Ulnar Insufficiency Fractures in Patients on Prolonged Bisphosphonate Therapy: A Case Report

Atypical fractures associated with prolonged bisphosphonate (BP) therapy rarely occur outside the femur, and the diagnostic criteria, appropriate treatment principles, and fixation methods for atypical ulnar fractures have not been established. The authors experienced the use of internal fixation with a metal plate and a new internal fixation method with an intramedullary nail in the treatment of an atypical ulnar fracture in a patient who had been on BP therapy for 10 to 20 years. This paper reports findings along with a review of the relevant literature.

Study of results of ender nailing and cannulated cancellous screw in the treatment of intertrochanteric fracture femur.

Background: Intertrochanteric fracture of femur is one of the most common fractures seen in general population. Till date various fixation devices are used for fixation of this fracture that includes both extra medullary and intramedullary implants. Ender and Simon Weidner popularised the condylocephelic intramedullary nailing for this fracture. But it is seen that fracture treated by ender nailing alone resulted in varus malunion. Aims & Objective: Along with ender nail we added the cannulated cancellous screw which results in controlled collapse of the fracture with union in anatomic position. Material and Methods: We studied 50 patients of intertrochanteric fracture treated by ender nail and cannulated cancellous screw between year 2009 to 2011. Follow up assessment was done by Harris hip score. Results: The union achieved in mean time of 7 weeks. In study of 50 patients we obtained 86% excellent to good results. 14% patient had fair to poor results. Conclusion: We found that use of Ender nail and cannulated cancellous screw results in fracture union in more anatomical position with better patient compliance and early mobilization.

Ender Nailing of the Tibial Shaft Fractures under the Local Anesthesia

PURPOSE: To evaluate the clinical result of ender nailing under local anesthesis was done to patient with tibia shaft fracture who had high risk for general anesthesia or spinal anesthesia. MATERIALS AND METHODS: 10 cases with ender nailing procedure under local anesthesia due to high anesthetic risk were selected from total of 20 cases with tibia shaft fracture operated with ender nailing. In each patient, hepatic, diabetic, cadiopulmonary complication and thromboembolism which can be initiated or aggravated by general or spinal anesthesia, were evaluated. Radiologic and clinical evaluation were used to check bone union. RESULTS: There were no complication of local anesthesia. Bone union were acquired in all cases with average bone union period of 18 weeks. There were no evidence of flexion deformity, limb shortening or joint contracture. CONCLUSION: Ender nail fixations under local anesthesia enable close reduction and intramedullary nailing and is effective in patient care but has no problem with bone union. For this reason, ender nail fixation under local anesthesia seem to be effective method if general of spinal anesthesia is difficult.

Modified Ender Nailing For Intertrochanteric Fracture of the Femur

PURPOSE: To evaluate the modified Ender nailing technique for the treatment of femoral intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: 31 cases of femoral intertrochanteric fractures treated by modified Ender nailing from May 1997 to December 2004 were included in this study. We analyzed the method of the anesthesia, amount of intraoperative blood loss, operation time, number of used nail, postoperative ability of ambulation, postoperative complication, and the time for radiological union. RESULTS: 22 cases were operated under epidural anesthesia and 9 cases under general anesthesia. The average amount of intraoperative blood loss was 55 ml and average time for operation was 37 minutes. The average number of used nails were 3.1. The postoperative ambulatory ability was clinically recovered to the preoperative ambulatory ability in 23 cases, and decreased than before in 8 cases. Postoperative complications included knee joint pain or limitation of motion of the knee joint and distal migration of the nails. The average time for radiological bone union was 17.1 weeks postoperatively. CONCLUSION: The modified Ender nailing technique is the one of the proper method in elderly femoral intertrochanteric fractures with associated medical problems. This method reduce the operation time and the amount of intraoperative blood loss.

