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Results for “Fracture Fixation, Intramedullary”

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PubMed1998

[Retrograde intramedullary nailing in proximal fracture of the humerus in the elderly patient. Results of a minimally invasive management concept].

Retrograde intramedullary fixation of proximal humerus fractures with flexible wires was evaluated in a prospectively documented study. Seventy-four fractures in 73 patients with unstable proximal humerus shaft or neck fractures were fixed with 3-11 flexible intramedullary wires. The age of the patients averaged 72 years (42 females, 31 males). In nine fractures additional implants (screws, cerclages) were used to fix dislocated fragments through an anterior approach to the shoulder. Complications associated with the procedure especially in osteoporotic bone were secondary loss of reduction (16%) and wire migration (21%) which lead to revision surgery in 14% of patients within 6 weeks. A minimum follow-up of 12 months (average 16.5 months) could be obtained in 61 patients (84%). According to the Neer- and Constant-scores 60% showed good or excellent results, 30% had a satisfactory and 10% had an unsatisfactory or poor result.--Retrograde intramedullary, flexible wire fixation can provide an overall satisfactory outcome in unstable proximal humerus fractures of the elderly. However, the high incidence of secondary wire dislocations especially in marked osteoporosis appears to be an unsolved problem of this treatment modality.

Aged↗

PubMed1998

Treatment of pathologic fractures of the humerus with Seidel nailing.

A retrospective study is presented of 14 patients with pathologic fractures of the humerus (12 established, two impending) treated with Seidel nailing from 1988 through 1995 in the authors' institution. There were nine women and five men whose average age was 59.5 years. Breast, prostate, and kidney hypernephroma accounted for the majority of the primary lesions. All but one lesion were located in the middle shaft of the humerus. Ten lesions were considered large (> 5 cm long). In five cases an open curettage and allografting were done. Early pain relief was successful in 85% of the patients. The worst complication found was definite nerve palsy in two (14.28%) patients. Ten fractures healed and two failed to heal. Two thirds of the patients had good functional results. The average survival was 12 months. Intramedullary fixation of pathologic fractures improves the quality of life by controlling pain for most patients.

Adult↗

PubMed2006

Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs.

We report a randomised prospective study comparing two implants, the Gamma trochanteric nail and the ACE trochanteric nail, in the treatment of intertrochanteric femoral fractures in the elderly. One hundred and twelve patients were randomised on admission into two treatment groups. Fifty-six patients were treated with Gamma nail implants, and 56 were treated with ACE trochanteric nail. The average age of these patients was 78 years. Twenty fractures were stable and 92 unstable. The mean follow-up time was 8 months (6 -12). Regular clinical and radiological review was done 1, 3 and 6 months postoperatively. Operation time, fluoroscopy time, blood transfusion and complications were recorded. The mobility score was used to assess the pre-injury and postoperative mobility status. All the patients were treated within 36 h of their accident. There were no complications during surgery. All the patients were mobilised in the first 24 h postoperatively, regardless of the fracture type, and weight bearing was permitted as tolerated. Union of the fracture was achieved in all patients. There was no statistically significant difference between the two groups with regard to the studied parameters. There was no mechanical failure of the implants despite the early patient mobilisation. Early operation and early mobilisation resulted in a good functional outcome in all patients. Both the trochanteric gamma nail and ACE trochanteric nail provide effective methods of treatment for intertrochanteric fractures in elderly patients.

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PubMed2005

Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study.

BACKGROUND: Unstable intertrochanteric fractures in elderly patients are associated with a high rate of complications. The purpose of this investigation was to compare the results of long-stem cementless calcar-replacement hemiarthroplasty with those of treatment with a proximal femoral nail for unstable intertrochanteric fractures in elderly patients. METHODS: Fifty-eight elderly patients with an AO/OTA type 31-A2 intertrochanteric fracture of the femur were randomized into two treatment groups and were followed for a minimum of two years. The twenty-nine patients in Group I were treated with a long-stem cementless calcar-replacement prosthesis, and the twenty-nine patients in Group II were treated with a proximal femoral nail. The two treatment groups were comparable with regard to demographic and injury variables. RESULTS: There were no significant differences between the groups in terms of functional outcomes, hospital stay, time to weight-bearing, or general complications. Patients treated with a proximal femoral nail had a shorter operative time, less blood loss, fewer units of blood transfused, a lower mortality rate, and lower hospital costs compared with those treated with the long-stem cementless calcar-replacement prosthesis. CONCLUSIONS: In elderly patients with an unstable intertrochanteric femoral fracture, a proximal femoral nail provides superior clinical outcomes but no advantage with regard to functional outcome when compared with a long-stem cementless calcar-replacement arthroplasty. LEVEL OF EVIDENCE: Therapeutic Level I.

