Guide-wire exchange before insertion of intramedullary nails

In the past, before a reamed intramedullary nail was inserted, it was mandatory to exchange the beaded-tip reaming guide wire with a smooth-tip wire. This additional step is optional in most new nail designs. Here we describe 2 cases in which not exchanging the wire led to initial wire incarceration and introduced additional steps that had to be taken before locked nailing could be completed. Intramedullary nail designs that avoid extra steps and thereby promote simplicity and reliability of insertion are potentially advantageous to both patient and surgeon. Eliminating the exchange tube and the smooth wire, however, should be approached with caution, as no time may be saved, and the procedure may be made much more difficult technically.     

重建钉治疗股骨转子下骨折

目的 报告重建钉治疗股骨转子下骨折的临床效果。方法 1997年1月～2003年6月间采用Russell—Taylor重建钉治疗股骨转子下骨折5l例，Russell—TavlorIA型9例，IB型26例，n型2例，IIB型14例。高能量损伤34例，低能量损伤17例。33．3％(17例)合并其它损伤．开放骨折5例。结果 平均随访18．5月(3～36个月)，5l例骨折全部愈合，临床骨愈合时间平均为术后13．5周(8～26周)。患肢功能按Sandcns髋关节创伤评分标准，优良率达94．11％(48／51)。3例老年患者术后关节疼痛。结论 用Russell—Taylor重建钉治疗各种类型的股骨转子下骨折都能取得良好疗效，骨愈合率高，并发症少。     

Double fractures of AO intramedullary femoral nails

We report two cases of double fractures of AO intramedullary femoral nails, with metallurgical analysis of one of the nails. Technical errors were noted in both cases and in these circumstances careful assessment of fracture union is required because double fracture can lead to potentially difficult revision surgery.     

Arthroscopically-assisted removal of retrograde intramedullary femoral nails

Retrograde nailing of femoral shaft fractures has become more prevalent as a result of its growing acceptance and familiarity to orthopaedic surgeons. Nail removal is occasionally indicated, which may require a formal arthrotomy. We describe an arthroscopic removal technique that has several advantages. The percutaneous technique imparts less morbidity than a more extensive arthrotomy. More importantly, additional intra-articular pathology can be thoroughly assessed and treated, such as meniscal tears and chondral injury, which may have occurred at the time of injury. These are potential causes of knee pain, which usually cannot be properly diagnosed without arthroscopy. Our findings also support the existence of a stable fibrous cap, which forms over the entry portal of a well-seated retrograde femoral nail as well as no evidence of intra-articular metallosis.     

Mechanics of intramedullary nails for femoral fractures

Biomechanical studies were carried out to assess the function and performance of intramedullary (IM) nails for femoral fractures. An appropriately sized femoral IM nail with a radius of curvature of about 109 cm would most closely match the anterior bow of most human femora. A number of parameters can interact to result in bursting of the femur during insertion of the nail. These include mismatch in curvature of the nail and femur, high stiffness in bending, and poor location of the starting hole. An anatomic starting position for the IM nail is just medial to the greater trochanter and anterior to the pyriformis recess. Moving anterior to the midline of the femur significantly increases the potential for bursting the femur during insertion of the nail. Other factors can decrease the force of insertion of the IM nail in the femur. These include overreaming, shortening the axial length of the fracture component, and use of a nail of lower bending rigidity. IM-nail-fixed femoral shaft fractures with locking bolts can be expected to have about 75% the rigidity of the intact femur in bending and can support about 400% of normal body weight (= 70 kg). Slotted IM nail/femur constructs have only about 3% the rigidity of the intact femur in torsion, while an unslotted (closed) section implant produces constructs with about 50% the rigidity. The distal locking bolts increase the torsional rigidity and maximum axial load capacity of the construct, and reduce the potential for shortening and the residual deformation upon release of a torsional load. Two distal bolts reduce the toggle of the nail in the femoral shaft.(ABSTRACT TRUNCATED AT 250 WORDS)     