Treatment of Intertrochanteric Fracture of the Femur with Ender Nail in the Elderly Patients with High Risk of Anesthesia

PURPOSE: To evaluate the usefulness of IM Ender nail in treating femoral intertrochanteric fractures with high risks including cardiovascular disease, pulmonary disease, liver cirrhosis, cerebrovascular disease, metastatic cancer, and skin problem at hip joint region. MATERIALS AND METHODS: Thirty-five patients of pre-existing diseases and femoral intertrochanteric fractures treated with Ender nailing, January 1990 to November 1997. Under the c-arm guided, closed reduction and internal fixation were performed using Ender nails, We analized operation time, blood loss, bone union, ambulation time and complications RESULTS: Mean operation time was 55 minutes, mean blood loss was 120 ml, mean radiological bone union was 12 weeks and average of partial weight bearing was 6.9 days. Postoperative complications were gastrointestinal discomfort in 3 cases, superficial wound infection in 1 case, knee pain in 7 cases, inguinal pains in 5 cases, distal migration of nails in 3 cases, varus deformity in 2 cases, proximal migration of nail with nonunion in 1 case. CONCLUSION: The intramedullary ender nail is useful method in treating femoral intertrochanteric fractures in high risk patients of anesthesia and blood loss or skin problem at hip joint region.

Treatment of the Humerus shaft Fracture with Closed Interlocking medullary Nail / 대한정형외과학회잡지

The interlocking nail is used as a valuable method in treating humerus shaft fracture because of the merit, including relatively simple procedure, one of the most stable fixation methods, and allowing early ROM excericise and low complication. Fourteen pateints with humerus shaft fractures were treated using interlocking nail at the Department of Orthopaedic Surgery Paik Hospital from Jan.1993 to Oct.1994. l. Among the 14 pateints, average age was 34.8 years and 9 cases were male and the most common cause of injury was traffic accident. 2. Associated injury including 3 cases of ipsilateral scapular fracture, I case of ipsilateral clavicle fracture, and 1 case of brachial plexus injury, and 1 case of radial nerve injury. 3. The mean duration of the radiologic bone union was 8.6 weeks. 4. There was no serious post operative complication such as non-union, infection, bending or rotational deformity at fracture site, impingement syndrome, metal failure of the nail or interlocking screws. 5. To prevent the impingement syndrom and rotator cuff injury, we countersinked the proximal end of the nail into the humeral head and minimized skin incision.

Clinical use of Ender Flexible Intramedullary Nail for the Proximal or Distal third Fracture of Tibia / 대한정형외과학회잡지

Authors reviewed 39 cases of proximal or distal fracture which had been managed with Ender flexible intramedullary nails to identify the proper region of tibial fracture for the nail and acceptable indication of retrograde nailing relevant to our clinical experiences. The results were as followings; l. Incidence of malunion with more than 10° of angulation was higher in the fracture of proximal 1/3 tibia than that of distal 1/3. Especially this phenomenon was more significant in case of combination with segmental fracture. 2. As all segmental fractures combined with proximal tibial fracture within 9cm from the plateau were malunited with angulation of 10° or more, another method of internal fixation should be considered. 3. Although degree of angulation was relatively larger in distal tibial fracture within 10cm from the plafond than that beyond 10cm and 2 cases of malunion with angulation of 10° or more were also found within 10cm from tibial plafond, there was no statistically significant difference. 4. Retrograde nailings were performed for 5 cases of proximal 1/3 fractures and 1 case of poor skin condition on the proximal entry. Clinical relevance: Suitable region of tivial fracture managed with Ender-flexible intreamedullary nail was fracture which occurred from 9cm distal to tibial plateau to 10cm proximal to tibial plafond.

