[Removal of a bent femoral nail : Case report: treatment strategy of a complex femoral deformity with a bent femoral nail in situ since 36 years]. / Entfernung eines verbogenen Femurnagels : Kasuistik: Behandlungsstrategie einer komplexen Femurdeformität mit einem seit 36 Jahren einliegenden, verbogenen Femurnagel.

To remove a bent femoral nail is always a challenging task for a surgeon. In the last 20 years several case reports and descriptions of techniques are to be found in literature, the goal being to weaken the nail at the apex and then straightening it in situ in most cases. Those reports all have one parameter in common: the necessity to remove the nail relates to a refracture of the femur.We report the case of a patient who presented with the explicit wish to have a bent femoral nail removed and a femoral angulation corrected because of pain in the ipsilateral hip. A femoral fracture had been treated by a Küntscher nail in 1982. A refracture with severe bending of the nail had occurred a short time later, which was treated conservatively without a second surgical procedure.We can show that a planned removal of a bent and well-osseointegrated Küntscher nail can be achieved without complications and that thereby a multiplane angulation in the femur can be corrected, paving the way for a future arthroplasty in this specific case.

A Novel, Low-Cost Telescopic Nail Design for Prevention and Treatment of Osteogenesis Imperfecta Associated Long-Bone Pathological Fractures in Children.

Telescopic nailing and intermittent doses of bisphosphonates are now considered the standard treatment for preventing long bone pathological fractures in osteogenesis imperfecta (OI) children. Even though the telescopic nail designs have evolved over time, we are yet to get an affordable, worldwide uniformly and easily available, surgeon-friendly telescopic nail with good rotational stability. We designed a telescopic nail with modifications in Küntscher nail (outer, hollow component) and square nail (inner, solid component). The distal end of the square nail has a slot to allow locking in the distal epiphysis using a threaded K wire. The interlocking geometry between the two nails allows reasonable rotational control while allowing only longitudinal movements. This novel, low-cost, rotationally stable telescopic nail design is a good alternative to existing telescopic nails in the market, especially for children from low and middle-income countries (LMIC) where affordability and uniform availability are a concern.

Spontaneous Distal Migration and Protrusion of a Küntscher Intramedullary Nail from the Left Femur: A Rare Complication.

Küntscher intramedullary nail (K-nail) proximal migration in the femoral medullary canal is a common postoperative complication. But spontaneous distal migration of the K-nail across the knee joint and protrusion over the tibia till the tibial tuberosity is a complication that has very rarely been reported in the literature previously. This is the case report of a 41-year-old man who presented with a pus discharging sinus over the tibial tuberosity for the last one year. K-nail insertion was done six years ago. The underlying cause of the migration of the K-nail is subject to controversy and speculation. Infection and delayed union with shortening are some etiological possibilities. Wrong selection of K-nail size, loosely fitted nail, premature weight-bearing, and disuse osteoporosis may also be contributory factors.

Kuntscher's nail removal techniques: an illustrative walk-through its journey.

The use of Kuntscher nail for femur fracture dates back to World War 2. Since then, the technique of intramedullary nailing has evolved and the use of Kuntscher nail has become almost obsolete. The orthopaedic surgeons across the globe are facing a new challenge of removal of these Kuntscher nails due to different indications. Different but scattered English literature has been published describing the experiences and techniques of surgeon with K nail removal. Up till now, no systematic analysis has been performed evaluating the available literature. We have planned a systematic review to evaluate and explore the various indications and techniques of K nail removal.

[A minimally invasive technique for removal of a firmly fixed Küntscher nail in primary hip arthroplasty]. / Eine minimalinvasive Technik zur Entfernung eines fest verklemmten Küntscher-Nagels in der primären Hüftendoprothetik.

This article reports the case of an 80-year-old male patient who presented to this hospital with symptomatic arthritis of the left hip. The special feature of this case was a Küntscher nail in the left femur that had been in situ for more than 50 years. Before implantation of the total hip arthroplasty the nail first had to be removed. As the Küntscher nail is a rarity nowadays there is no standardized procedure for the removal of such a nail. This case report describes a minimally invasive possibility to remove a Küntscher nail in total hip arthroplasty.

[Medial fracture of the femoral neck with enclosed Küntscher nail]. / Mediale Schenkelhalsfraktur bei einliegendem Küntscher-Nagel.

We report about an 81-year-old male patient who suffered a medial femoral neck fracture after a fall on the left leg. A total hip arthroplasty was planned based on the appropriate indications. The planning was complicated by the presence of an intramedullary Küntscher femoral nail inserted after a motorcycle incident approximately 60 years ago. After fenestration of the proximal lateral femur, the nail was sawn off and a cemented total hip arthroplasty and plate osteosynthesis were performed.

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.

Open interlocked nailing without a targeting device or X-ray guidance for non-union of the femur: a case series.

From October 2005 to August 2007, we operated on six patients who had femoral non-unions and performed interlocked intramedullary nailing without X-ray guidance or a targeting device. There were three fractures of the distal femur, two fractures of the mid-shaft and one of the proximal femur. Fatigue failure of a non-interlocked Kuntscher nail and one nail migration were the presenting features in two patients. The presence of sclerosis of the bone ends in four cases and a need for cancellous bone grafts at the site of non-union in all patients made wide dissection and open reduction unavoidable. There was a limb length discrepancy in all patients before surgical intervention. Partial weight bearing was commenced at 6 weeks post-operation. There was no case of wound infection. There was no misplaced screw. Minimum range of knee flexion was 105° at 2 months post-operation. These early results call for a closer look at this cheap, safe and effective means of handling femoral non-union in third world societies where there is paucity of instrumentation and implants for interlocked nailing.

Dynamic osteosynthesis by modified Kuntscher nail for the treatment of tibial diaphyseal fractures.

BACKGROUND: We evaluated a series of diaphyseal fractures of the tibia using low-cost, Indian-made modified Kuntscher nail (Daga nail) with the provision of distal locking screw for the management of the tibial diaphyseal fractures. MATERIALS AND METHODS: One hundred and fifty one consecutive patients with diaphyseal fractures of tibia with 151 fractures who were treated by Daga nail were enrolled. One of the patients who had died because of cancer, and the two patients who were lost to follow-up at 3 months were excluded from the study.Therefore data of 148 patients with one hundred and fortyeight fractures is described. One hundred twenty closed fractures, 20 open Grade I fractures, and eight open Grade II fractures as per Gustilo and Anderson classification were included in this study. One hundred fourteen men and 34 women, with a mean age of 38.4 years, were studied. The result were analysed for Surgical time, duration of hospitalisation, union time, union rate, complication rate, functional recovery and crutch walking time. The fractures were followed at least until the time of solid union. RESULTS: The follow-up period averaged 15 months (range, 6-26 months). Union occurred in 140 cases (94.6%). The mean time to union was 13 weeks for closed fractures,17.8 weeks for Grade I open fractures, and 21.6 weeks for Grade II open fractures. Compartment syndrome occurred in two patients. Superficial infection occurred in five cases of Grade I and II compound fractures. Three closed fractures and one case of Grade I compound fracture required bone grafting for delayed union. Two cases of Grade II compound fracture with nonunion required revision surgery and bone grafting. Twelve cases resulted in acceptable malalignment due to operative technical error. In four cases, the distal screw breakage was seen, but none of these complications interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or ankle injury. CONCLUSION: Unreamed distally locked dynamic tibial nailing (modified Kuntscher nail/Daga nail) can produce excellent clinical results for diaphyseal tibial fractures. It has the advantages of technical simplicity, minimal cost, user-friendly instrumentation, and a short learning curve.

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.