Good radiological and functional results after intramedullary nailing of distal radius fractures

Abstract

To evaluate the results after fixation of distal radius fractures using Micronail® internal fixation, a prospective cohort study was performed, including displaced fractures of the distal radius (AO type A 2.2, A3.1, and A3.2). In total, 60 patients were included and 44 patients were available for 1-year follow-up (radiological and clinical examination) and 39 for 5-year follow-up (telephone interview). It was found that all fractures healed, with an average radial volar tilt of 2°, radial length of 11 mm, and a radial inclination of 22°. The functional result was excellent-to-good in 93% of the patients. Thirteen patients (30%) reported paraesthesia of the superficial branch of the radial nerve at the 1-year follow-up. In four patients the paraesthesia of the radial nerve was persistent. No other complications or reoperations were reported by the patients at the 5-year follow-up and only one implant had been removed. The study confirms that the Micronail® is a minimal invasive method that can provide a stable fixation of selected distal radius fractures and provide a good functional outcome with a very low need of implant removal after fracture healing with few complications related to the operation, the main complication being permanent damage to the radial nerve.     

Investigation of perioperative hidden blood loss of unstable intertrochanteric fracture in the elderly treated with different intramedullary fixations

ObjectiveOur aim was to investigate perioperative hidden blood loss (PHBL) of unstable intertrochanteric fracture (UIF) in the elderly treated with different intramedullary fixations.Patients and methods120 consecutive elderly patients with UIF treated by intramedullary nails between January 2013 and September 2016 were enrolled in the retrospective study, including 52 patients (mean age 79.6 ± 6.3) for the Third generation Gamma Nail (TGN), 51 patients (mean age 79.3 ± 7.4) for the Proximal Femoral Nail Anti-rotation (PFNA), 17 patients (mean age 76.2 ± 5.8) for the Intertrochanteric Antegrade Nail (InterTan). The PHBL and total blood loss (TBL) were calculated based on the haematocrit change from admission to 72 h after the operation. The differences of perioperative visible blood loss (PVBL), PHBL, and TBL among TGN, PFNA, and InterTan were compared. The statistical analysis was made using One-way ANOVA for comparison among groups, and Mann-Whitney U test was conducted to a direct comparison between two procedures.ResultsThe mean TBL of all patients was 911.3 mL (range, 446.8-1697.3 mL), whereas the mean PHBL was 771.8 mL (range, 331.5–1756.5 mL), being about 84.5% of TBL. The PVBL in the TGN group was 201.4 ± 101 mL, the TBL was 871.3 ± 196.1 mL, the PHBL was 709.4 ± 181 mL. In the PFNA group, the PVBL was 147.3 ± 81.6 mL, the TBL was 892.6 ± 234.8 mL, and the PHBL was 787.7 ± 250.9 mL. The InterTan group had a PVBL of 246.5 ± 89.7 mL, the TBL was 1086.1 ± 198.1 mL where the PHBL was 910 ± 167.9 mL. The patients in the InterTan group had the largest amount of PHBL and TBL among three groups (P < 0.01), there was no difference between TGN and PFNA group (P = 0.2141).ConclusionsElderly patients with UIF treated by intramedullary fixations always have a significant amount of PHBL, which is much greater than that observed intra-operatively. Regular perioperative measurements of full blood count are necessary to avoid anaemia. InterTan nail is associated with a significantly higher PHBL than that of TGN and PFNA, which needs to be monitored carefully in usual clinical practice.     

髓内钉InterTan与重建钉治疗股骨近端骨折的临床疗效

目的：探究髓内钉InterTan与重建钉治疗股骨近端骨折的疗效。方法资料随机选取2013年6月—2014年6月该院收治的135例股骨近端骨折患者,随机分为研究组68例,对照组67例。对照组行股骨近端重建钉治疗,研究组行髓内钉InterTan治疗,分析两组治疗效果。结果研究组术中出血量（228.65±28.42）mL、住院时间（16.53±5.68）d 及完全负重时间（6.75±1.49）d均优于对照组的（325.57±54.28）mL、（23.62±7.26）d与（10.82±1.93）d,差异具有统计学意义（P＜0.05）;术后研究组髋关节Harris评分（93.63±4.45）分高于对照组（80.24±4.88）分,差异具有统计学意义（P＜0.05）。结论髓内钉InterTan较之股骨近端重建钉治疗疗效确切,可显著改善股骨近端骨折患者髋关节功能。     

