Comparison of the radiological and functional results of a plaster splint and dynamic stabilization splint for Boxer's fractures: A prospective randomized controlled study.

PURPOSE: This study compared the clinical and radiological results of fifth metacarpal neck fractures treated with a short-arm plaster splint (SAPS) versus a dynamic metacarpal stabilization splint (DMSS). MATERIALS AND METHODS: The 119 patients were referred to our institute between 2018 and 2019 and treated with SAPS or DMSS after appropriate initial closed reduction. Follow-up examinations were conducted at days 10 and 20, and at 1, 2, and 3 months after treatment. Alignment of the fracture, range of motion (ROM), and complications were evaluated during each visit. Grip strength was evaluated using a dynamometer. Self-care, usual daily activities, pain/discomfort, and anxiety/depression were evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) and a VAS. RESULTS: Of the 119 patients, 103 completed all follow up examinations. In total, 51 patients were treated with SAPS and 52 with DMSS. Skin lesions were detected in five patients in the DMSS group, but none in the SAPS group (p = 0.008). The grip strength of patients in the DMSS group was statistically better at the 1-, 2-month and 3-month follow-up visits (p < 0.001). ROM of the interphalangeal and metacarpophalangeal joints were statistically better in the DMSS group at the 1-month visit (p < 0.001) but similar at the 3-month visit (p = 0.27). Wrist ROM was statistically higher in the DMSS group at the 3-month visit (p < 0.05). Self-care, usual daily activities, pain/discomfort, and anxiety/depression were statistically better in the DMSS group at all follow-up visits (p < 0.05), as determined by the EQ-5D-5L. CONCLUSION: Dynamic stabilization of a stable boxer's fracture with DMSS is as effective as static stabilization with SAPS for maintaining the reduction and ensuring union. However, DMSS provides better early ROM, comfort, and muscle strength, as well as an earlier return to usual daily activities despite the occasional skin lesions happened.

Chronic recurrent multifocal osteomyelitis: A multidisciplinary experience of 22 pediatric cases with a mean follow-up of 27 months.

BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is not a well known disorder among nonpediatricians. The aim of this study is to retrospectively evaluate the clinical outcomes of twenty-two CRMO patients presenting to two referral centres. METHODS: This retrospective study included twenty-two children (12 males, 10 females; mean age 13 years; range 7-17 years). The diagnosis was based on clinical, radiological, and pathological findings. Data were retrieved from hospital charts. RESULTS: The mean delay in diagnosis was 26 months (range, 0-96 months). The mean follow-up after diagnosis was 27.4 months (range, 6-47 months). Symptoms included pain, limping, local swelling, morning stiffness, and fever. 18 patients had multifocal and 4 patients had unifocal disease. Bone lesions were detected with whole-body or local MRI (Magnetic Resonance Imaging). The mean number of bone lesions was 2.5 (range, 1-8). Ten cases underwent biopsy to exclude malignancy and infection. Prior to diagnosis, cast immobilization or curettage was erroneously performed in four patients. One patient suffered from vertebral compression fracture. There is no growth disturbance or deformity in any patient. CONCLUSION: This study demonstrated that early recognition of the disease can be improved by using Bristol criteria which should be evaluated by a multidisciplinary team rather than one single specialist. In this way, the reliability of these criteria is improved and the treatment could be given earlier with decreased delay in diagnosis. This multidisciplinary approach is also important for decision for biopsy, timely aggressive medical treatment, and follow-up of the disease to minimise possible complications.

Dia-metaphyseal fractures of the distal tibia treated with intramedullary nails distally locked with an innovative locking system: a retrospective clinical study.

PURPOSE: In this study, we aimed to present our clinical and functional results of distal tibial dia-metaphyseal fractures treated with an intramedullary nail that locks distally with an innovative distal locking system called a distal supportive bolt locking screw (DSBLS). METHODS: Forty-eight patients with distal tibia dia-metaphyseal fractures operated with IMNs distally locked with DSLBS in a level I trauma center were included. Inclusion criteria were fractures of the distal tibia at one-third the distal segment level with simple articular involvement. Functional and radiological assessments were made after at least 14 s. Results were evaluated according to the Johner and Wruhs criteria. The quality of the initial alignment and during follow-ups, malunion, nonunion, and any other complications were evaluated. Technical problems during interventions and implant failures during follow-ups were assessed. RESULTS: All fractures achieved union. The average healing duration was a mean of 17.4 (8-24) weeks. Initial fixation in the recurvatum between 5° and 10° was detected in six patients. No loss during initial reduction was detected during the follow-up of any patient. According to the Johner and Wruhs criteria, 42 patients were functionally evaluated as excellent and six were evaluated as good. No loosening, migration, or breakage of the DSLBS were observed in any patient. CONCLUSION: The DSBLS provided a stable anchor point for the nail even for very short metaphyseal fragments. It prevented rotation and angulation in both the coronal and sagittal planes without preventing compression, which is mandatory for early weight bearing and bone union.

