Treatment of femur shaft fractures in children with Ender nails

Ender-nailing is a proved method in the treatment of sub- and pertrochanteric fractures in old people. In special cases Ender-nailing can be useful in the treatment of other types of fractures. 3 cases of Ender-nailing of femoral shaft fractures in childhood are reported.     

交锁髓内钉手术治疗肱骨干骨折

目的介绍采用交锁髓内钉手术治疗肱骨干骨折。方法自1999年1月～2003年1月采用交锁髓内钉(远端不交锁)治疗肱骨干骨折36例。男28例，女8例；年龄19～59岁，平均38岁。AO分型，A型24例，B型11例，C型1例，均采用闭合复位、顺行插钉技术，远端不交锁，术后第2天肩肘带保护下开始功能锻炼，不采用其它外固定。结果随访26例，随访时间3～38个月，平均20个月，所有病例伤口Ⅰ／甲愈合，骨折无延迟愈合及不愈合。平均愈合时间9周，术后肩肘关节功能恢复良好。结论交锁髓内钉是治疗肱骨干骨折较好方法，远端可不交锁。     

The use of Ender nails in fractures of the tibial shaft

Between November 1979 and January 1983, we treated fifty-one severe fractures of the tibial shaft with multiple intramedullary Ender nails. Thirty-six fractures were treated within two weeks after injury. Forty-one fractures united in less than four months and eight, in four to eight months. Only two were not united after eight months. An anatomical reduction was maintained in all but three of the fractures, in which the tibia shortened. Two tibiae united with an angulation of 7 degrees and one with 6 degrees, as measured in two planes. There were two infections, both after an open fracture. It has been our experience that Ender nails provide excellent rotational stability, allow early full weight-bearing, and markedly decrease the duration of need for immobilization. Ender nailing was of value both for the acute management of complicated high-energy fractures of the tibial shaft with extensive soft-tissue damage and as a salvage procedure to maintain reduction of a fracture when other techniques had failed.     

Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails

Between January 1991 and December 2002, we treated 92 acute, displaced, closed humeral shaft fractures (AO classification type A). We used three fixation methods: dynamic compression plates (DCP) in 36 patients, Ender nails (EN) in 32 patients and interlocking nails (ILN) in 24 patients. The patients were followed for a minimum of 24 months. At one year, all fractures except two (one DCP/one ILN) had united. Patients treated with EN had shorter mean operation time, 51 (35–110) min; less mean blood loss, 70 (30–170) ml and shorter mean hospital stay, 5.8 (3–12) days. There were three iatrogenic radial nerve palsies: two in the DCP group and one in the ILN group. There was one wound infection. There were three cases with impingement of the shoulder but range of motion was restored after nail removal. For patients with multiple trauma or high operative risk, EN fixation served as a safer and faster procedure. ILN fixation offered a stable fixation via a smaller incision but more fracture comminution might happen.

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Résumé Entre janvier 1991 et décembre 2002 nous avons traité chirurgicalement 92 fractures diaphysaires humérales fermés déplacés ( classification AO type A). Nous avons utilisé trois méthodes de fixation: plaque à compression dynamique (DCP) chez 36 malades, clou de Ender (EN) chez 32 malades et clou verrouillé (ILN) chez 24 malades. Les malades ont été suivis pendant un minimum de 24 mois. Àprés un an toutes les fractures sauf deux avaient consolidé (un DCP/un ILN). Les Malades traité avec EN ont eu un temps dopération moyen plus court, 51 (35–110) min, une perte sanguine plus faible, 70 (30–170) ml et un plus court séjour à lhôpital , 5.8 (3–12) jours. Il y avait trois paralysies iatrogènes du nerf radial, deux dans le groupe DCP et une dans le groupe ILN. Il y avait une infection. Il y avait trois cas avec un conflit de lépaule mais lamplitude de mouvement a été restauré après ablation du clou. Pour les malades avec multiples traumatismes ou risque opératoire élevé, lenclouage de Ender est une procédure plus sûre et plus rapide. Lenclouage verrouillé a permit une fixation stable par une plus petite incision, mais avec un risque plus grand de comminution de la fracture.

     

Functional treatment of closed humeral shaft fractures

We treated 93 consecutive patients, average age 53 (16–90) years, with closed humeral shaft fractures applying a functional brace immediately after injury. Seventy-two (77%) fractures healed without problems. There were significantly more consolidation problems in fractures in the proximal third (46% consolidated) compared to those at the middle (81% consolidated) and distal third (86% consolidated) of the shaft. Logistic regression analysis revealed the only predictive factor in respect to successful brace treatment was fracture location. No significant difference was found in respect to healing between different AO-type fractures.

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Résumé Nous avons traité 93 malades consécutifs, dâge moyen 53 ans (16–90), avec une fracture diaphysaire humérale fermée en utilisant une attelle fonctionnelle immédiatement après le traumatisme. Soixante-douze (77%) fractures ont guéri sans problème. Il y avait plus de difficultés de consolidation dans les fractures du tiers proximal (46% ont consolidé) comparé à celles du tiers moyen (81% ont consolidé) et du tiers distal (86% ont consolidé) de la diaphyse. Lanalyse statistique a révélé que le seul facteur prédictif de la réussite du traitement est la localisation de la fracture. Aucune différence significative na été trouvée selon les types de la classification AO.

