Mechanical Properties of Novel Interlocking Intramedullary Nail for Fixing Transverse Olecranon Fractures / 医用生物力学

Objective To study the effect of interlocking intramedullary nail on fixing transverse olecranon fracture. Methods Nine pairs of fresh ulna specimens were collected and the transverse fracture model of olecranon was established. Kirschner wire tension band and interlocking intramedullary nail were used to repair the fracture. Cyclic dynamic tension loads with amplitude of 25 N, mean value of 45 N and frequency of 05 Hz were applied to the triceps tendon under simulated elbow flexion conditions of 30°, 45° and 60°, respectively. The fracture displacements of specimens within 300 cycles were recorded in three groups. ResultsAt 30° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.831±0.333) mm and (3.723±2.390) mm, respectively. At 45° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.167±0.374) mm and (2.455±0.609) mm, respectively. At 60° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.407±0.342) mm and (3.112±1.025) mm, respectively. The fracture displacement of interlocking intramedullary nail was smaller. Conclusions The mechanical properties of interlocking intramedullary nail are better than those of Kirschner wire tension band, and the interlocking intramedullary nail is more stable and firmer for fixing transverse olecranon fracture. Moreover, the interlocking intramedullary nail is installed with the operating tool, thus the operation is more accurate and faster, and the operation efficiency is greatly improved.

Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture / 中国修复重建外科杂志

Objective: To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. Methods: The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Results: Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Conclusion: Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.

A meta-analysis of expandable intramedullary nail versus interlocking intramedullary nail for treatment of femoral shaft fracture / 中国组织工程研究

BACKGROUND: A large number of studies have confirmed that expandable intramedullary nails and interlocking intramedullary nails have a good effect in repairing limb fractures. However, for the treatment of femoral shaft fractures, the advantages and disadvantages of the two kinds of fixation methods are not inconclusive. OBJECTIVE: To systematically review the safety and effectiveness of expandable intramedullary nail and interlocking intramedullary nail for treatment of femoral shaft fracture. METHODS: A computer-based online search was conducted in PubMed, Web of Science, EBSCO, The Cochrane Library, CNKI, VIP and Wanfang databases to screen the relevant clinical controlled trials of expandable intramedullary nail versus interlocking intramedullary nail for the treatment of femoral shaft fractures. Two reviewers screened the literature according to the strict inclusion criteria, and assessed the research quality of the finally included literatures, and extracted the data. Meta-analysis was performed using Stata 13. 0 software. RESULTS AND CONCLUSION: (1) A total of 7 studies (3 randomized controlled and 4 non-randomized controlled trials) were included, involving 492 patients. Expandable intramedullary nailing group contained 246 patients. Interlocking intramedullary nailing contained 246 patients. (2) The results of meta-analysis showed that compared with the interlocking intramedullary nailing group, fracture healing time, operation time, fluoroscopy time and hospital stay were shorter in the expandable intramedullary nailing group [SMD=-0. 87, 95%CI(-1. 20, -0. 54), P=0; SMD=-2. 45, 95%CI(-3. 33, -1. 58), P=0; SMD=-2. 83, 95%CI(-3. 68, -1. 97), P=0; SMD=-0. 96, 95%CI(-1. 73, -0. 18), P=0. 016]. Intraoperative blood loss was less in the expandable intramedullary nailing group than that in the interlocking intramedullary nailing group [SMD=-4. 12, 95%CI(-6. 38, -1. 87), P=0]. There was no significant difference in the rate of bone nonunion or delayed healing and the overall incidence of complications between the two groups. (3) Therefore, we theoretically believe that expandable intramedullary nailing is more advantageous than interlocking intramedullary nailing in the treatment of femoral shaft fractures, but the postoperative recovery is similar. Limited to the quality of the methodology of this study, it fails to consider the effect of the type of fracture and the interference of the field. The results need to be treated with caution, and more randomized controlled trials are needed to confirm.

