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PubMed1989

Intramedullary devices for tibial fracture stabilization.

Reamed tibial nails that allow interlocking have been the most significant recent advance in the management of tibial fractures. Interlocking nails have expanded the indications for intramedullary fixation to include most nonarticular tibial fractures. Regardless of the amount of comminution, tibial fractures extending from just distal to the tibial tuberosity to 5 cm above the ankle joint may now be safely stabilized with interlocking nail devices.

Adult↗
PubMed1999

Pulmonary gas exchange during intramedullary fixation of femoral shaft fractures.

BACKGROUND: This study was undertaken to determine if the alveolar dead space fraction (Vd/Vt) or the alveolar-arterial oxygen gradient (A-a DO2) increased during intramedullary fixation of femoral shaft fractures. METHODS: Fifty hemodynamically stable patients with femur fractures were prospectively enrolled. Three serial measurements of Vd/Vt and A-a DO2 were obtained immediately before femoral nailing (Pre), 30 minutes after nailing (+30), and 120 minutes after nailing (+120). Vd/Vt was determined by simultaneously measuring PaCO2 and the steady-state end-tidal CO2 (PetCO2), where Vd/Vt = (1 - PetCO2/PaCO2). RESULTS: Vd/Vt before nailing was 0.09 +/- 0.09 (mean +/- SD); at +30 and +120, Vd/Vt was 0.10 +/- 0.06 and 0.08 +/- 0.07, respectively (p > 0.2; paired t test, both time points). A-a DO2 before nailing was 84 +/- 85 mm Hg, and it did not change significantly at +30 (89 +/- 69 mm Hg; p = 0.51 vs. Pre; paired t-test) or at +120 (51 +/- 45 mm Hg). No difference in data was found with analysis by fracture classification or number of reamer passes. Vd/Vt and A-a DO2, however, were both significantly increased in patients with lung contusion (n = 6) before nailing, but neither measurement increased after nailing. One patient developed fat embolism (Vd/Vt of 0.35 at Pre and 0.31 at +120), and another patient experienced postoperative pulmonary thromboembolism (Vd/Vt increased from 0.06 at Pre to 0.17 at +120). CONCLUSION: The process of femoral nailing does not cause enough pulmonary embolization to alter pulmonary gas exchange as measured by Vd/Vt and A-a DO2. If Vd/Vt is increased preoperatively, the likelihood of subsequent pulmonary dysfunction secondary to either preoperative lung injury or fat embolism is increased.

Adult↗
PubMed1978

The Jones fracture revisited.

Twenty-two patients with twenty-three fractures of the proximal part of the diaphysis of the fifth metatarsal, an injury originally described by Jones, are reported. The average follow-up was 3.5 years. Delayed union occurred in twelve (66.7 per cent) of eighteen patients treated conservatively. Four patients were operated on within two weeks of injury. The clinical picture in nine of the twenty-two patients suggested that the injury was a stress fracture. Force-platform analysis in eleven cases confirmed that the injury results from vertical and mediolateral forces concentrated over the fifth metatarsal and that it is not caused by inversion. Thirteen of the twenty-three fractures were in young athletes, often occurring during training and causing significant disability. In this group of patients, and in a select number of recreational athletes and non-athletes with delayed union, intramedullary screw fixation of the fracture is advised.

Adolescent↗
PubMed1996

Retrograde intramedullary nailing of the femur using a tibial nail--the adjunctive use of an existing implant: a case report.

A 74-year-old male involved in a pedestrian-automobile collision sustained a comminuted supracondylar-diaphyseal femur fracture. The fracture was stabilized by retrograde intramedullary fixation with a Synthes unreamed tibial nail. Knee motion reached 0 degree-120 degrees by the sixth postoperative day and the fracture healed within twelve weeks. Twelve months after his injury, his knee motion was symmetric to his uninjured side and he had resumed full preinjury activities, including martial arts training. Although antegrade intramedullary nailing remains the treatment of choice for fractures of the femur, this case highlights the usefulness of retrograde nailing and demonstrates the adjunctive application of an existing implant, the tibial nail, in certain special trauma situations.

Accidents, Traffic↗
PubMed2000

Comparison of intramedullary fixation and percutaneous pinning of displaced and comminuted Colles' fractures: a prospective and consecutive study.

This consecutive study comprised 86 patients who were available for follow up 5-51 months after sustaining a Colles' fracture--Older type IV. A total of 42 patients were treated with Kirschner (K) wires of whom one had bilateral fracture. Forty-four patients (of whom two had bilateral fractures) were treated with Rush nails. A functional assessment of the patients was made using both a questionnaire and a clinical examination. The end-results of residual deformity, subjective and objective findings, and complications were evaluated according to the Lucas' modification of the Sarmiento demerit point-rating system. At follow-up, the ulnar/radial deviation was significantly better in the patients operated on with K-wires (37 degrees compared with 27 degrees, p < 0.02, range in both groups 0-80 degrees), but no differences were found in the other directions of movement. A total of three patients (7%) developed complications. The final result showed that 40 (93%) of the fractures treated with K-wires were excellent or good compared with 38 (86%) of those operated on with a Rush nail. One fracture in each group (2%) had a poor outcome. Comparison of the final results showed no significant difference between the two groups.

