Lengths of intramedullary nails and treatment efficacy of osteoporotic unstable intertrochanteric fracture / 中华创伤骨科杂志

Objective:To investigate the effects of lengths of intramedullary nails on the treatment efficacy of osteoporotic unstable intertrochanteric fracture.Methods:Retrospectively analyzed were the data of patients with osteoporotic unstable intertrochanteric fracture who had been admitted to Department of Orthopedics, China-Japan Friendship Hospital from January 2017 to December 2019. According to the lengths of intramedullary nails, the patients were divided into 2 groups. In the short nail group of 135 cases, there were 38 males and 97 females with an age of (82.2 ± 7.7) years and an intramedullary nail with a length of 170 mm was used. In the long nail group of 32 cases, there were 8 males and 24 females with an age of (81.5±7.1) years and an intramedullary nail longer than 300 mm was used. The amount of intraoperative hemoglobin drop value, operation time, Harris hip score at 6 months after surgery, incidence of complications and mortality were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability between groups ( P>0.05). There were no significant differences between the 2 groups in intraoperative hemoglobin drop value [(19.8±2.2) g/L versus (20.0±2.1) g/L], Harris hip score (72.0±3.0 versus 71.2±3.6), incidence of complications [3.0% (4/135) versus 6.2 (2/32)] or mortality [14.3% (19/135) versus 15.6% (5/32)] ( P>0.05). The long nail group needed significantly longer operation time than the short nail group [(84.6±5.6) min versus (92.0±7.2) min] ( P<0.05). Conclusions:In the treatment of osteoporotic unstable intertrochanteric fracture, short and long intramedullary nails show no significant difference in hemoglobin drop value, functional score, complications or mortality, indicating they can both lead to safe and reliable curative efficacy. However, long nails need longer operation time.

Distal Humeral Shaft Fracture with Simultaneous Ipsilateral Supracondylar Humeral Fracture in a Child: A Case Report

@#In children, simultaneous ipsilateral fracture of the distal shaft humerus and supracondylar humerus is rare. To the best of our knowledge, there are no available data on supracondylar humeral fracture (SCHF) combined with ipsilateral distal humeral shaft fracture. This report aimed to discuss a novel case with an appropriate management scheme. We present a case of a 5-year-old boy with ipsilateral distal shaft humerus fracture and SCHF. He underwent closed reduction and antegrade elastic stable intramedullary nail (ESIN) fixation with good clinical outcome. These injuries affect a child’s bony growth, and careful treatment is warranted. Upper extremity fractures could present in different combinations. The ESIN procedure with antegrade technique facilitated reduction and fixation of the fracture by prevention of iatrogenic ulnar nerve injury or pin-tract infection. Moreover, it allowed performance of early range of motion exercises.

Removal of locked intramedullary nails with the aid of bolts

Background: Removal of an intramedullary nail would require the extraction system of the inserted nail to be available. Sometimes the system is not available, and an alternative system would have to be utilised. Aim of the study was to document the removal of interlocked nails using bolts in the absence of appropriate fitting extraction system.Methods: A prospective study of consecutive patients seen by the authors between September 2016 and September 2018 in private clinics in Port Harcourt where the authors were invited to remove intramedullary nails. Bolts fitted to the proximal tips of the nails were utilized. With the aid of plier applied to the bolts and mallet, the nails were extracted. The patients’ socio-demographic and information relevant to the injury were obtained. Data was analysed using SPSS version 23.Results: Fifteen patients were seen. Ages ranged from 29 to 72 years, consisting of 10 males and five females. The tibia was affected in six and the femur in nine. There were five united tibial fractures and one non-united tibial fracture, six united femoral fractures and three non-united femoral fractures. Indication for removal was mostly patients’ request. Duration of surgery ranged from 1 to 4 hours. All the nails were extracted. Complications included broken nail, heterotopic calcification, bony overgrowth/ ingrowth/ongrowth around the nail and interlocking screws. There was no mortality.Conclusions: In the absence of conventional intramedullary nail extraction system, appropriate size bolts can be applied to the threaded proximal tip of nails and used for nail extraction.