Age Factors↗

PubMedDate not supplied

Intramedullary Kirschner wiring for tibia fractures in children.

This is a retrospective analysis of the results of 84 tibial fractures in children treated by intramedullary Kirschner wiring. Thirty were open fractures (9 grade I, 10 grade II, 8 grade IIIA, 3 grade IIIB). There were 65 boys and 18 girls with an average age of 10.23 years (range 4-15). The patient was placed supine on an orthopedic traction table. Under fluoroscopic control, two Kirschner wires (2.5-3.5-mm thick) were introduced antegrade from proximal metaphysis (level of tibial tuberosity) to distal metaphysis, one each from medial and lateral cortices. Open fractures were stabilized after meticulous wound débridement. Average time to union was 9.5 weeks (range 8-14). None developed delayed union. However, one grade IIIB open fracture progressed to infected nonunion; it healed after an autogenous bone graft. No infections were seen in closed fractures, but four superficial and one deep infection occurred in open fractures. Closed intramedullary Kirschner wire fixation for unstable or open tibial fractures in children is a simple surgical technique that produces good clinical and functional results.

Adolescent↗

PubMed2005

Intramedullary nailing following external fixation in femoral and tibial shaft fractures.

BACKGROUND: Intramedullary nailing is the standard of care for the definitive management of lower extremity long bone fractures. Occasionally, temporary external fixation is used in fractures with severe open wounds or vascular injury before definitive intramedullary nailing. Secondary intramedullary nailing following external fixation is somewhat controversial, especially with respect to the duration of external fixation that is allowable before the risk of infection following later nailing becomes too great. Several recent studies have provided further insight into this issue. OBJECTIVE: The primary objective is to evaluate infection and nonunion rates in patients treated with temporary external fixation and secondary intramedullary nailing for lower extremity long bone fractures. The secondary objective is to evaluate whether the duration of external fixation and the interval time (defined as the time from external fixator removal to intramedullary nailing) influence the risk of infection after intramedullary nailing.

External Fixators↗

PubMed2005

[Internal fixation of proximal humerus fractures].

BACKGROUND: Intramedullary nails and angle-fixed plates have recently been used in proximal humerus fractures. Rigid implants might be associated with an increased risk of failure in osteoporotic conditions. METHODS: Unstable fractures of the surgical neck were created in 24 pairs of human humeri. The biomechanical properties of four implants were analysed. These were a nail with conventional interlocking (PHN-K), a nail with spiral blade interlocking (PHN-S), the T-plate, and an internal fixator with elastic screw properties (reference). The specimens were subjected to axial loading and torque. Stiffness, plastic deformity, and load to failure were assessed. RESULTS: The PHN-S was stiffer than the internal fixator. The PHN-K and T-plate were stiffer only during torque. Less subsidence was observed for the PHN-S. This implant failed at higher loads than the other implants. CONCLUSIONS: The PHN-S offers biomechanical advantages in unstable fractures of the surgical neck of the humerus. Elastic implant properties, however, are disadvantageous.

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PubMed2003

Proximal tibial fracture stability with intramedullary nail fixation using oblique interlocking screws.

OBJECTIVES: The purpose of this study was to evaluate the mechanical stability of oblique interlocking screws in supplementing intramedullary nail fixation of high proximal tibial fractures. DESIGN: In vitro experimental testing. SETTING Orthopaedic biomechanics laboratory, Sunnybrook and Women's College Health Sciences Center. PARTICIPANTS: Ten paired fresh-frozen human cadaver tibiae. INTERVENTION: One tibia of each pair was randomized to be instrumented with an intramedullary nail (M/DN; Zimmer, Warsaw, Indiana), while the other was stabilized with a 13-hole stainless steel lateral tibial head plate (Synthes AO/ASIF). Specimens were tested in varus-valgus (v/v), flexion-extension (f/e) and torsion, before and after a 2-cm gap osteotomy was performed in the proximal segment. Testing of the nailed tibiae was performed with and without oblique proximal screws. Bone density was physically determined by removing a core of trabecular bone from the distal end of each tibia following testing. MAIN OUTCOME MEASUREMENT: Biomechanical construct stability. RESULTS: The addition of the proximally placed oblique screws increased the stability of the nail construct in v/v by 50% (6.8 mm, P < 0.05), in f/e by 47% (7.2 mm, P < 0.05), and in torsion by 18% (3.0 degrees, P < 0.05). There was no significant difference observed between the stability of the intramedullary nail construct with oblique screws and the plated construct. Trabecular bone density had a significant effect in reducing stability (P < 0.05) in nail and plate fixation. CONCLUSION: The addition of oblique interlocking screws significantly improves the stability of a nailed proximal tibia fracture and provides comparable stability to a plate osteosynthesis.