Efficacy analysis of inverted intramedullary nail combined with medial minimally invasive plate in treatment of type C2 and C3 distal femoral fractures / 中华创伤杂志

Objeetive To investigate the clinical efficacy of inverted intmmedullary nail combined with medial minimally invasive plate in treatment of type C2 and C3 distal femoral fractures.Methods A retrospective case control study was conducted on 38 patients with complex distal fractures of the femur treated from January 2015 to January 2017.There were 22 males and 16 females,aged 24-72 years [(45.6 ± 2.5)years].AO fracture classification was type C2 in 24 patients and type C3 in 14.All of them were fresh closed fractures.The time duration from injury to operation was 4-16 days (average,7.5 days).Based on the different surgical methods,the patients were divided into lateral single plate fixation group (single plate group,20 patients) and inverted intramedullary nail combined with medial minimally invasive locked plate fixation group (locked plate group,18 patients).The two groups were compared in terms of operation condition,early weight bearing time,fracture healing time,postoperative complications,postoperative knee function and activity of living.Hospital for Special Surgery (HSS) score was used for evaluating postoperative knee function and Barthel index for activity of living.Results The patients were followed up for 10-24 months [(12.2 ± 1.8) months].The operation duration was (110.5 ± 35.4) min for single plate group and (116.7 ± 42.3) min min for locked plate group(P ＞0.05).Intraoperative blood loss in single plate group was [(450.5 ± 120.7)ml] and [(455.2 ± 130.4) ml] in locked plate group (P ＞ 0.05).The early weight bearing time in single plate group was (28.5 ± 8.6)days and 18.7 ± 4.9 (P ＜ 0.01)days in the locked plate group.The fracture healing time in single plate group was (8.5 ± 2.2) months,and [(6.5 ± 1.6) months] in locked plate group (P ＜ 0.01).After 3 weeks,6 months and 12 months,HSS scores of knee joint function of the locked plate group was significantly better than that of single plate group (P ＜ 0.01).At 6 months and 12 months after operation,Barthel index score of locked plate group was significantly better than that of single plate group (P ＜ 0.01).No infection occurred in two groups after operation.There were no complications such as internal fixation failure,knee valgus,external rotation deformity or fat embolism in locked plate group.There were two cases of internal fixation failure,one knee eversion,and two knee varus in single plate group (P ＜ 0.01).Conclusion Compared with single plate fixation,the therapeutic method of inverted intramedullary nail combined with medial minimally invasive locked plate has the advantages of early weight bearing time,quick recovery,better function restoration and fewer complications,and hence is a preferable choice for treatment of type C2 and C3 complex distal femoral fractures.

Comparative results of non-operative and operative treatment of humeral shaft fractures / 北京大学学报(医学版)

Objective:To compare the difference between non-operative and operative treatment of humeral shaft fractures.Methods:From March 2005 to October 2012,252 cases of humeral shaft fractures were treated and were adequately followed up.According to the treatment methods,the patients were divided into 2 groups:the non-operative group and the operative group.In the non-operative group,there were 76 cases treated with plaster/small splint fixation,meanwhile there were 176 cases treated with inter nal fixation either by plating or by nailing in the operative group.The follow-up parameters included:fracture healing rate,fracture union time,complications rate,Constant-Murley shoulder score and Mayo elbow score.Results:The mean follow-up period was (31.24 ± 20.06) months (ranging 6 to 103 months).There were no statistical differences in age,open fracture number,fracture site and Arbeitsgemeinschaft ftir Osteosynthesefragen (AO) classification between the non-operative group and the operative group.The fracture healing rate:the non-operative group:96.1％ (72/76),the operative group:97.7％ (172/176),P =0.46;the fracture union time:the non-operative group:(10.24 ± 2.93) weeks,the operative group:(10.69 ± 2.51) weeks,P =0.22;the complication rate:the non-operative group:5.3％ (4/76),the operative group:15.3％ (27/176),P =0.03.The complications included:nonunion:the non-operative group:3.95％ (3/76),the operative group:2.3％ (4/176),P =0.434;radial nerve palsies:the non-operative group:0％ (0/76),the operative group:5.7％ (10/176),P =0.035;bone split:the non-operative group:0％ (0/76),the operative group:1.7％ (3/176),P =0.556;elbow stiffness:the non-operative group:l.3％ (1/76),the operative group:0.6％ (1/176),P =1.000;shoulder pain:the non-operative group:0％ (0/76),the operative group:5.1％ (9/176),P =0.061.The Constant-Murley shoulder score:the non-operative group:97.37±4.94,the operative group:96.34 ± 6.88,P =0.244.The Mayo elbow score:the non-operative group:99.80 ± 1.72,the operative group:99.49 ± 2.73,P =0.923.Conclusion:The results of non-operative treatment of humeral shaft fractures appeared with excellent results with lower complications rate compared with that of the operative treatment.

