Treatment of femoral shaft fractures with Grosse-Kempf intramedullary nail

Ninety consecutive femoral shaft fractures in 87 patients treated by reamed Grosse-Kempf intramedullary nailing were reviewed. The median observation time was 45 months. The functional results were excellent or good in 82% of the fractures, fair in 16%, and poor in 2%. Four non-unions and two superficial infections were observed. Leg shortening of more than 2 cm was recorded in 2 patients. Rotatory malalignment exceeded more than 15° in 2 patients. We conclude that reamed Grosse-Kempf intramedullary nailing is an excellent treatment for femoral shaft fractures. Although this study represents the first period during which we used the nail, the number of complications was acceptable. Received: July 8, 1999 / Accepted: December 6, 1999     

Biomechanical performance of locked intramedullary nail systems in comminuted femoral shaft fractures

The biomechanical properties of commercially available locked nail systems designed for use in comminuted femoral shaft fractures were compared and evaluated. Ender nails as well as three forms of interlocking nails, Brooker-Wills (B-W), Klenm-Schellman (K-S), and Grosse-Kempf (G-K), were implanted in cadaver femora. The femora were tested in torsion, bending, and axial loading to failure. Two fracture models were tested--a 3 cm subtrochanteric defect and an 8 cm midshaft defect. Results of the testing revealed the three interlocking nails to be comparable to each other and superior to Ender nails in bending and torsion. However, the distally bolted locked nails (K-S, G-K) resisted significantly higher loads than either the distally bladed locked nail (B-W) or Ender nails when tested to failure by axial loading.     

Closed humeral shaft fractures treated by elastic intramedullary retrograde nail

25 humeral shaft fractures operated on at our institute with the intramedullary elastic Marchetti-Vicenzi nail were reviewed. Three were pathologic fractures. Patients mean age was 48 ranging from 13 to 95 years. The patients were followed until consolidation and shoulder and elbow function were evaluated with respectively the Constant and the Mayo Clinic score. All the fractures eventually healed with good clinical results. There were no major complications during nail insertion. The M-V nail has been shown to be a practical and reliable device, characterised by both an easy technique and a stable fixation, with a low complication rate and low X-rays exposure times. The choice of an elastic unreamed intramedullary nail, with a retrograde insertion, that allows a solid for proximal fixation by means of a bundle of divergent pins, has proven to be useful and safe for shoulder function.     

江西钢板与髓内钉治疗股骨干骨折的多中心研究

目的 探讨钢板与髓内钉两种内固定方式在江西省的应用现状与疗效差异.方法 回顾性分析江西省5家三甲医院于2007年1月至2009年12月收治且获得随访的390例(410侧)股骨干骨折患者资料,按照内固定治疗方式不同分为两组:钢板组(采用钢板治疗股骨干骨折)257例(271侧),男197例,女60例;髓内钉组(采用随内钉治疗股骨干骨折)133例(139侧),男108例,女25例.记录并比较两组患者的手术时间、术中出血量、术后住院时间、恢复下地时间、术后并发症发生情况及末次随访时Karlstr(o)m-Olemd疗效评定结果.结果 髓内钉组手术时间[(149.2±27.9) min]较钢板组[(120.2±28.1) min]长,术中出血量[(459.7±108.8)mL]较钢板组[(429.9±113.7)mL)多,差异均有统计学意义(P＜0.05).两组患者术后住院时间[(13.7±5.2)d vs.(14.1±5.6)d]和恢复下地时间[(3.5±0.9)个月vs.(3.7±0.9)个月]比较差异均无统计学意义(P＞0.05).两组患者术后总的并发症发生率(43/257vs.15/133)、末次随访时Karlstr(o)m-Olerud疗效评定优良率(232/257vs.125/133)差异均无统计学意义(P＞0.05),但钢板组内固定断裂发生率(17/257)明显高于髓内钉组(1/133)[OR =9.24,95％ CI(1.22,70.14),P=0.03].结论 钢板和髓内钉治疗股骨干骨折均可取得满意效果,但江西省髓内钉的使用率和使用效果明显低于国际及国内水平.     

Fresh femoral shaft fractures treated with un-reamed intramedullary nail: 203 cases

OBJECTIVE: To discuss the experience treating fresh femoral shaft fractures with un-reamed intramedullary nail. METHODS: 203 cases of fresh femoral shaft fractures who had been treated with un-reamed intramedullary nail from November. 1995 to January. 1999 were analyzed retrospectively. 18 cases were open, classified as Gustilo I, and. 185 cases were closed. Traction table and image intensifier were used during operation. Closed reduction, un-reamed and free hand distal locking technique were used. Active movements of nearby joints were encouraged and partial weight bearing of 10 - 15 kg were allowed right after operation. RESULTS: All 203 cases of fresh femoral shaft fractures got bone union within 4 - 6 months. No case of delayed union and infection happened. 1 distal locking screw was broken. All patients gained normal extremity functions. CONCLUSION: Un-reamed intramedullary nailing of fresh femoral shaft fracture has less damage to the local soft tissue and blood supply. It has a relative stable fracture fixation, and less interruption to the healing procedure. It is one of the best methods for treating femoral fracture.     

