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At least 235 records · Page 13Linked to original sources
PubMed2006

Locked intramedullary nailing of metacarpal fractures secondary to gunshot wounds.

PURPOSE: To investigate the results of fixation of 10 metacarpal shaft fractures secondary to low-velocity gunshot wounds with locked intramedullary nails. METHODS: We reviewed the results of 10 patients with locked intramedullary nailing of the metacarpal for low-velocity gunshot wounds. Autogenous bone grafting was used in 9 of the 10 fractures. The follow-up period averaged 26 months. The parameters evaluated included angulation, rotational alignment, shortening of the digit, postoperative metacarpophalangeal (MCP) range of motion, and time to union. RESULTS: Nine of 10 fractures showed corticocancellous bone autograft incorporation in the midshaft of the metacarpal on radiographs 3 months after surgery; the single fracture without bone grafting did not unite and required an additional procedure with bone grafting to achieve union. The MCP flexion averaged 81 degrees. All MCP joints attained full extension except for 2 that had a 10 degrees extension lag. One metacarpal required an extensor tendon tenolysis and an MCP capsulotomy. No malrotation of the digits was noted and none of the patients developed an infection. The average shortening was 1.2 mm and 1 metacarpal had an angulation of 6 degrees. CONCLUSIONS: Locked intramedullary nailing of the metacarpal with autogenous iliac crest bone graft is an effective technique for treating low-velocity gunshot metacarpal fractures associated with bone loss and comminution. The locked implant maintains satisfactory alignment, length, and rotation of the metacarpal until graft incorporation and bone healing occurs.

Adolescent↗
PubMed1993

Immediate internal fixation of low-velocity gunshot-related femoral fractures.

Fractures caused by gunshots are increasingly common in urban hospitals and trauma centers. The rising incidence and complexity of these injuries present difficult management problems and health care burdens. In a 3-year period, from 1989 through 1991, 21 patients with femoral shaft fractures from low-velocity bullets were treated with intramedullary fixation within 15 hours of admission. Eighteen patients were available for follow-up. The fractures had healed in all patients. Average hospitalization for an isolated injury was 7 days. There were no complications related to immediate internal fixation. Immediate internal fixation of femoral shaft fractures caused by low-velocity gunshots can be performed in an efficient and cost effective manner.

Adolescent↗
PubMedDate not supplied

Bone formation following intramedullary femoral reaming is decreased by indomethacin and antibodies to insulin-like growth factors.

OBJECTIVE: We aimed to: 1). compare rates of in vitro bone formation following reamed and nonreamed intramedullary fixation in a murine model of femoral fracture healing; and 2). examine whether antibodies to insulin-like growth factor (IGF) I, IGF II, or indomethacin (an inhibitor of the inflammatory process) affect bone formation following intramedullary reaming. DESIGN: Experimental study. PARTICIPANTS: Twenty-four C57 black mice were randomized to two groups: reamed ( = 12), and nonreamed intramedullary nail insertion ( = 12). INTERVENTION: In the reamed group, the femoral canals were successively reamed with 30-, 27-, 25-, and 23-gauge stainless steel pins and stabilized with a 27-gauge pin. In mice randomized to the nonreamed group, a 27-gauge pin was inserted. An external three-point bending force created a midshaft transverse femoral fracture. Seven days postsurgery, each mouse was killed, and the right femur was removed. Following pin removal, the callus was minced, the bone marrow was removed, and both were ultracentrifuged at 1200 rpm for 5 minutes. The supernatent was cocultured with 3-day-old murine calvarial cells in culture media. At day 5 of culture, reamed plasma and calvarial cell cocultures were exposed to either 1.0 micro g/mL of anti-IGF I, 1.0 micro g/mL of anti-IGF II, 2 micro M indomethacin, or served as controls (calvarial cells only). The cells were cultured for a total of 21 days. MAIN OUTCOME MEASUREMENTS: The number of bone nodules was quantified by light microscopy. RESULTS: Reamed pin insertion resulted in 4.1-fold and 8.9-fold increases in the mean number of bone nodules compared to pins inserted without reaming and controls, respectively (399 +/- 40.0 vs. 97.0 +/- 21.0, < 0.001). The positive effect of intramedullary reaming on bone nodule formation was reversed with the administration of antibodies to IGF I and IGF II. The addition of anti-IGF I or anti-IGF II to calvarial, or osteoblastlike, cells treated with supernatent from the callus and bone marrow of mice with prior intramedullary reaming resulted in significant declines in the mean number of bone nodules ( < 0.001). Specifically, treatment of osteoblastlike cells with anti-IGF I or anti-IGF II resulted in 7.0-fold and 5.4-fold declines in mean bone nodule formation compared to cells without such treatment. CONCLUSIONS: Intramedullary reaming prior to pin insertion resulted in a significantly greater number of bone nodules than pin insertion only. Antibodies to IGF I, IGF II, and indomethacin reversed the stimulatory effect of reaming on bone nodule formation, suggesting their role in modulating the course of fracture healing following intramedullary reaming.

