failures (two cases) in nailing group. Conclusion: There is a role for surgical intervention for certain cases of displaced and comminuted clavicle fracture in order to avoid malunion or non-union and their potential long-term sequelae. Both the surgical modalities of plating, and nailing provide good functional outcome and allow early return to occupational activities.
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Objective:To determine the mechanical properties of our self-designed novel cross-locking intramedullary nails and the impact of number of conical locking nails on the fixation through a finite element analysis and specimen experiments.Methods:Mimics 19.0 and SolidWorks 2014 were used to create transverse fracture models of the olecranon which were subjected to fixation with respectively K-wire tension band (KTB) and our self-designed novel cross-locking intramedullary nails (NIN). The strengths of KTB and NIN fixation were analyzed by Ansys. Fifteen human ulna specimens were used to construct a transverse fracture model of the olecranon; an Instron E10000 mechanical testing machine was used to determine mechanical properties in fixation respectively with KTB, one NIN (NIN-1) and 3 NINs (NIN-3).Results:In the finite element analysis, in simulation of the forearm flexed at 45° under a 100 N load, the deformation of the fracture surface of the olecranon in fixation with KTB, NIN-1 and NIN-3 was respectively 0.131 mm, 0.123 mm and 0.121 mm. In the specimen experiments, in simulation of the forearm flexed at 45°, the maximum failure loads for fixation with KTB, NIN-1 and NIN-3 were (313.38±27.68) N, (528.56±53.58) N and (871.04±94.95) N, respectively, showing significant differences among the 3 groups ( P<0.05). The maximum failure load for NIN-3 fixation was significantly greater than that for KTB or NIN-1 fixation, and the maximum failure load for NIN-1 fixation was significantly greater than that for KTB fixation ( P<0.05). Conclusions:Compared with KTB fixation, NIN fixation is more convenient in operation and has better mechanical properties. NIN-3 fixation has the best mechanical properties.
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Objective:To compare the efficacy between Multiloc humeral intramedullary nail system (Multiloc) and proximal humerus internal locking system (PHILOS) in the treatment of adult proximal humeral fractures.Methods:A retrospective analysis was conducted of the 83 adult patients with proximal humeral fracture who had been treated at Trauma Center, The Second People's Hospital of Changzhou from August 2018 to March 2021. They were 33 males and 50 females, with 45 left sides and 38 right sides injured. By the Neer classification, there were 48 two-part, 22 three-part and 13 four-part fractures. The patients were assigned into 2 groups according to different treatments: an observation group ( n=41) receiving treatment by Multiloc and a control group ( n=42) receiving treatment by PHILOS. The 2 groups were compared in terms of humeral neck shaft angles and visual analogue scale (VAS) pain scores preoperation and one month postoperation, Neer shoulder function score at the last follow-up, and incidence of adverse reactions. Results:The preoperative general data showed no statistically significant differences between the 2 groups, indicating the groups were comparable ( P>0.05). The humeral neck shaft angle (127.4°±3.6°) was recovered significantly better and the VAS pain score (1.3±0.3) was significantly lower in the observation group than in the control group (129.6°±4.5°,2.1±0.3) one month after operation ( P<0.05). The excellent to good rate by Neer score at the last follow-up (90.24%, 37/41) was significantly higher and the incidence of adverse reactions (2.44%) significantly lower in the observation group than in the control group (71.43%, 30/42 and (19.05%, 8/42) ( P<0.05). Conclusion:In the treatment of adult proximal humeral fractures, compared with PHILOS, the Multiloc system is more effective in improving shoulder joint function, promoting shoulder motion recovery and reducing pain.
