Primary stabilization of open fractures of the lower extremity with the interlocking nail--the results of a study of 91 patients

The authors report on a series of open fractures (Type I and Type II) on the lower extremities of 91 patients, treated at the I. University Clinic of Traumatology, Vienna and at the Traumatologic Department of Wilhelminenspital, Vienna from 1975-1987. There were 25 open femoral- and 66 open tibial fractures. We have seen 60% Type I and 40% Type II fractures on the femur as well as on the tibia. 74% of the patients were male. The patients' ages ranged from 15 to 92 years with a median of 32 years. The main fracture type was the comminuted fracture with over 50%. In contrast to the references in the literature (9, 11, 21) we noticed an infection rate of only 1.2%. 96% of the operated and checked up patients received bone union with the interlocking nail. We cannot in any way attribute these results solely to the used implant. Conscientious indication in the application of the interlocking nail, an exact preoperative management with prophylactic antibiotic as well as an excellent operative technique are also taken into consideration. The choice of the static interlocking nail (73%) after the closed reduction (80%) of these open fractures is supposed to be a measure against infection. Due to these results we are of the opinion that the interlocking nail when selectively used in the hands of an expert can be recommended not only in closed fractures but also in Type I and II open fractures of the femur and the tibia as long as the special principles of treatment are not neglected.     

交锁髓内钉治疗胫骨下段骨折

目的：探讨交锁髓内钉在胫骨下段骨折中的应用,方法：应用透视下复位及交锁髓内钉闭合穿钉内固定治疗胫骨下段不稳定骨折17例,其中闭合骨折11例,开放骨折6例,开放骨折中I型3例,II型2例,IIIA型1例。结果：17例均获得随访,平均13个月（6－19个月）,最终结果评分采用Johner-Wruh评分标准,结果优14例,良2例,差1例,无1例感染,无断钉和骨不连,结论：对于胫骨下段不稳定骨折的治疗,闭合交锁髓内钉是一个较好的选择。     

带瞄准装置的交锁髓内针在下肢骨折中的应用(附76例报告)

目的 总结使用带锁髓内针治疗股骨、胫骨骨折的临床经验。方法 回顾性分析从1998年6月～2001年1月所做带锁髓内针治疗股骨和胫骨骨折的病人76例，其中股骨30例，胫骨46例，均为闭合性骨折。术中股骨均采用开放复位，胫骨闭合复位26例，开放复位20例，未使用C型臂X光机透视：术后病人即刻行邻近关节功能活动锻炼。结果 30例胶骨干骨折3个月内临床骨愈合；46例胫骨骨折6个月临床愈合。胫骨、股骨病人中有30例远端锁钉未能锁上，无断钉断针及感染发生全部病人术后关节功能恢复达正常的90％～100％。结论 操作简单，不需电视X光机透视，易于推广。内固定稳定可靠，抗疲劳度好，能早期行功能锻炼，最大限度的恢复肢体功能。     

Retrograde femoral interlocking nail in complex fractures

Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur. This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture. The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90 degrees of movement, these were old fractures and non-cooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil. Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is economical also.     

交锁髓内钉治疗股胫骨骨折110例分析

目的　探讨交锁髓内钉治疗股、胫骨骨折的疗效 ,分析并发症发生原因 ,提出防治措施。方法　 110例股、胫骨骨折 (闭合骨折 83例 ,开放骨折 2 7例 ) ,除 2例股骨和 5例胫骨闭合复位未扩髓外 ,余均采用开放复位并有限扩髓 ,应用交锁髓内钉固定。随访 3～ 2 4个月 ,平均随访 14个月。结果　 110例骨折全部愈合 ,其中髓内钉折断 5例 ,锁钉折断或松动退出 4例 ,骨折成角畸形 4例 ,骨折延期愈合 8例 (股骨 3例 ,胫骨 5例 ) ,无感染病例。按Johner -Wruh法功能评定 :优 83例 ,良 2 3例 ,中 3例 ,差 1例。结论　只要掌握好手术指征及正确处理所遇问题 ,交锁髓内钉治疗股、胫骨骨折是一种较好的内固定方式     

Stable osteosynthesis by interlocking cylinder nailing for fractures of the femur and tibia

Between 1979 and 1986, 140 patients with fractures of the femur and 94 with tibial fractures were treated with our own interlocking cylinder nail system and followed for 1 to 3 years. Overall, 97.9% of fractures of the femur and 93.6% of the tibia were found to have achieved excellent or good results clinically and radiologically. Complications included: delayed union which developed in 2 patients with femoral and tibial fractures and deep infection which developed in 3 of the tibial fractures. Even in highly comminuted fractures, the fracture site can be fixed securely with the interlocking cylinder nail system. Because mechanical strength of the cylinder nail is by far superior to that of the clover nail, the patient may be allowed early full weight bearing on his affected leg.     