股骨顺打交锁髓内钉治疗股骨骨折的初步研究

目的探讨股骨顺打交锁髓内钉(FAN)治疗股骨干粉碎性骨折或股骨干合并股骨颈骨折的方法和疗效。方法2005年7月～2006年7月,采用FAN治疗股骨骨折6例,其中股骨干粉碎性骨折4例,股骨干合并股骨颈骨折1例,转子下骨折合并股骨干骨折1例。结果所有患者获得3～10个月(平均8个月)随访,均获得了满意疗效,骨折愈合良好,临床功能恢复正常。结论FAN治疗复杂股骨干骨折,具有使用方便、符合生物力学要求、手术创伤小的优点,且有利于伤肢功能恢复。但需正确掌握其手术操作技术。     

带锁髓内钉固定治疗股骨或胫腓骨骨折

1996年 7月～ 1999年 12月 ,我院对 2 1例下肢骨折采用切开复位带锁髓内钉固定治疗 ,取得满意效果。1　材料与方法1.1　病例资料　本组 2 1例 ,男 15例 ,女 6例 ,年龄 18～ 4 7岁。股骨骨折 12例 ,左侧 5例 ,右侧 7例 ;胫腓骨骨折 9例 ,左侧 3例 ,右侧 6例。其中开放性骨折 4例 ,陈旧性骨折 7例 (包括延迟愈合及骨不愈合 ) ,全部采用切开复位带锁髓内钉固定治疗。1.2　手术方法　开放性骨折 ,立即清创 ,内固定 ;闭合性骨折一般在创伤后10ｄ左右 ,待患肢肿胀消退后再行手术。以骨折端为中心 ,切口 4～ 8ｃｍ ,暴露骨折端后少量剥离骨膜 ,直视…     

弓形髓内针治疗股骨胫腓骨骨折

1992～ 1999年我院使用弓形针治疗股骨胫腓骨骨折 98例 ,疗效满意。1　材料与方法1 1　病例资料　本组 98例 ,男 70例 ,女 2 8例 ,年龄 12～ 68岁。车祸 4 5例 ,砸伤 2 0例 ,摔伤 18例 ,挤压伤 15例。损伤部位 :股骨干上段骨折 8例、中段骨折 18例、下段骨折 12例 ;胫骨干上段骨折 10例、中段骨折 2 6例、下段骨折 2 4例。其中包括股骨、胫腓骨骨折经钢板和Ｖ形针、梅花针髓内穿针术后发生弯曲折断 3例。1 2　治疗方法　术前根据股骨胫骨的长短、髓腔的大小选择适当规格的弓形针。股骨在股骨髁上 4ｃｍ即髌骨上缘股骨轴线两侧傍开 5ｃｍ各作…     

Ipsilateral hip and femoral shaft fractures treated with intramedullary nails

This study retrospectively analysed 34 patients with ipsilateral hip and femoral shaft fractures treated over a period of 10 years between January 1995 and January 2005. They had an average age of 35 years. Twenty-six (76.47%) of these cases suffered high-velocity trauma (RTA); six others had fallen from a height (17.65%), and two had suffered only minimal trauma (5.88%). Twenty were extracapsular (58.82%) and 14 were intracapsular. They were evaluated with an average follow-up of 28 months, both clinically and radiologically; 26 patients (76.47%) had a good result (Friedman and Wyman score). When the intracapsular fracture was detected postperatively, there was one delayed union and one non-union. When the fracture is diagnosed preoperatively, we recommend reconstruction nail fixation. If the hip fracture is diagnosed intra- or postoperatively following nailing of the shaft, we propose the miss-a-nail technique as an option.