The clinical effect of cross locking intramedullary nail in treatment of fracture of tibia and fibula / 中国现代医生

Objective To observe the clinical effect of cross locking intramedullary nail in treatment of fracture of tibia and fibula. Methods From January 2010 to January 2014, 80 cases of patients with tibia and fibula fracture were ret-rospectively analyzed, 30 patients were treated with interlocking intramedullary nail internal fixation to establish the groupⅠ,30 patients were treated with plate fixation set up group Ⅱ, 20 patients were treated with external fixation to establish group Ⅲ,curative effect and bone healing time, fracture healing time, complications were compared of three groups of patients after treatment. Results InⅠgroup, the excellent and good rate of tibia and fibula fracture patients after operation was 93.33%, was respectively higher than that of group Ⅱ(80.00%) and groupⅢ (70.00%)(P<0.05). Group Ⅰ of tibia and fibula fracture callus in patients with postoperative emergence time, fracture healing time were shorter in the group Ⅱ and group Ⅲ (P<0.05). The incidence of complications in group Ⅰ was 6.7%, significantly lower than that of group Ⅱ complications incidence rate of 20%, 30% of group Ⅲ(P<0.05). Conclusion The inter-locking intramedullary nail in treatment of tibial and fibular fracture curative effect , can significantly shorten the heal-ing time of fracture, and has less complication, the operation effect is significantly better than the other methods of in-ternal fixation, and is worthy of promotion and application.

The efficacy of tibial shaft fractures treated with interlocking nails / 中国医师进修杂志

Objective To investigate the difference of efficacy of interlocking nails and dynamic compression plate in tibial shaft fractures.Methods The clinical data of 137 cases with tibial shaft fractures were reviewed retrospectively.They were divided into two groups according to the various treatments which included interlocking nails group(72 cases with 79 fractures) and dynamic compression plate group(65 cases with 70 fractures).The efficacy,healing fineness rate,function score after operation and complications were compared.Results After operation,the patients were followed up 21.4 months on average.The postoperative callus time,weight-bearing limb time,healing time and postoperative fixation time taken in interlocking nails group was shorter than that in dynamic compression plate group [(2.36 ± 0.46) months vs.(3.12 ± 0.57) months,(2.42 ± 0.51) months vs.(3.14 ± 0.63) months,(7.65 ± 1.29) months vs.(9.33 ±1.54) months,(12.64 ± 3.76) months vs.(16.38 ± 3.15) months],and there was significant difference (P＜ 0.05).The healing fineness rate was 97.5％(77/79) in interlocking nails group,and 92.9％(65/70) in dynamic compression plate group,and there was nosignificant difference (x2 =1.76,P ＞0.05).The incidence of comphcations in interlocking nails group was higher than that in dynamic compression plate group[25％(2H9) vs.12.9％(9H0)],and there was significant difference(P ＜ 0.05).Condmions Interlocking nails have better biomechanical features with high union rate,low infective rate and good recovery of joint function.The clinical result of interlocking nails for the tibial shaft fractures is also better than that of dynamic compression plate.