The Complication in the Treatment Modality of Intertrochanteric Fracture of Femur / 대한정형외과학회잡지

Intertrochanteric fractures of femur were increasing in their incidence in morden life. The compression hip screw and Ender nail are popular treatment modalities of the interochanteric fracture of femur. We had tried to clarify the complications of intertrochanteric fracture according to the treatment modality-compression hip screw and Ender nail. We obtained the results as followings with the patients who had intertrochanteric fracture of femur which were managed by compression hip screw (56 cases) and Ender nail (22 cases) through the period of March 1987 to June 1993. The summary of the results; 1. Mechanical complications were developed in 9 patients(16%), 9 complications in the group with compression hip screw and 7 patients(32%), 12 complications in Ender nail. 2. Local complications were developed in 4 patients(7%) in compression hip screw and 10 patients (46%) in Ender nail and the most common local complication was the knee joint pain(7 patients; 32%). 3. Statistically, more significant decrease of neck-shaft angle was shown with group using Ender nail for unstable fracture than stable fracture group and compression hip screw group. 4. The degree of shortening was incrased in group with Ender nail than in group with compression hip screw, but there was no statistical significance. 5. The grade of osteoporosis was not related to the change of neck-shaft angle and shortening and also to the development of mechanical complication. According to the above results, compression hip screw was a more stable fixation device than Ender nail in the unstable intertrochanteric fracutre.

Comparative Study of Interlocking and Ender Nails fixation of Diaphyseal Fracture of Femur / 대한정형외과학회잡지

Interlocking and Ender nail fixations have been widely used for the surgical treatment of diaphyseal fractures of femur. Interlocking nail could give advantage of high stability to unstable, cominuted fractures. It requires, however, advanced technique and exposure to radiation harzard, often complicated by further comminution, displacement, breakage of drill bit or loosening of locking screws. Ender nail, on the contrary, is easier in procedure without reaming, thereby maintaining endosteum and requiring short operation time. It, however, cannot avoid complications of shortening, rotational deformity, migration of nails, etc. This study aimed at comparative evaluation of the clinical results of two different nailings(23 Interlocking and 19 Ender nails) performed from March 1987 to March 1993. The study materials were 42 femoral fractures out of 41 adult patients with the followed-up between one and seven years(average 3.5 years). The results are summarized as below: 1. Fracture occurred mostly in the mid-diaphysis(81%) and the Type III comminution(63%) was most common according to the Winquist-Hansen classifiaction. 2. The operative time averaged ninty five minutes in Interlocking nailing, while sixty minutes in Ender nailing. The blood loss was negligible in both techniques. 3. Fluoroscopic assessment after insertion of the nails revealed that Interlocking gave superior stability to Ender nail, while Ender nail produced earlier callus formation(7.5 weeks in average) than Interlocking nail(9.0 weeks in average, p 0.05). 4. Interlocking nail was complicated by loosening of locking screws in two, angulation in one, breakage of drill bit in one cases. Ender nail showed protrusion in two, limb shortening in three, rotational deformity in three cases respectively. There was neither operative infection nor nonunion.

The Use of Ender nails in Distal One-Third Fractures of Tibia / 대한정형외과학회잡지

The distal one-third fractures of tibia have much difficulty in treatment due to enumerous complications such as skin necrosis, angular deformity and delayed union. As for using Ender nails in distal tibial fractures, the stability of fixation can be strengthened with fanning of the nails in distal fragments and using more than 3 nails and 1cm longer nail. Twenty-two patients having distal tibial fractures, were carried out Ender nailing at Department of Orthopaedic Surgery, Maryknoll Hospital from May 1989 to September 1992. The results were as follows; 1. The distal end of fracture line was situated from 3cm to 9cm above plafond, and the mean duration of radiological bony union was 14.9 weeks except one case of nonunion. 2. Mild angulation developed in two cases and complications such as nonunion, superficial infection and backing out of nail were noted, but it did not affect the results.

Treatment of the Fracture of Distal Tibia with the Intramedullary Nailing (Comparison between Ender and Interlocking Nailing) / 대한정형외과학회잡지