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Résumé Etude rétrospective de 34 patients, d’age moyen 35 ans, qui présentaient une fracture homolatérale du col et de la diaphyse fémorale entre janvier 1995 et janvier 2005. 26 cas (76,47%) étaient survenus après un traumatisme à haute énergie, 6 (17,65%) après une chute d’une hauteur importante et 2 (5,88%) après un traumatisme minime. 20 fractures du col étaient extracapsulaires et 14 intracapsulaires. L’évaluation clinique et radiologique était faite avec un recul moyen de 28 mois et montrait 76,47% de bons résultats selon le score de Friedman et Wyman. Quand la fracture intracapsulaire était détectée après l’opération il y avait un retard de consolidation et une pseudarthrose. Quand la fracture du col est diagnostiquée précocement nous recommandons la fixation par clou. Si cette fracture est diagnostiquée pendant ou après l’enclouage diaphysaire, nous proposons une technique de clou perdu comme option thérapeutique.

     

借助瞄准器定位带锁髓内钉治疗肌骨骨折

带锁髓内钉由于交锁特点能有效维持骨的长度 ,抗扭转应力强 ,近十余年在我国创伤骨科领域得到了广泛应用。术中锁钉安置是手术成功的关键 ,特别是远端锁钉的安放费时 ,并且需Ｘ线影像增强才能定位 ,射线的接触给手术人员带来一定的伤害。自1997年以来 ,我院对 3 1例股骨骨折患者运用近远端瞄准器进行手术定位 ,获得良好效果。1　材料与方法1.1　病例资料　本组 3 1例 ,男 2 2例 ,女 9例 ,年龄 18～ 69岁。左侧 19例 ,右侧 12例。骨折类型 :横断、斜形骨折 5例 ,其余均为粉碎性骨折 (按Ｗｉｎｑｕｉｓｔ分型Ⅲ型 11例、Ⅳ型 15例 )。新鲜骨折…     

Flexible intramedullary nails for ipsilateral femoral and tibial fractures

Between June 1981 and August 1983, six patients were treated with flexible intramedullary nails for both femoral and tibial fractures in six floating knees. All six patients were males averaging 26 years of age and all six were involved in motor vehicle accidents. Concomitant associated injuries were common. Two femoral and five tibial fractures were open. All fractures were stabilized within 24 hours of injury by closed intramedullary nailing with Ender nails. At final followup, there was one femoral and one tibial nonunion in the same patient. For the remaining patients, femoral union averaged 10.3 weeks and tibial union averaged 18 weeks. Five patients regained full motion at the hip, and four regained full motion at the knee and ankle. Four patients returned to their preinjury level of function; two were less active, one ambulating without the use of external assistive devices, and one using a cane.     

Biomechanical analysis of supracondylar femoral fractures fixed with modern retrograde intramedullary nails

OBJECTIVES: Several new retrograde supracondylar intramedullary nails have been developed to specifically address fractures of the distal femur. The nails appear clinically effective, but there are few biomechanical data documenting the stability of the fixation or the mechanical stiffness of the different designs. The goal of this study was to assess the torsional and bending stiffness of four designs of intramedullary nails developed for this application. METHODS: Four nail designs were tested in torsion and bending to determine system stiffness: Ace supracondylar, Richards "five hole" and "multi-hole" supracondylar, and Biomet retrograde. The nails were inserted into cadaveric femurs in which a one-centimeter distraction osteotomy had been created seven centimeters proximal to the condyles. The constructs were then tested on an Instron biaxial testing system. RESULTS: There were no statistically significant differences in bending stiffness among the groups of nails (range 0.79 to 1.18 newtons/meter; p > 0.1). However, the Ace nails (1.10 newtonmeters/degree) did exhibit a statistically lower torsional stiffness compared with the other nails (2.20 to 2.21 newton-meters/ degree; p < 0. 1). No differences were noted as a function of the number of locking holes. CONCLUSIONS: The bending stiffness of four currently available designs of retrograde intramedullary nails does not appear to be dependent on design variations. The torsional stiffness did vary among the four designs, but this was not determined by the number of fixation holes provided. It appears that a well-placed retrograde supracondylar nail of modern design should have sufficient stiffness to support the femur and provide stability during fracture healing.     

