Retrograde intramedullary nailing of femoral shaft fractures. A prospective study

Purpose of the study. Antegrade intramedullary nailing is seen as a most effective method in the management of femoral fractures. However, complications may arise due to the surgical approach.Can these disadvantages be avoided by using a retrograde approach? Material and methods. In a prospective study 70 femoral fractures in 62 patients were stabilised using a long intramedullary nail by a retrograde approach. Results. We were able to re-examine 50 patients (57 fractures) 13,3 (3–36) months after the operation.Apart from one non-union by infection, all fractures healed in time. Flexion of the knee joint was within a normal ROM in 81% of shaft fractures 12 months or more after the operation, as was the case in 44% of distal fractures. A inhibition of extension was not found in any patient.Two patients had a femoral shortening of up to one centimeter.We observed no rotational malalignement of more than 5°.The clinical results were excellent in 89% of shaft fractures, and in 50% of supra-/diacondylar fractures. In 18 cases a nail removal was already performed, thereby allowing an arthroscopical follow-up inspection of the knee joint.No knee pathology due to nailing was found in either case. Conclusion. Our results show the advantages of retrograde intramedullary nailing in comparison to the antegrade method.     

Unreamed interlocking nailing in open fractures of tibia

PURPOSE: To assess the clinical outcome of unreamed intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open fractures as a result of the unreamed intramedullary nailing. METHODS: Between June 1999 and May 2000, a total of 60 cases of open tibial shaft fractures were operated on with unreamed interlocking nails at Safdarjung Hospital, New Delhi, India. Records of 56 patients (4 women and 52 men) were available for study. Only injuries associated with the tibial shaft were included. Traffic accidents were the cause of fractures in all patients. All fractures were classified according to Gustilo and Anderson system for open fractures. There were 30 (53.6%) type-I, 18 (32.1%) type-II, 4 (7.1%) type-IIIA, and 4 (7.1%) type-IIIB fractures. After thorough debridement under anaesthesia, an unreamed interlocking nail was inserted with assistance by an image intensifier. All nails were statically locked with one screw each proximally and distally. RESULTS: The patients were followed up for a mean period of 20 months (range, 18-24 months) and were evaluated according to the modified Ketenjian's criteria. Results were good to excellent in 85.8% cases, and poor in 10.7% cases. Only 2 of 8 patients with type-III fractures had good results. Two of 4 type-IIIA and all 4 type-IIIB fractures had chronic osteomyelitis. Of 56 patients, 6 had early infection, 6 had delayed union, 6 had infected non-union, 2 had nail breakage, 8 had screw breakage, and 10 had anterior knee pain. CONCLUSION: Unreamed interlocking tibial nailing can be safely used for type-I and type-II open injuries even with delayed presentation. Use of unreamed nailing in those type-III fractures with delayed presentation was not recommended, because of high incidence of complications.     

Results of the treatment of femoral and tibial fractures following interlocking nailing and plate osteosynthesis. A comparative retrospective study

The Howmedica lock nail was introduced to an ordinary hospital where femoral and crural fractures had been stabilised in the past almost exclusively by plate-type osteosynthesis. Since only minor change had taken place regarding surgeons and surgical environment, the decision was taken to compare two groups of patients with lock nailing and plate-type osteosynthesis. Most of the nailing patients could immediately expose the injured extremity to load. Hospitalisation for them was as short as twelve days on average. They were fit for work not later than six months from surgery. Plate-type osteosynthesis patients, on the other hand, were hospitalised five weeks, on average. None of the patients could fully use his or her leg, after two months. Pseudoarthrosis was quite frequent in the wake of plate-type osteosynthesis but was not observed at all after lock nailing. The risk of posttraumatic osteomyelitis was considerably reduced. Covered nailing proved to be applicable to the majority of cases. A specifically designed image converter was used in cases of distal locking. Lock nailing proved to provide a great number of advantages, with cost saving being one of them. It is a routine method that can be used at any general hospital, once the surgical team on the spot has been familiarised with the technique.     