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Objective:To compare the efficacy between intramedullary nailing (IMN) and minimally invasive percutaneous pate oteosynthesis (MIPPO) in the treatment of distal tibial fractures.Methods:China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database, Pubmed, Embase, Cochrane, and Web of Science databases were searched by computer for publications on IMN and MIPPO in the treatment of distal tibial fractures published in official journals at home and abroad from January 2010 to August 2020. The studies included were evaluated by 2 authors using the Cochrane collaboration’s tool for assessing risk of bias. The main extraction indexes were operation time, union time, superficial infection, deep infection, malunion, delayed union or nonunion, and soft tissue irritation. Review Manager 5.3 software was used for data analysis.Results:A total of 7 studies with 653 patients were included, with 325 in the IMN group and 328 in the MIPPO group. Meta analysis showed the following: operation time in the IMN group was significantly shorter than that in the MIPPO group ( MD=-10.75, 95% CI:-19.92~-1.58, P=0.02); superficial infection rate in the IMN group was significantly lower than that in the MIPPO group ( RR=0.58, 95% CI: 0.39~0.88, P=0.01); fracture malunion rate in the IMN group was significantly higher than that in the MIPPO group ( RR=1.87, 95% CI: 1.15~3.04, P=0.01). Concerning soft tissue irritation, incidence of anterior knee pain in the IMN group was significantly higher than that in the MIPPO group ( RR=16.98, 95% CI: 3.30~87.34, P=0.0007) while incidence of soft tissue irritation at the fracture site in the IMN group was significantly lower than that in the MIPPO group ( RR=0.13, 95% CI: 0.04~0.40, P=0.0004). There were no significant differences between the 2 groups in fracture healing time, deep infection rate, delayed union rate or nonunion rate ( P>0.05). Conclusions:Although both IMN and MIPPO are fine treatments of distal tibial fractures, IMN may be superior in prevention of superficial tissue infection but prone to anterior knee pain while MIPPO may be superior in prevention of malunion but prone to soft tissue irritation at the fracture site. Therefore, MIPPO is suggested in cases with fine pretibial soft tissues while IMN is used to reduce soft tissue infection otherwise.
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OBJECTIVE: The most commonly used intramedullary fixation systems for the treatment of elderly intertrochanteric fractures include the proximal femoral anti-rotation intramedullary nail (PFNA), the proximal femoral anti-rotation intramedullary nail of Asian (PFNA-II) and interlocking intramedullary nail for proximal femur (Inter-TAN), but the clinical effect of the three in the treatment of A2 and A3 type intertrochanteric fractures is still controversial. Meta-analysis was used to compare the clinical efficacy of Inter-TAN, PFNA, and PFNA-II in the treatment of unstable intertrochanteric fractures in the elderly. METHODS: A computer was used to search databases such as Cochrane, Embase, PubMed, Sinomed, CNKI, Wanfang, and VIP to collect and compare the literatures of Inter-TAN, PFNA, and PFNA-II in the treatment of elderly unstable intertrochanteric fractures. The search period was from the establishment of the database to December 2019. Two reviewers independently read the screening literature, extracted data and evaluated the quality. Meta-analysis was performed using RevMan5.3 software. RESULTS: (1) A total of eight studies were included, with 1 349 patients, including two randomized controlled studies and six cohort studies. The evidence level was ≥ III. (2) Meta-analysis showed that the operation time and intraoperative fluoroscopy time were longer, and intraoperative blood loss was more in the Inter-TAN group than those of the PFNA-II group [MD=-16.60, 95%CI (-23.22,-9.99), P 0.05). There was no significant difference in tip-apex distance, length of hospital stay, and Harris score of Inter-TAN group compared with PFNA group and PFNA-II group (P > 0.05). The incidence of postoperative screw cut-out in the Inter-TAN group was less than in the PFNA group and the PFNA-II group [OR=6.47, 95%CI(2.79, 15.00), P 0.05). CONCLUSION: For patients with osteoporosis and poor stability, Inter-TAN can provide better stability and reduce postoperative complications. For patients with poor general conditions and greater surgical risk, PFNA-II internal fixation can be selected.
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BACKGROUND: Tubular bone fractures of limbs are common in traumatic orthopedics, among which anatomic intramedullary nailing has been gradually applied in clinical treatment in recent years, and has achieved good curative effect. OBJECTIVE: To summarize the application characteristics, advantages and development direction of anatomic intramedullary nailing in tubular bone fractures of limbs. METHODS: PubMed, Web of science, CNKI, Wanfang and VIP were searched for articles published from January 1900 to May 2020. The key words were “tubular bone, anatomic intramedullary nail, ulna, radius, humerus, femur, tibia, fibula” in Chinese and English. Totally 379 articles were initially examined, and 34 were finally included for review and analysis according to inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The development history and application characteristics of anatomic intramedullary nailing in tubular bone of limbs were introduced in this paper, which was considered to have a broad clinical prospect. (2) Intramedullary nailing is gradually replacing external fixation in the treatment of tubular bone fracture, and anatomical intramedullary nailing will become the first choice of treatment. (3) Anatomic intramedullary nailing provides a better choice for intramedullary fixation of tubular bones of limbs and reduces the occurrence of related complications because its main nailing structure is more in line with the unique design of tubular bone marrow cavity of human body and the combination of distal and proximal screws with the main nailing to provide stronger holding force and anti-rotation ability. (4) The anatomic intramedullary nails have been applied in foreign countries and later in China. For example, the ZNN anatomic intramedullary nails produced by Zimmer Company in the United States are mostly used in the treatment of lower limb tubular bone fractures. In China, the anatomic intramedullary nails have just been introduced into the treatment of hip fractures (intertrochanteric and subtrochanteric fractures) and are rarely used in the treatment of tibial shaft fractures. (5) In the future, the new generation of anatomic intramedullary nails will combine biological detection, information sensing and other technologies more efficiently, so as to realize the technology and intelligence of materials.
