Intramedullary fixation for fractures of the shaft of the tibia. 1952.
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Fracture Fixation, Intramedullary↗
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Intramedullary fixation of humeral shaft fractures.
In this paper we document seventy fractures of the humeral shaft that were treated by intramedullary fixation between 1970 and 1981. Complications developed in forty-seven (67 per cent) of the fractures, and forty-five (64 per cent) required at least one additional operative procedure. Of the sixty fractures that were internally fixed within six weeks after injury, nine (15 per cent) had a delayed union and five (8.3 per cent) had a non-union, two of which persisted despite subsequent surgery. Three of the ten fractures that were internally fixed more than six weeks after injury never united despite additional procedures that were done to secure union. Delayed union and non-union were more common in open fractures (33 per cent) than in closed fractures (21 per cent), and with open reduction (39 per cent) than with closed or so-called semi-open reduction (9 per cent). Deep infection occurred in three (5 per cent) of the fractures and was more common in open (17 per cent) than in closed fractures (2 per cent). One of the three open fractures that were treated by immediate fixation became infected, as compared with only one of the nine open fractures treated by delayed fixation. Painful adhesive capsulitis of the shoulder developed in thirty-four (56 per cent) of the patients who had fractures treated with distally directed pins, but motion of the elbow was not restricted in the nine patients with fractures treated with proximally directed pins.
Adolescent↗
A comparison of malreduction after plate and intramedullary nail fixation of forearm fractures.
A study was performed to compare the degree of malreduction after intramedullary nail and plate fixation of the forearm and to determine if the degree of malreduction was clinically significant. Eight matched pairs of forearms, including the wrist and elbow joints, were harvested from cadaver upper extremities. The forearms were put through a full range of motion, and physiological loads were applied to simulate those during normal use. Standardized anteroposterior and lateral radiographs of each forearm were obtained with the specimen intact, and after an osteotomy and internal fixation of one bone, both bones, and with gap at the osteotomy sites. In each forearm pair, plating was randomly performed in one specimen and intramedullary nailing was performed in the matching contralateral specimen. Forearm architecture was assessed by quantification of the magnitude and location of maximum radial bow and radial angulation. In this study, plate fixation was superior to nail stabilization in restoration of the normal radial architecture. Plating did not change any of the radiographic indices (magnitude and location of maximum radial bow and radial angulation) at any stage of testing. None of the radiographic indices was changed by nailing of only one of the forearm bones. The magnitude of maximum radial bow and the radial angulation were changed by nailing both forearm bones after osteotomy and both forearm bones with a gap (p < 0.05). Despite this, both techniques were well within the limits of what is radiographically acceptable for reduction.(ABSTRACT TRUNCATED AT 250 WORDS)
Bone Nails↗
Rush pin intramedullary fixation for fractures of the proximal humerus.
We have treated almost 700 proximal humeral fractures, and selected from them a series of 16 cases which required operative intervention in the form of semiclosed reduction and internal fixation with the Rush pin because of the marked amount of displacement and risk on nonunion. We favor the 3/16 inch Rush pin for this operation. Fractures of the surgical neck comprise the vast majority of cases operated upon in this series. They are the easiest to reduce and fix by the Rush pin technique. Certain comminuted severely displaced fractures involving the anatomic neck of the humerus and/or greater and lesser tuberosities also lend themselves to this operation with comparable results to other methods of treatment. There have been no postoperative motalities and minimal morbidity. The operation can be performed rapidly and requires only a short period of immobilization and hospitalization.
Adolescent↗
Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures, and how to avoid them.
Flexible intramedullary nailing has become a popular method of fixation of pediatric femoral fractures. The authors analyzed their first 5-year experience with titanium elastic stable intra-medullary nailing, specifically to report the complications associated with this technique and to provide recommendations to avoid these complications. Seventy-eight children with 79 femoral fractures were treated by this method. Complications included pain/irritation at the insertion site (41), radiographic malunion (8), refracture (2), transient neurologic deficit (2), and superficial wound infection (2). Ten patients required reoperation prior to union. Malunion and/or loss of reduction requiring reoperation was strongly associated with the use of nails of mismatched diameters (odds ratio = 19.4) and comminution of more than 25% (odd ratio = 5.5). Pain at the insertion site was significantly associated with bent or prominent nail ends. Most complications are minor, and many are preventable. Surgeons should advance nail ends to lie against the supracondylar flare of the femur to avoid symptoms at the insertion site and should avoid implanting nails of two different diameters. Comminuted fractures should be monitored carefully and might benefit from additional immobilization.
