Treatment of fractures of long bones with flixible intramedullary nailing [minimal invasive technique]

ABSTRACT

Intramedullary nailing to fix femoral shaft fractures have been described by Rush [Rush, 1968], who used the rods he designed. The technique was made popular by Ender and Simon-Weidner [Ender et al. 1970] in Europe and by Pankovitch [Pankovitch, 1987] in the United States. The principle of osteosynthesis with intramedullary fixation is a biomechanic idea that aims at developing the bridging of external callus; traction forces are transformed to compression forces on the fracture by two bent pins that cross each other and touch the bone at three points. The flexibility of the pins allows microscopic oscillating movements, putting changing compression on the different parts of the fracture line. Under radiographic control, fractures of the femur, tibia and humerus were stabilized with multiple pins according to the diameter of the medulla of the shaft. Forearm fractures were splinted with a single pin each in radius and ulna. The method is safe in elective trauma surgery and will especially be useful in poly traumatized patients with minimal x-ray exposure in a short time. During a 2-year period [2002-2003], 58 patients were treated with intramedullary stabilization with Ender nails. Thirty patients with trochanteric fractures had a median age of 65 years and fourteen patients with tibial fractures had a median age of 30 years. Four patients with humeral shaft fractures had a median age of 45 years and ten patients with fractures of the forearm had a median age of 20 years. In our results, trochanteric fractures united in 26 cases [86.6% excellent results] and penetration of the pins and varus deformity in 4 cases [13.4%]. Tibial fractures united in 12 cases [85.6% excellent results] and varus deformity less than 30 degrees in one case [7.2%] and posterior angulation in one case [7.2%]. Forearm fractures united in 8 cases [80% excellent results] and delayed union in 2 cases [20%]. Humeral shaft fractures united in 3 cases [75% excellent results] and delayed union in 1 case [25%].In conclusion, nailing with flexible prebent Ender nails reduces the operating period, x-ray exposure, and allow minimal surgical wound especially in trochanteric fractures. The use of this technique is not ideal in unstable fractures because the nails fail to control external rotation and shortening