ABSTRACT
PURPOSE: The purpose of this study was to compare the results of treatment of distal tibial fractures between intramedullary (IM) nailing and minimally invasive plate osteosynthesis (MIPO). MATERIALS AND METHODS: Between January 2007 and February 2012, 57 patients (57 cases) were treated for distal tibial fractures. Thirty-two patients (32 cases) were treated with IM nailing (nail group) and the 25 patients (25 feet) were treated with MIPO (plate group). Clinical results were compared using range of motion (ROM) of the ankle joint, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Olerud-Molander score between nail group and plate group. Radiographic results were compared using mean bony union time, coronal and sagittal malunions, and shortening between the groups. RESULTS: Mean ROM of the ankle joint was significantly larger in nail group until 6 months after surgery; however, it was not different between two groups at the last follow-up. AOFAS score and Olerud-Molander score were not different between two groups at the last follow-up. In the nail group, two malunions more than 5 degrees were observed in coronal and sagittal planes, respectively. One case showed non-union in the plate group, however, bone union was obtained after autogeneous bone graft. CONCLUSION: Treatment using IM nailing is more advantageous in terms of postoperative rehabilitation than MIPO in distal tibial fractures.
Subject(s)
Humans , Ankle , Ankle Joint , Follow-Up Studies , Foot , Fracture Fixation, Intramedullary , Range of Motion, Articular , Rehabilitation , Tibia , Tibial Fractures , TransplantsABSTRACT
Closed intramedullary nailing is a favorite surgical technique for tibial shaft fracture. After closed interlocking intramedullary nailing, proximal and distal locking screws are inserted for increasing rotational force and axial stability. Vascular complications associated with tibial nailing for fractures are very rare. Here, we described a case of a pseudoaneurysm of the anterior tibial artery after tibial nailing. We opted for minimally invasive treatment consisiting of thrombin injection and vascular plug insertion. Because pseudoaneurysm of the anterior tibial artery can induce severe complications, one should, when performing closed intramedullary nailing, make a quick diagnosis and start treatment right away.
Subject(s)
Aneurysm, False , Embolization, Therapeutic , Fracture Fixation, Intramedullary , Nails , Thrombin , Tibial Arteries , Tibial FracturesABSTRACT
PURPOSE: To compare the result of treatment between minimally invasive plate osteosynthesis (MIPO) using periarticular plate and intramedullary nailing in treatment of distal tibia fractures. MATERIALS AND METHODS: 28 cases of distal tibia fractures form Jan. 2006 to Mar. 2008 were divided into two group. Minimum follow-up was for 12 month. Group 1 consisted of 14 patients who were treated by MIPO technique and group 2 consisted of 14 patients who were treated by interlocking intramedullary nailing. The results were compared by assessing radiologic and clinical result. RESULTS: The mean bony union time was 14 weeks (8~17) in group 1 and 15 weeks (11~20) in group 2. Operation time was 58 minutes (55~65) in group 1 and 82.7 minutes (70~100) in group 2. The average angulation in AP view was 1.5 degrees (0~2) in group 1 and 2 degrees (0~5) in group 2, in lateral view was 1.8 degrees (0~4) in group 1 and 2.3 degrees (0~12) in group 2. The average range of motion for dorsi flextion was 17.5 degrees (15~20) in group 1 and 18 degrees (16~20) in group 2, for plantar flextion was 45 degrees (42~50) in group 1 and 44 degrees (42~50) in group 2, which means that there were no severe limitation of motion in all patients, resulting in satisfactory ambulation. There was no post operative complications such as skin irritation problem caused by internal device and no implant failure and superficial wound infection. CONCLUSION: There were no difference in bony union time, clinical result and anatomical reduction between Group 1 and Group 2 in distal tibia fractures, but operation time was shorter in MIPO than nailing.