Adolescent↗
Combined intramedullary Kirschner wire and intra-osseous wire loop for fixation of finger fractures.
An intramedullary Kirschner wire was combined with an intra-osseous wire loop for fixing finger fractures. The mechanical stability of this technique to resist a bending moment in the sagittal plane was compared with four other conventional methods: single loop, loop and an oblique Kirschner wire, crossed Kirschner wires and dorsal plating. It was found that when the applied force was small, the technique was much more stable than the crossed Kirschner wires and was similar to the others. The ability to withstand mechanical failure was much better than most of the methods except the dorsal plate. This technique is recommended for replantations, transverse fractures and short oblique fractures with little comminution.
Animals↗
Intramedullary rod fixation of femoral shaft fractures: comparison of open and closed insertion techniques.
Meta-analysis of published series of intramedullary rod fixation in fractured femurs revealed significantly higher union rates, lower deep infection rates and a better range of knee motion when closed rather than open techniques of insertion were used. A separate retrospective review of 58 femoral fractures at one hospital showed outcomes consistent with those reported in the literature; these results were obtained during a 6-year period when staff were learning closed techniques. Technical failures of the closed technique can be avoided by paying attention to well-established operative details. A system for grading outcomes was developed to compare objectively the results of treatment of fracture patients. The literature and the authors' experience support the adoption of closed techniques for intramedullary rod insertion in femoral shaft fractures.
Adolescent↗
Compartment syndrome following intramedullary fixation of pediatric forearm fractures.
This study was designed to evaluate the incidence of compartment syndrome (CS) resulting from the treatment of both-bone forearm fractures in children. A retrospective analysis of 285 consecutive children who presented with both-bone forearm fractures was performed. Of 235 closed injuries, 205 were treated with closed reduction and casting; none of these patients developed CS. Thirty of the closed injuries were treated with closed reduction and intramedullary fixation; three of these patients (10%) developed CS. Fifty patients sustained open fractures and were treated with debridement and open reduction with intramedullary pinning; CS developed in three of these patients (6%). The eighty patients treated with intramedullary fixation had an increased incidence of CS compared with the 205 patients treated with closed reduction and casting (P < 0.001). Within the group of patients who had surgery, patients with longer operative times and more use of intraoperative fluoroscopy were at higher risk of developing CS.
Adolescent↗
Intramedullary fixation of complicated fractures of the humeral shaft.
Since 1973, a specially designed intramedullary nail has been used for fixation of humeral shaft fractures complicated by malalignment, multiple trauma, metastatic disease, radial nerve palsy, or nonunion. A series of 22 consecutive patients with good to excellent results in 20 patients (91%) is reported. The humeral anatomy is reviewed to illustrate the method and the rationale for intramedullary fixation. This method is advocated over routine use of compression plate and screws because incision and surgical time are both minimal, and the fracture site is not exposed in primary cases unless there is radial nerve involvement. Closed reduction remains the preferred treatment for most fractures of the humeral shaft.
Adult↗
Complications of intramedullary fixation of pediatric forearm fractures.
A retrospective review of 20 children with forearm fractures treated with intramedullary fixation is presented. Indications for surgery included fracture malreduction, open fracture, polytrauma, unstable fracture pattern, and compartment syndrome. Both radius and ulna were fractured in patients. Intramedullary fixation of both bones was performed in eight cases, ulna alone in nine, and isolated radius in three. A limited open approach to one or both bones was necessary for insertion of the intramedullary rod in 15 of 20 cases, including the eight open fractures. Eighteen complications occurred in 10 of 20 patients, including hardware migration, infection, loss of reduction, reoperation, nerve injury, significant decreased range of motion, synostosis, muscle entrapment, and delayed union. Despite the complications, 17 patients had excellent and two had good outcomes. Although excellent clinical results can be expected with intramedullary fixation, complications related to the surgical technique can be expected.
Adolescent↗
[Results following percutaneous intramedullary pin fixation in distal radius fractures].
42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures.
Adult↗
Technique tip: local bone grafting technique for Jones fracture management with intramedullary screw fixation.
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Bone Screws↗
[Intramedullary fixation in (impending) femur fractures caused by tumor metastases].
