Elastic intramedullary nailing of midclavicular fractures

The majority of midclavicular fractures are treated conservatively. Fractures that require internal fixation are treated by plate osteosynthesis as the standard procedure. Elastic stable intramedullary nailing is an increasingly popular alternative for the internal fixation of displaced midclavicular fractures. In a three-year period, 15 fractures of the clavicle were treated by elastic intramedullary nailing. Fracture healing, clinical outcome and complications were assessed. Mean follow-up time was one year All fractures healed clinically and radiologically. Non-union or infections were not observed. Functional results according to the Constant score were excellent. Complications consisted of skin irritation in four cases. One acromioclavicular joint separation was observed postoperatively. Elastic stable intramedullary nailing of displaced midclavicular fractures is a minimally invasive technique with excellent functional results and early pain relief.     

Elastic stable intramedullary nailing for midclavicular fractures in athletes: indications, technical pitfalls and early results

This prospective consecutive case series was done to evaluate indications, technical pitfalls and functional outcome of elastic stable intramedullary nailing of displaced midclavicular fractures in 14 athletes. Constant score and radiographs were evaluated after 1 and 6 weeks, 3 months and 6 months in 13 patients. Mean age was 28 years. The average follow-up was 17 months. Mean operation time was 62 minutes. Open reduction through an additional small incision was necessary for 7 fractures. Mean hospital stay was 1.2 days. Secondary fracture displacement was observed in 1 patient. The Constant score averaged 81 after 1 week, 96 after 6 weeks and 98 after 6 months. Compared to the contralateral side, average shortening of the clavicle was 1.7 mm. Overall, elastic stable intramedullary nailing provided good restoration of the length of the clavicle and allowed immediate active mobilisation with early return to normal activity. Functional results were excellent.     

Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1-5 years

Background Osteosynthesis of clavicular fractures is sometimes indicated. Since plate fixation may lead to complications, we have used elastic stable intramedullary nailing and report our experience of midclavicular fractures in 32 adults.

Patients and methods From 2000 to 2005, we treated 32 adults (26 men), median age 40 (19-66) years, by intramedullary nailing with a titanium elastic nail (TEN). All patients were re-examined after median 27 (12-59) months.

Results Nonunion was not observed. 20 clavicles healed without shortening. 12 clavicles healed with shortening of more than 5 mm. Migration of the TEN in 8 patients required secondary shortening of the nail in 5 of them. Nail breakage after fracture healing was observed twice. The nails were removed in 29 patients after a median of 6 (1.3-15) months postoperatively. No patient sustained a re-fracture after TEN removal. The mean Constant score was 95 (SD 1.9) points and the mean DASH score was 5 (SD 2.3) points.

Interpretation Intramedullary stabilization of midclavicular fractures with a titanium elastic nail is a minimally invasive technique with good cosmetic and functional results. Intramedullary fixation can be seen as an alternative to plate fixation and nonoperative treatment.     

Elastic stable intramedullary nailing of tibial shaft fractures in children

Most pediatric tibia shaft fractures are amenable to nonoperative treatment with satisfying results, yet surgical stabilization is necessary in certain cases. The purpose of our study was to determine the effectiveness and the complications associated with elastic stable intramedullary nailing in severe pediatric tibial fractures. We retrospectively reviewed 24 tibia shaft fractures in 24 patients that were treated operatively by elastic stable intramedullary nailing between 1997 and 2005 at our institution. Extensive review of all charts and radiographic data was completed at Cincinnati Children's Hospital Medical Center. There were 8 closed and 16 open fractures. The average union time for all tibia fractures was 20.4 weeks. The average union time for closed and open fractures was 21.5 and 20.2 weeks, respectively. Complications include 2 (8%) neurovascular, 2 (8%) infections, 2 (8%) malunions, and 1 (4%) leg-length discrepancy. Although complications do exist, elastic stable intramedullary nailing of pediatric tibia shaft fractures using Nancy nails is an effective treatment option.     

Elastic stable intramedullary nailing of tibial shaft fractures in children

Purpose  

Tibial fractures in the skeletally immature patient are usually treated without surgery. Elastic stable intramedullary nailing (ESIN) is commonly used for other diaphyseal fracture locations. Its advantages are minimally invasive surgery with a short hospitalisation duration, primary bone union and early weight bearing. The purpose of this study was to assess the use of ESIN in displaced tibial fractures in children over 6 years old and in cases of polytrauma.     

Elastic stable intramedullary nailing of femoral shaft fractures in children

We report the use of elastic stable intramedullary nailing (ESIN) in 123 fractures of the femoral shaft in children. Flexible rods are introduced through the distal metaphyseal area, and the aim is to develop bridging callus. Early weight-bearing is possible and is recommended. There was one case of bone infection and no delayed union. Complications were minimal, the most common being minor skin ulceration caused by the ends of the rods. A surprising feature was the low incidence of growth changes, with a mean lengthening of only 1.2 mm after an average follow-up of 22 months. Compared with conservative treatment, ESIN obviates the need for prolonged bed rest and is thus particularly advantageous for treating children.     