Double femoral osteotomy fixed with a Puddu plate and a retrograde intramedullary nail to treat biapical deformity of the femur / Osteotomia femoral dupla fixada com placa Puddu e haste intramedular retrógrada para tratamento de deformidade femoral biapical

ABSTRACT Biapical femoral deformities are challenging to treat. In order to correct concomitant metaphyseal and diaphyseal deformities of the femur, the authors propose a double femoral controlled osteotomy with combined internal fixation, consisting of a Puddu plate and an intramedullary nail. The method was described in two patients. Results were analyzed using a visual analog scale (VAS), the Lysholm score, and SF-36. No complications were found. Complete consolidation of the osteotomies and radiographic alignment correction were achieved. Results were obtained with a minimum follow-up of 66 months. Both patients had improved for pain (VAS from 60 to 40 and from 50 to 20 at reassessment), function (Lysholm score from 78 to 93 and from 55 to 73) and quality of life (SF-36, both mental - from 40.7 to 57.1 in case one and from 24.7 to 59.7 in case two - and physical - from 27.7 to 45.6 and from 28.2 to 46.8). The authors have found that this technique is a reliable, accurate, and reproducible solution for biapical deformities of the femur.

RESUMO O tratamento das deformidades femorais biapicais é desafiador. Para a correção das deformidades metafisárias e diafisárias concomitantes do fêmur, os autores propõem uma osteotomia dupla femoral controlada com uma fixação interna combinada com uma placa de Puddu e uma haste intramedular. O método foi demonstrado em dois pacientes. Os resultados foram analisados com escala visual analógica (EVA) e os escores Lysholm e SF-36. Não foram encontradas complicações. A consolidação total das osteotomias e a correção do alinhamento radiográfico foram alcançadas. Os resultados foram obtidos com um seguimento mínimo de 66 meses. Ambos os pacientes apresentaram melhoria na dor (EVA de 60 a 40 e de 50 para 20), função (Lysholm de 78 a 93 e 55 a 73) e qualidade de vida (SF36, ambos mentais - de 40,7 a 57,1 no caso um e 24,7 a 59,7 no caso dois - e físico - de 27,7 para 45,6 e de 28,2 para 46,8). Os autores concluíram que essa técnica é uma solução confiável, precisa e reprodutível para deformidades biapicais do fêmur.

Interlocking intramedullary nail versus plate for distal femoral fractures in adults:a meta-analysis / 医学研究生学报

Objective Along with the development of science and technology , increase in the number of species gradually distal femoral fractures internal fixation materials , the choice of performer operation method is put forward to the test .To provide theo-retical basis for surgery of adult distal femoral fractures by systematically compare the distal femoral fractures in adults treated by intr -amedullary nail and plate . Methods We searched for articles comparing intramedullary nail and plate for distal femoral fractures in adults in Cochrane library, HighWire, CNKI, PubMed, super star MedaLink, Wanfang database.Manual retrieval related magazines, the retrieve date from June 2003 to June 2013.The RevMan5.1 provided for the extraction of available data after evaluate the quality of eligible literature . Results A total of 1200 patients were included ( 545 in the intramedullary nailing group and 655 in the plate group).Compared with the plate, intramedullary nail significantly reduced the risk of total complications (RR=0.48,95%CI[0.35, 0.67],P<0.01).Shorten the hospital stay (WMD =-3.55,95%CI[ -4.89, -2.24], P <0.01),full weight-bearing time (WMD=-0.80,95%CI[-1.49,-0.10],P=0.02), healing time(WMD=-3.32,95%CI[ -3.72,-2.92],P<0.01), all the above differences are statistically significant .In addition, this study found that intramedullary nail group is better in operation time and blood loss than steel group , but the conclusion by contrast in some literature . Conclusion Intramedullary nailing treatment of distal femoral fractures in adults can decrease the occurrence of postoperative complications .And in the operation time , hospitalization time, healing time, load time and blood loss, etc is superior to the steel group .Influenced by quality into literature , the above conclu-sion needs high quality case-control study further confirmed .