The Use of Twisting and Tightening Tool to Strengthen the Cerclage and Tension Band Wiring.

Cerclage and tension band wiring are being used in most bone surgeries in different disciplines. The regularity of the twist on the node of a cerclage and tension band is thought to determine cerclage stability. For this purpose, a novel twisting and tightening tool was designed. This tool maintains extremely regular twists on the node, which we consider to be important for stability. In the present biomechanical trial, we aimed to investigate the consistency of the twists forming the cerclage node. This study was performed on a total of 30 cerclage loops. In group A (n = 15), the cerclage wire was tightened manually by a clipper, while in group B (n = 15), it was tightened using the twisting and tightening tool. In biomechanical tests, the cerclage loops were pulled apart by 2 hooks connected to the biomechanical device. The velocity was adjusted to 20 mm/min. On statistical analysis, there was a significant difference in the ultimate strength (P = .03) and the mean tensile strength (P = .01) between groups A and B. It was found that the strength of the cerclage wire can be increased by maintaining more regular twists. The twisting and tightening tool is a reasonable and useful device for both clinical and experimental usages.

Can the complications of distal locking be prevented with a new nail that offers a novel locking technique in the treatment of humeral shaft fractures?

OBJECTIVES: This study aims to investigate whether complications related to distal locking can be prevented with InSafeLOCK® nail in the treatment of humeral shaft fractures. PATIENTS AND METHODS: Hospital records of 31 patients (15 males, 16 females; mean age 54.4±10.1 years; range, 20 to 86 years) treated with InSafeLOCK® nail for humeral shaft fractures were investigated retrospectively between February 2016 and January 2019. Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification was used to determine the type of fracture. During the implementation, the elapsed time for distal locking was investigated. Complications encountered during both implementation and postoperative follow-up were investigated. RESULTS: Fourteen of the fractures were type A, 12 were type B, and five were type C. The mean follow-up time was 18.2 (range, 6 to 30.5) months. The mean duration for distal locking was 2.1 (range, 1.2 to 3.1) minutes. In one (3.2%) patient, cortical penetration occurred at the anterior cortex of the humerus at distal to the nail. In one patient, nail breakage occurred at the distal part of the nail. In one patient, rotational instability occurred due to screw loosening. CONCLUSION: InSafeLOCK® humeral nail is safe when applied with the recommended technique. It can easily be applied without damaging the veins, nerves or other soft tissues around the elbow due to the internal distal locking feature; furthermore, there is no need to use fluoroscopy or targeting guide. Thus, it is possible to avoid complications that may occur during and after distal locking in conventional intramedullary nail implementations.

Biomechanical comparison of a new handy tension band with malleolar screw, bicortical screw and conventional tension band for the fixation of transverse medial malleolar fractures.

OBJECTIVES: This study aims to compare the biomechanical features of a new handy tension band with the malleolar screw, bicortical screw and conventional tension band for the fixation of transverse medial malleolar fractures. MATERIALS AND METHODS: This study used 20 Kirschner wires, five cerclage wires, six double-hole U pins, six cortical screws, six malleolar screws, three malleolar clamps and one osteotomy set. A total of 24 tibias of two-year-old cows were obtained and stripped from soft tissue. Each tibia was cut with an electric saw at 15 cm proximal to the tibiotalar joint surface and the proximal tibia sections were discarded. A transverse fracture line was created with an osteotome on the medial malleolus. The tibias were separated into four groups with six tibias in each group. The distal tibia medial malleolar transverse fragments were fixed under guidance of fluoroscopy with the malleolar screw, bicortical screw, conventional tension band and the new handy tension band. RESULTS: In the application of both transverse and axial force, the new handy tension band resisted higher forces in respect of catastrophic damage force being more resistant compared to the bicortical screw, malleolar screw, and conventional tension band. However, in respect of the 2 mm displacement force of the forces applied in the axial and transverse sections, no difference was determined between the handy tension band and the other three implants. CONCLUSION: The new handy tension band seems to be more successful when biomechanically compared with the other implants.