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PubMed2005

Intramedullary nailing of metacarpal shaft fractures.

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.

Fracture Fixation, Intramedullary↗

PubMed1996

Use of a supracondylar nail for treatment of a supracondylar fracture of the femur following total knee arthroplasty.

Treatment of displaced or comminuted supracondylar fractures of the femur following total knee arthroplasty is challenging and problematic. Closed treatment has been associated with malunion, nonunion, and loss of motion, whereas early operative treatment has been associated with infection as well as nonunion. Intramedullary fixation of these fractures has the theoretical advantage of preserving periosteal blood supply while allowing early motion. The use of a nail specifically designed for supracondylar femur fractures to treat a a periprosthetic fracture about a well-fixed total knee arthroplasty is reported. This device provides a valuable treatment option to the surgeon treating this difficult problem.

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PubMed1975

Treatment of infected un-united femoral shaft fractures.

Twenty patients treated for osteomyelitis following intramedullary fixation of fractures of the femoral shaft were assessed from the standpoint of antibiotics, internal fixation, drainage, sequestrectomy and external support. Analysis of intramedullary fixation in the form of Küntscher nailing with respect to the rate of union, duration of treatment and number of operative procedures, suggests that rigid intramedullary fixation is superior to plates and screws and plays an important role in development of union in the presence of infection.

Adolescent↗

PubMed2003

Intramedullary transmetatarsal Kirschner wire fixation of Lisfranc fracture-dislocations.

Lisfranc joint injuries are frequently the result of high-energy accidents. The usual method of treatment is open reduction and internal fixation or closed reduction with percutaneous pinning. In cases in which soft tissue injury may compromise open reduction and internal fixation or traditional pinning techniques, transmetatarsal Kirschner wire fixation may be performed, allowing the placement of temporary hardware away from the site of soft tissue injury. The following report details this technique as it has been used in 3 patients.

Adult↗

PubMed1993

[Unreamed intramedullary nail or external fixator in complicated tibial fracture? A comparative analysis].

Sixty-seven fractures of the tibial shaft with concomitant soft tissue injury were managed at the "Bergmannsheil" Bochum, University Clinic between May 1, 1991 and March 31, 1993. 33 fractures underwent unreamed nailing whereas 34 fractures were stabilized with external skeletal fixation. There were 20 closed fractures with soft tissue compromise (13 types GII and 7 types GIII (Oestern/Tscherne classification)) and 25 compound fractures (8 grade I, 12 grade II and 27 grade III (Gustilo-Anderson classification)). The grade III open fractures were subdivided by the Gustilo-Mendoza-Williams classification (13 types IIIA, 10 types IIIB and 4 types IIIC). Sixty-five fractures have healed (1 amputation type IIIC, 1 patient died). The mean time to union was 28 weeks in the fixator group and 23.5 weeks in the unreamed nail group (statistically not significant, p < 0.095). Also the infection rate (1 case in each group), the fasciotomies due to compartment syndrome, the number of bone grafts, the number of device change and mesh grafts was not statistically significant in both groups. Only the number of performed flaps for wound coverage was statistically significant higher in the fixator group (p < 0.05). In the unreamed nailing population, breakage of the locking bolts occurred in 4 cases. In 3 cases secondary reamed nailing was necessary (2 delayed unions, 1 avulsion of distal bolts). Two fractures underwent dynamization by removal of the distal locking bolts 6 weeks post initial static nailing. The unreamed nail is a versatile implant for tibial shaft fractures with closed and open soft tissue compromise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Intramedullary stabilization of neoplastic destructive disease involving the subtrochanteric region of the femur.

Neoplastic destructive disease involving the subtrochanteric region of the femur is a difficult condition to treat. This is a retrospective study of 11 femurs in 10 patients with subtrochanteric destructive lesions or pathologic fractures that were stabilized with the Zickel intramedullary device. The study investigated underlying disease process, ambulatory status, operative parameters, time to death, and associated metastasis. The average survival time of the patients who died was 4.7 months. All of the patients involved in this study could be mobilized, but only 3 out of 10 were ambulatory. This study concludes that the intramedullary fixation of pathologic fractures or lesions of the subtrochanteric region does not necessarily allow ambulation, but does allow mobilization of debilitated patients.

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PubMed2006

Eight years' clinical experience with the Orthofix tibial nailing system in the treatment of tibial shaft fractures.