Study on influence of early dynamization of interlocking intramedullary nail on treatment effect of lower limb fracture / 重庆医学

Objective To study the influence of early dynamization of interlocking intramedullary nail on the treatment effect of the patients with lower limb fracture .Methods 62 patients with lower limb fracture treated with interlocking intramedullary nail in our hospital from June 2010 to March 2012 were selected as the research subjects and divided into the control group and the obser-vation group with 31 cases in each group according to random number table .The control group was treated with routine treatment method ,while the observation group was treated with early dynamization .Then the Johner-Wruch score ,healing time ,rate of ad-verse fracture healing ,incidence rate of complications and fracture healing related factors before and after the treatment were ana-lyzed and compared .Results The Johner-Wruch score excellent and good rate of the observation group was higher than that of the control group ,the healing time was shorter than that of the control group ,the rate of adverse fracture healing and the incidence rate of complications were lower than those of the control group ,the fracture healing related factors after treatment were all better than those of the control group ,the differences had statistical significance (all P<0 .05) .Conclusion The early dynamization of interloc-king intramedullary nail has the better effect for treating lower limb fracture and its influence on the fracture healing related factors is better too .

A comparative study of patients with tibial shaft fracture underwent interlocking intramedullary nail postoperative between dynamization and non-dynamization / 重庆医学

Objective To prospectively compare the clinical outcome of dynamization and non-dynamization of interlocking intr-amedullary nail on union of tibial shaft fractures (fracture gap0 .05];16 weeks after internal fixation surgery ,VAS score of the dynamization group was statistically higher than that of the non-dynamization group [(4 .1 ± 0 .6) vs .(2 .3 ± 0 .8) ,t=16 .100 ,P<0 .05];the knee pain rate of the dynamization group was statistically higher than that of the non-dynamization group (28 .7% vs .12 .9% ,χ2 =5 .764 ,P<0 .05) .Conclusion When treating tibial shaft fractures with closed reduction and intramedullary nail fixation ,the main fracture gap<2 .0 mm ,early dynamization didn′t have any advantage .

Comparison of therapeutic effects on compound tibial and fibular fractures with two different methods / 中国医师进修杂志

Objective To compare the healing effect of compound tibial and fibular fractures with two different fixation methods of external fixators (EF) and interlocking intramedullary nail ( INF). Methods Eighty-six cases of compound tibial and fibular fractures received different treatment, 36 cases in EF group and 50 cases in INF group. The difference between two groups was statistically analyzed according to WU Yue-song and XU Bo-cheng standard and Johner-Wruh score. Results All cases were followedup for 6-24 months,average (16.0 ± 2.4) months. The excellent and good rate were 80.6% (29/36) in EF group and 88.0%(44/50) in INF group respectively. There was no significant difference between two groups (Z =-1.103,P ＞0.05). Conclusions To the compound tibial and fibular fractures patients,INF can be considered as an effective method. It's an important therapy choice with EF to heal the compound tibial and fibular fractures.

Treatment of Forearm Shaft Fracture with Modified Interlocking Intramedullary Nail

PURPOSE: To evaluate the result of forearm shaft fracture treated by modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA). MATERIALS AND METHODS: 15 patients with fracture of radius, ulna, radio-ulna shaft treated by modified interlocking intramedullary nail from December 2003 to February 2007 were analyzed. Modified interlocking intramedullary nail has paddle blade tip and fluted rod, so the distal screw fixation was not needed but had relatively firm fixation. It has advantages including short operation time, small operation scar. The average follow up period was 8.3 months (range, 5~15 months). We analyzed the results by average union time and the functional results according to Anderson's criteria. RESULTS: The mean duration of union was 9.8 weeks in radius and 11.4 weeks in ulna. The average range of motion of forearm was 74.6 degree in supination and 72 degree in pronation.. Functional results assessed by Anderson were rated excellet in 12 cases, satisfactory in 3 cases. We found no complications such as delayed union, non-union, neurovascular injury and infection. CONCLUSION: Modified interlocking intramedullary nail (Acumed, Hillsbrough, IN, USA) is a viable therapeutic alternative in the management of forearm shaft fracture.