胫骨干骨折髓内钉固定后病人膝关节前侧疼痛的临床观察

目的 :探讨胫骨干骨折髓内钉固定后病人膝关节前侧疼痛的发生情况及影响因素。方法 :统计分析我院骨外科2009年1月至2012年9月收治的128例胫骨干骨折患者的临床资料。结果 :128例患者中,所有患者均没有发生髌韧带断裂、髓内钉断裂、骨折不愈合等情况。84例患者发生了膝关节前侧疼痛,发生率为65.6%;近端十字锁钉方式、有扩髓情况的胫骨干骨折髓内钉固定后病人膝关节前侧疼痛的发生率均显著高于平行锁钉方式、无扩髓情况的患者,但不同性别、年龄、骨折类型、髓内钉直径患者膝关节前侧疼痛的发生率之间的差异均不显著。结论 :胫骨干骨折髓内钉固定后病人膝关节前侧疼痛的发生率较高,主要影响因素为近端锁钉方式、扩髓情况。     

内侧皮质不同复位等级对股骨转子间骨折髓内钉内固定术后临床疗效的影响

【摘要】 目的 探究内侧皮质不同复位等级对股骨转子间骨折 (FIF) 股骨近端髓内钉内固定术后临床疗效的影响。 方法 选取2016年6月至2019年10月正阳县人民医院收治的76 例FIF患者作为研究对象,并根据股骨近端髓内钉内固定术后即刻正位 X 线片显示的头颈骨块内侧皮质和股骨干内侧皮质的位置关系将患者分为正性支撑组(25例)、中性支撑组 (26例)和负性支撑组(25例),其中正性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质内上方,中性支撑组患者头颈骨块内侧皮质与股骨干内侧皮质影像学上完全对位,负性支撑组患者头颈骨块内侧皮质位于股骨干内侧皮质外上方。 对比观察 3 组患者术中出血量、手术时间、术后即刻尖顶距(TAD)、骨折愈合时间、股骨颈长度及颈干角变化情况以及临床疗效与并发症发生情况。结果 3 组患者术中出血量、手术时间及术后即刻 TAD 无明显差异 (F =0.021、0.015、0.255,P =0.980、0.985、0.880)。 正性支撑组患者骨折愈合时间明显短于负性支撑组 (q =5.373,P <0.001),而正性支撑组和中性支撑组、中性支撑组和负性支撑组间无明显差异 (q =3.145、2.280,P = 0.074、0.246)。术后即刻及术后3个月,正性支撑组患者股骨颈长度均明显长于中性支撑组和负性支撑组(术后即刻: q =6.172、13.920,P 均 <0.001;术后 3 个月: q =16.240、30.600,P 均 < 0.001),且中性支撑组患者股骨颈长度明显长于负性支撑组 (q = 7.887、14.660,P均<0.001);正性支撑组患者颈干角均明显大于中性支撑组和负性支撑组 (术后即刻: q = 3.562、7.839,P =0.037、P <0.001;术后 3 个月: q =12.360、24.860,P 均 <0.001),且中性支撑组患者颈干角明显大于负性支撑组 (q =4.353、12.740,P =0.008、P <0.001)。 术后 6 个月,正性支撑组患者中优 15 例、良 8 例、中 1 例?差 1 例,明显优于中性支撑组患者的优8例、良8例、中7例、差3例以及负性支撑组患者的优 6 例、良 7 例?中 6 例、差6例 (Z = - 2.520、- 3.150,P = 0.012、0.002),而中性支撑组与负性支撑组间无明显差异(Z = -0.917,P =0.359)。正性支撑组患者术后并发症发生率为 4.00%,中性支撑组患者术后并发症发生率为23.08%,负性支撑组患者术后并发症发生率为 28.00%,3 组患者并发症发生情况无明显差异 (χ2 =5.361,P =0.069)。 结论 FIF患者髓内钉内固定术后内侧皮质正性支撑复位稳定性更好,可明显缩短骨折愈合时间,改善股骨颈长度及颈干角,临床疗效较好,术中有意识的获得正性支撑复位非常必要。     

Strain response of an instrumented intramedullary nail to three-point bending

Objectives:?An experimental biomechanical evaluation of an instrumented intramedullary nail (TriGen® META Nail, Smith&Nephew®) was undertaken. The objectives were two-fold. The first was to identify the most sensitive strain gauge positions and orientations on the nail, and the second was to demonstrate that the nail was capable of detecting changes in stiffness of the nail–bone composite. The function of the instrumented nail is to quantify fracture healing objectively and directly, and so to predict delayed repair or non-union 2 months before current methods.