Biomechanical comparison of humeral nails with different distal locking mechanisms: Insafelock nails versus conventional locking nails.

OBJECTIVE: The aim of this study was to compare the biomechanical resistance to rotational and axial forces of a conventional locking nail with a newly designed intramedullary humeral nail developed for humeral shaft fractures with a secure locking mechanism through the distal part of the nail. METHODS: InSafeLOCK humeral nail system (group 1, TST, Istanbul, Turkey) and Expert humeral nail system (group 2, DePuy Synthes, Bettlach, Switzerland) of the same size (9 × 300 mm) were examined. In total, 24 fourth-generation humerus sawbones were used in the experiment. Osteotomy was performed at the humerus shaft, and a defect was created by removing 1 cm of bone. After pre-loading 5000 cycles at a frequency of 2 Hz and a force of 50-250 N for axial loading and 5000 torsion torques between 0.5 Nm and 6.5 Nm at a 2 Hz frequency for torsional loading, the failure load values of each load were recorded. Distal interlocking was performed with an endopin in group 1, while a double cortex screw was used in group 2. RESULTS: All samples successfully passed the cyclic loading. The initial and final stiffness values were similar between the groups after axial loading (p = 0.873 and p = 0.522, respectively). The mean axial failure load values in groups 1 and 2 were 2627 ± 164 N and 7141 ± 1491 N, respectively. A significant difference was found in the axial failure load values (p = 0.004). Significant differences were observed between the initial and final torsional stiffness between the two groups (p = 0.004 and p = 0.004, respectively). No significant difference was found in the failure load values after torsional loading (11791 ± 2055 N.mm and 16997 ± 5440 N.mm) (p = 0.055). CONCLUSION: These results provide a biomechanical demonstration of the adequate stability of both nails after axial and rotational loading. The reliability of the newly developed InSafeLOCK humeral nail system, which does not require fluoroscopic control and an additional incision for distal locking, supports its use in the clinic.

InSafeLock humeral nail provides a safe application for proximal and distal locking screws with distal endopin - An anatomical study.

INTRODUCTION: Efforts to prevent iatrogenic neurovascular injuries with humeral intramedullary nailing lead to design new implants and inside to out distal locking technique using an endopin aims to provide a safer screw application. InSafeLock (TST, Istanbul, Turkey) humeral nail have been recently developed to minimize the possible screw related complications. The anatomical relationship between locking screws and neurovascular structures with the application time were compared between Trigen Humeral Nail (Smith and Nephew, Memphis, USA) and InSafeLock Humeral Nail. HYPOTHESIS: InSafeLock humeral nail would be safer than Trigen Humeral nail in terms of neurovascular injury. MATERIALS AND METHODS: Seven cadavers were used with both shoulders and surgical application of two nails was performed as the manufacturer guide. An Insafelock humeral nail was used for each right humerus and a Trigen humeral nail was used for each left humerus. Once the nails were placed, proximal and distal region of the nails were dissected to evaluate the relationship between screws and adjacent anatomical structures. The duration of the each screw was assessed via a stopwatch. RESULTS: No significant finding was noted for the relationship between the neurovascular structures and proximal screws in two groups (p<0.05). The distal locking of the InSafeLock humerus nail had a shorter application time and no neurovascular damage was recorded. DISCUSSION: The newly developed Insafelock humerus nails are at least as safe and effective as current humeral nails available on the market. Additional benefits include the preservation of neurovascular structures, as the Insafelock humerus nail does not require the use of an extra incision. Furthermore, surgical time is significantly shorter with using distal endopin. LEVEL OF STUDY: III, controlled laboratory study.

Zoledronic acid : Treatment option for Gorham-Stout disease.

Gorham-Stout disease is a rare bone resorption disease, the etiology and prognosis of which is uncertain but it is thought to be benign. It can involve one or more bones and can cause pain, swelling, deformity and fractures in affected bones. Diagnosis is made with a combination of clinical, radiological and histopathological examinations once other causes of osteolysis have been excluded. Due to its rarity, there is no standard therapeutic approach.

Medial malleolus fractures: A biomechanical comparison of tension band wiring fixation methods.