A comparison of results between minimnlly invasive percutaneous plate osteosynthesis and interlocking intr-amedullary nail for treatment of tibia fracture / 中国基层医药

Objective To compare the clinical results between minimally invasive percutaneous plate osteo-synthesis(MIPPO) and interlocking intramedullary nail(IIN) for treatment of tibia fracture. Methods 50 eases with tibia fracture were treated with MIPPO technique and 35 cases were treated with IIN. Five factors including surgery time ,intereperation bleeding,in hospital time, healing time and complications were studied statistically to analyze the two kinds of internal fracture fixations. All the patients were followed up for 12 ～ 30 months after operation( average 16months). Compare the condition of limb functional recover between the two kinds of internal fracture fixations accord-ing to Johner-Wruhs standard. Results The operating time [ ( 96.5±5. 0) min ], the bleeding [ ( 60.3±6.6 ) ml ] and the bone healing time [ ( 16.2±7.4) week ] in MIPPO group were significantly lower than in the IIN group ( allP <0.05). The operating time was( 170.6±6.2) ml,the bleeding was( 110.0±8.5)min and the bone healing time was (19.5±5.6)week in the IIN group. While there were no significant difference in hospital time,Johner-Wruhs system and the complications between IIN and MIPPO group( allP>0.05). Conclusion It has high cure rate and long-term curative effect that the two kinds of internal fracture fixations for treatment of tibia fracture. The.technique of MIPPO has the advantages of small trauma and quickly recovery characteristics. It was a ideal therapy in treatment of tibia fracture.

Interlocking Intramedullary Nail in Distal Tibia Fracture

PURPOSE: To evaluate the effectivity of interlocking intramedullary nailing for distal tibia fracture and prognostic factor to bone healing. MATERIALS AND METHODS: From April 2000 to June 2005, 21 cases who had distal tibia fracture were treated by interlocking intramedullary nail were analyzed. The duration of follow-up was more than 1 year. We evaluated clinical results by IOWA ANKLE rating system and union time by simple X-ray. Furthermore, we estimated prognostic factor to union time. RESULTS: The bone union was achieved at average 18.5 weeks. At the last follow-up, there was no non-union and infection. Average IOWA ANKLE rating score was 91.3 point. The union time was delayed in open and segmental fracture at initial fracture. And severe soft tissue injury in open fracture revealed bad result. CONCLUSION: We concluded that interlocking intramedullary nail is effective method for treatment of the distal tibial fractures. And, adequate soft tissue management is important to bone healing and clinical outcome.

Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing

PURPOSE: To analyze the causes and the clinical results of treatment for the nonunion of femur shaft fractures that occurred after interlocking intramedullary nail fixation. MATERIALS AND METHODS: We reviewed 19 cases of aseptic nonunion of femur shaft fracture in 174 patients after interlocking IM nailing from March 1999 to February 2004 and followed up for more than one year. First we investigated the factors causing nonunion. For operative options, two methods about exchange nailing and exchange nailing with bone graft were performed. Finally clinical results were analyzed with bone union rate by treatment methods and compared with the nonunion factors statistically. RESULTS: According to the causes and types of nonunion, we performed larger IM nail change in 10 cases and IM nail change with bone graft in 9 cases. Bone union was achieved in all cases. Average bone union period were 18.5 weeks in exchange group and 16.1 weeks in exchange with bone graft group. There are significant difference between treatment methods statistically (p<0.05). Compared with the nonunion factors, initial open fracture and smoking groups showed late union rate statistically. CONCLUSION: Based on our analysis, IM nail change is a useful method for nonunion after initial IM nailing in femoral shaft fracture, and additional bone graft that according to the radiologic pattern and stability, especially the fracture gap is also a useful option for nonunion treatment.

