PubMed · 13589869
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L V RUSH. 1958. Fracture problems. 24. Summary of basic pinning technics.. https://pubmed.ncbi.nlm.nih.gov/13589869/
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Uncorrected bony deformity or stiffness resulting from a metacarpal shaft fracture can produce a significant functional or cosmetic deficit. Intramedullary fixation of metacarpal shaft fractures using small flexible rods can provide stable internal fixation while minimizing the extent of soft tissue trauma that is associated with more extensive surgical techniques such as plate or screw fixation. The flexible rod is usually introduced in a proximal to distal direction to avoid injury to the metacarpophalangeal joint and extensor mechanism. Closed reduction of the fracture and percutaneous insertion of the rod improve operative efficiency and allow what is truly a minimally invasive procedure. The use of a proximal locking pin greatly enhances fixation and has resulted in an expansion of the surgical indications to include spiral and comminuted fractures. Usually a single locked nail is used, although it is possible to insert multiple nails if necessary. A radiopaque plastic cap can be applied over the cut end of the nail to minimize irritation of the adjacent soft tissues during rehabilitation. Post-operatively, splint or cast immobilization is often unnecessary. The nails are routinely removed after the fracture has completely healed.
We report a case of an anterior interosseous nerve palsy after closed reduction and percutaneous pinning of open fractures of the radius and ulna in an adult. Operative findings showed that the anterior interosseous nerve was trapped between the distal and proximal part of the fractured radius. Treatment by neurorrhaphy gave a satisfactory result.
We evaluated the outcome of multiple intramedullary nailing at the same surgery for traumatic long-bone fractures. All but 2 of 27 patients (average age 40) had been involved in motor vehicle accidents, and 17 of them presented with other associated nonorthopedic injuries. Ten patients had open fractures. Sixty-one nails were used. The average time from accident to fixation was 8.16 h, and the average time in the operating room was 5.4 h. No patients died; all required blood transfusion; and eight patients were admitted for at least 24 h to the intensive care unit. The average hospital stay was 27 days, the mean time to full weight-bearing was 4 months, and the average time to radiographic healing was 7.5 months. Three patients required dynamization to achieve fracture union; three underwent exchange nailing for nonunion and one for nail breakage. Thus, early fixation of multiple long-bone fractures by intramedullary nailing in polytrauma patients is an acceptable treatment method.