Is Distal Locking Constantly Necessary When Intertrochanteric Femur Fracture Is Stably Fixed in the Distal Area with Intramedullary Hip Nail? / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to investigate the constant necessity of distal locking when intertrochanteric fracture was treated with an intramedullary hip nail. MATERIALS AND METHODS: From April 2010 to June 2013, 47 stable intertrochanteric fractures (AO/OTA 31-A1) were treated with second generation intramedullary hip nailing. They were followed-up for more than 12 months. In the first group of 18 cases distal locking was used, and in the second group of 29 cases, distal locking was not used. We compared the radiologic and clinical results of the two groups. RESULTS: Comparison of the two groups of patients showed no difference in terms of radiological and functional results. Postoperative thigh pain developed in eight cases (17%). A statistically difference was observed between isthmic diameter and used nail diameter (Fisher exact test, p=0.01) for postoperative thigh pain. In logistic regression analysis, the difference between isthmic diameter and used nail diameter was the most statistically significant factor in development of postoperative thigh pain (p=0.04, odd ratio=27.75). CONCLUSION: Our results suggested that the second generation intramedullary hip nail may be successfully implanted without distal interlocking in 31-A1 intertrochanteric femur fracture when the reduction status was satisfactory and stable fixation of the distal area was estimated by less than 3 mm difference between isthmic diameter and used nail diameter.

Navigation in intramedullary nailing of long bone fracture / 中华创伤骨科杂志

Objective This paper illustrates the application of fluoronavigation in intramedullary nailing in long bone fractures (femur and tibia), especially during the procedure of distal locking. We also explore the possibility of distal locking with an image bank of intramedullary nails and under navigation. Furthermore medical robots are being developed to further improve the precision of the procedure. Methods In our hospital, distal locking in 55 cases of femoral nailing and 36 cases of tibial nailing were performed under navigation. Another 13 cases of distal locking were performed with the image bank. Result The overall successful rate of distal locking was 97%. Conclusions Fluoronavigation in distal locking of intramedullary nailing of long bone fractures has achieved a high successful rate. Development of an image bank could further decrease the X-ray exposure suffered by the patient and operation theater staffs.