The effects of extracorporeal shock wave treatment combined with expanding bone marrow autografts in the treatment of nonunion of femoral shaft fractures with interlocking intramedullary nails / 中华物理医学与康复杂志

Objective To investigate the effect of extracorporeal shock waves (ESWs) combined with expanding bone marrow autografts in treating nonunion of femoral shaft fractures with interlocking intramedullary nails.Methods Thirty patients with femoral shaft fractures which had not united were divided into an ESW group,an expanding bone marrow group,and a combined treatment group using a table of random numbers.Each group had 10 cases.In the ESW group,no expanding bone marrow was employed in fixing the intramedullary nails and ESW therapy was begun at day 14 after the operation.In the expanding bone marrow group,bone marrow was grafted around the broken ends of fractured bones.In the combined treatment group patients underwent both treatments.The conditions of the callus and the fracture lines in the 3 groups were separately evaluated using X-rays at the 4th,8th,12th and 16th week after the operation.Results At week 4,the average callus and fracture line scores in the combined treatment and expanding bone marrow groups were significantly better than those in the ESW group.At the 8th week after the operation,the average callus and fracture line scores in the combined treatment group were significantly higher than in the ESW group and expanding bone marrow groups.Later,the callus and fracture scores in all 3 groups continued to rise significantly.At the 12th and 16th week the scores in the combined treatment group were significantly better than those in the ESW group and the expanding bone marrow group,while the scores in the ESW group were significantly better than those in the expanding bone marrow group.The cure rates in the ESW,bone marrow and combined treatment groups were 60％,50％ and 100％ respectively at week 16.Conclusions The combined treatment was significantly more effective than either treatment alone.There was no significant difference in effectiveness between the ESW and expanding bone marrow treatments.ESW combined with expanding bone marrow autograft is an effective way to promote bone knitting in the treatment of nonunion of femoral shaft fractures with interlocking intramedullary nails.

Avaliação radiológica dos dispositivos de fixação de fraturas: parte II: placas, hastes intramedulares e fixação externa: [revisão] / Radiologic evaluation of fractures fixation devices: part II: plates, intramedullary nails and external fixation: [review]

Após a redução da fratura, dispositivos de fixação interna ou externa podem ser utilizados para promover estabilidade e manter o alinhamento dos fragmentos ósseos. O objetivo do presente estudoé descrever a aparência radiológica e a aplicação dos principais materiais cirúrgicos usados no tratamento de fraturas. Os autores fazem uma revisão bibliográfica sobre o tema e apresentamimagens radiográficas que ilustram o uso dos principais dispositivos de fixação de fratura. Na segunda parte deste estudo serão enfatizados os aspectos radiológicos dos principais tipos de placas, hastes intramedulares e fixadores externos, assim como a aplicação destes dispositivos no tratamento das fraturas. Entendemos que o papel do radiologista na abordagem das fraturas compreendedesde a sua detecção até a caracterização do tipo de tratamento e sua evolução, o que torna essencial a familiarização deste profissional com os materiais usados para a fixação de fraturas.

After the reduction of a fracture, internal or external fixation devices can be used to promote stability and keep the alignment of the bone fragments during the healing process. The objective ofthe present study is to describe the radiologic findings and the applicationof surgery materials found in daily practice and used in fractures treatment. The authors perform a review on the subject and present radiographic images showing the utilization of the mainfractures fixation devices. In the second part of this study the radiologic findings of the main plates, intramedullary nails and external fixation frames will be emphasized and its application willalso be approached. We understand that the work of the radiologist in the fracture approach includes from the diagnosis to the characterization of the lesion and its evolution. Therefore, it is important that the radiologist knows the applications of the fracture fixation devices.

Animal experimental study of fracture fixation with PDLLA mixed with chitosan / 中国矫形外科杂志

[Objective]To explore the effect of fracture healing with intramedullary nail of poly-DL-lactic acid(PDLLA) mixed with chitosan and basic fibroblast growth factor(b-FGF),and provides the basis for clinical application.[Method]Middle tibia fracture model of 120 healthy adult rabbits of New Zealand were established and randomly divided into 6 groups as follows:experimental(A):30 rabbits with PDLLA+CHS+ b-FGF;control:5 groups(18 animals for each group):control(B) with PDLLA+CHS,control(C) with PDLLA,control(D) with PDLLA+b-FGF,control(E) with Kirschner's wire,and control(F) with Kirschner's wire+b-FGF.Radiological and histological follow-up was performed in 4,8,12 weeks postoperatively.[Result]All animals were survival.There was no significant difference(P