Subject(s)
Humans , Follow-Up Studies , Fracture Fixation, Intramedullary , Nails , Range of Motion, Articular , Skin , Tibia , Walking , Wound InfectionABSTRACT
PURPOSE: To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and interlocking IM nailing in the treatment of distal tibia fracture without involvement of ankle joint retrospectively. MATERIALS AND METHODS: 38 patients with distal tibia fracture from Jan. 2004 to Oct. 2005 were divided into two groups. Minimum follow-up was for 12 months. Group MIPO consisted of 18 patients were treated with MIPO and group Nail consisted of 20 patients were treated with interlocking intramedullary nail. The results were compared between two groups by assessing bony union time and operation time. Clinical evaluation was evaluated by Olerud score. RESULTS: The mean bony union time was 14.4 weeks (12~17 weeks) in group MIPO and 16.7 weeks (13~19 weeks) in group Nail (p=0.011). The mean operation time was 1.05 hours (0.6~1.6 hours) in group MIPO and 0.74 hours (0.4~1.1 hours) in group Nail (p=0.044). The Olerud score was 83.8 (75~100) in group MIPO and was 89.6 (70~100) in group Nail (p=0.075). In Complication, group MIPO showed one metal failure and two skin irritations, group Nail showed three superficial wound infections. CONCLUSION: MIPO was the shorter bony union time and the longer operation time than the interlocking intramedullary nailing. There were no significant differences between the two groups in clinical results.
Subject(s)
Humans , Ankle Joint , Follow-Up Studies , Fracture Fixation, Intramedullary , Nails , Skin , TibiaABSTRACT
PURPOSE: To evaluate the post-operative functional reduction of the shoulder joint and the impacting factors to post-operative shoulder joint function in interlocking IM nailing treatment of humeral shaft fracture. MATERIALS AND METHODS: From April 1999 to August 2004, 35 patients (35 cases) whom admitted to hospital for humeral shaft fracture and treated using interlocking intramedullary nail were followed up for more than 1 year. 1 year post-operative shoulder joint function were evaluated using American Shoulder Elbow Surgery Scale (ASES). Pre-operative shoulder joint pain, radiologically degenerative change and extent of nail protrusion were evaluated, and each factor was correlated with function of the shoulder joint. RESULTS: 33 cases out of 35 cases showed union and average union period was 12 weeks. Complications consisted of 2 cases of nonunion, 1 case of infection, 1 case of loosening of distal fixing screw, 1 case of radial nerve palsy and 1 case of axillary nerve palsy. Shoulder joint function 3 months after operation : mean ASES score 78.2, 12 months after operation : mean ASES score 89.6. Pre-operative shoulder joint pain and nail protrusion showed to be statistically related to shoulder joint function. CONCLUSION: If the operation leaves no protrusion of intramedullary nail, it can be concluded to be relatively safe and effective.
Subject(s)
Humans , Elbow , Fracture Fixation, Intramedullary , Paralysis , Radial Nerve , Shoulder Joint , ShoulderABSTRACT
[Objective] To explore choice of therapeutic methods and curative effects in postoperative non-union of tibial fracture with interlocking intrameduilary nails.[Method]There were 36 cases of postoperative non-union in the 348 cases of tibial fracture with interlocking intrameduliary nails.Among them,10 cases were treated with tile extracorporeal shock wave;8 cases were changed dynamization of intramedullary nailing;6 cases were changed dynamization of intramedullary nailing and added bone autografting;5 cases were added bone autografting;3 cases were treated with changing plate and adding bone autografting;4 cases of the hyperplastic non-union were treated with changing interlocking intramedullary nails.[Result]All the cases were followed up for an average of 28 months.There were more short bone healing times by second-time operation in 6 months than after 6 months(P
ABSTRACT