Adult↗
PubMed2002

Unreamed intramedullary nail versus external fixation in grade III open tibial fractures.

BACKGROUND: The optimum method for skeletal stabilization of severe open fractures of the tibial shaft remains controversial. METHODS: We compared the results of the AO unreamed tibial nail (URTN) with external fixation (Ex-Fix) in the treatment of patients with a grade III injury of the tibial diaphysis. Thirty patients were retrospectively reviewed, with a mean follow-up of 25 months (range, 12-56 months). Seventeen patients were treated with external fixation (grade IIIA, 12 patients; grade IIIB, 4 patients; and grade IIIC, 1 patient) and 13 with a URTN (grade IIIA, 6 patients; grade IIIB, 6 patients; and grade IIIC, 1 patient). Both groups were comparable with respect to age, gender, fracture severity, and Injury Severity Score. RESULTS: Mean time to full weight bearing was 37.4 weeks in the Ex-Fix group versus 22.2 weeks in the URTN group (p = 0.0069, t test). Seven patients in the Ex-Fix group required further surgery for nonunion versus two in the URTN group. There were four significant pin track infections. Removal of URTN was required in one case of deep infection. CONCLUSION: This study supports the use of the URTN over external fixation in the treatment of severe open tibial fractures.

Adolescent↗
PubMed1996

[Intramedullary nailing of open fractures].

The goal of treatment of open fractures is to prevent infection, promote fracture healing, and restore normal limb alignment and function. The initial treatment of these fractures includes: debridement, soft tissue coverage, antibiotic therapy, and fracture stabilization. Four different techniques for intramedullary nailing for the fixation of open fractures have been employed: (1) unreamed, unlocked nails (i.e., Ender and Lottes, which have low infection rates, but are mechanically insufficient); (2) reamed unlocked nailing (which relies on overreaming to provide stability through bone-nail surface contact, but is associated with high infection rates); (3) reamed locked nailing (which may rely on limited reaming because of the interlocking screws); and (4) unreamed nailing (which always relies on interlocking screws and is associated with function better than and infection rates similar to those with external fixation, but has an increased incidence of screw breakage). In contrast to the biological problems in the tibia, those problems encountered in the femur are more predominantly mechanical in origin. For humeral shaft fractures, shoulder problems associated with the antegrade approach are frequent, and bypassing the rotator cuff with a retrograde approach appears advantageous.

Anti-Bacterial Agents↗
PubMed2007

Treatment of pathological humeral shaft fractures with unreamed humeral nail.

PURPOSE: The purpose of this study is to analyze the results of intramedullary fixation of pathological humeral shaft fractures using an unreamed humeral nail (UHN). PATIENTS & METHODS: Twenty-one consecutive patients with 24 humeri fractured secondary to metastatic disease were retrospectively reviewed. The primary tumors included carcinomas of breast (11), kidney (2), multiple myeloma (2), colon (2), prostate (1), thyroid (1), lymphoma (1) and unknown origin (1). All fractures were stabilized with antegrade unreamed humeral nailing. Cemented technique was performed in 5 procedures. The mean age was 64 (range, 40-86), male to female ratio 6:15. RESULTS: Blood loss was unremarkable in 19 patients (22 procedures). Two patients who underwent fixation of additional pathological fractures during the same operation were given a total of 3 units of PC perioperatively. Mean postoperative hospitalization period due to one UHN procedure alone was 3 days (range, 2-7 days). Two patients died of their disease within 3 weeks of surgery. The remaining 19 patients returned to nearly normal function within 6 weeks after nailing. One patient developed postoperative local wound cellulitis. Relief of pain was rated as good in all but one patient. Adjuvant therapy was given in 20 procedures. Bony union was achieved in 88% (15/17) of all the cases where the patient had survived a minimum of 3 months. CONCLUSION: Unreamed humeral nailing of the pathological humeral shaft fractures provides immediate stability and pain relief, minimum morbidity and early return of function to the extremity.

Adult↗
PubMed1999

Pain control and cultural norms and expectations after closed femoral shaft fractures.