Femoral neck fracture in an arthrodesed hip treated by a supracondylar intramedullary locked nail

We describe a case of a femoral neck fracture occurring 51 years after a hip arthrodesis. This rare lesion in an obese woman was treated with a straight supracondylar nail with proximal and distal locking inserted retrograde from the subtrochanteric area into the ileum. Full weight bearing was achieved within 1 week postoperatively, and union was present 3 months following the operation.     

Antegrade locked intramedullary nailing in humeral shaft fractures

Thirty-three humeral nailings were carried out using the Russell-Taylor nail. Twenty-two acute fractures and one non-union united, gave an overall union rate of 70%.Eighteen patients (56%) experienced pain in the shoulder or at the fracture site. Thirteen patients (41%) had poor shoulder function. Only 17 (51%) of the patients were satisfied with the outcome. Fourteen patients (42%) needed further surgery.We conclude that antegrade intamedullary nailing of humeral shaft fractures leads to a substantial risk of non-union and impairment of shoulder function. There was no significant correlation between fracture comminution and fracture healing in our study.     

逆行带锁髓内钉治疗肱骨干中下段骨折的临床观察

目的:通过分析21例逆行带锁髓内钉治疗肱骨干中下段骨折的疗效,探讨治疗体会及教训。方法:2002年10月至2005年2月采用AO逆行带锁髓内钉治疗肱骨干中下段骨折21例,新鲜骨折19例,陈旧骨折2例;肱骨中段骨折10例,下段骨折11例;男13例,女8例;平均年龄34.5岁(23～56岁)。2例陈旧骨折均为不愈合,行自体植骨;5例伴桡神经损伤者行探查术。最终随访时应用Constant-Murley肩关节评分和Mayo肘关节评分评估治疗结果。结果:21例均获随访,平均时间20.8个月(18～24个月),除1例陈旧骨折和极远端骨折外全部愈合。肩、肘关节功能除1例陈旧骨折肘关节功能一般外均较满意。Constant-Murley肩关节评分平均(83.6±13.4)分(50～97分),优12例,良5例,一般4例,差0例;Mayo肘关节评分平均(88.6±9.8)分(65～95分),优13例,良5例,一般3例,差0例。结论:逆行带锁髓内钉是治疗肱骨中下段骨折较理想的方法,严格的手术适应证、精确的手术技术、稳定的锁定是手术成功的关键。     

股骨干骨折髓内钉远端徒手锁钉技术及应用解剖学研究

目的:探讨股骨干骨折髓内钉固定时远端徒手锁钉的可行性。方法:选取成人不成对股骨防腐标本22根,对12根标本远端锁钉横截面的周径、外侧边边长及外侧上下角进行测量。选最大截面运用平面几何与三角函数来计算探针通过截面外侧边上探测孔的最大摆动角并确定探测孔的最佳定位点。用直径1mm的克氏针经过直径4mm的探测孔来探测直径为9mm的髓内钉,并通过10根股骨干骨折模型及15例临床股骨干骨折病例对徒手锁钉法加以验证。结果:股骨干远端锁钉横截面即股骨远端骨骺线上3cm处的横截面,其外周径为(153.00±7.45)mm,外侧边长为(36.30±2.65)mm,外上角为102.42±5.85°,外下角为81.00±3.25°,外侧边髓腔厚度(1.96±0.04)mm。在最大的横截面处当探查孔直径为4mm时,在外侧两边角区存在盲区(即髓内钉位于其间但通过探查孔的探针不能探到的区间)。但当髓内钉通过约10cm的髓腔狭窄段时,髓内钉不会到达盲区。探针向上、向下的最大摆动角均为44°,当探查孔定位于外侧边中点时,如髓内钉通过的10cm的髓腔狭窄段,骨折复位满意时是可以被探针探及的。应用此法在10根标本及14例利用定位器远端锁钉失败的临床病例中获得成功。结论:通过股骨外侧4mm的探查孔用直径1mm的细克氏针滑移来寻找髓内钉徒手锁钉的方法是可行的。     

磁力导航带锁髓内钉治疗股骨干骨折

2008年1月～2010年6月,我们使用磁力导航交锁髓内钉内固定治疗36例股骨干骨折患者,成功解决了远端锁钉困难的问题,效果满意,报道如下。1材料与方法1.1病例资料本组36例,男28例,女8例,年龄20～45岁。开放骨折2例,均为GustiloⅠ度损伤;闭合骨折34     

磁力导航交锁髓内钉内固定治疗股骨干骨折

股骨干骨折临床常见,约占全身骨折的6%[1],交锁髓内钉内固定术是目前最为常用的治疗方法之一.但由于受很多因素的影响,其远端锁钉的安装准确性低[2],有一定的失败率,影响了内固定效果.Durakbasa等[3]报告95枚远端锁钉中有23枚不成功,占24.2%.     