Animals↗
PubMed1995

Intramedullary nailing after external fixation of the tibia.

Intramedullary nailing after external fixation of fractures of the tibia has high complication rates including nonunion and infection. The authors review the literature regarding this technique and refine the indications for secondary IM nailing. The report distinguishes between sequential secondary nailing and reconstructive secondary nailing. Sequential secondary nailing, as defined, is done by protocol and is planned from the onset of treatment. The technique includes only a short period in the external fixator, a planned interval between removal of the frame and placement of the IM nail, and specific exclusion criteria. This technique essentially uses the external fixator as a temporary traction device while the soft tissue envelope is reconstructed. Reconstructive procedures, as defined, are not done by protocol and not planned from the onset of treatment. Patients are usually in the external fixator for extended periods of time. The indications are variable and include delayed union, nonunion, malunion, and infected nonunion. The authors conclude that when done by protocol sequential IM nailing is safe and effective. Reconstructive IM nailing, however, has strict contraindications that include: a history of or an active infection of the pin tract, wound, or bone; the presence of an open wound or pin tract; and the presence of a ring or halo sequestrum. Yet reconstructive secondary procedures can be effective in healthy individuals if the soft tissue envelope is completely reestablished, if antibiotics are administered preoperatively, and the nail is placed without reaming.

Adult↗
PubMed1986

The effects of reaming and intramedullary nailing on fracture healing.

Most closed fractures of the shaft of the femur and tibia can be treated successfully with internal fixation with medullary or interlocking nails. Unlike plate fixation, intramedullary nailing does not provide absolutely rigid fixation, so that some motion at the fracture site exists. The process of reaming causes circulatory disturbances in the inner two-thirds of the diaphyseal cortex. However, this does not impede the formation of external callus. The parts of bone that have sustained vascular damage by trauma or surgery are revascularized. Delay in the healing process due to disruption of the blood supply to fracture fragments is not known. The majority of patients are able to weight-bear a few days after surgery.

Animals↗
PubMed1980

Subtrochanteric femoral fractures.

Femoral fractures in the subtrochanteric and proximal shaft regions require special management because of the great stresses inflicted on the area. Stability is best achieved with intramedullary fixation when there is adequate control of both proximal and distal fragments. Intertrochanteric fractures with small subtrochanteric components can often be adequately fixed with strong nail plate or screw plate devices. When the major fracture is subtrochanteric, an intramedullary device should be used to permit stability of the bone by impaction. Experience with a special device composed of an intramedullary rod and triflanged nail indicates that this appliance performs well in the fixation of subtrochanteric fractures.

Aged↗
PubMedDate not supplied

Biomechanical analysis of antegrade and retrograde flexible intramedullary nail fixation of pediatric femoral fractures using a synthetic bone model.

Biomechanical testing was performed to evaluate the stability of simulated transverse and comminuted femoral fractures after retrograde and antegrade flexible titanium intramedullary nail fixation. Ten synthetic adolescent-sized femoral bone models were used. Five underwent retrograde fixation with two C-shaped nails inserted from medial and lateral entry portals. The other five underwent antegrade fixation using one C- and one S-shaped nail through lateral entry holes just inferior to the greater trochanter. Retrograde nail fixation demonstrated significantly less axial range of motion and greater torsional stiffness than antegrade fixation in both transverse and comminuted fracture patterns. However, there appeared to be a biomechanical trend of greater resistance to shortening for antegrade nails.

Adolescent↗
PubMed1995

Report on new types of intramedullary rods and treatment effectiveness data for selection of intramedullary rodding in osteogenesis imperfecta.

