Femoral malrotation following intramedullary nail fixation

Intramedullary nailing of femoral shaft fracture can result in inadvertent malalignment. Malrotation is the most common cause of deformity, but it is underrecognized, in part because of the difficulty in accurately assessing rotation as well as the variation that exists in normal anatomy. The consequences of femoral malrotation are not completely understood. However, initial biomechanical studies suggest that it causes a substantial change in load bearing in the affected extremity. Clinical examination, fluoroscopy, and ultrasonography are useful in measuring femoral rotational alignment intraoperatively and postoperatively. CT is useful in the identification of the degree of malrotation and in surgical planning.     

Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up

Introduction

The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft.

A novel femoral intramedullary plug with sliding mechanism

A novel femoral intramedullary plug with a sliding mechanism has been developed and evaluated clinically. The new plug consists of a pair of specially designed components, each shaped like an obliquely cut cylinder. Postoperative plain radiographs of 30 arthroplasties using the plug were examined for cement leakage, plug migration, and radiolucent line formation between the cement and the femoral cortex. Plugging was complete in 22 cases. Leakage of the cement was seen in 4 cases, and migration of the plug was seen in the other 4 cases. Our study showed the efficacy of the plug in occluding the femoral canal completely in 14 of 22 cases. The plug appears to be promising for clinical applications, because it has good biocompatibility and can occlude the femoral canal tightly.     

Hybrid component fixation in total knee arthroplasty: minimum of 10-year follow-up study

Hybrid total knee arthroplasty (TKA) (uncemented femur with cemented tibia and patella) was introduced in the late 1980s to gain the theoretical advantage of durable cementless femoral fixation while avoiding the problems noted with cementless tibial fixation. From December 1992 to July 2000, 215 patients (235 knees) who underwent hybrid TKA were enrolled in this study. Five types of prosthesis (AGC, Maxim, LCS-M, LCS-APG, and Scorpio) were used. Revision rate for aseptic loosening was 16 (6.8%) of 235 knees. At 10 and 15 years, survivorship with tibial or femoral revision as the end point was 0.95 and 0.92, respectively. Hybrid TKA provides durable fixation with clinical and radiographic performance at minimum 10 years comparable with cemented series.     

10-year follow-up of patients with and without mediastinitis

Mediastinitis is a dreaded complication of CABG surgery. Short-term outcomes have been described, but there have been only a few long-term studies. We examined the survival of patients undergoing isolated CABG surgery between 1992 and 2001. Mediastinitis was identified during the index admission. Proportional hazards regression was used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI 95%). Among 36,078 consecutive patients, there were 5749 deaths during 148,319 person years of follow-up. There were 418 cases of mediastinitis (1.16%). The incidence of death was 11.15 per 100 person/years with mediastinitis and 3.81 deaths/100 person years without. (P < 0.001). We also examined the mortality rates of patients who survived at least 6 months after their CABG surgery. Patients with mediastinitis had an incidence rate of 5.70 deaths per 100 person/years while those without had a rate of 2.66 deaths per 100 person/years (P < 0.001). After adjustment for baseline differences in patient and disease characteristics, the hazard ratio was 2.12 (CI95% = 1.86,2.58; P < 0.001). The adjusted hazard ratios for patients who survived 6 months postsurgery was 1.70 (CI95% = 1.36,2.13; P < 0.001). Mediastinitis is associated with a marked increase in both acute and long-term mortality rates.     

Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: A 7- to 9-year follow-up study

The first 100 consecutive primary hip arthroplasties with the Arthopor 2 acetabular component (Joint Medical Products, Stamford, CT) with supplemental screw fixation performed by the senior author were prospectively studied. The mean patient age was 57 years. Seventy-seven cemented and 23 cementless stems were placed, with 32-mm femoral heads used in most of the patients. Eighty-six hips were reviewed at 7–8.8 years (mean, 7.8 years). The mean Harris hip score at final follow-up evaluation was 94 points. No cups have been revised, although 2 cups in patients with radiation osteonecrosis were loose radiographically. One patient underwent revision of a severely worn liner. Despite a relatively high mean linear wear rate of 0.27 mm/y (range, 0.13–0.57 mm/y), no radiographic evidence of pelvic osteolysis was seen. The Arthopor 2 cup performed well with respect to pelvic osteolysis, despite the presence of substantial polyethylene debris. The relatively high polyethylene wear rate is attributed in part to the younger patient population and the use of 32-mm femoral heads paired with thin polyethylene liners.     

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%.     

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     

Femoral hernioplasty with a mesh plug

Prosthetic repair of femoral hernias is now standard practice. The aim of the study was to evaluate the results obtained using different types of polypropylene plugs in relation to the different anatomic-surgical aspects of the hernia. Twenty-five femoral hernioplasties were performed, 3 with Gilbert's conical plug, 18 with a dart plug, and 4 with Lichtenstein's cylindrical plug. The functional rehabilitation was rapid, and there were no postoperative complications; over follow-up periods of 3-132 months no recurrences have been reported. The correct choice of plug in femoral hernioplasty makes for efficacy, safety and simplicity. The possibility of choosing among different types of plug in relation to the anatomical characteristics of the hernia provides the surgeon with the right degree of flexibility for achieving the best possible result.     