OBJECTIVE: To determine the results and complications of intramedullary nailing of (impending) pathologic femoral fractures. DESIGN: Retrospective. SETTING: University Hospital Maastricht. TIME. Between 1979 and 1993. METHOD: We analysed the results of 29 patients treated before 1990, and 12 patients treated after 1990, with a total of 46 (impending) pathologic femoral fractures. We evaluated primary cancer, duration of illness, pain, mobility, complications and survival. RESULTS: Mobility and pain improved after intramedullary nailing. In the group operated before 1990, in whom the femoral neck had not been stabilised, a femoral neck fracture was seen in 5 cases as a result of a metachronous metastasis. Once a metastasis developed in the scar. Because of these results we decided to stabilise the whole femur, including the femoral neck, with the Russell-Taylor Reconstruction Nail, and to irradiate the whole operation field. Neither femoral neck fractures nor metastases in the scar occurred after 1990. CONCLUSION: Intramedullary nailing is a valuable technique for stabilising (impending) pathologic femoral fractures. It is important that the whole femur, including the femoral neck, be stabilised and that the entire operation field be irradiated. The Russel-Taylor Reconstruction Nail is a suitable implant for this purpose.
Adult↗
Elastic stable intramedullary nailing of midclavicular fractures in athletes.
BACKGROUND: Intramedullary fixation of midclavicular fractures may be a better option than non-operative treatment for high performance/professional athletes because of the potential reduction in recovery time. OBJECTIVES: To evaluate the effectiveness of intramedullary fixation in high performance athletes and the time required to return to sporting activity. METHODS: Data were taken from a prospective study on intramedullary fixation techniques using the elastic stable Ti nail (TEN, Synthes) for the treatment of displaced midclavicular fractures, initiated in 1996. The patients in 12 cases were classified as high performance/professional athletes. These cases were used to evaluate the technique specifically in this population. Fractures were classified according to the Orthopaedic Trauma Association (OTA) system. Patients were evaluated before and after surgery for shoulder function and subjective pain. After the operation, radiological assessments documented fracture healing, and clinical outcomes scores were obtained. Time required to return to training and competition was documented. RESULTS: All fractures were transverse or oblique. Mean (SD) shoulder abduction increased from 36.3 (8) degrees before surgery to 154.2 (17) degrees afterwards (p<0.001). Mean subjective pain score using a visual analogue scale (0-100) decreased from 71.7 (18) points before surgery to 19.2 (6) points (p<0.001) three days after. There were no complications. Hospital stay averaged 2.9 (1) days. Mean delay to resumption of training was 5.9 (1) days, and to resumption of competition it was 16.8 (5) days. The mean Constant clinical outcomes score one year after hardware removal was 98.3 (2) points. CONCLUSIONS: Intramedullary fixation of displaced midclavicular fracture was successful in terms of clinical outcome and rapid resumption of sporting activities. This treatment should be offered to athletes as an alternative to non-operative treatment.
Adolescent↗
Closed intramedullary fixation of humeral shaft fractures.
During a seven-year prospective study, 158 humeral shaft fractures in 157 patients were treated with closed intramedullary nailing. Only humeral fractures not responsive to closed reduction and immobilization and those in noncomplaint patients were eligible. No immobilization was used postoperatively. Seven patients were lost to follow-up. A total of 148 fractures healed; there were three nonunions. The average time to clinical union was 7.2 weeks. There were no infections or malunions. Eight of 11 preoperative and three postoperative radial nerve palsies were lesions in continuity and healed spontaneously. The remaining three had been severed by missiles and needed further attention. Nail withdrawal occurred in eight patients; five of these needed nail revision. Final range of motion for the elbow averaged 132 degrees and shoulder abduction-external rotation averaged 168 degrees.
Adolescent↗
Intramedullary Steinmann pin fixation of forearm fractures in children. Long-term results.
The current study is a retrospective clinical and radiographic review of all children treated with intramedullary Steinmann pins for fixation of diaphyseal forearm fractures at one institution. Thirty patients were reviewed. Twenty-five patients had fractures of both bones, three had Monteggia fracture-dislocations, and two had isolated radial fractures. Eight fractures were open. The average age of the patients at the time of surgery was 9 years 3 months (range, 4 years 1 month-14 years 3 months). Time to union averaged 6 weeks but a slightly longer healing time was seen in patients older than 10 years of age. Subjective, objective, and radiographic evaluation at 3 years 6 months average followup revealed no significant side to side differences. There were six complications (two pin site infections, two cases of fracture displacement after pin removal, one extensor pollicus longus tendon rupture requiring repair, and one refracture), none of which affected outcome at followup. When combined with an open reduction, one intramedullary Steinmann pin provides adequate stability in most diaphyseal forearm fractures in children with excellent results and few complications.
Adolescent↗
Intramedullary screw fixation of Jones fractures. Analysis of failure.