Authors reviewed 42 fractures of distal tibia fixated with Ender nails(24 cases) or Interlocking nails(18 nails) at the Chosun university Hospital from 1986 to 1992. The purpose of this study is to compare the bony union, the complications and the functional results of two groups(Ender nailing group and Interlocking nailing group). The follow-up period was average 19 months(range, 12 to 36 months). The results were as follows 1. The most common causes of the injury were traffic accidents(36 cases). 2. In the Ender nailing group, 8 cases are closed fractures and 16 cases are open fractures. Among 24 cases, 14 cases are simple fractures and 10 cases comminuted fractures. In interlocking nailing group, 7 cases are closed fracture and 11 cases are open fractures. Among 18 cases, 8 cases are simple fractures and 10 cases are comminuted fractures. 3. The average radiologic union was obtained at 19.3 wks in Ender nailing group, and 18.1 wks in interlocking nailing group. 4. Major complication was a delayed union in both group(5 cases-Ender nailing group, 3 cases-Interlocking group). 5. According to the criteria of functional results by Klemm and Borner, we obtained a 87.5% of Excellent and good results in Ender nailing group(21 out of 24 cases) and 94.4% of Excellent and good results in Interlocking group(17 out of 18 cases). 6. There was no significant difference between the two groups in stable fractures of distal tibia, so we suppose that Ender nailing is a good technique in these cases due to its simplicity and the economic price. But in more unstable fractures such as long oblique, spiral and comminuted fractures, we think that intramedullary interlocking nailing is better due to its stability.

The Use of Ender nails in Distal Tibial Fractures / 대한정형외과학회잡지

Fracture of distal one third of tibia is prone to develop angular deformity during weight bearing and delayed union by inadequate immobilization. Most surgeons have performed internal fixation with plate and screws or interlocking Kuentscher nail to provide stability to the fractured tibia. When open reduction and internal fixation is carried out, the periosteum and muscular attachments must be stripped off. And in interlocking Kuentschernailing extraoperative time needed to insert distal screw, and the medullary reaming destroys nutrient circulation by which fracture healing is hindered. However, flexible Ender nailing is a simple procedure which does not necessitate reaming, and also does not disrupt or strip off soft tissues at the fracture site. Authors carried out Ender nailing in 16 patients having distal tibial fractures who were treated at the Orthopaedic Department, Kang-Nam St. Mary's Hospital from February, 1985 to December, 1988. The results are as follows: 1. The radiological union was obtained at 13.3 weeks after operation, and primary healing was taken place. 2. Fractures could be securely fixed by intramedullary Ender nailing. 3. Mild angulation developed in 3 cases, but it did not affect the results. Through the results Ender nailing is proven to be an effective, reliable, and safe method in treatment of fracture of the distal one third of tibia with minimum residua and complication, and brings the natural fracture healing.

Supracondylar Fracture of the Femur Treated by Ender nail / 대한정형외과학회잡지

Supracondylar fracture of the femur is not as common as the shaft fracture. There is wide range of potential complication in the treatment of these fractures and the method of the treament and the evaluation of it's result is variable and remains controversial. Until 1960, we believed conservative treatment supirior to the operative treatment of the supracondylar fracture of the femur. But recently, anatomical reduction and internal fixation with early joint motion showed satisfactory results and is the trend of treatment of these fracture. The authors of this thesis performed treatment of supracondylar fracture of femur by utilizing Ender nails and screws in 13 cases during the period from October 1987 to November 1988 and it was found that operation was relatively simple, bleeding was little and early exercise of knee was allowed and even for patients of old age internal fixation could be maintained easily.

Comparison Between Ender Nail and Compression Hip Screw in the Treatment of Intertrochanteric Fracture of Femur / 대한정형외과학회잡지

Intertrochanteric fracture of femur is increasing in their incidence. Recently Ender nail and compression hip screw are very popular but they have disadvantage in the treatment of intertrochanteric fracture of femur. We have treated 49 cases of intertrochanteric fractures from December 1979 to October 1985 using Ender nail(31 cases) and compression hip screw(18 cases) respectively and compared the results. The summary of the results obtained were as follows: l. Average operation time was 72 minutes in Ender nail group and 146 minutes in compression hip screw group. 2. Average blood loss was 154ml in Ender nail group and 661ml in compression hip screw group. 3. Roentgenographic union was obtained in 12 weeks in both groups. 4. Minor postoperative complications were 24 cases in Ender nail group and 3 in compression hip screw group. Among 24 complications of Ender nail group, 19 were about the knee joint. Our conclusion is that Ender nailing is useful modality in the treatment of unstableintertrochanteric fractures who are old and high risk patients.