Osseointegrated wrist-joint prostheses: A 15-year follow-up with focus on bony fixation

Five patients with rheumatoid arthritis or osteoarthrosis of the wrist joint were followed up for 15 (14–17) years after wrist-joint arthroplasty with semiconstrained artificial joint mechanisms that had been anchored to bone using the osseointegration principle. They were fixed by one titanium screw introduced into the radius, and two or more titanium screws introduced distally into the metacarpal bones. In four cases a screw was also introduced into the ulna thereby constituting one component in a distal radio-ulnar (DRU) joint mechanism. The titanium screw introduced into the radius and the distal metacarpal screws osseointegrated in all cases. In three cases the mechanism of the wrist joint or parts of it were replaced with new components that could be attached to the screws that were already osseointegrated. We conclude that wrist joint prostheses can be anchored to the surrounding bone using osseointegration and that they remain fixed for at least 15 years. The principle allows replacement of the joint mechanism, if needed, with maintenance of the osseointegrated anchoring elements.     

In vivo properties of an intramedullary hydroxyapatite plug to improve femoral stem fixation

An intramedullary hydroxyapatite (HA) plug was inserted in each tibia of five rabbits. Histological observation showed the presence of newly formed bone tissue bridging between the inner cortex and the HA plug at 3 months postoperatively. This new bone was in direct contact with the HA plug, and there was no fibrous tissue intervention. Based on these results, the HA plug was used in a hip hemiarthroplasty with bone cement. The radiograph taken 4 years postoperatively showed that the plug-bone interface was indistinct, and some of the plug's edges became rounded by replacement with newly developed bone. The femoral component was stable without subsidence. The HA plug stabilized by bone ingrowth in the femoral canal would certainly be useful to prevent the femoral component from subsiding, in addition to increasing the cement-bone interface pressure at the time of surgery.     

Closed femoral intramedullary nailing without drilling--a 14-year evaluation

A sufficiently stable osteosynthesis is demanded on the basis of the conditions formulated for the healing of bone fractures. This demand applies to fractures in general. For intramedullary nailing in particular, it is a major postulate that sufficient stability can only be attained if the medullar cavity is drilled open. Such drilling aims at establishing an extended contact between the cortical substance of the bone and the nail while exercising at the same time a clamping force that is elastic in transverse direction. In our accident emergency hospital (Ludwigshafen) the medullar cavity is not drilled open. This entails the use of frequently very thin intramedullary nails so that the nail can pass through the hourglass-like narrow pathway in the centre. Although this kind of osteosyntheses is insufficient in respect of stability and ensuring rotation, the healing of bone fractures does not present any problems. As a matter of fact, 450 femurs have been treated at our hospital during the pase 14 years with intramedullary Küntscher nailing without drilling. It is demonstrated that this kind of stabilising the fracture is associated with an extremely low incidence of pseudarthroses and infections. Further complications are stated.     

Pulmonary embolism due to an indefinite plug: 5-year follow-up

Thoracic computed tomography angiography revealed a filling defect with an internal air density in the lower lobar branch of the left pulmonary artery accompanied by pleural fluid, in a patient who applied with sudden onset chest pain and dyspnoea. The filling defect remained stable after anticoagulant treatment. No progression or complications were observed in 5-year follow-up. In pulmonary embolism that does not resolve despite adequate treatment, non-thrombotic sources, particularly foreign body, should be considered.     

Treatment of pathological humerus shaft fractures with intramedullary nails with or without cement fixation

Introduction  

Bone metastasis is a severe complication for patients with cancer. Not only does it cause intractable pain and other clinical problems such as fracture after trivial injury, it also signifies that the malignant process is incurable. Since life expectancy of metastasised cancer patients has improved due to advanced oncological treatment but is still limited, appropriate surgical intervention has increased.     

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     

Femoral lengthening with a motorized intramedullary nail

Purpose — We assessed whether an intramedullary lengthening device would reduce the problems normally associated with the external fixation technique. We also wanted to determine whether it is a reliable construct for limb lengthening and deformity correction in the femur.

Patients and methods — We conducted a matched-pair comparison of 30 femoral lengthenings, 15 with a motorized intramedullary nail (the nail group) and 15 lengthenings with an external ring fixator (the fixator group). The patients were matched based on age, sex, amount of lengthening, and the etiology of leg length discrepancy. Mean lengthening was 35 (25–55) mm in the nail group and 38 (15–75) mm in the fixator group. Outcome measures were: lengthening and alignment achieved, consolidation index, knee range of motion (ROM), and complications.

Results — The pairs in this matched-pair study were similar in terms of age, sex, diagnosis, and amount of lengthening. The planned amount of lengthening was achieved in all patients in both groups and axis correction was considered sufficient. The mean radiographic consolidation index in the nail group, at 1.5 (0.9–3.0) months/cm, was better than the mean value for the fixator group (1.9 (0.9–3.4) months/cm) (p = 0.01). Knee ROM was better in the nail group during the lengthening, 6 weeks after lengthening was completed, and 6 months after lengthening was completed (p < 0.001). A larger number of complications were observed in the fixator group than in the nail group.

Interpretation — A lengthening nail may be superior to external fixation in femoral lengthening, when the anatomical conditions and the complexity of the deformity allow the use of an intramedullary nail.