Objective To measure the extent of malrotation of femur fractures with CT scan after fixation with interlocking intramedullary nailing , and to discuss the methods which can help to correct the malrotation of femur fracture during the operation. MethodWith CT scan, the anteversion of femur fracture after the close reduction and fixation with interlocking intramedullary nailing in 56 cases was measured, and the difference of anteversion between the fracture side and the contralateral side was evaluated. The increase of anteversion represented internal rotation of the distal fragment, whereas the decrease of anteversion meaned external rotation. According to AO classification system, the type A of infratrochanteric fractures happened in 9 cases, type A of femoral shaft fractures happened in 12 cases, type B in 15 cases,type C in 7 cases,and 13 cases of femoral supercondyle fractures were type A. ResultThe results of measurement showed that the femoral anteversion after fixation with interlocking intramedullary nailing was changed in all patients. The anteversion of the femoral shaft fracture ranged from 13.35?to 47.21?. The aneversion of infrotrochanteric fractures ranged from -7.12?to 36.35?, and the supercondyle fracture of femur from -11.10?to 39.22?. For the extent of malrotation of distal femoral fracture, the internal rotation was more obvious than the external rotation. The number of Internal rotation cases accounted for 60.71%, and the external cases accounted for 39.29%. The maximum internal malrotation happened in femoral shaft fracture, from 1.37?to 29.82?with average malrotation 12.34?. and the minimum internal malrotation happened in infratrochanteri fracture, from 0.81?to 23.21?,with the average malrotation 8.32?. The medium internal malrotation was femoral supercondyle fracture, from 1.72?to 27.11? with the average malrotation 8.38?. The maximum external malrotation happened in femoral shaft fracture, from 1.11?to 21.12?with the average of them 9.33?. The minimum external malrotation happened in infratrochanteri fracture, from 1.31?to 16.23?with the average 7.71?. The medium external malrotation was seen in femoral supercondyle fracture, from 0.97?to 17.96?with average 8.22?. For these three parts of femoral fracture, the partnership T test was done between the fracture side and the contralateral side, the results showed that there were significant differences among of them,P
ABSTRACT
[Objective]To observe the clinical effect of the treatment of hyperplastic nonunion of the tibia with interlocking intramedullary nailing,fascia pedicled callus flap and bone grafting.[Method]Twelve cases of nonunion of the tibia were treated with intramedullary interlocking nailing,fascia pedicled callus flap and bone grafting,and there were 8 males and 4 females.The patients age ranged from 26 to 64 years,with an average of 45 years.[Result]All cases were followed-up for an average of 48 months and achieved a solid union within 4～6 months.[Conclusion]Intramedullary interlocking nailing,fascia pedicled callus flap and bone grafting have the design of the reasonable biomechanics,the function of untispinning and unticurtailing,less partial blood decompose.The fascia pedicled callus flap and iliac bone grafting could result in solid union and it is a recomment method for promoting bone-healing up after grafting and forming.
ABSTRACT
PURPOSE: To investigate the bone union time of patients treated with interlocking intramedullary nailing in wedged tibial shaft fracture and to evaluate the factors that influence this result. MATERIALS AND METHODS: 32 patients treated with interlocking intramedullary nailing for wedge tibial shaft fracture were reviewed with a follow-up period of more than 1 year. Radiographic results were assessed with diameter (%) and length (mm) of wedge fragment, pre and postoperative displacement (mm) of wedge fragment. We also checked the bone union time of the main fragment and the wedge fragment (paired t-test). We investigated the bone union time acocording to the diameter, length of wedge fragment, pre and postopertvie displacement (correlation analysis). RESULTS: Bone union time of the main fragments averaged 15.3 weeks (6~53 weeks) and that of wedge fragment averaged 24.2 weeks (8~64 weeks) (p=0.005). There was no correspondence between wedge fragment diameter and bone union time (p=0.681), but the bone union time of wedge fragment increased in proportion to its diameter (r2=0.747, p=0.031). There was no correspondence between preoperative displacement of wedge fragment and bone union time (p=0.574), but the bone union time increased in proportion to postoperative displacement of wedge fragment (r2=0.730, p=0.001). CONCLUSION: Wedge fragments need longer time for bone union than main fragments in interlocking intramedullary nailing for wedge tibial shaft fractures. We need to pay attention to the displacemet of fragments in treating tibial shaft fractures with large wedge fragment.