BACKGROUND: This study compared the biomechanical properties of three different fixation methods of tension band wirings, used in the treatment of medial malleolus fractures. The first method used an innovative "handmade bent pin" for cerclage fixation. The second method used a U-shaped K-wire to attach the cerclage to the medial tibial cortex. These two novel fixation techniques were compared with the traditional tension band wiring technique which is fixated to the bone by a screw. HYPOTHESIS: Novel fixation techniques of tension band wiring provide stable fixation. MATERIAL AND METHODS: In this study 27 artificial bone models, which medial malleolus fractures were simulated on, were used. Using an electromechanical test device, the force required to pull out each implant was assessed and compared. RESULTS: This study found that; while handmade bent pinning resulted averagely 840.25N (range: 647-1066±118.72) and U-shaped K-wire fixation was 381.71N (range: 176-651±150.2) pull out strength, traditional tension band wiring indicated 871.33N (range: 549-1008±137.74) pull out strength. DISCUSSION: Handmade bent pinning method provide similar results with traditional tension band wiring. Therefore, in suitable cases, it may be an acceptable alternative to traditional tension band wiring techniques when treating malleolar fractures. Although the outcomes of U-shaped K-wire fixation indicated lower than other two groups, the outcomes were comparable with the literature. So while performing tension band wiring, both handmade fixation systems may be used in certain cases. For Orthopaedic surgeons, it is better to know and think about these alternative handmade pinning systems created from simple K-wires during the surgery if needed. LEVEL OF EVIDENCE: IV, Biomechanical trial.

An Unusual Orthopaedic Disease: Sarcoidosis-A Case Report.

Sarcoidosis is an idiopathic, noncaseating granulomatous disorder with wide systemic involvement. It is encountered widely around the world and it affects both sexes, all the races in all age groups. Lungs, eyes, and skin are the organs most commonly affected. Constitutional features such as weight loss, fatigue, and myalgia are the most common symptoms. Bone involvement, which is very rare, was reported as present in 3 to 13% of effected cases, and it is most commonly seen in hands and feet, compared with long bone involvement, which is extremely rare. We hereby present a case with a diagnosis of sarcoidosis and multiple bone involvement emphasizing the importance of differential diagnosis.

A novel intramedullary nail for use in the treatment of supramalleolar malunion and nonunion: A preliminary report of three cases.

INTRODUCTION: The fractures around the supramalleolar region are difficult to manage and deformities may occur following insufficient or inadequate treatment attempts. The treatment of those deformities is even more challenging. The available options for surgical fixation have inherent problems considering the soft tissue problems, infection and compliance of the patients. In this study, we report the preliminary outcome of new IMN system in use of supramalleolar deformities. PATIENTS AND METHODS: Three patients with supramalleolar deformities were recruited for this study. Two patients had periarticular distal tibia malunions and one patient had nonunion in same region. All patients were operated with using newly designed intramedullary nail system with a unique distal interlocking bolt screw. The outcome for each patient was followed-up and evaluated with using AOFAS score. RESULTS: The patients were followed up for 3 years, 3 months, and 6 months, respectively. The AOFAS scores were 36, 33, and 21 preoperatively; and 75, 68, and 75 postoperatively in Patients 1, 2 and 3, respectively. CONCLUSION: In our patient series, adequate fixation following correction of the deformity was seen. Although the number of the cases are limited this study provides encouraging results regarding the outcome of new IMN system in use of supramalleolar deformities.

Comparação entre fio de kirshner e hastes elásticas de titânio em fraturas pediátricas da diáfase femoral / Kirschner wire versus titanium elastic nails in pediatric femoral shaft fractures

Objetivo: Avaliar a eficácia da fixação intramedular usando o fio deKirschner em comparação com hastes elásticas de titânio (HET)nas fraturas pediátricas da diáfise do fêmur. Métodos: Pacientespediátricos com fraturas da diáfise femoral foram submetidos àfixação intramedular usando o fio de Kirschner ou HET em umgrupo de 42 crianças com idade média de 6,55±2,42 (4-11) anos.Resultados: Não houve diferença significativa entre os grupos,onde 16 (38,1%) pacientes foram tratados com fio de Kirschner e26 (61,9%) pacientes com HET em termos de duração de união.Ademais, nenhum dos pacientes demonstrou má união ou uniãoretardada. Conclusões: O uso do fio de Kirschner ajustado em vezde HET na fixação intramedular de fraturas diafisárias do fêmurem crianças selecionadas pode ser uma opção cirúrgica vantajosadevido ao menor custo, fácil acessibilidade e ausência da necessidadede uma segunda cirurgia para remoção do implante. Nívelde Evidência III, Estudo Retrospectivo.

