Outcomes of long bone fractures treated by open intramedullary nailing at the St Ann's bay hospital, Jamaica / Resultados clínicos de las fracturas de huesos largos tratadas mediante enclavijado intramedular abierto en el hospital de Saint Ann's bay, Jamaica

Between May 2001 to August 2004, 35 patients had open nailing of long bones. There were 40 fractures fixed. Of these 40 fractures, there were 25 femoral fractures, 11 were tibial fractures and 4 were humeral fractures. There were 33 (82.5%) closed fractures and 7 (17.5%) open fractures. In the group of patients with open fractures, there were two Grade I, two Grade II and three Grade IIIB. Seven (20%) patients were lost to follow-up; all of whom had closed fractures. The final analysis as it relates to complications was done using 28 patients with 32 fractures. The majority of fractures healed without significant complication. All the patients with closed fractures went on to bony union. There was one non-union and three delayed unions. There were two infections (osteomyelitis) and this was from the open fracture cohort. This represents an infection rate of 28.6% in this cohort. Two (7.0%) patients had persistent pain and one (3.6%) patient had early removal of the nail because of failure of fixation. The mean time from injury to surgery for the fractured femur was 15.5 (range 0-49) days; fractured tibia 24.4 (range 0-40), days and fractured humerus 41.5 (20-81) days. The mean hospital stay was 18.9 (range 9-37) days for patients with fractured femur; for fractured tibia, it was 20.5 (range 3-82) days and for fractured humerus, it was 22.7 (range 3-82) days. The mean postoperative stay was 4.1 (range 1-14) days for fractured femur, 4.5 (range 1-14) days for fractured tibia and 4.0 (range 1-10) days for fractured humerus. The mean time to healing (consolidation) as defined by X-rays was 5.0 (range 3-11) months for fractured femur, 5.2 ( range 3-11) months for tibia and 7.0 (range 6- 8) months for fractured humerus.

Desde mayo de 2001 hasta agosto de 2004, 35 pacientes recibieron reducción de fracturas de huesos largos mediante enclavijado a cielo abierto. Se produjeron 40 fijaciones de fracturas. De estas 40 fracturas, 25 fracturas fueron del fémur, 11 fueron de la tibia, y 4 del húmero. Hubo 33 (82.5%) fracturas cerradas y 7 (17.5%) fracturas abiertas. En el grupo de pacientes con fracturas abiertas, hubo dos fracturas de grado I, dos de grado II y tres de grado IIIB. El análisis final en cuanto a las complicaciones, se realizó con 28 pacientes con 32 fracturas. La mayoría de las fracturas se curaron sin complicaciones significativas. Todos los pacientes con fracturas cerradas lograron finalmente la unión ósea. Hubo uno que no logró la unión y tres uniones retardadas. Se produjeron dos infecciones (osteomielitis), provenientes de la cohorte de fractura abierta. Esto representa una tasa de infección del 28.6% en dicha cohorte. Dos (7.0%) pacientes presentaban dolores persistentes, y a un (3.6%) paciente le fue retirado el clavo tempranamente debido a que la fijación falló. El tiempo promedio desde la lesión hasta la cirugía, fue de 15.5 días (rango 0-49) para la fractura del fémur; 24.4 días (rango 0-40) para la fractura de la tibia, y 41.5 días (20-81) para la fractura del húmero. La estancia promedio en el hospital fue de 18.9 días (rango 9-37) para los pacientes con el fémur fracturado; para la fractura de la tibia fue de 20.5 días (rango 3-82), y para el húmero fracturado fue 22.7 días (rango 3-82). La estadía postoperatoria promedio fue 4.1 días (rango 1-14) para el fémur fracturado, 4.5 días (rango 1-14) para la tibia fracturada, y 4.0 días (rango 1-10) días para los casos de fractura del húmero. El tiempo promedio de sanación (consolidación) tal como lo definieron los rayos X fue 5.0 meses (rango 3-11) para el fémur fracturado, 5.2 meses (rango 3-11) para la tibia y 7.0 meses (rango 6-8) para el húmero fracturado.

A simple new technique to remove a bent Kuntscher nail.

We present our technique to remove a bent intramedullary femoral nail in a 26 year-old man admitted with an abnormally angulated right thigh within 3 days. His right femoral shaft was broken by a traffic accident 2 months ago. This fracture was treated with a Kuntscher nail fixation by the open method. For the operative techniques, the fracture site was exposed using a previous incision at the lateral thigh. After dissecting soft tissue and periosteum from the fracture site, we increased the varus deformity of the femur including the nail inside the medullary canal until the nail formed the “V shape” and extracted the nail simultaneously. A limited corticotomy was conducted to allow more space for the nail to escape. After removal of the bent nail, the fracture was stabilized with a 12×360 mm. static interlocking nail (Grosse-Kempf).

Unlocked Nailing vs. Interlocking Nailing for Winquist Type I and II Femoral Isthmus Fractures. Is there a Difference?

Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for noncomminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus unlocked intramedullary nailing in such fractures. Ninety-three cases of noncomminuted femoral isthmus fractures (Winquist I and II) treated with interlocking nailing and unlocked nailing from 1 June 2004 to 1 June 2005 were reviewed; radiological and clinical union rates, bony alignment, complication and knee function were investigated. There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with unlocked femoral nailing is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. We therefore conclude that unlocked nailing is still useful for the management of non-comminuted isthmus fractures of the femur.

To assess the management of fracture on middle third of the tibia shaft with Kuntscher nail

46 patients with occult fracture on middle third of tibia shaft due to many causes were surgical treated by intramedullary fixation with Küntscher nail: 37 patients were treated at Viet Duc Hospital from January 1996 to July 1999 and 9 patients were treated at Hospital No 103 from April 1993 to July 1999. Outcomes: very good 27 cases (84.37%), good 5 cases (15.63%). Advantages of this procedure were firm fixation; early rehabilitation that helping bone union; easy to use so that it can be used at all hospitals; dissection of periosteum in this procedure is less than fixation with screw that making less vascular damages and better healing. Disadvantages were higher risk of infections, slower bone union, and this procedure can’t be used for fracture of upper or lower third of tibia shaft

Resection-arthrodesis utilizing intramedullary rod fixation and autogenous bone grafting for giant cell tumor about the knee

Three patients with giant cell tumor involving the bones about the knee, i.e. located in the proximal end of the tibia or distal end of the femur were treated by local resection and arthrodesis using an intramedullary nail (Kuntscher nail) and autogenous fibular graft. Union was attained in seventeen months on the average. The procedure gives a bright hope in attaining satisfactory tumor control, improved rehabilitation, and resumption of a vigorous life-style within one year. Furthermore, it has been found to be simpler, cheaper and less formidable and is suitable to our local situation.(Auth)

Fixation of Infected Nonunion of Femur by a Kuntscher Nail Stuffed with Antibiotic Laden Bone Cement: A Case Report / 대한정형외과학회잡지

A case of established infected nonunion of femur after open reduction and internal fixation of proximal femoral fracture with plate and screws in a 20-year-old man has been satisfactorily treated with a conventional Kiintscher nail filled with antibiotic laden bone cement in its hollow cavity. Though the removal of plate and screws, wound debridement, insertion of antibiotic laden bone cement bead at the nonunion site with temporary external skeletal fixation and skeletal traction preceded, a rigid fixation by the nail and vancomycin elution from the cement are believed to have contributed for bony union without troublesome complication of infection in this case.