可膨胀髓内钉Fixion系统治疗四肢骨折

目的：可膨胀髓内钉Fixion^TM系统是髓内钉固定理念和技术的革新,本文探讨这一新技术在治疗四肢骨折中的方法和临床效果,以及临床应用过程中的一些体会。方法：自2004年8月至2005年1月,21例骨折病人采用Fixion^TM系统治疗。男16例,女5例,年龄21～75岁。1例为开放伤,3例为骨折不愈合,1例病理性骨折。应用部位为胫骨干5例;股骨干7例;肱骨干4例;股骨近端5例。结果：本组21例伤口全部一期愈合,手术时间35～210min,平均90min。术中出血30～1500ml,平均出血量280ml,术中平均透视4．9次。X线片示股骨干、胫骨干骨折术后4周均有骨痂出现,骨折术后临床和影像学愈合时间为：胫骨干骨折12周,股骨干骨折10周,肱骨骨折12周,股骨近端骨折10周。无感染、脂肪栓塞、深静脉血栓、骨折不愈合、肢体短缩及旋转畸形发生。结论：可膨胀髓内钉根据髓腔解剖特点呈沙漏样固定,应力分布更为均匀;节省了扩髓和锁钉的操作,减少了创伤、手术时间、医生和病人接受的X线剂量和感染率;轴相弹性固定加快了骨折愈合时间。在掌握好适应证和正确操作的前提下,Fixion^TM系统治疗四肢骨干骨折和股骨近端骨折有比传统交锁髓内钉更好的效果,尤其适用于骨质疏松病人的治疗。     

The interlocking nail for long comminuted and compound fractures of the femur and tibia. Technique and results

Interlocking nailing is presented as an optimal method for the treatment of fractures of femur and tibia, which are complicated because of the length of these bones. Cases from the literature and cases treated by the authors gave a total of 208 fractures of the femur and 158 fractures of the tibia (comminuted fractures and fractures "à deux étages"). There is a low complication rate as a closed procedure was applied whenever possible. In the femur the nail fractured in eight cases (3.9%), while in seven cases infection was observed (3.5%) and in three cases pseudarthrosis. Following interlocking nailing of the tibia we found deviation of the axis by greater than 5 degrees in eight cases (5%) of 158, including 44 open fractures. Fracture of the nail occurred in one case (0.6%), and we observed six cases of infection (3.8%) and one of pseudarthrosis (0.6%).     

Complex femur fractures: treatment with the Wagner external fixation device or the Grosse-Kempf interlocking nail

One hundred complex femur fractures were treated with the Grosse-Kempf interlocking nail and 35 were treated with the Wagner external fixation device. Retrospectively, we analyzed the results in the two groups to determine specific indications for the future use of these nails. The Grosse-Kempf nail, although a technically demanding procedure, achieved excellent overall end results in comminuted closed fractures, and in Type I, Type II, and some Type III open fractures after appropriate wound care. We found that the Wagner apparatus was a simple, easy device for obtaining initial fracture stabilization in contaminated Type III-B and Type III-C open fractures. It does, however, require substantial postoperative care; four cases required secondary intramedullary fixation. We found a high infection rate with secondary reamed intramedullary nailing after initial stabilization with the external fixator.     

Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures

Purpose: Open tibia fracture is prone to infection, consequently causing significant morbidity and increasing the hospital stay, occupational loss and onset of chronic osteomyelitis. Intramedullary nailing is one choice for treating tibia shaft fractures. To improve the delivery of antibiotics at the tissue-implant interface, many methods have been proposed as a part of prophylaxis against infection. This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking (IMIL) nail in the prevention of infection in Gustilo type I and II open tibia fractures and to compare the results with regular intramedullary nail. Methods: The study included 28 patients with open tibia fractures (Gustilo type 1 or type 2); of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing. Randomization was done by alternate allocation of the patients. Follow-up was done postoperatively (day 1), 1 week, 6 weeks, and 6 months for bone union, erythrocyte sedimentation rate (ESR), hemo globin and C-reactive protein (CRP). Statistical significance was tested using unpaired t-test. A p value less than 0.05 was considered significant. Results: There were 4 cases of infection in controls (regular IMIL nail) and no infection among patients treated with gentamicin-coated nail during the follow up (X2 = 4.66, p = 0.031). At 6 months post operatively, CRP (p = 0.031), ESR (p = 0.046) and hemoglobin level (p = 0.016) showed significant dif ference between two groups. The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up (p = 0.016). Conclusion: Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo type I and II open tibia fractures.     