Treatment failures after screw fixation of Jones fractures are reported to be infrequent. Between 1993 and 1999, 15 patients (mean age, 21.7 years) underwent cannulated screw fixation of a Jones fracture at our institution. There were six treatment failures: four refractures and two symptomatic nonunions. The mean time to full activity was 6.8 weeks for the patients with failure compared with 9 weeks for patients who did not have complications. Although all patients were asymptomatic and radiographically progressing to union before return to full activity, only one of six patients with failures had complete radiographic union, compared with six of seven patients with no complications. There was a higher proportion of elite athletes (division I or professional level) among the failure group (83%) compared with those without complications (11%). There were no significant differences in age, sex, screw diameter, use of bone graft, or age of fracture between patients with failures and those without complications. Return to full activity, especially among elite athletes, before complete radiographic union was predictive of failure. Even though intramedullary screw fixation offers advantages over nonoperative treatment, a significant risk of postoperative complications exists.
Adolescent↗
[Intramedullary fixation of humerus shaft fractures. An analysis of complications of 2 implants with special reference to outcome after management with the unreamed humerus interlocking nail].
INTRODUCTION: Operative treatment of humeral shaft fractures has gained a new impetus with the development of intramedullary interlocking systems for the humerus. Because of the anatomical structure of the humeral marrow cavity, a regular jamming of nail into bone is not to be expected, so that the stability of these systems needs to be achieved through an interlocking mechanism. Among the commercially available interlocking nailing systems the unreamed humeral nail (UHN) and the Seidel-nail (SHN) can be regarded as the standard implants. DESIGN: In a retrospective study comparing two groups of patients, each treated with one of the two systems, problems and advantages, as well as disadvantages were analyzed, and the complications inherent in the systems examined. PATIENTS: Between 1988-1992, 47 patients with humeral shaft fractures were treated with a Seidel interlocking nail: 25 acute and 18 pathological fractures as well as 4 non-unions (Group 1). Between 1997-1999, 34 patients with humeral shaft fractures were treated with the unreamed humeral nail (UHN). A total of thirty-five (n = 35) nailings (30 acute and 4 pathological fractures, as well as one re-osteosynthesis after emergence of a non-union) were carried out. Three primary palsies of the radial nerve ensued: two with loss of sensitivity, and one complete paralysis (Group 2). METHODS: Based on pre- and postoperative X-rays and follow-up examinations, the healing process and complications inherent in each of the systems were evaluated. RESULTS: Intra-operative complications of Seidel-nailing (Group 1) were seen in 5 cases: failure of the proximal target device in 2 (4.2%) cases; the breaking of the long screwdriver during the distal locking in 1 (2.1%) case; blockade of nail-insertion due to the spreading distal lamellas in 1 (2.1%) case; in 1 (2.1%) case it was impossible to find the imbus of the distal locking screw with the screwdriver. Incorrect surgical technique resulting in further fragmentation of the shaft required revisions in 2 (4.2%) cases. In 3 cases (6.4%), the insertion of the nail was insufficient, so that an impingement resulted. In 12 cases, postoperative complications after Seidel-nailing resulted: 3 (6.4%) radial nerve palsies, of which 2 (4.2%) were transitory; 3 (6.4%) infections; in 3 (6.4%) cases, loosening of the locking bolt inserted in the frontal plane; in 1 (2.1%) case, loosening of the distal spreading screw. The system failed in treating 2 (of 4) non-unions, whereas successful ossification and repair occurred in all acute fractures. In Group 2 (UHN) the acute fractures of 33 cases healed without complications. Intra-operative complications of the unreamed nail: in 2 cases (5.6%), failure of the target devices resulted in malpositoning of interlocking screws. The following intra-operative complications of the retrograde technique were observed: burst of a fragment at the insertion site in 1 case (2.8%); intra-articular positioning of the most proximal interlocking screw in another case (2.8%). Postoperative complications of the unreamed nail: breaking of a proximal and a distal interlocking screw in 1 case (2.8%), which had no influence on the healing progress. In 1 case (2.8%) both proximal interlocking screws came loose and a non-union ensued. After re-osteosynthesis with the same technique, bony repair was achieved. CONCLUSION: The possibilities of operative methods in treatment of humeral shaft fractures are enhanced by intramedullary interlocking systems. Comparing with the Seidel nail, the unreamed humeral nail (UHN) has two advantages: it can be inserted anterogradely as well as retrogradely, and it provides the possibility of compressing the fracture, resulting in a high rotational stability. Due to these results, the application of the UHN is recommended.
Adult↗