Major advances in the surgical treatment of fractures of long bones in children with Osteogenesis Imperfecta (O.I.) have been made in the last several years. The current mainstay of treatment is bracing and active rehabilitation. When this fails surgery is indicated. The type of fixation device used is generally some type of stainless steel rod. The rod stabilizes the fracture as well as accepts the load across the fracture site thus enabling the fracture to heal. However, the current rods in use have complications. One such complication is cortical atrophy felt to be secondary to the removal of stress from the bone. This phenomena is called stress shielding. Stress shielding in the current rods prompted the study of two new types of rods which more closely approximate the modulus of elasticity of bone. The use of such rods should eliminate the problems of stress shielding. The following paper describes the effectiveness of the various intramedullary rods in the treatment of Osteogenesis Imperfecta fractures. It also reports on the initial results of two new types of intramedullary rods which more closely approximate the modulus of elasticity of bone and therefore may eliminate stress shielding. These rods may replace the stainless steel rods as the "gold standard" of therapy for surgical fixation of long bone fractures in children with Osteogenesis Imperfecta.

Animals↗
PubMed2003

Treatment of pathological fractures of the humerus with a locked intramedullary nail.

OBJECTIVE: The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications occur. This study aimed to assess the use of a new humeral nail to treat pathological fractures and impending pathological fractures of the humerus. METHODS: 29 patients received 31 Austofix locked intramedullary humeral nails: 25 for pathological fractures and 6 for impending fractures; 24 nails were inserted anterograde and 7 retrograde. Cement augmentation was applied in 4 patients, and adjuvant therapy was used in 28 patients. Complications occurred in 12 patients. RESULTS: Fixation failed in 6 patients: 2 due to intraoperative fractures during retrograde nailing, one due to a fracture through screw holes postoperatively, and 3 due to local progression of disease. Difficulty in distal locking of the nail was encountered in 4 patients. Locked intramedullary nailing resulted in a stable humerus in 80% of patients. CONCLUSION: Retrograde insertion of the nail is associated with an increased risk of intra-operative fracture, and disease progression can occur, despite the administration of adjuvant therapy.

Adult↗
PubMed1995

Open tibial diaphyseal fractures. Results of unreamed locked intramedullary nailing.

Forty-three high energy open tibial diaphyseal fractures were treated with unreamed locked intramedullary nails from 1989 to 1992, and were reviewed at a minimum of 1 year from injury. There were 6 Grade I, 2 Grade II, 16 Grade IIIA, 9 Grade IIIB, and 1 Grade IIIC open fractures. Ninety-eight percent of the fractures united in an average time of 6.1 months. However, 47% of the fractures required an additional procedure before union. Complications included 49% of fractures with malunions, 12% deep infections, 41% locking screw breakages, and 20% compartment syndromes. These results are similar to those achieved with external fixation of open tibial fractures. The unreamed locked intramedullary nail has not improved the outcome of open tibial diaphyseal fractures because the biologic consequences of the injury are of greater significance than the methods or techniques of fracture stabilization.

Adult↗
PubMed2006

Intramedullary fixation of tibial shaft fractures using an expandable nail: early results of 54 acute tibial shaft fractures.

OBJECTIVE: To evaluate and present our experience using the expandable nail system for the treatment of acute tibial shaft fractures. DESIGN: Retrospective study. SETTING: Two level-1 trauma centers-University teaching hospitals. METHODS: Fifty-four consecutive patients were treated by this nail system for acute tibial shaft fracture. Two nail diameters were used, 8.5 mm and 10 mm. Operation, hospitalization and healing times, reaming versus nonreaming, isolated versus multiple injuries, and reoperations were recorded and analyzed statistically. RESULTS: Follow-up was obtained either until fracture healing or for a minimum of 1 year with an average of 14 months (12 to 24). All fractures healed in an average time of 72 days (21 to 204). The average healing times for patients treated with 8.5-mm and 10-mm nails were 77.2 days (27 to 204) and 63.4 days (21 to 121), respectively. Average operative time was 103 minutes (40 to 185) if reamed and 56 minutes (30 to 80) if unreamed. Average healing times were 65.4 days (21 to 190) if reamed and 79.5 days (42 to 204) if unreamed. There were 11 complications (20.4%) related to the nailing: 3 deep infections, 2 superficial infections, 2 bone shortenings of 1 cm secondary to nail protrusion in the knee, 1 compartment syndrome, 1 fracture propagation, 1 distal malalignment, and 1 delayed union. Hardware was removed in 6 patients (3 infections, 2 patients' request and 1 protrusion into the knee), and 1 additional patient underwent exchange nailing due to a delayed union. CONCLUSIONS: The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. This study demonstrates satisfactory healing and alignment for the treatment of tibial shaft fractures using this device. However, caution must be exercised when using this nail in cases of significant comminution and in cases where the fracture pattern involves the more proximal or distal aspect of the tibial shaft.

Adult↗