Effect on fibula-tibia fracture treatment by two different intramedullary nails / 中国矫形外科杂志

[Objective]To evaluate and compare the effects of fibial-tibial fracture(FTF) treated by interlocking intramedullary nail (I I N group A) and intramedullary expand expanded self-lock nail (IESN group B).[Method]From June 2000 to September 2003,one hundred sixteen cases of FTF were treated by I I N(N=60)or IESN (N=56) and followed-up for 12~24 months (average 17.9 months).Results were compared between group A and group B.[Result]In group A,the satisfactory rate,union rate,close reduction rate,medullary expanding rate,complication rate and antirotation ability were 89.5%, 96.7%, 71.6%, 51.6%,21.6% and +++ respectively.In group B,that were correspondently 91.0%,98.5%,89.3%,5.3%,3% and +.[Conclusion]Adopting the biological osteosynthesis either the I I N or IESN for treatment of FTF could get a result of more satisfactory rate and higer union rate.Applying a stable fixation,the IESN is more suitable for instable FTF.Such as multisegmental or comminuted targe oblique FTF,while of fering a flexible fixation,IESN is preferable for transverse fractures of middle and lower third tibia and fibula.

Analysis of the complications of interlocking intramedullary nail for treatment of tibial fracture / 中国矫形外科杂志

[Objective]To explore the complications of tibial fracture treated with interlocking intramedullary nail.[Method]The full data of 785 cases of tibial fiacture treated with interlocking intramedullary nail were studied retrospectively.[Result]Mean follow-up period was 27 months (8~40months).There were some complications as follows: infection rate was 2.7% (21 cases),fracture nonunion 1.5% (12 cases),fracture delayed union 6.8% (53 cases),fracture malunion 0.9% (7 cases),knee pain 6.8% (53 cases),nail broken 1.4% (ll cases),locking screw broken or drop out 2.2% (17 cases).[Conclusion]Proper manipulations,strict indications,and postoperative treatment are vital to prevent the complications.

Surgical treatment of bilateral tibial fracture with interlocking intramedullary nail and/or AO external fixator / 中国矫形外科杂志

Objective To evaluate the clinical value and relating problems in treating bilateral tibial fracture by using interlocking intramedullary nail and/or AO external fixator.MethodTotally 33 patients of bilateral tibial fracture treated with interlocking intramedullary nail and/or AO external fixator from April 1998 to January 2006 were retrospectively reviewed.There were 26 males,7 females,with an average age of 34.4 years.According to the AO/ASIF classification,there were type A 9 limbs,type B 13 limbs and type C 17 limbs.According to Gustilo classification there were type Ⅰ 10 limbs,type Ⅱ 6,ⅢA 5,type ⅢB 4 and type ⅢC 2.Duration from injury to operation was 5.5 days(3 hour～12 days). ResultAll patients were followed up for 6～36 months,with the average time being 16 months.All fractures had bon union.The union time averaged 16 weeks in closed fractures and 18 weeks in open fractures.Delayed union occurred in 4 limbs.There were 3 limbs of superficial infection.The results were excellent in 19 cases,good 11 cases,fair 3 cases according to the criteria of Johner-Wruh.Rate of excellent and good result was 90.9%.No fat embolism syndrome,deep in fection,failure of fixation and malunion were not found in this group.ConclusionThe advantages of interlocking intramedullary nail and/or AO external fixator in treatment of bilateral tibial fracture has advantages of easy performance,reduced destruction of blood supply to the fracture ends,rigid fixation,high union ratio of fractures,promotion of early functional extercise and satisfactory effect.The selection of the fixation device should be adopted according to the types of the fracture.