Objective: To evaluate the effectiveness of intramedullary fixationusing the Kirschner-wire (K-wire) compared to the titaniumelastic nail (TEN) in pediatric femoral shaft fractures. Methods:A sample of 42 pediatric patients with a mean age of 6.55±2.42years (range 4-11 years) presenting femoral shaft fractures underwentintramedullary fixation using the K-wire or TEN. Results:There was no significant difference found between groups, ofwhich 16 (38.1%) patients were treated with K-wire and 26(61.9%) patients were treated with TEN in terms of union duration.Moreover, none of the patients showed nonunion or adelayed union. Conclusions: The use of adjusted K-wire insteadof TEN in the intramedullary fixation of femoral shaft fracturesin selected children may be an advantageous surgical optiondue to the lower cost, easy accessibility and no need for asecond surgery for implant removal. Level of Evidence III,Retrospective Study.

Functional Comparison of Immediate and Late Weight Bearing after Ankle Bimalleolar Fracture Surgery.

AIM: The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures. METHODS: Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment. RESULTS: According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2. CONCLUSION: As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.

KIRSCHNER WIRE VERSUS TITANIUM ELASTIC NAILS IN PEDIATRIC FEMORAL SHAFT FRACTURES.

OBJECTIVE: To evaluate the effectiveness of intramedullary fixation using the Kirschner-wire (K-wire) compared to the titanium elastic nail (TEN) in pediatric femoral shaft fractures. METHODS: A sample of 42 pediatric patients with a mean age of 6.55±2.42 years (range 4-11 years) presenting femoral shaft fractures underwent intramedullary fixation using the K-wire or TEN. RESULTS: There was no significant difference found between groups, of which 16 (38.1%) patients were treated with K-wire and 26 (61.9%) patients were treated with TEN in terms of union duration. Moreover, none of the patients showed nonunion or a delayed union. CONCLUSIONS: The use of adjusted K-wire instead of TEN in the intramedullary fixation of femoral shaft fractures in selected children may be an advantageous surgical option due to the lower cost, easy accessibility and no need for a second surgery for implant removal. Level of Evidence III, Retrospective Study.

Treatment of diaphyseal forearm atrophic nonunions with intramedullary nails and modified Nicoll's technique in adults.

OBJECTIVE: The aim of this study was to evaluate the outcome of tricorticocancellous autologous bone grafting with intramedullary forearm nails in the treatment of radius or ulna aseptic nonunion. METHODS: The study included 8 patients (mean age: 39 years; range: 19 to 55 years) who underwent plate-screw osteosynthesis for the treatment of nonunion (6 ulna, 2 radius) following forearm fracture. In all cases, the length of the applied tricortical graft was below 3 cm. Patients were evaluated using the visual analog scale, Grace and Eversmann scale and DASH score. Wrist flexion and extension and postoperative hand and forearm grip strength were assessed. RESULTS: Graft incorporation and union was completed at a mean of 22 (range: 18 to 28) weeks. No patient had nonunion, deep infection or radioulnar synostosis. Follow-up ranged from 18 to 52 months. Radiographic union was achieved in all patients. Mean visual analog scale pain score was 1 (range: 0 to 3). Grace and Eversmann ratings were excellent in 5 and good in 3 patients. Mean DASH score was 10.7 (range: 1.7 to 21.7) points. CONCLUSION: Intramedullary nailing and tricorticocancellous iliac bone block grafting appears to be a technically easy and reliable procedure that enables early postoperative rehabilitation in the treatment of nonunion of the forearm.

Biomechanical comparison of antirotator compression hip screw and cannulated screw fixations in the femoral neck fractures.

OBJECTIVE: The aim of this study was to compare the biomechanical properties of minimal invasive sliding antirotator compressive hip screw (MIS-A-CHS), and multiple cannulated screws (CS) on a Pauwels type 3 femoral neck fracture model. METHODS: A Pauwels type 3 vertical femoral neck fractures was created on 12 third-generation proximal femur models which were divided into two equal groups. The fracture was fixed with three CS in the first group, and MIS-A-CHS in the second group. The axial and rotational stiffness and maximum compression effect were compared between the groups. RESULTS: The axial and rotational stiffness and maximum compression were significantly higher in MIS-A-CHS group (912.5 N, 540 N and 10.2 N/m, respectively) than the CS group (627.5 N, 380 N, and 3.9 N/m, respectively). CONCLUSION: MIS-A-CHS appears to be a more secure fixation method in Pauwels type 3 femoral neck fractures than the CS.

New interlocking intramedullary radius and ulna nails for treating forearm diaphyseal fractures in adults: a retrospective study.