Subject(s)
Humans , Follow-Up Studies , Fracture Fixation, Intramedullary , TibiaABSTRACT
PURPOSE: To compare of results between open interlocking intramedullary nailing combined with cerclage wiring and closed interlocking intramedullary nailing in treatment of femoral shaft comminuted fracture, we reviewed retrospectively 62 femoral shaft fractures. MATERIALS AND METHODS: We reviewed retrospectively 62 femoral shaft comminuted fractures, who had been followed up for a minimum one year including Winquist-Hansen classification II, III, IV from January 1996 to December 2002. The group I include the patients who treated with closed interlocking intramedullary nailing. The group II include the patients who treated with open interlocking intramedullary nailing combined with cerclage wiring. RESULTS: The average bone union time was 18.6 weeks in group I, 27.6 weeks in group II. The complication included 3 delayed unions, 1 nonunion and shortening of more than two centimeters in 1 patents in group I. In group II, The complication included 2 infections, 7 delayed unions and 3 nonunions. CONCLUSION: We can use open interlocking intramedullary nailing with cerclage wiring in some femur shaft comminuted fractures, but there are many problems and complications. So we must consider it carefully before using this method.
Subject(s)
Humans , Classification , Femur , Fracture Fixation, Intramedullary , Fractures, Comminuted , Retrospective StudiesABSTRACT
PURPOSE: To investigate the effect of fibular malreduction on ankle joint after tibia interlocking IM nailing of tibial and fibular fractures according to type of fibular fractures at preoperation. MATERIALS AND METHODS: Thirty-nine patients who had ipsilateral tibiofibular fracture were analyzed clinically and radiographically. The talocrural angle and the distance from joint line to the tip of fibular were measured on both ankle standing AP view. The difference of angle and distance of both ankle were analyzed by paired t-test and correlation between defference and AOFAS score by Spearman correlation coefficients. RESULTS: The difference of The talocrural angle and the distance from joint line to the tip of fibular of both ankle was statistically significant (p0.05). CONCLUSION: In tibia interlocking IM nailing of tibia and fibula fracture, malreduction of fibula could cause the change of ankle joint.
Subject(s)
Humans , Ankle Joint , Ankle , Fibula , Joints , TibiaABSTRACT
PURPOSE: To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing. MATERIALS AND METHODS: Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing. RESULTS: Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6+/-2.9 degrees and average antero-posterior angle was 0.8+/-3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks. CONCLUSION: Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.
Subject(s)
Humans , Debridement , Follow-Up Studies , Fracture Fixation, Intramedullary , Range of Motion, Articular , Soft Tissue Injuries , TibiaABSTRACT
PURPOSE: The aims of this study were to determine the effectiveness of the treatment using augmentation plate fixation for nonunion of long bone fracture after interlocking intramedullary nailing MATERIALS AND METHODS: Thirteen patients with nonunion of the long bone fracture after interlocking intramedullary nailing who underwent augmentation plate fixation were evaluated; followed up for more than 1 years. We evaluated five patients with nonunion of the humerus, three of the tibia and five of the femur. Twelve of thirteen patients were carried out autogenous cancellous bone graft and augmentation plate fixation was performed without removal of intramedullary nail for all patients. RESULTS: For the cause of nonunion, seven patients were by iatrogenic factors such as insecure fixaton and six patients were by fracture itself such as severe comminution and open fracture. Bone union was achieved in thirteen patients all and the average bony union time was 4.2 months (ranged from 3 to 5.5 months) for the humerus, 6.4 months (ranged from 4 to 8.5 months) for the tibia and 7.3 months (ranged from 5.5 to 9 months) for the femur. There were no complications such as reoperation, infection or plate failure. CONCLUSION: TAugmentation plate fixation is effective treatment option for the management of long bone fracture nonunion after intramedullary nailing.