Methods:?Eight flat pockets were machined onto the surface of the nail and three strain gauges attached in each pocket. The instrumented nail was inserted into fourth generation biomechanical grade Sawbones® tibiae with three different fracture configurations as well as into a non-fractured bone. The nail–bone composite was loaded in three-point bending at five positions to determine the strain changes in each of the eight strain gauge pockets located along the length of the nail. To simulate callus in the simplest way and to increase the stiffness of the nail–bone composite, loops of duct tape in multiples of four were applied over the fracture locus. A three-point loading jig was used to obtain the change in strain with increasing stiffness. Relative displacement of the bone ends was quantified using radiostereometric analysis.

Results:?There was no single position of greatest strain sensitivity for all fracture types. The greatest change in strain occurred when the strain gauge pocket and fracture line were closest. Applying the loading moment directly over the strain gauge pocket also maximised its sensitivity. The duct tape callus simulation showed that the instrumented nail was able to detect a change in stiffness of less than 4.1 Nm/°.

Conclusions:?It has been shown that the instrumented nail can detect physiologically relevant changes in stiffness, and so to provide a useful function as an objective monitor of fracture repair.     

The effect of an intramedullary self-reinforced poly-L-lactide (SR-PLLA) implant on growing bone with special reference to fixation properties. An experimental study on growing rabbits

Polylactic acid (PLA) is a synthetic biodegradable material. The self-reinforced implants made of poly-L-lactic acid (SR-PLLA) were manufactured of biodegradable polymeric matrix reinforced with fibres of the same material. The purpose of this study was to find out the effect of an intramedullary SR-PLLA implant on growing bone and its applicability to the fixation of a femoral shaft osteotomy in a growing rabbit. In seven rabbits 6 weeks of age a SR-PLLA implant 2.0 mm in diameter and 50 mm in length was introduced into the intramedullary cavity of the right femur. A proximal femoral shaft osteotomy of the right femur was made in another ten 6-weeks-old rabbits. After accurate reduction, fixation of the osteotomy was achieved with an intramedullary 2.0 mm by 50 mm SR-PLLA-rod. The follow-up times were 6 and 28 weeks. An intramedullary SR-PLLA-rod neither caused any disturbance of the bone growth nor abnormalities of the peripheral blood cell counts. Solid union of the osteotomy was seen in six weeks after fixation with SR-PLLA implant.     

Postoperative alignment in revision total knee arthroplasty,a comparison between intra and extra-medullary tibial alignment

BackgroundRevision total knee arthroplasty commonly involves stemmed components. If the diaphysis is engaged, this technique may be problematic for mechanical alignment (MA) in cases of tibial bowing, which are not infrequent (up to 30%).The aim of this study is to compare an intra-medullary(IM) and extra-medullary(EM) alignment method. We hypothesized that IM technique and canal-filling stems may result more frequently in valgus MA. On the other hand, an EM technique could produce less valgus knees but is at risk of creating MA outliers.MethodA retrospective radiographic analysis of revision TKAs was performed. The patients were divided to either the EM or IM alignment group and compared on the overall post-operative MA. The following parameters were measured on standing, long leg x-rays: Hip-knee-Ankle angle (HKA), mechanical lateral distal femoral angle and mechanical medial proximal tibial angle (mMPTA).Results119 cases of revision TKAs were included (EM = 80, IM = 39). There was a difference between the EM and IM group for the mean mMPTA (89.94° vs 90.92°, effect size = 0.45, p = 0.013) and HKA angle (1.64° vs 0.05°, effect size = 0.52, p = 0.0064). A higher proportion of IM patients were in overall valgus alignment (16/39, 41%) vs EM group (16/80, 20%, p = 0.0134). Both techniques showed the same proportion of outliers, defined as HKA angle more than 5 degrees from neutral mechanical alignment (11/80 vs 5/39, p = 0.286).ConclusionThe extra-medullary alignment method with short cemented stems creates less valgus mechanical alignment than the intra-medullary technique with press-fit stems, without creating more MA outliers.     

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。