Curative effect review of short reconstruction intramedullary nail in treating 35 patients with femoral intertrochanteric fracture / 中国矫形外科杂志

[Objective]To discuss the application of the short reconstruction intramedullary nail in treating intertrochanteric fracture.[Method]From Jan 2000 to Aug 2004,35 patients(14 males and 21 females)with femoral intertrochanteric fracture were treated by short reconstruction intramedullary nail.Various data were analyzed for evaluating the characteristics and curative effect.[Result]The mean incision length was 3.5 cm,the average duration of operation and intraoperative X-ray fluoroscopy was 65 min and 0.16 min,respectively.The mean blood loss was 50 ml.None of the complications occurred postoperatively,including nonunion,deep venous thrombosis or infection of the incision etc.except only 1 malunion due to inappropriate surgical skill.Internal fixation loosening didn't appear in 97% of the patients.[Conclusion]Using short reconstruction intramedullary nail to treat intertrochanteric fracture can obtain satisfing outcomes of different concerns,such as time-saving,small incision,few complications,quick recovery and so on,which indicates that it should be the first choice for the treatment of femoral intertrochanteric fracture.

Evaluation of interlocking intramedullary nails and dynamic compression plate for the fixation of ulnar fracture:a comparative study of their biomechanical properties / 中国矫形外科杂志

[Objective]Ulnar fractures fixed by interlocking intramedullary nails or dynamic compression plates were tested to compare their biomechanical function,in order to provide the theoretical basis for clinical practice.[Method]In the experiment,12 pieces of fresh ulnars were used to produce middle-part transverse fracture models;which were fixed by interlocking intramedullary nails or six-hole 3.5 mm dynamic compression plates seperately.The diameter of intramedullary nail was 4mm,and the length was 200-230mm.The specimen was set on the MTS test machine.The rigidity and strength of ulnar fractures fixed by interlocking intramedullary nails were compared with those of ulnar fractures fixed by six-hole 3.5 mm dynamic compression plates in the anti-axial test,anti-bending test,anti-torsional test.[Result]In the anti-axial test,anti-bending test and anti-torsional test,the rigidity of ulnar fractures fixed by interlocking intramedullary nails was 450.00?38.42 N/mm,45.64?5.24 N?cm/Deg,11.42?1.21N?cm/Deg in sequence;while the rigidity fixed by dynamic compression plates was 405.40?29.26 N/mm,41.00?4.78 N.cm/Deg,10.05?1.32 N?cm/Deg accordingly.Burdened 1000N axial pressure,the displacement of interlocking intramedullay nail fixing specimen was 2.20?0.11 mm,and the compression plate fixing specimen was 2.48?0.15 mm.Given a 5 N?M bending burden,the maximum radial bending degree of interlocking intramedullay nailfixing specimen was 3.25?0.15 mm,which was 3.60?0.21 mm of compression plate fixing specimen.In the anti-torsional test,the interlocking intramedullay nail and compression plate fixing specimen could burden 2.40?0.13 N?M and 1.90?0.10 N?M respectively.The experimental data were analyzed by software SPSS.10,which came to a distinguished difference by t-test(P

Clinical efficacy of minimally invasive treatment of humeral shaft fracture with revolving intramedullary nails / 中国矫形外科杂志