带锁髓内钉治疗股骨干骨折

我院自1998年1月-2001年5月,应用带锁髓内钉治疗各种类型股骨干骨折41例,取得满意疗效. 　　1 临床资料 　　本组41例(42个股骨)中男32例,女9例;右侧25个股骨,左侧17个股骨.平均年龄37岁(17～65岁).均为闭合性骨折.骨折类型(AO分型):A型15侧,B型22侧,C型5侧.致伤原因:交通事故伤31例,摔伤6例,砸伤4例,合并胫腓骨骨折7例,踝部骨折5例,骨盆骨折3例,肋骨骨折3例,5例合并休克,4例有颅脑外伤.……     

交锁髓内钉治疗股骨和胫腓骨骨折

目的探讨交锁髓内钉治疗股骨和胫腓骨骨折的疗效：方法对47例（51肢）股骨和胫腓骨骨折采用交锁髓内钉固定,分析临床疗效。结果随访7～36个月,骨折全部愈合,功能恢复良好,效果满意。结论交锁髓内钉治疗股骨和胫腓骨骨折具有适应证广、创伤小、固定牢靠等优点,可作为股骨和胫骨干骨折的首选治疗方法。应严格掌握适应证及手术时机,熟练掌握操作技术。     

Effects of dynamization after interlocking tibial nailing: an experimental study in dogs

Dynamization of statically locked tibial nails was studied in a canine model. Reamed static interlocking nails were inserted in 16 canine tibiae with unstable osteotomies. At 8 weeks, half were dynamized. At 20 weeks, the tibiae were harvested and studied radiographically, biomechanically, and histologically. Apparent clinical union was present in all tibiae. Complete radiographic bony union was achieved in 13 of 16, with residual radiolucent lines in two tibiae in the static and one in the dynamic group. Biomechanically, dynamization improved stiffness at the fracture site. Histological patterns were similar, but there were trends toward a denser trabecular callus pattern in the dynamized group. The results of this animal study indicate that although dynamization may have a beneficial effect on the quality of early bony healing, static interlocking does not decrease the rate of bony union.     

Stabilization of supra- and intercondylar femoral fractures with retrograde interlocking nailing

Surgical Principles In patients with supracondylar fracture the closed reduction and internal fixation with a medullary pin or nail [1, 2, 4, 5, 10, 12, 13] very frequently cause a deformity of the distal end of the femur. A fixation is not possible in the presence of a short distal fragment. In these instances and in intercondylar femoral fractures an angled blade-plate, a dynamic condylar screw, a T- or Y-shaped plate, or an external fixator can be used [6–9, 11]. If there is an instability on the medial side of the fracture, additional cancellous bone grafting is indicated. In spite of adequate postoperative care the plate becomes sometimes loose and due to it a varus deformity results with decreased knee motion. To avoid these complications Henry et al. developed the GSH-nail [3]. The nail is inserted into the medullary canal of the femur through a transarticular approach. The nail has to be locked at the distal and proximal end. If the fracture is comminuted, restoration of the articular surface has to be achieved first. In 1991 we modified this method and developed an appropriate intramedullary nail and an insertion handle.     

Intramedullary nailing of the femoral shaft: a prospective, randomized study.

We conducted a prospective, randomized study on 84 consecutive patients with 88 acute, traumatic femoral shaft fractures using 32 Grosse-Kempf nails, 29 Russell-Taylor nails, and 27 Synthes nails. Although total operative times and proximal and distal locking times were similar for the three groups, the procedure was faster with the Grosse-Kempf nail. Three proximal fractures could not be locked with the Synthes nail. At first follow-up, we found no significant difference in terms of pain, limp, range of motion, or time to union; however, we removed fewer Synthes nails to resolve patient complaints of pain. Three delayed unions were attributed to fracture distraction. We conclude that all three nails are suitable for the treatment of almost all femoral shaft fractures. A careful analysis of intraoperative technique and instrumentation indicates that all three nails can be used safely and easily once experience is gained. Clinical outcome is similar regardless of the nail chosen.     