     

带锁髓内钉治疗肱骨骨折

2002年9月～2005年12月,我科应用带锁髓内钉治疗肱骨干骨折16例。效果满意。     

Femoral shaft fractures treated by Ender nails using a trochanteric approach

We describe the use of Ender nails for the internal fixation of femoral shaft fractures by a closed technique via the greater trochanter and report the treatment of 100 patients with 106 fractures, of which 88 were reviewed 12 months or more after operation. There was primary union in 85 fractures (96.6%) and significant angulation, rotation or leg length discrepancy in eight (9%). We discuss the principles of management which we have evolved.     

Treatment of humeral shaft delayed unions and nonunions with humeral locked nails

OBJECTIVE: To report experience with use of humeral locked nails in treating humeral delayed unions and nonunions. The following techniques yielded encouragingly good results: static locking, short-to-long segment nailing, bone grafting, fracture compression, and minimal surgical trauma. DESIGN AND METHODS: A total of 41 consecutive patients with 13 delayed unions and 28 nonunions were treated with humeral locked nails. Delay from trauma to surgery averaged 4.2 months for delayed union and 15.5 months for nonunion. The average age of patients was 50.2 years; average follow-up time was 23.2 months. There were 7 proximal-third fractures, 21 middle-third fractures, and 13 distal-third fractures. The antegrade approach was used for 13 fractures and retrograde for 28. Open nailing was performed in 39 fractures and closed nailing in 2. If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applied. Bone grafting was performed in the fractures with open nailing. Thirty-four fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails. RESULTS: With a single operation, all but two patients achieved osseous union in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original nail and concurrent bone grafting. The second patient, undergoing hemodialysis for chronic renal failure, had persistent nonunion. At follow-up, for patients with antegrade nailing, all but four patients had less than 20 degrees limitation of shoulder abduction. For patients with retrograde nailing, all but two had less than 10 degrees limitation of elbow motion. Only the patient with persistent nonunion had continual pain and significant impairment of arm function. CONCLUSIONS: Humeral locked nailing seems to be effective for humeral delayed unions or nonunions. It may be an acceptable alternative for fractures unsuited for plate fixation, such as those with comminution, osteoporosis, or a severely adhered radial nerve.     

手法闭合复位结合外固定架治疗儿童肱骨干骨折的临床观察

目的 :探讨闭合复位微创治疗儿童肱骨干骨折的临床疗效。方法 :2011年7月至2015年4月采用手法闭合复位结合外固定架固定治疗39例儿童肱骨干骨折,男27例,女12例;年龄3~14岁,平均8.6岁;受伤至治疗时间2 h~7 d,平均2.7 d;其中上段骨折6例,中段骨折21例,下段骨折12例。所有患儿为闭合性损伤,损伤后出现疼痛、肿胀、局部畸形及活动受限等症状,X线检查提示肱骨干骨折。采用肩关节功能Neer评分及肘关节功能HSS评分记录并对比分析治疗前后肩肘关节疼痛、功能、活动度。结果:39例患者均获随访,时间6~12个月,平均8.6个月。术后2例出现针道浅表感染,经换药愈合;其他病例针孔愈合良好。治疗前后肩关节Neer各项评分和总分比较差异均有统计学意义(P0.01),治疗前后肘关节HHS疼痛、功能及总分比较差异均有统计学意义(P0.01)。末次随访患者肩关节功能Neer评分为88.82±2.50,其中优29例,良9例,可1例;肘关节功能HSS评分为91.51±5.09,其中优秀30例,良好7例,一般2例。结论:手法闭合复位结合外固定架治疗儿童肱骨干骨折,具有创伤小、复位效果确切、固定可靠、利于肩肘关节早期功能锻炼等优点,此疗法可作为临床上治疗儿童肱骨干骨折的方法之一。     

交锁髓内钉在股骨干骨折治疗中的应用

目的探讨扩髓交锁髓内钉治疗股骨干骨折的疗效。方法对2000年1月～2004年12月采用小切口开放复位、扩髓后交锁髓内钉固定治疗的155例(164侧)股骨干骨折患者进行回顾性分析,所有患者均采用静力固定。结果143例患者获6～36个月(平均12．3个月)随访。疗效按马元璋等评定标准评定：优124例,良14例,可4例,差1例,优良率为96．5%。1例患者交锁髓内钉断裂再手术,3例患者远端锁钉偏出。结论扩髓交锁髓内钉是治疗股骨干骨折理想的方法,骨折愈合率高,并发症少。     