INTRODUCTION: The treatment goal for diaphyseal forearm fractures in adults is to restore axial and rotational stability. The treatment of these fractures with intrmaedullary locked nailing remains sparse. We therefore evaluated IM nails for treating forearm diaphyseal fractures in adults. METHODS: We retrospectively reviewed adult patients with isolated unilateral or bilateral fractures of the radius, ulna, or both, who were treated with closed or mini open reduction with a new IM nail between May 2008 and January 2012 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. Primary outcomes were Grace and Eversmann rating, Disabilities of the Arm, Shoulder and Hand (DASH) scores. RESULTS: The 43 enrolled patients (mean age, 37 years; 32 men) had 59 forearm fractures: 14 isolated radius fractures, 17 isolated ulna fractures (2 bilateral), and 28 fractures of both the radius and ulna. Mean time to fracture union was 13 weeks (range 10-14 weeks) for ulnar fractures and 12 weeks (range 10-13 weeks) for radial fractures. No patient had nonunion, deep infections, or radioulnar synostosis. Followup ranged from 12 to 44 months. Grace and Eversmann ratings were excellent in 38 patients and good in 5. Mean DASH score was 6.5 points (range 0-13.3). CONCLUSIONS: Intramedullary nailing of adult forearm diaphyseal fractures appears to be a good alternative to plate osteosynthesis. The advantages are short operative time, minimal invasive techniques, and sufficient stability in all planes that allows early motion without additional fracture support.

Treatment of isolated diaphyseal fractures of the radius with an intramedullary nail in adults.

BACKGROUND: The goal of the radius diaphysis fractures in surgical treatment is restoration of bone length, rotation correction and to secure fixation that allows early mobilization. The purpose of this study is evaluating the results of intramedullary (IM) radius nail for the treatment of isolated adult diaphyseal fractures of the radius. MATERIALS AND METHODS: We retrospectively reviewed adults with isolated fractures of the radius, who were treated with closed or mini open reduction with a IM radius nail between May 2008 and November 2011 and who were followed for a least 1 year. Patients with a Galeazzi fracture, a pathological fracture, or patients with nonunion after previous surgeries were excluded. All patients were allowed full range of motion without any external support. Primary outcomes were Grace and Eversmann rating, Disabilities of the Arm, Shoulder and Hand (DASH) scores. RESULTS: Twenty-three enrolled patients (mean age 34 years; 17 men) had 23 isolated radius fractures. Mean time to fracture union was 12 weeks (range 10-13 weeks) for radius fractures. No patient had nonunion, deep infections, or radioulnar synostosis. Follow-up ranged from 12 to 42 months. Grace and Eversmann ratings of 21 patients were excellent or good, and 2 patients were medium. Mean DASH score was 4.2 points (range 0-13.3). CONCLUSIONS: Our experience indicates that this new IM radius nail may be considered as an alternative to plate osteosynthesis for fractures of the radius diaphysis in adults. IM nailing of radius fractures provides reliable bony union and excellent postoperative clinical results in adults.

Interlocking intramedullary ulna nails in isolated ulna diaphyseal fractures: a retrospective study.

OBJECTIVE: The aim of this study was to evaluate the results of multifunctional intramedullary (IM) ulna nailing following diaphyseal fracture of the ulna. METHODS: Adult patients with isolated fractures of the ulna treated with closed or mini-open reduction using the new IM ulna nail between May 2008 and January 2011 and who were followed for a least one year were retrospectively reviewed. Patients with a pathological fracture or nonunion after previous surgeries were excluded. Functional outcome was assessed using the Grace and Eversmann rating system, patient-reported outcomes using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Wrist flexion and extension was evaluated using a goniometer. RESULTS: The 18 patients (13 male, 5 female; mean age: 28 years, range: 18 to 64 years) had a total of 20 isolated ulna fractures (two bilateral). Mean time to fracture union was 13 (range: 10 to 14) weeks. No patient had nonunion, deep infection or radioulnar synostosis. Follow-up time ranged from 12 to 36 months. Grace and Eversmann ratings were excellent in 15 patients, good in 2 and poor in one. Mean DASH score was 8.08 (range: 0 to 17.5) points. CONCLUSION: The new IM ulna nails may be considered an alternative method for isolated diaphyseal fractures of the ulna. Advantages of this method include its short operative time, insertion by closed and minimal invasive techniques, use of scope only in reduction and locking control, as well as minimal cosmetic defect, small operative scar and early mobilization without additional fixation.