Subject(s)
Humans , Femur , Fracture Fixation, Intramedullary , Fractures, Bone , Fractures, Open , Humerus , Reoperation , Tibia , TransplantsABSTRACT
PURPOSE: We report results of intramedullary nailing in humeral shaft fracture and upon the many factors which contributed to shoulder pain & motion limitations. MATERIALS AND METHOD: We reviewed the clinical results in twenty seven patients with a minimal 1 year follow up. There were 18 fresh fractures and 8 nonunions. We performed rotator cuff repair and acromioplasty in 6 patients with rotator cuff injuries at same time. RESULTS: The bone union was obtained in 26 patients, but not in one patient. Eighty nine% of patients were satisfied with the operative results. The average postoperative pain (VAS) was 0.1 at rest and 2.6 at maximal ROM. The limitations of motion compared with the unaffected side were; forward flexion 10 degrees , external rotation at the side 13 degrees , internal rotation 3 thoracic spine difference and abduction 14 degrees . The fracture type and the presence of nonunion did not affect shoulder pain or motion. The active patients had preferable results. Patients treated with rotator cuff repair and acromioplasty at same time had better results but there were not statistically significant. CONCLUSION: Antegrade interlocking intramedullary nailing for the treatment of humeral shaft fracture showed excellent results, especially in for long spiral, comminuted and segmental humeral shaft fractures. However, it should be noted that early rehabilitation after stable fixation and a delicate and accurate surgical technique are important to obtain good shoulder motion and bone healing.
Subject(s)
Humans , Follow-Up Studies , Fracture Fixation, Intramedullary , Humerus , Pain, Postoperative , Rehabilitation , Rotator Cuff , Shoulder , Shoulder Pain , SpineABSTRACT
Objective To compare the treatment effect of internal fixation with retrograde interlocking intramedullary nails or condylar plates in the treatment of comminuted fracture of the femoral condyle. Methods 36 cases of comminuted fracture of femoral condyle admitted from 2000 to 2005 were treated with retrograde interlocking intramedullary nails (n=19) or condylar plates (n=17). Union time of fracture and the recovery of knee function were observed respectively. Results The average union time of fracture of the cases treated with retrograde interlocking intramedullary nails was 102 days, and the score of knee function was 84.59. Whereas in the cases treated with condylar plates the union time of fracture was 91.35 days, and the score of knee function was 91.10. Significant differences in both union time of fracture and knee function between the two therapeutic methods were observed (P
ABSTRACT
PURPOSE: During interlocking nailing the displaced butterfly fragments can be left in situ or reduced by opening the fracture site. The purpose of this study is to investigate the fate of the displaced comminuted butterfly fragments when left unreduced and factors that influences fracture union in comminuted femoral fracture after closed interlocking nailing. MATERIALS AND METHODS: Out of 95 closed interlocking nailings done for fractured femur from July 1990 to July 1993, 43 femoral fractures that had comminuted fragments larger than 1 cm were followed for more than 18 months postoperatively, The correlations between the size of the comminuted fragments, its distance from the femoral shaft, the angulation of the fragment, the gap of the main fracture sites and bone union were analyzed. RESULTS: The distance between the fragment and the femoral shaft and angulation spontaneously decreased gradually, even the fractures having inverted fragments were united uneventfully, and the union rate of the fractures with gap less than 3 mm was higher than those with gap greater than 3 mm. CONCLUSIONS: The displaced fragment need not be reduced by open method and minimizing the fracture gap is recommended in increasing the union rate.
Subject(s)
Butterflies , Femoral Fractures , Femur , Fractures, ComminutedABSTRACT
This study analyzed the factors causing the angular deformity as the tibia fracture below isthmus were treated with interlocking nails. For this purpose, we observed 70 cases of tibia fractures in the Gil General Hospital as subjects. Of the 70 cases under the treatment, 32(45.7%) showed the angulation of over one degree, and 11(15.7%) showed that of 5-10 degrees in any plane. According to the outcomes of this studies, the degree of angulation seemed to have close relation to the length of fracture line. Also, if the fracture line reached to the isthmus, angulation was apt to be caused. Even though most angulated cases had concomitant fibular fracture, fibular fracture, itself, seemed to have no direct relation to angulation. In consequence, the intramedullary interlocking nailing needs special carefulness in the case of breakage of cortical buttress such as long fracture line, butterfly fragment and fracture including isthmus.