General interlocking intramedullary nail for the surgical management of low subtrochanteric femoral fracture / 中国矫形外科杂志

[Objective]To discuss the feasibility and efficacy of the treatment of low subtrochanteric femoral fracture(LSFF) by using general interlocking intramedullary nail(GIIN).[Method]Between March.2000 and January.2006,47 cases(38 males,9 females) of LSFF were treated with limited incision and 6IIN.The mean age of the patients were 41.2 years(range 25 to 78 years).29 of them were injured in a traffic accident,7 in falling,6 in crush by a heavy object and 5 in pedestrain injury.According to Seinsheimer classification,11 cases were type IA,10 cases were type lB,19 cases were type ⅢB,and 7 cases were type Ⅳ(8 combined with other fractures)6 of these were open fractures(4 cases of Gustilo-Anderson type Ⅰ and 2 cases of type Ⅱ).The procedure included following step: all patients were treated with limited open reduction.The pyriform sinus entry point were localized with retrograde reamed;then,intramedullary nail was performed through the anterograde approach after limited reamed.All fractures were fixed statically.The operation time were from 50 minutes to 130 minutes(averaging 90 minutes).[Result]All the cases,were followed up for 11 to 34 months,with an average time of 33 months.The alignment of fracture was good.The bone union time were 2.5～6 months,the average 3.9 months.Fracture union rate was 100%.The functional evaluation was done by Sanders traumatic hip rating scale.of the 47 cases,31 were excellent,14 good and 11 fair.The excellent and good rate was 95.7%.There were no infection,implant breakage,limb shortening and varus deformity.[Conclusion]In treatment of LSFF,the GIIN is worth to recommend because it is simple for use,no need of X-ray monitoring during the operation,reliable,high union rate,rare complications,and good effects.Reasonable application of GIIN,better fracture reduction and early active functional rehabilitation(earlier activities and later weight bearing) are the keys to obtain a good clinical result.

Percutaneous locking compression plate and interlocking intramedullary nail:a comparison in the treatment of distal tibia shaft fracture / 中国矫形外科杂志

[Objective]To evaluate the radiographic and clinical results of locking compression plate and interlocking intramedullary nail in the treatment of distal tibial shaft fracture(4 to 11cm proximal to tibiotalar joint).[Method]A total of 65 cases of distal tibia shaft fractures were retrospectively reviewed from 2003 to 2007.Thirty-seven cases were treated with locking compression plate as group A,and 28 cases were treated with interlocking intramedullary nail as group B.According to AO classification system,32 cases were type A,12 were type B,21 were type C.[Result]All cases were followed up for 12-24 months(mean,16.5 months).Five cases were found delayed or nonunion,with 1 case in group A and 4 cases in group B.One case in group A and 2 cases in group B were found developed deep infection.Two cases in group A and 8 cases in group B received second operation.The good-to-excellent rates of ankle joint function were 91.9% in group A and 71.4% in group B.The good-to-excellent rates of knee joint function were 97.3% in group A and 78.6% in group B.[Conclusion]Distal tibial shaft fracture could be treated successfully with either percutaneous plates or intramedullary nails.Percutaneous locking plate is better than intramedullary nail in aspect of prevention of delayed union,malunion and second operation.

Clinical evaluation of retrograde interlocking intramedullary nail for internal fixation of the femoral shaft fractures distal to the isthmian / 中国矫形外科杂志

[Objective]To evaluate the clinical effects of retrograde interlocking intramedullary nail(RIIN) for internal fixation of the femoral shaft fractures distal to the isthmian.[Method]Thirty-seven cases(39 limbs) of femoral shaft fractures distal to the isthmian were treated with RIIN from October 1999 to January 2005.Their outcomes were reviewed retrospectively.There were 8 limbs of open fracture and 31 limbs of close fracture.All fractures were fixed statically.[Result]All patients were followed up for 8~24 months,with the average time of 15 months.Two limbs suffered suoerficical infection, all limbs had bony union within 9~20 weeks,with the average time of bone union of 15 weeks.No deep part infection,malunion and nail failure were observed.The rate of being excellence with Merchan evaluation was 97.4%.[Conclusion]Internal fixation with RIIN for femoral shaft ftractures distal to the isthmian can demonstrating good biomechanic property lead to high union rate of fraeture with less complications.The technique of RIIN must be performed strictly during operation and early active functional rehabilitation is the key to obtain good isthmion clinical result.