钛制弹性髓内钉治疗成人锁骨中段骨折的初步报告

目的探讨钛制弹性髓内钉治疗成人锁骨中段骨折的初步效果。方法2005年2月～2006年3月，采用切开复位、自锁骨胸骨端插入钛制弹性髓内钉内固定治疗21例有移位的锁骨中1／3骨折患者。术后1d开始耸肩训练，肩关节不负重被动活动功能训练2周，术后3周允许肩关节外展超过90°。结果21例患者术后获平均7．8个月（5～11个月）随访。所有骨折均获愈合，平均愈合时间为2．1个月（1．7～2．4个月）。肩关节功能Constant-Murley评分平均为（92．1±4．5）分。8例出现钉尾部皮肤刺激症状，但无一例发生破溃。结论钛制弹性髓内钉内固定是治疗成人锁骨中段骨折的有效方法之一，具有创伤小、美观、愈合率高及肩关节功能恢复好的优点。     

弹性髓内钉治疗儿童前臂骨折疗效观察

目的 探讨弹性髓内钉治疗儿童前臂骨折的效果.方法 48例儿童前臂骨折在C臂X线透视机下复位弹性髓内钉固定.结果 术后随访12个月,除2例失随访外,按Berton评价标准评判与正常一侧比较.本组优37例,良7例,可2例.优良率95.2%.结论 弹性髓内钉治疗儿童前臂骨折安全,微创,功能恢复良好.     

钛制弹性髓内钉治疗成人锁骨中段骨折的临床评价

目的 探讨钛制弹性髓内钉(TEN)治疗锁骨中段骨折的临床疗效.方法 2005年2月至2007年2月收治41例移位的成人锁骨中段骨折,均在伤后1周内行有限切开复位,自锁骨胸骨端插入TEN内固定.结果 41例患者术后获平均14.5个月(7～24个月)随访.所有骨折均获愈合,平均愈合时间为1.8个月.术后3 d的主观疼痛较术前有显著降低(t=3.26,P<0.01).肩关节活动度:术前前屈平均25.6°,术后2周前埔平均95°,差异有统计学意义(t=2.81,P<0.01);术前外展平均23.5°,术后2周外展平均88.5°,差异有统计学意义(t=2.93,P<0.01).平均7.2个月(5.4～9.5个月)后取出TEN,没有出现再骨折.最后随访时,肩关节的Constant评分平均为95.2分(86.5～97.0分),DASH评分平均为2.5分(0.5～8.0分),肩关节活动度:前屈平均155°,外展平均160°.1例出现TEN远端穿出骨皮质.结论 TEN治疗成人锁骨中段明显移位骨折是一种安全、微创的手术方法.     

弹性髓内针固定治疗儿童长骨骨折

目的评价弹性髓内针内固定治疗儿童长骨骨折的疗效。方法采用弹性髓内针治疗儿童骨折43例,35例采用闭合复位弹性髓内针固定,8例配合小切口复位固定。结果43例均获得随访,时间4～24个月。骨折均获得临床愈合,时间4～24周。参照Flynn提出的髓内针治疗骨折的评分标准：末次随访时优41例,良2例,优良率100%。其中股骨干骨折延迟愈合1例,针尾刺激症状3例;无骨不连、畸形愈合和骨骺损伤。结论弹性髓内针内固定是治疗儿童长骨骨折的有效方法,适用于3～13岁儿童骨折,具有微创、康复快、并发症少等优点。     

弹性髓内钉治疗儿童胫骨干骨折

2010年3月～2013年4月,我院应用弹性髓内钉（elastic stable intramedul-lary nailing,ESIN）治疗35例儿童胫骨干骨折患儿,疗效满意,报道如下。     

钛合金弹性髓内针治疗儿童股骨干骨折

目的 观察钛合金弹性髓内针固定治疗儿童股骨干骨折的临床疗效.方法 对49例5～13岁儿童股骨干骨折采用经皮闭合复位钛合金弹性稳定髓内针固定治疗,随访4～24个月.结果 全部病例未出现手术并发症,术后6～8周达到骨性愈合,患肢与健侧等长46例,2例较健侧长0.6～1.0 cm,1例缩短0.7 cm,均无跛行.X线摄片检查...     

Elastic stable intramedullary nailing for displaced proximal humeral fractures in older children

Purpose To demonstrate the effectiveness of intramedullary fixation of severely displaced proximal humeral physeal fractures in skeletally immature children using the elastic stable intramedullary nail (ESIN). Methods Retrospective recruitment of 14 patients aged 10–15-years old with severely displaced proximal humeral physeal fractures between 1999 and 2004 in a single regional specialist paediatric orthopaedic hospital. The fractures were graded using the Neer classification; severe displacement constituted Neer II–IV or displacement >1 cm and angulation >45°. Patients were followed up and assessed using the Disabilities of the Arm, Shoulder and Hand score (DASH) and the Neer Shoulder score. Radiographs were assessed for deformity. Subjective satisfaction was assessed. Results Fourteen patients with mean follow-up of 30 months (12–66 m) from surgery. All fractures were radiologically united at a median time of eight weeks (7–10 weeks). At follow-up, Neer Shoulder mean score was 96.79 (range 83–100) and DASH mean score 2.26 (0–7.5). Subjectively 71% were very satisfied and 29% were satisfied. Conclusions We commend stabilisation using ESIN in the management of the displaced proximal humeral physeal fracture in older children, once reduction of the fracture has been achieved by either closed or open means. ESIN is safe and allows early return to pre-injury function.     