The Treatment of Tibial Shaft Fractures by Ender's Nailing / 대한정형외과학회잡지

Between July 1982 and July 1985, we treated thirty-one fractures of the tibial shaft by intramedullar ary Ender's nailing at the Department of orthopedic Surgery of Pusan Paik Hospital. Reductions of the fractures were achieved by closed method in 25 cases and open method in 6 cases. The results were as follows. 1. The average age was 34. 5 years and the most common cause of injury was traffic accident(67.7%) 2. Nineteen cases (61%) were closed fracture and 12 cases (39%) open. Seventeen cases (55%) were simple fracture and 14 cases (45%) comminuted. The most common level of the fracture was middle third of the tibial shaft. 3. Twenty cases (64.5%) had associated injuries and average interval from injury to operation was 11. 8 days. 4. The average healing time was 16.7 weeks and the time prolonged in comminuted fractures than in simple fractures. 5. Complications were one case of valgus deformity (11°), one case of delayed union with pseudoane urysm of anterior tibial artery on fracture site and one case of infected nonunion in Grade III open comminuted fracture. 6. Ender nails are relative ease of nailing, allow early weight bearing and decrease complication. Ender nailing is considered to be a good method in treating tibial shaft fracture especially for management of multiple injured patient and when other procedures have failed.

A Clinical Analysis of Treatment of Intertrochanteric Fractures between the Fixation with Ender Nail and Sliding Screw Plate / 대한정형외과학회잡지

The incidence of the interochanteric fracture of femur is increasing and this increase is likely to continue for many years due to increase of traffic accident and old people. The primary goal in the treament of an elderly patient with an intertrochanteric fracture is to return the patient to his prefracture activity as soon as possible. Rapid mobilization of a pain free patient helps to prevent skin ulceration, pneumonia, urinarystasis, thromboembolic disease and other complications of confinement to bed in the eldery. For there reasons, treatment of intertrochanteric fractures by surgical methods has become the standard procedure. The authors treated 53 cases of intertrochanteric fractures from March 1978 to February 1985 with Ender nail or sliding screw plate. The results obtained as follows: l. In the 34 cases where sliding screw plates were used, the patients average age was 49.4 years old and in the 19 cases where Ender nails were used, the average in age was 63.2 and therefore, compared to the sliding screw plate, the patients using Ender nails were about 13.8 years older. 2. In the cases where Ender nails were used, the average operation hours took in the average of 55 minutes and whereby, in the cases where sliding dcrew plates were used, took in the average of 125 minutes, and during the operation time, the amout of hemorrhage in the cases of Ender nail was about 150ml and the sliding scew plate resulted in about 610ml. 3. The average weight bearing period in the cases which Ender nails were used took in the average of 2.5 weeks, where by the sliding scew plates took in the average of 9.8 weeks. 4. In the cases where Ender nails were used, the radiological bony union time was about 12.7 weeks and the sliding screw plate took about 16.1 weeks. 5. In the cases of Ender nail, if, in the geriatric age, the indication is chosen well, it will result in a benefial treatment method.

The Use of Ender Nails in Fractures of the Tibial Shaft / 대한정형외과학회잡지

Twenty one cases of adult tibial shaft fractures were fixed with flexible intramedullary nails at the Department of Orthopedic Surgery, Kang Nam General Hospital. The results are summerized as follows; l. Average healing time was 17 weeks. No case of nonunion was experienced. 2. As the operation was perfomed by closed method under fluoroscopic control, reduction of operation time is a major advantage. 3. Fixation was usually strong enough to allow immediate weightbearing and mobilization of the adjacent joints without external immobilization. 4. Three cases of delayed union and 2 cases of rotational malunion were experienced, but shortening and angulation were not so severe as to affect overall functional results. 5. In conclusion, Ender nailing is considered to be a valuable method in treating tibial shaft fractures. Even in cases with multiple injuries and in selected open cases, Ender nailing can be a saft procedure.