Subject(s)
Butterflies , Congenital Abnormalities , Hospitals, General , TibiaABSTRACT
The conventional therapy for supracondylar fracture of the femur is open reduction and internal fixation with plate and screws. But, wide dissection of the thigh with the following devascularization of the distal femur caused a high incidence of complications like joint stiffness, delayed union, nonunion, infection and loosening or breakage of plate and screws. On the contrary, interlocking intramedullary nailing does not need the exposure of the fracture so that soft tissue dissection and devascularization can be minimized. Undoubtedly, rapid healing by abundant formation of callus is promoted, irrespective of the degree of comminution. We reviewed 9 cases of interlocking intramedullary nailing for supracondylar and intercondylar frtures of the distal part of the femur at Pusan National University Hospital from November 1993 to December 1995. The mean time to union was 14 weeks (range, 11-23weeks). According to Rating System of Neer et al., excellent was 7 cases, satisfactory in 1 case and unsatisfactory in 1 case. Interlocking intramedullary nailing was applied to Type A, C1 and C2 of the AO classification but considered difficult to apply to Type B and C3. For the firm fixation and the prevention of nail breakage, the nail should be inserted deepest in order to place two distal screws as distally as possible from the fracture site. If necessary the distal tip of nail was cut off for use. Interlocking intramedullary nailing does not need the exposure of fracture site. Satisfactory result could be obtained by reducing complications such as joint stiffness, delayed union, nonunion, infection and breakage of implants caused by wide dissection of the thigh with the following devascularization of the distal femur for the open reduction and internal fixation with plate and screws. It also could be obtained by performing early ROM exercise with firm, fixation.
Subject(s)
Bony Callus , Classification , Femur , Fracture Fixation, Intramedullary , Incidence , Joints , ThighABSTRACT
The intramedullary nailing for the tibial fracture has been used in selected cases of fresh diaphyseal fracture and nonunion. However, with modern technical improvement such as image intensifier and interlocking, the indications have been expanded considerably. Interlocking intramedullary nailing has been popularized because it enables preservation of the range of motion of the joint, early weight bearing and early bony union. Between August, 1989 and July, 1991 interlocking nailing in the tibial fracture has been performed for 53 cases with follow up more than one year. The results were as follows; 1. All were treated with closed nailing and static locking was performed as a principle. Only three cases needed dynamization of the 47 patients treated with static locking nailing. 2. The union rate was 96.296 and mean period of fracture union was 15.2 weeks. 3. In the distal one third of fracture, rigid fixation could be achieved by adjusted length by cutting the distal end. 4. In 7 proximal tibial fractures, 4 fractures were accompanied with complications such as nonunion, angulation deformity and shortening. Therefore, interlocking nail is inadequate treatment of proximal unstable fractures. 5. In the delayed and nonunion treated by interlocking nailing, bony union was achieved in all 3 cases without bone graft and cast immobilization.
Subject(s)
Humans , Congenital Abnormalities , Follow-Up Studies , Fracture Fixation, Intramedullary , Immobilization , Joints , Range of Motion, Articular , Tibia , Tibial Fractures , Transplants , Weight-BearingABSTRACT
We treated 74 fractures of the tibia by Interlocking intramedullary nail from Jan. 1982 to Mar. 1988. 58 of the fractures were fresh, 11 of these were open fractures. The other had 14 delayed union and nonunion and 2 ostetomy for malunion. Mean follow-up was 12.4 month and we analysed as follows: 1. Of 74 fractures, 73 fractures united and then the union rate was 98.5%. 2. Interlocking IM nail could be used to the majority of fractures of the shaft of tibia from 6cm below the knee joint to 5cm above the ankle joint. 3. Interlocking nail had rigid rotational stability and was appropriate for the treatment of severe unstable fractures. 4. Delayed union or nonunion was a good indication for intramedullary nsilling. 5. The major complication was deep infection. When the fixation was rigid with intramedullary nail, bone union was progressed in spite of infection. 6. Interlocking Intramedullary nailing provided rigid fixation of fracture and then it made possible early joint motion exereise and ambulation.