Marchetti nailing of closed fresh humeral shaft fractures

INTRODUCTION: The purpose of this study was to analyse the results of Marchetti nailing. METHOD: Between 1995 and 2003, 143 patients with closed fresh humeral shaft fractures were treated with the Marchetti-Vicenzi nail. The fractures were classified according to the AO classification: 37 A1, 24 A2, 25 A3, 22 B1, 15 B2, 7 B3, 7 C1, 4 C2 and 2 C3. RESULTS: Fracture healing was obtained in 136 cases. The mean healing time was 11 weeks. There were seven non-unions. The range of motion of the shoulder was excellent in 95 patients (66.4%), moderate in 43 (30%) and poor in five (4.2%). The elbow had an excellent range of motion in 89 patients (62.2%), moderate in 48 (33.5%) and poor in six (4.2%). The functional result was excellent in 56 patients (39.1%), good in 62 (43.3%), fair in 18 (12.6%) and poor in seven (4.9%). CONCLUSION: Marchetti-Vicenzi nailing appears to be a good method for the treatment of humeral shaft fractures. It is technically easy and its results are satisfactory.     

顺行交锁髓内治疗肱骨干骨折不愈合

目的 评价顺行交锁髓内钉治疗肱骨干骨折不愈合的临床效果。方法 对13例肱骨干骨折不愈合采用自体髂骨移植,顺行Russell-Rayler交锁髓内钉治疗。术后行X线片检查和肩关节功能评估。结果 平均随访18个月（14－25个月）,13例均获骨愈合,平均愈合时间4．3个月（3－7个月）。肩关节功能：优9例,良3例,一般1例。肩关节功能完全恢复9例,3例有来自近端交锁螺钉的肩关节撞击症状。结论 对肱骨干骨折不愈合可采用顺行交锁髓内钉治疗;为促进骨愈合,骨端加压和骨移植是必要的。     

Treatment of humeral shaft fractures by closed fixation using multiple intramedullary Kirschner wires

BACKGROUND: The purpose of this study is to present the results of closed fixation of humeral shaft fractures with multiple intramedullary Kirschner wires. METHODS: Twenty-nine humeral shaft fractures in patients 14 to 60 years old were treated by closed fixation with multiple intramedullary Kirschner wires. Each patient was placed supine on the table and was administered general anesthesia. The fractured arm was held vertically up by a transolecranon traction, while the C-arm was kept parallel to the ground and opposite to the affected arm. A cortical window was created approximately 1.5 cm proximal to the olecranon fossa, after splitting the triceps. Under fluoroscopic control, multiple Kirschner wires were introduced retrograde therein, into the medullary cavity, to reach the humeral head. The wire tips were kept splayed to stabilize the fracture. Postoperatively, the limb was supported by an arm sling. RESULTS: Twenty-five fractures (86.4%) healed with excellent clinical and functional results, in an average of 11 weeks. Union was delayed in two patients, and one fracture had a nonunion after repeated trauma. Movements at the shoulder and the elbow were excellent to good in 27 patients (93%), whereas 2 patients (6.8%) had significant limitation of extension at the elbow. CONCLUSION: This technique has been found simple and effective in providing a stable fixation of transverse and short oblique fractures of the humeral diaphysis. Further study is required to evaluate this procedure in more extensive fracture patterns, as well as to compare the results with other methods of internal fixation.     

分叉式交锁髓内钉治疗肱骨干骨折

目的报告肱骨分叉式交锁髓内钉(BLIN型钉)治疗肱骨干骨折的疗效。方法用BLIN型钉治疗肱骨干骨折20例,钢板治疗肱骨干骨折29例,分别从手术情况、并发症、生物力学、骨折愈合情况、功能恢复等方面进行比较。结果随访4～16个月,钢板组平均骨折愈合时间4.2月,术后桡神经麻痹4例,螺钉松动、钢板弯曲1例,骨不连2例。BLIN型钉组平均骨折愈合时间9.6月,术后无一例发生桡神经麻痹,无一例钢钉折弯或断裂,骨折愈合牢固可靠,功能恢复良好。结论肱骨分叉式交锁髓内钉治疗肱骨干骨折,虽然骨折愈合时间较钢板长,但其他方面均优于钢板。     

Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming

A prospective study of closed intramedullary fixation of fractures of the shaft of the humerus, using Ender nails, was performed over a six-year period. Eighty-nine fractures in eighty-eight patients were treated with no immobilization postoperatively. Three patients were lost to follow-up. Eighty-five of the remaining eighty-six fractures healed, the average time to clinical union being 7.2 weeks. Non-union of one fracture occurred and there were no infections or malunions. Six of the nine preoperative and two postoperative radial-nerve palsies were lesions in continuity and healed spontaneously. The remaining three radial nerves that had been severed by a missile needed further attention. One of the nails backed out in eight patients, requiring revision in five. The average lack of complete extension of the elbow was 4 degrees and flexion of the elbow was 132 degrees. Abduction of the shoulder averaged 91 degrees; external rotation, 54 degrees; and internal rotation, 68 degrees. We conclude that closed intramedullary Ender nailing can be performed safely and effectively in selected fractures of the humeral shaft. However, only fractures that are recalcitrant to closed reduction and immobilization or fractures in the non-compliant patient should be considered for this form of operative treatment.