Intramedullary nailing has become a popular and effective procedure for the treatment of most tibial fractures. However, concerns regarding difficulties with reduction, the use and extent of intramedullary reaming, and hardware failure are probably the only constraints to its widespread use. In this prospective study, we present the clinical and radiographic results of the Orthofix tibial nailing system used in the treatment of tibial shaft fractures. One hundred and fifteen fresh tibial fractures in the same number of patients with a mean age of 37.5 years (17-85 years) were treated with operative stabilisation using the Orthofix tibial nailing system. All of the operations took place in a conventional operating theatre, on a simple tranlucent operating table and with manual reduction of the fracture. In the majority of the cases closed reduction and conventional reaming were performed and the mean duration of the operation was 38 min. Fracture healing occurred at 16 weeks (11-30 weeks) and was confirmed both clinically and radiographically. In six cases (two severely comminuted and four segmental fractures) delayed union occurred, however there were no tibial non-unions necessitating re-operation. There were no substantial differences in time to fracture union or in the rate of complications related to minimal open reduction. In addition, there seem to be more benefits than risks in the use of power intramedullary reaming during intramedullary fixation of tibial shaft fractures. In conclusion, most tibial shaft fractures can effectively and safely be treated using this type of locking intramedullary nailing device, with relatively few complications, and with satisfactory long-term clinical results.

Adolescent↗

PubMed2002

[Technique of intramedullary osteosynthesis of the clavicle with elastic titanium nails].

This prospective controlled clinical trial was performed to assess fracture healing and clinical outcome after intramedullary nailing of midclavicular fractures. Within 3.5 years elastic-stable intramedullary nailing was performed in 62 patients with 65 midclavicular fractures. Surgery was performed in supine position. The ventral cortex of the proximal clavicle was opened using a 2.5 mm drill. The nail was advanced laterally under fluoroscopic control. If closed reduction failed, an additional incision was made to enable direct manipulation of the fragments. There were no infections, no implant displacements or refractures. Postoperatively, the mean subjective pain was significantly lower, and the range of motion improved. We observed one nonunion. The mean Constant-score 6 months after hardware removal was 96.9 +/- 3.3 points. Intramedullary fixation of midclavicular fractures with an elastic titanium nail is a safe minimally invasive surgical technique, producing excellent functional and cosmetic results.

Adolescent↗

PubMed2001

Limited bone loss in the hip and heel after reamed intramedullary fixation and early weight-bearing of tibial fractures.

OBJECTIVE: To determine changes in bone mineral density at the hip and calcaneus in the injured and uninjured sides after surgery for tibial fractures. DESIGN: Prospective, longitudinal study. SETTING: University hospital. PATIENTS AND METHODS: Twenty-six patients with a tibial fracture were treated with a reamed and statically locked intramedullary nail with early weight-bearing. Dual-energy x-ray absorptiometry at the proximal femur and quantitative ultrasonography at the calcaneus were performed bilaterally after surgery and after three, six, and twelve months. RESULTS: At three months, the bone mineral density in the trochanteric region in the injured limb had decreased almost 4 percent (p < 0.007), a reduction still present at twelve months, whereas in the femoral neck, the reduction was approximately 2.5 percent at twelve months (p < 0.03). The stiffness index and speed of sound at the calcaneus on the injured side decreased (p < 0.03 and p < 0.008, respectively) during the first three months, whereas at twelve months, there was no significant difference when compared with those measured directly after surgery. There were no significant changes at any time in the proximal femur or calcaneus of the uninjured limb. CONCLUSION: Treatment with a reamed statically locked intramedullary nail and early weight-bearing resulted in limited bone loss in the proximal femur and calcaneus of the injured limb. After twelve months, the bone properties at the heel were restored, whereas there was still a small reduction at the hip. Compared with previous studies of patients with similar fractures treated with casts and restricted weight-bearing, the loss in bone mineral density was less and not as longstanding.

Adolescent↗

PubMed1975

[Treatment of fractures of the humerus by intramedullary fixation].

The Hackethal's technique of intramedullaring wiring for humeral fracture represents the immobilisation procedure particularly convenient for this bone. This procedure can be realised without special instrumentation with Kirschner's wires and image intensifior. To allow the approach of the fracture, the patient's position is choosed upon the topography of the lesion. The intramedullaring wiring is always done from down to up. Indications for this procedure are: humeral shaft fracture, humeral neck fracture, and fractures of the shaft and of the neck. During the reduction of the fracture, the immoderate use of a image intensifior seams to be the major risk. Hackethal's technique for medullary wiring was used in 21 patients, only one pseudarthrosis was noted. The fonctionnal recovery of the arm is usually realised in three months.

Adolescent↗