The purpose of this observation-cohort survey study was to compare the analgesia given and satisfaction with analgesia after a uniform orthopedic injury and operation in culturally disparate settings. Twenty-five patients with isolated closed femoral shaft fractures treated with intramedullary rod fixation within 1 week of injury were retrospectively evaluated at two urban hospitals in the United States. They were compared with a matched group from three urban hospitals in Vietnam (two in Hanoi and one in Ho Chi Minh City [Saigon]). Ages and sex did not differ significantly between the two groups. The mean weight of the Vietnamese group was significantly less than that of the US group (58 vs. 81 kg). During the 14 days following injury, the Vietnamese and American groups were given a mean of 0.9 mg/kg per day versus 30.2 mg/kg per day of morphine equivalent units, respectively. Two (8%) of the Vietnamese group felt their pain control had been inadequate, versus 20 (80%) of the US group. Similarly, 2 (8%) of the US group and 7 (28%) of the Vietnamese group felt they had received "too much" pain medication. Mean heart rates during the first 5 days after surgery were not significantly different in the two groups. Only 4% of the US group felt they had had an accurate impression of how much a femur fracture would hurt prior to the injury, whereas 76% of Vietnamese patients responded that they imagined such an injury would be approximately as painful as it was. Results were similar for preconceptions of pain as a result of surgery and during the postoperative period. More than 50% of patients from the US group felt there must be some explanation other than the femur fracture to explain the severity of their pain, such as infection, missed injury, hardware failure, or inappropriate medical care. Despite much higher administration of narcotic analgesia, American patients with femoral shaft fractures were much more dissatisfied with their analgesic results. In assessing the recommended dosing for "adequate analgesia" and "analgesic requirements," determinations may depend less upon tissue injury than upon cultural norms and patient expectations.

Adult↗
PubMedDate not supplied

An in vitro biomechanical investigation of an MP35N intramedullary interlocking nail system for repair of third metacarpal fractures in adult horses.

OBJECTIVE: To compare monotonic mechanical properties of gap-ostectomized third metacarpal bones (MC3) stabilized with an MP35N interlocking nail system with contralateral intact bones. ANIMALS OR SAMPLE POPULATION: Twenty-four pairs of cadaveric equine MC3s. METHODS: Third metacarpal bones were divided into 4 mechanical testing groups (6 pairs per group): compression, palmarodorsal (PD) and mediolateral (ML) 4-point bending, and torsion. One MC3 from each pair was randomly selected as an intact specimen, and the contralateral gap ostectomized bone was stabilized with a 4-hole, 14-mm-diameter, 250-mm-long, MP35N intramedullary nail, and four, 7-mm-diameter, 60-mm-long MP35N interlocking screws (constructs). Mechanical testing properties were compared between intact specimens and constructs with a paired t test (significance set at P <.05). RESULTS: Intact specimens were significantly stronger and stiffer than constructs in all testing modes except PD bending. Constructs achieved mean yield strengths that were 57% (compression), 81% (PD bending), 68% (ML bending), and 78% (torque) of intact specimens. Constructs achieved mean stiffnesses that were 53% (compression), 58% (PD bending), 41% (ML bending), and 47% (torque) of intact specimens. CONCLUSION: Monotonic yield mechanical properties of MP35N intramedullary interlocking nail-stabilized, gap-ostectomized MC3 were lower than those of paired intact bones but exceeded reported in vivo loads for dorsopalmar bending and compression and estimated in vivo torsional loads. CLINICAL RELEVANCE: Considering the benefits associated with intramedullary interlocking nail fixation of fractures, this system should be considered for use for repair of MC3 fractures with applicable fracture configurations.

Animals↗
PubMed1991

Management of supracondylar fractures of the femur with the GSH intramedullary nail: preliminary report.

The GSH supracondylar nail is a closed section rigid intramedullary device that combines the biomechanical advantages of intramedullary fixation with the stability of rigid internal fixation for the management of supracondylar fractures of the femur. The use of this implant is indicated in the management of distal comminuted nonarticular fractures and fractures with intraarticular extension. Intramedullary fixation provides improved fracture stabilization in both elderly patients with osteoporotic metaphyseal bone and in younger patients with extensively comminuted fractures. The experience with the GSH supracondylar nail has shown that it provides better results than supracondylar plating for the stabilization of acute fractures or revision of failed internal fixation.

Adult↗
PubMed1985

A new type of intramedullary nail for the internal fixation of subtrochanteric fractures of the femur.

The Author has developed a modified intramedullary nail for the stabilisation of fractures in the subtrochanteric and proximal one-third of the femur. Due to its three tapered fins the rod fits well into the funnel-like medullary cavity of the proximal femur preventing varus or rotational displacement of the proximal fragment. This method has been applied in 16 cases. Its particular advantages are the chance to perform the operation closed, a short operating time and period in hospital, early weight bearing and a simple surgical technique without the need for special instrumentation, requiring little radiographic exposure during surgery. The ideal and relative indications for the application of the technique are discussed. Biomechanical tests have confirmed that the finned medullary nail is the most stable method of fixation of the fractures when compared with other alternative devices.

Adult↗