带锁髓内钉治疗胫骨骨折(附76例报告)

目的 总结带锁髓内钉治疗胫骨骨折的经验。方法 采用带锁髓内钉内固定的不同类型的胫骨骨折76例。其中闭合骨折55例，开放骨折21例。76例平均随访时间17．9个月(4～31个月)。疗效评定采用Johner-wruh评分标准。结果 在55例闭合骨折中，优49例，良5例，中1例；21例开放骨折，优17例，良3例。差1例。术后均无继发性骨筋膜室综合征，无神经损伤、钉体断裂和感染。结论 带锁髓内钉适用于治疗胫骨骨折，非扩髓带锁髓内钉适于开放骨折和多发伤；早期手术并不影响预后。且可减少并发症。     

Subtrochanteric femur fractures: a comparison of the Zickel nail, 95 degrees blade plate, and interlocking nail.

Seventy-nine nonconsecutive patients with subtrochanteric femur fractures were divided into three groups based on the method of fracture fixation. Group I consisted of 21 patients treated with a Zickel nail, Group II comprised 25 patients treated with a 95 degrees blade plate, and Group III included 33 patients treated with an interlocking nail. All patients in Group I and Group II had open reduction and internal fixation of their fractures. Ninety-four percent of the patients in Group III were treated by closed intramedullary nailing. The average operating times for Groups I, II, and III were 212, 272, and 181 min, respectively, while blood loss averaged 900, 1,500, and 600 ml for each group, respectively. Group I had one infection, ten malunions, and one nonunion. Group II had one infection, six malunions, and two nonunions. Group III had no infections, two malunions, and one nonunion. We conclude that closed interlocking nailing is the treatment of choice for acute nonpathologic subtrochanteric femur fractures in adults. There is decreased blood loss, reduced operating time, and fewer complications than with either the Zickel nail or the 95 degrees blade plate regardless of the fracture pattern or the degree of fracture comminution.     

Intramedullary nailing of femoral shaft fractures. Part III: Long-term effects of static interlocking fixation.

The results of treatment of fractures of the femoral shaft with static interlocking nailing were reviewed retrospectively to determine the clinical importance of any stress-riser or stress-shielding properties of the nail. These properties, if relevant, would have been manifested by refracture of the femur, either through a hole used for a locking screw or through the original site of fracture after extraction of the device. Two hundred and fourteen fractures that had been treated with static interlocking nailing and that had healed without conversion to dynamic intramedullary fixation were divided into two groups. In Group I, which comprised 111 fractures, the static interlocking-fixation device was retained and in Group II, which comprised 103 fractures, the static interlocking-fixation device was removed during one operative procedure at an average of fourteen months after the injury. The average duration of follow-up was thirty months from the time of the original fixation in both groups. All patients in Group II were followed for a minimum of six months after removal of the nail. No femur in Group I, in which the static interlocked nail remained in situ, refractured. No femur in either group fractured through the proximal or the distal holes used for the locking screws. No locking screws or nails broke. One patient (1 per cent) in Group II had a refracture of the femoral shaft through the site of the original fracture six weeks after removal of the nail.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intramedullary nailing with interlocking

Summary The locked or unlocked intramedullary nail is considered today in most institutions the first choice for stabilisation of the majority of closed diaphyseal fractures of the femur and tibia. In 1st and 2nd degree open fractures of the tibia, the unreamed locked nail may perhaps become the preferred implant. In spite of very favourable results with nailing, not all fracture problems of long bone will be solved with this device. The plate and external fixator will remain indicated in most fractures with meta- and epiphyseal extension as well as in situations in which the intraoperative fluoroscopy is not available. Our experience with the new AO universal femur and tibia nails are being reported.     

非扩髓交锁髓内钉治疗开放性胫骨干骨折

目的:评估非扩髓交锁髓内钉治疗开放性胫骨干骨折的疗效。方法:应用非扩髓交锁髓内钉治疗21例开放性胫骨干骨折。男18例,女3例,年龄23岁～59岁,平均36.3岁。AO/ASIF分类A型10例,B型9例,C型2例。Gustilo分类Ⅰ型9例,Ⅱ型11例,ⅢA型1例。结果:所有患者得到4～21个月随访(平均14.3个月)。所用髓内钉直径平均8.9mm。骨折平均愈合时间27周(13～34周)。采用Johner-Wruh评分,结果优14例,良6例,差1例,无感染,无断钉和骨不连。结论:非扩髓交锁髓内钉治疗开放性胫骨干骨折,只要严格掌握适应证和手术时机,彻底清创,熟练掌握操作技术,具有创伤小、能早期活动、骨折愈合率高和感染率低等优点。     