保守治疗与钛制弹性髓内钉治疗移位锁骨中段骨折的疗效对比分析

目的 比较保守治疗与钛制弹性髓内钉(TEN)治疗明显移位锁骨中段骨折的疗效.方法 回顾性研究2005年2月至2007年9月间采用保守治疗(保守治疗组,100例)或TEN固定(TEN固定组,60例)治疗并获得随访的160例移位锁骨中段骨折患者资料.比较两组患者术后的肩关节功能(Constant评分和DASH评分)、患者对治疗结果的满意度、恢复正常生活的时间、并发症发生率、肩部外观及锁骨愈合后的X线表现.结果 所有患者术后获平均18个月(9～31个月)随访.保守治疗组和TEN固定组Constant评分分别为72.5分和90.5分(t=3.280,P=0.020),DASH评分分别为26.5分和2.4分(t=2.420,P=0.032);满意率分别为75.0%和96.7%(X2=1.450,P=0.042);恢复正常生活时间分别为6～8周和2～3周;并发症发生率分别为13.0%和3.3%(X2=1.890,P=0.020).保守治疗组28例肩部不对称,42例解剖位置愈合.TEN固定组肩部基本对称,56例解剖位置愈合.结论 TEN固定治疗移位的锁骨中段骨折,在肩部功能评分、满意率及并发症发生率等方面比保守治疗更有优势,因此不推荐使用保守治疗,TEN固定可作为一种有效的治疗方法.     

Treatment of femoral shaft fractures with a titanium intramedullary nail

Ninety-nine femoral shaft fractures were treated with locked intramedullary nails made from titanium alloy. One of the distal interlocking screws failed in six fractures (6%) and both screws failed in two fractures (2%). Delayed union was associated with all of the eight fractures that had locking screw failure. Young, heavier patients who had nails of small diameter had an increased risk of screw failure. Additional surgery was needed when both screws failed. The authors still use this nail, but currently prefer to ream the medullary canal more so that larger nails can be inserted. Decisions concerning weightbearing are made on an individual basis for each patient, and currently full weightbearing is delayed for young, active, and heavy patients. Two distal interlocking screws should be inserted for treatment of femoral shaft fracture when a Ti locked intramedullary nail is used.     

Elastic stable intramedullary nailing in forearm shaft fractures in children: 85 cases

The results of elastic stable intramedullary nailing (ESIN) of 85 forearm fractures in children are reported. A single curved nail was inserted into each forearm bone with closed reduction. Immediate mobilization was allowed postoperatively. In a 3 year 6 month follow-up of 76 patients, 92% had excellent results with a full range of movement. There were neither nonunions nor infections. ESIN is recommended in the treatment of displaced forearm fractures in children older than 10 years of age, and in younger children when conservative treatment fails.     

新型钛制弹性钉微创治疗移位锁骨中段骨折的疗效分析

目的探讨应用新型钛制弹性钉微创治疗移位锁骨中段骨折的临床疗效。方法自2012-02—2013-12应用自行研制的新型钛制弹性钉自锁骨内侧端髓腔内置入固定治疗38例移位锁骨中段骨折。结果所有患者获得8~24个月(平均15.5个月)的随访,术后8~18周骨折全部愈合(平均11.8周),无感染、退钉及断钉。本组手术时间35~70 min,平均45.8 min;术中出血量30~80 ml,平均50.5 ml;术中透视时间30~52 s,平均38.6 s;住院时间6~15 d,平均10.4 d。30例术后8~13个月取出内置物(平均10.2个月),取钉术后无再骨折发生。术后3 d患者主观疼痛较术前显著改善,差异有统计学意义(P0.001),术后2周患肩活动度较术前明显提高,差异有统计学意义(P0.001)。2例出现钉尖端穿出锁骨后外侧端并抱怨肩后部刺痛感;1例术后1周出现锁骨内侧端开口处皮质劈裂伴缺损;其余患者术后随访无复位丢失及移位加重。末次随访时Constant肩关节功能评分87~96分(平均91.5分),DASH评分为0~29分(平均5.6分)。结论采用新型钛制弹性钉内固定治疗成人移位锁骨中段骨折是一种安全、微创的方法,术后肩关节功能恢复好、并发症少、患者满意度高。     

Proximal humeral fractures and intramedullary nailing: Experience with a new nail system

Objectives:   

The goal of this study was to evaluate fracture healing and alignment as well as functional outcome and complication risks after internal fixation with the intramedullary proximal humeral nail (PHN). This device shows promise for applications involving the reconstruction of the humeral shaft and head with minimal soft tissue stripping and for providing a locked, fixed-angle construct for secure fixation to permit controlled, early, and active rehabilitation.