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@#A bent intramedullary (IM) nail becomes challenging and technically demanding to the orthopaedic surgeon for nail extraction. A broken nail can be easily removed through the fracture site. However, a bent nail has to be broken before it can be removed. Several studies and case reports outline the strategies and techniques for removing a bent IM nail. However, there is a paucity of guidelines and standard protocol describing the best and inexpensive strategy. We report a case where two years following surgery for intramedullary nailing of the right femur, the IM mail was bent following secondary trauma. We used a technique based on the principles of an ability to fully cut the nail and extract it in two pieces by using a Jumbo cutter which is available in the orthopaedic armamentarium. This technique is simple yet economical, with the likelihood of causing less soft tissue damage and thermal necrosis.
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OBJETIVOS: Mostrar resultados, complicaciones y lecciones aprendidas utilizando el clavo intramedular magnético (IML, Intramedullary Magnetic Lengthener) en un grupo de pacientes sometidos a alargamiento óseo. PACIENTES Y MÉTODOS: Entre enero 2017 y diciembre 2019, 9 pacientes (15 segmentos), edad entre 15 y 39 años, fueron sometidos a alargamiento óseo con IML: 5 pacientes tuvieron alargamiento femoral bilateral por talla baja, 1 paciente se sometió a alargamiento de Piernas bilateral por Tibia vara y acortamiento mesomélico y 3 recibieron alargamientos femorales unilaterales por discrepancia de longitud de extremidades. Todos fueron operados por el mismo cirujano, con técnica standard. Se indicó kinesiterapia al menos 5 veces por semana durante la fase de distracción. RESULTADOS: En todos se logró el objetivo de alargamiento planteado. No hubo complicaciones intra ni postoperatorias graves (TVP, TEP, Embolia grasa), ni fallas del sistema distractor. Un paciente desarrolló contracturas articulares de ambas rodillas por no adhesión a Kinesiterapia. Ninguno requirió aporte de injerto óseo, sin embargo en 2 pacientes de alargamiento de Fémur bilateral, se presentó deformidad en varo, que hizo necesario recambio a clavo convencional y un paciente desarrolló una parálisis transitoria del Nervio Peroneo común. CONCLUSIONES: El advenimiento de los IML significó un gran avance en el campo de la osteogénesis por distracción, sin embargo, aún se trata de un procedimiento complejo, que debe ser planificado cuidadosamente para minimizar los riesgos y complicaciones. Una selección meticulosa del paciente y la evaluación física y psicológica previa, son fundamentales para el éxito del procedimiento. Los casos bilaterales requieren de un seguimiento cercano, por el riesgo de falla del implante.
objective: We show our results, complications and lessons learned using the Intramedullary Magnetic Lengthener (IML) in a group of patients who were subjected to bone lengthening. PATIENTS AND METHODS: Between January 2017 and December 2019, 9 patients (15 segments), aged between 15 and 39 years, underwent bone lengthening with IML: 5 patients had bilateral femoral lengthening due to short stature, 1 patient had bilateral leg lengthening due to Tibia vara and mesomelic shortening and 3 had unilateral femoral lengthening for limb length discrepancy. All were operated by the same surgeon, with standard technique. Physical therapy was indicated at least 5 times per week during the distraction phase. RESULTS: In every case, the proposed lengthening amount was achieved. There were no serious intraoperative or postoperative complications (DVT, Pulmonary Embolism, Fat Embolism), nor failures of the distractor system. One patient developed knee joint contracture due to non-adherence to Physical therapy. None required bone grafting, however, in 2 patients with bilateral Femur, a varus deformity appeared, which required nail exchange with a conventional trauma nail. One case developed a transit common Peroneal Nerve palsy. CONCLUSIONS: IMLs represent a great advance in the bone lengthening realm, however, it is still a complex procedure, which must be carefully planned to minimize risks and complications. Meticulous patient selection and prior physical and psychological evaluation are essential to the success of the procedure. Bilateral cases need a closer follow up, because implant failure is a potential risk.