Retrograde traditional femoral or tibial locked intramedullary nails for distal femoral injuries

Recently, the use of retrograde locked intramedullary nailing has become an increasingly accepted treatment option for distal femoral injuries. A retrograde traditional femoral or tibial locked nail has sometimes replaced a standard supracondylar nail, which has biomechanical disadvantages and a high cost. To date, this modified technique has been reported in few articles, and the suitability and technical points of this method have not been well defined. The aim of this study was to review the related literature, compare the findings with the author's experiences, and then possibly clarify the role of retrograde traditional locked nails in the treatment of distal femoral injuries.     

弹性髓内钉治疗儿童股骨干骨折

目的观察弹性髓内钉治疗儿童股骨干骨折的疗效。方法股骨干骨折患儿47例,其中男25例,女22例;年龄6～14岁,平均9岁。均采用复位后钛制弹性髓内钉固定。结果所有患儿获得随访5～15个月,平均9个月。根据Flynn标准,结果均为优。无神经损伤、骨折延迟愈合、骨骺损伤发生,未见畸形愈合及需要再次手术的病例。3例患肢短缩0.4～0.7cm,不影响正常活动。2例钉道处皮肤出现＂激惹＂现象。结论弹性髓内钉治疗儿童股骨干骨折并发症少,临床效果满意。     

股骨转子下骨折髓内钉治疗的手术技巧

目的总结和评价应用髓内钉治疗股骨转子下骨折的手术技巧。方法2004年12月至2007年10月,应用髓内钉治疗69例股骨转子下骨折患者,男42例,女27例;年龄28—68岁,平均48．6岁。根据Russell—Taylor分型：ⅠA型17例,ⅠB型11例,ⅡA型28例,ⅡB型13例。结果除8例失访和2例随访期间死亡外,其余59例患者均获得随访,随访时间8～20个月,平均13个月。骨折愈合时间2．5—6个月,平均3．9个月。术后参照由Sandes等推荐的创伤性髋关节等级评分,优18例,良32例,中6例,差3例。结论在正确掌握手术技巧的前提下。髓内钉是治疗股骨转子下骨折的首选方法。     

Locked flexible intramedullary nails in treatment of unstable femoral fractures

Twenty patients with unstable femoral fractures were treated with distally locked flexible intramedullary nails. We present our surgical technique and our results. The method has the following advantages: it prevents rotational malalignment and shortening, it is a closed procedure, no reaming is necessary, there is no increase in c-arm time, and there is minimal increase in operative time. Locked flexible intramedullary nails should be used in patients with unstable femoral fractures who have dense metaphyseal bone. Osteopoenia is a contraindication to this method as it increases the risk of nail penetration into the hip.     

交锁髓内钉在治疗股骨干缺损性骨不连中的应用

目的 分析股骨干缺损性骨不连的原因，探讨交锁髓内钉植骨固定治疗股骨干缺损性骨不连短肢畸形的优缺点。方法 采用交锁髓内钉固定，自体髂骨充填骨缺损区的术式治疗股骨干骨不连短肢畸形12例，病例随访平均20个月。结果 12例全部一期愈合，平均愈合时间22个月。肢体延长平均3．2cm。无主钉、锁钉弯曲、折断等内固定失败。结论 股骨干缺损性骨不连的主要原因是骨折固定不牢固造成骨吸收所致。交锁髓内钉植骨固定合理可靠，是治疗股骨干缺损性骨不连短肢畸形的较理想方法，但骨愈合缓慢。植骨应避免遗留骨缺损，负重时间应向后推迟。     

Treatment of distal femoral fractures with intramedullary supracondylar nails in elderly patients.

30 acute fractures of the distal femur in 29 elderly patients were treated with a Russell-Taylor intramedullary supracondylar nail (IMSC). 26 of the 30 fractures (87%) united in 2-8 months. Two patients died before fracture union for reasons unrelated to the fracture. Two patients were reoperated upon, in one case the fracture was not adequately reduced at the first operation; in the other patient the nail broke 4 months after operation. In all patients knee flexion reached at least 90 degrees. No infections or thromboembolic complications were seen. The IMSC nail provided the necessary stable fixation with only a few complications in this group of elderly patients without the need to prolonged immobilisation.