扩髓交锁髓内钉治疗胫骨萎缩性骨不连

[目的] 探讨胫骨萎缩性骨不连的原因及扩髓交锁髓内钉治疗胫骨萎缩性骨不连的效果。[方法] 对26例胫骨萎缩性骨不连的病例采用扩大髓腔的交锁髓内钉内固定。[结果] 经6个月～2年的随访，骨折全部愈合，关节功能明显改善。[结论] 扩大 髓腔的交锁髓内钉内固定是治疗胫骨萎缩性骨不连的理想方法。     

Femoral metastatic fractures treated with intramedullary nailing

Between 1993 and 1998, 49 consecutive patients with impending or complete pathological fractures of the femur due to metastatic bone disease were treated with intramedullary nailing. Twenty-four were treated with a long Gamma nail and 32 with an AO nail with a cephalomedullary spiral blade. Both implants gave a good functional result with relief of pain and improved mobility with no difference in morbidity between either group (P>0.05).

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Résumé  Entre 1993 et 1998, 49 patients présentant une fracture du fémur imminente ou complète à cause de métastases osseuses ont été traités avec des enclouages. 24 ont été traités avec des enclouages Gamma, et 32 avec des enclouages AO avec la lame spirale. Le résultat fonctionnel était bon dans les deux groupes sans différence de morbidité (P>0.05).

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Accepted: 28 January 2000     

交锁髓内钉治疗股骨干骨折(附45例报告)

目的: 探讨使用交锁髓内钉治疗股骨干骨折的应用、手术方式选择及疗效。方法: 对使用交锁髓内钉治疗 45例 (48肢) 股骨干骨折的疗效进行回顾性分析。手术采用闭合、小切口或有限切开复位, 用三维瞄准器锁定骨折远、近端。结果: 48例患者平均随访 13. 5个月, 肢体、关节功能恢复优良率 91. 1%(41 /45), 一期骨折愈合率 89. 6% (43 /48 )。平均骨临床愈合时间 6. 8个月。感染率 2. 1% ( 1 /45 )。1例髓内钉断裂。结论: 交锁髓内钉是目前治疗股骨干骨折的首选方法, 术中应常规静力固定, 不剥离或少剥离骨膜, 不强求解剖复位, 尽量闭合复位、有限扩髓。     

Distal diaphyseal fractures of the tibia treated by modified Grosse-Kempf nail

Fractures of the distal fourth of tibia are difficult to treat because of the possible involvement of the joint, the comminution of the fragments, the local skin conditions and the surgical method required. There are many methods of osteosynthesis, and these range from external fixation to use of a plate to combined methods. Intramedullary nailing is generally not indicated in the treatment of such fractures, but if the correct technical procedure is used, indications may be widened, and the method may even be used in cases such as these. It is necessary to saw the tip of the nail so that the distal holes go beyond the fracture line. A total of 30 cases of fracture of the distal fourth of the tibia treated by Grosse-Kempf nailing sawed distally are reported.     

Grosse-Kempf髓内交锁钉治疗股骨干骨折延迟愈合及骨不连

目的探讨ＧｒｏｓｅＫｅｍｐｆ髓内交锁钉（ＧＫ钉）治疗普通髓内钉或加压钢板固定股骨干骨折失败的延迟愈合或骨不连的疗效。方法采用ＧＫ钉治疗股骨干骨折延迟愈合及骨不连１２例。结果随访１１例,随访时间平均１１个月,骨折均达骨性愈合,平均愈合时间为５５个月。结论ＧＫ钉除具有普通髓内钉的优点外,还可以有效防止骨折旋转,固定牢靠。     

The locked flexible intramedullary humerus nail in pediatric femur and tibia shaft fractures: a feasibility study

There are several options for the treatment of long bone fractures in skeletally immature patients. Surgeon experience, type of fracture, and the possibility of damage to the physeal area dictate individual fracture management patterns. Notably, nail devices have not gained popularity in this patient group. Intramedullary locking nails have become the standard of care in adult patients due to decreased morbidity and mortality. A novel nail has been developed for humeral shaft fractures that uses a lateral starting position to avoid damage to the rotator cuff in humeral fracture fixation. This is possible because of the nail's transient flexibility during insertion. This study illustrates that it is feasible to insert this type of nail through multiple entry portals for both tibial and femoral fracture fixation, without damaging the physeal blood supply or growth areas.     

Treatment of femoral shaft fractures with the Brooker-Wills interlocking intramedullary nail

Fifty femur fractures were treated with the Brooker-Wills intramedullary locking nail. The indications included subtrochanteric, subisthmal, segmental or comminuted acute fractures or nonunions, and intramedullary shortening procedures. Eighteen technical problems in 13 (26%) patients were encountered during insertion of the nail. The incidence of technical problems was high early in the series and in procedures done with the patient in the supine position. Adverse clinical results from technical errors occurred in two patients. Most technical errors seem avoidable with careful technique. The mean healing time was only 12.1 weeks and there were four nonunions (8%). One patient had a 10 degrees malunion, four patients had 1-2 cm of shortening, and there were two late device fractures. No patients had rotational malalignment or deep infections. The results and complication rate are comparable to those reported for other interlocking systems. The Brooker-Wills nail is useful for treatment of complex femur fractures and has been effective in preventing malrotation, angulation, and excessive shortening.