交锁髓内钉治疗开放性胫腓骨骨折并发症的原因分析及防治

[目的] 观察交锁髓内钉治疗开放性胫腓骨骨折的并发症的原因及防治措施。[方法]1999年1月～2004年12月用交锁髓内钉治疗开放性胫腓骨骨折120例。男76例，女44例；Gustilo Ⅰ型67例，Ⅱ型47例，Ⅲa型6例；左侧39例，右侧81例；年龄15～78岁，平均34．5岁；Gustilo Ⅰ，Ⅱ型均采用扩髓及静力型固定，Ⅲa型6例均未扩髓。[结果] 120例均得到随访，平均30个月（2个月～5年）。愈合时间12～56周，平均27．4周。术中并发症有髓内钉开口错误3例，术中再骨折4例，小腿软组织损伤4例，锁钉误穿7例，大隐静脉和腓总神经损伤各1例；术后并发症主要有感染8例，膝关节疼痛3例，锁钉断裂4例：主钉断裂1例，骨折迟缓愈合12例，肢体短缩和膝关节内翻各1例。疗效根据Johner-Wruhs标准进行评分，优102例，良16例，差2例，优良率98.3％。[结论] 交锁髓内钉治疗胫腓骨开放性骨折存在一定的并发症，在临床使用中必须引起高度重视；Gustilo Ⅱ以上骨折以不扩髓为宜。     

Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing.

Ninety-five subtrochanteric femoral fractures were treated with an interlocking nail. There were 69 closed and 26 open fractures. This injury was the result of high-energy trauma in 77% of the cases. The average time to healing was 25 weeks. There were three delayed unions, one nonunion, and six malunions. Essentially all nonpathologic, subtrochanteric femur fractures can be stabilized by interlocking nailing, regardless of the fracture pattern or degree of comminution. Favorable mechanical characteristics of interlocking nails have eliminated the requirement of surgically reconstituting the medial femoral cortex. Closed interlocking nailing is the preferred treatment for subtrochanteric fractures of the femur resulting from trauma.     

带锁髓内钉治疗股骨胫骨骨折

目的：探讨带锁髓内钉有股骨,胫骨骨折的应用。方法：选用江苏省武进市生产的带有远近瞄准器的股骨,胫骨钉,治疗不同类型肌骨骨折10例,胫骨骨折8例,结果：随访8月－2年3个月,18例均骨性愈合,未出现骨折,断钉感染及膝,踝关节僵硬等并发症,结论：带锁髓内钉治疗下肢骨折治愈率高,并发症少。     

Corrective osteotomy of the shaft of the femur and tibia with an interlocking nail

The indication for nailing a femur or tibia fracture has been extended by the method of interlocking up to the meta/diaphyseal zone. For the stabilization of osteotomies in these regions, the nail was used in 16 cases of femur and 21 of tibia corrections between 1982 and 1986 in orthopedic university clinic Berlin. The osteotomies were done with a small skin incision in open way. Although there were three infections bone consolidation was succeeded in all but one patient with the planned axis. The first achieved gain in length could not be hold in five cases after removing the interlocking screws in order to give full weight bearing to the leg for callus formation. In situations of non-unions with wrong position of refracture of biologically troubled bones after plating the method of interlocking nail is stable and enables bone recovery after grafting by drilling. The possibility of early full weight bearing is a great advantage for the rehabilitation of patients, who had been suffering of the delayed healing of their leg. The nail itself preserves the right position of the bone in two dimensions, even if there are not exact fitting osteotomy fragments, and the interlocking screws secure the bone against malrotation.     

扩髓带锁髓内钉治疗股骨、胫骨干骨折不愈合、延迟愈合

目的　总结使用扩髓带锁髓内钉治疗股骨、胫骨干骨骨折不愈合、延迟愈合的临床经验。方法　回顾自 1999年 4月～2 0 0 1年 6月使用扩髓带锁髓内钉治疗股骨干、胫骨干骨折不愈合、延迟愈合病人 2 1例 ,其中股骨 8例 ,胫骨 13例 ,钢板固定术后 ,股骨 3例 ,胫骨 6例。普通髓内针股骨 5例。外固定架胫骨 2例。石膏固定胫骨 3例 ,骨牵引股骨 2例。均采用有限切口切开复位顺行扩髓 ,静力锁定加植骨术。结果　随访半年以上 18例 ,骨折均愈合 ,临近关节功能达正常。无感染、断钉等并发症。结论　采用有限切口切开复位、扩髓、静力锁定治疗股骨、胫骨干骨折不愈合、延迟愈合 ,具有骨折稳定性可靠、有利于骨折愈合和早期关节活动的优点 ,是治疗股骨、胫骨干骨折不愈合、延迟愈合的有效方法之一。