[Objective] To evaluate the clinical efficacy of treatment of humeral shaft fracture with revolving intramedullary nails.[Method]Sixty-two cases with fracture of hume ral shaft were treated by revolving intramedullary nails between January 2000 and February 2006.Their were 38 male cases and 24 female cases.Their average age was 36.9(ranged 20～58).Fifty-fous cases were closed fractures,and eight cases were opened.Sixty-two cases with fracture of humeral shaft according to AO classification,41 cases were type A,15 cases were type B,6 cases were type C.Sixty-two patients with the humeral shaft fracture were treated with limited open reduction and minimally invasive internal fixation with revolving intramedullary nails.Scientific and rational rehabilitative treatment was carried out in each case after the operation.All patients were follow-up between 14 months and 30 months.The average follow-up period was 24 months.[Result]The fracture union occurred in sixty-two patients.The average healing time was 15 weeks.According to Rodriquez-Merchang shoulder functional score system,the excellent result was achieved in 36 patients,good in 20 and fair in 6.The excellent and good rate was 90.3%.All cases got good function recovery.The effects were satisfactory.There were no complications in all cases,such as infection,iatrogenic fracture,shortening,break of nail,fat embolism syndrome and peripheral nerve injury.[Conclusion]Revolving intramedullary nails for treatment of humeral shaft fracture is effective with litter interference with the blood supply of the bone fracture and with stable immobilization.Due to the abutment of the longitudinal bars along the entire length of the medullary canal wall,highly resistant to the rotational strength was achieved.The advances of revolving intramedullary nails are convenient in operative procedure with little invasive of operation,early function exercise,high raito of fracture healing and safety compared with the normal operative therapy.The operation indication and timing should be controlled strictly.The manipulation should be familiar.This kind of treatment is worth to be recommended.

Causes analysis and management of postoperative complications after femoral fractures treated with interlocking intramedullary nails / 中国矫形外科杂志

[Objective]To investigate the causes and treatment methods of postoperative complications of femoral fractures treated with interlocking intramedullary nails.[Method]A total of 243 cases of femoral fractures from Jan 1999 to Dec 2004 were treated with interlocking intramedullary nails.There were 14 cases having complications,delayed union in 1,nonunion in 3,nailing failure in 6(locking scerw loosen in 4,locking scerw folding in 1,locking scerw breakage in 2),nail breakage in 1,re-fracture in 1 and knee ankylosis in 1.Two cases with delayed union to convert the fixation from statictody namicin time;3 cases with nonunion were treated with bone grafting.Breakage nail and re-fractuer cases were treated with enlarging intramedullary tunels,exchanging nails and bone grafting.One of locking scerw loosen were treated with exchanging nails and bone grafting.Knee ankylosis were treated with quadriceps plasty.[Result]Through treatment,the delayed union and the nonunion were all healed and got recovery of knee function.[Conclusion]Though it has certain complications,the interlocking intramedullary nails used for femoral fractures have more advantages than other internal fixations.It needs to take valid measures to reach a satisfying result when complication appears.

Intramedullary nails for correction of deformity in the lower limbs in children with osteogenesis imperfecta / 中国矫形外科杂志

[Objective]To explore the application of the intramedullary nails for correction of deformity in the lower limbs and decrease the opportunity of refracture in children with osteogenesis imperfecta.[Method]From Jan.2000 to Aug.2004,8 patients(3 males and 5 females),with 13 femurs and 3 tibias totally,with deformity in lower limps were corrected by multi-osteotomy and fixed with intramedullary nails,2 for K-wires;3 for Ender nails;and 3 for flexible intramedullary nails.[Result]All deformities were perfectly corrected.All patients were available at final follow up,for 9 months to 60 months,mean 30 months.None of the complications occurred postoperatively,such as infection in the incision or pin tract,nonunion,and refracture.One patient can walk by a stick from wheel-chair help preoperatively and one K-wire was disrupted near the end.[Conclusion]Multi-osteotomy and fixed intramedullary nails,can correct the deformity in the lower limbs perfectly and decrease the opportunity of refracture in children with osteogenesis imperfecta,which has been proved to be a reliable method.

Treatment of tibiafibular fractures with rectangle-shaped intramedullary nails / 第二军医大学学报

Objective:To summarize the 10 year clinical experience of treating tibiafibular fractures with rectangle shaped intramedullary nails(RIN). Methods:From January 1987 to December 1996, 4 682 cases (3 278 male and 1 404 female) of tibiafibular fractures from 9 hospitals were treated with RIN . Three kinds of reduction methods including open reduction, semi open reduction and closed reduction were used during operation. Results:Results showed 2 173 cases (62.89%) got excellent result, 947 got good (27.40%), 214 got moderate (6.19%), 121 got poor (3.50%). The total healing rate was 90.29%. Conclusion:RIN has excellent biological characteristics which can provide a flexible interfixation when treating tibiafibular fractures, and the operation is simple, it also can be used for severe open fractures. RIN is one of the good techniques in treating tibiafibular fractures.