Treatment of unstable femoral shaft fractures with closed interlocking intramedullary nailing

From 1979 to 1982, 64 femoral shaft fractures in 62 patients were treated by closed interlocking nailing at Harborview Medical Center, Seattle, WA, U.S.A., and Parkland Memorial Hospital, Dallas, TX, U.S.A. Twenty-nine patients sustained multiple system injuries and 29 of the involved extremities (45%) had at least one additional injury. There were 17 (26%) open fractures. Static mode nailing was used to treat 52 fractures; dynamic mode nailing was performed for 12 fractures. Patient follow-up averaged 17 months (range 7-41 months). The average time to union was 13.5 weeks. Normal femoral length within 1 cm was achieved in 97% of cases. Knee range of motion averaged 127 degrees. Complications (9%) included two delayed unions, one nonunion, two cases of shortening or lengthening of more than 1 cm, and one case of malunion with angulation or more than 10 degrees. The delayed unions and nonunions healed after one additional procedure. This study shows that closed interlocking nailing is a safe, effective technique that provides stable fixation in most unstable femoral shaft fractures. This technique represents a major advance in the treatment of difficult femoral shaft fractures that would be poorly suited for standard closed nailing.     

48例股骨骨折小切口带锁髓内钉内固定体会

2004年1月-2007年12月，我院应用小切口带锁髓内钉内固定治疗股骨骨折48例，取得满意效果     

The Grosse-Kempf nail for distal femoral fractures. 2-year follow-up of 25 cases

Totally, 25 patients with an infraisthmic fracture of the femur, treated with a Grosse-Kempf slotted nail, were followed up for a median of 21 (8-44) months. The median age of the 9 males and 16 females was 45 (18-90) years. No deep infections occurred. An excellent result was obtained in 14 patients, good in 5, fair in 5, and poor in 1 patient in whom intraoperative splintering led to a 9-cm shortening. We conclude that intramedullary locked nailing of fractures of the infraisthmic, extraarticular part of the femur compares favorably with alternative methods.     

Complications of interlocking nailing for lower leg fractures: a 3-year follow up of 102 cases.

Of the 109 patients treated by interlocking nailing for lower leg fractures between 1985 and 1990 at the A.?.KH Schwaz and the LKH Bad Ischl, Austria, 92 underwent follow-up examination. Data were analyzed using a personal computer. Special attention was paid to fracture pattern, level, complications, and length of sick leave. Compared with a previous study, an increasing number of compound fracture patterns were evaluated. Except for 14 misalignments and two late infections after new injuries, no other serious complications were detected. Interlocking nailing can be highly recommended even for open fractures up to the second degree at any level from the second fifth to the fourth fifth of the tibia.     

Cannulated interlocking titanium prosthesis in pathological proximal femoral fractures: a prospective study

The surgical management of metastatic lesions of proximal femur poses a challenge to the surgeon. Internal fixation procedures may not be feasible due to the location and size of the lesion and long stem endoprosthetic replacement may be a safer and preferred option. Bone cement though ideal may not be desirable in high risk patients. Un-cemented cannulated intramedullary prosthesis combines the principles of hemiarthroplasty and an interlocking intramedullary fixation. The prosthesis was used in 10 consecutive patients with 10 completed and 2 impending fractures of proximal femur with a disease free acetabulum. Surgical revision was considered the end point of the study. Pain free, full weight bearing mobilisation was possible in eight patients and no patient required revision until their death. The prosthesis provided a satisfactory solution with minimum surgical complications in high risk patients in our study.     

Early versus delayed stabilization of femoral fractures. A prospective randomized study

A prospective randomized study comparing the results of early with delayed reduction and stabilization of acute femoral fractures in adults was performed over a two-year period in 178 patients. Only patients who were more than sixty-five years old and had a fracture of the hip were excluded. Arterial blood gases, injury-severity score at the time of admission, pulmonary function, days in the hospital, days in the intensive-care unit, and hospital costs were recorded for all patients. The patients were divided into two groups: those who had an isolated fracture of the femur and those who had multiple injuries. When stabilization of the fracture was delayed in the patients who had multiple injuries, the incidence of pulmonary complications (adult respiratory-distress syndrome, fat embolism, and pneumonia) was higher, the hospital stay was longer, and the number of days in the intensive-care unit was increased. The cost of hospital care showed a statistically significant increase for all patients who had delayed treatment of the fracture compared with those who had early stabilization.