Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was...Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was used to examine data of patients with proximal metastatic cancer of the femur who were treated with internal fixation in Department of Orthopaedics,Beijing Friendship Hospital,from January 2007 to December 2018.Blood loss,postoperative pain,functional score,length of stay,and survival rates were compared,and postoperative complications were assessed.Results:Complete follow-up data were available for 33 patients.The mean follow-up period was 12.2±3.6(range:9-32)months and the average age was 72.3±4.7(range:59-83)years old.There were 20 females and 13 males.Twenty-three patients had undergone IMN and 10 DHS,according to bone defects and the patient’s overall condition.The median survival time was 10 months in the IMN group and 11 months in the DHS group.Duration of surgery(t=-7.366,P<0.001)and length of hospital stay(t=-3.509,P<0.001)differed significantly between the two groups.There was one case of breakage of internal fixation in the IMN group.Conclusions:There was no significant difference between DHS and IMN in terms of surgical efficacy.IMN and DHS were different in terms of surgical time and hospital stay.However,due to the limited number of cases in this study,multi-factor analysis has not been performed and needs to be further verified in future analysis.When developing a surgical plan,it is recommended to consider the patient’s condition and the surgeon’s experience.展开更多
BACKGROUND Multiple myeloma(MM)bone disease is indicative of MM,and reduces patient life quality.In addition to oncological,antineoplastic systemic therapy,surgical therapy in patients with MM is an essential treatmen...BACKGROUND Multiple myeloma(MM)bone disease is indicative of MM,and reduces patient life quality.In addition to oncological,antineoplastic systemic therapy,surgical therapy in patients with MM is an essential treatment within the framework of supportive therapy measures and involves orthopedic tumor surgery.Nevertheless,there are few reports on intramedullary(IM)nailing in the treatment of MM-induced proximal humeral fracture to prevent fixation loss.We here describe a case of pathological fracture of the proximal humerus caused by MM successfully treated with IM nailing without removal of tumors and a review of the current literature.CASE SUMMARY A 64-year-old male patient complaining of serious left shoulder pain and limited movement was admitted.The patient was finally diagnosed with MM(IgAλ,IIIA/II).After treatment of the pathological fracture with IM nailing,the patient's function recovered and his pain was rapidly relieved.Histopathological examination demonstrated plasma cell myeloma.The patient received chemotherapy in the Hematology Department.The humeral fracture displayed good union during the 40-mo follow-up,with complete healing of the fracture,and the clinical outcome was satisfactory.At the most recent follow-up,the patient's function was assessed using the Musculoskeletal Tumor Society score,which was 29.CONCLUSION Early surgery should be performed for the fracture of the proximal humerus caused by MM.IM nailing can be used without removal of tumors.Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.展开更多
AIM: To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw(PIS) for intramedullary nailing(IMN).METHODS: Thirty-six dry cadaver ulnas were split into two equal pieces sagital...AIM: To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw(PIS) for intramedullary nailing(IMN).METHODS: Thirty-six dry cadaver ulnas were split into two equal pieces sagitally. The following points were identified for each ulna: the deepest point of the incisura olecrani(A), the point where perpendicular lines from A and the ideal IMN entry point(D) are intersected(C) and a point at 3.5 mm(2 mm safety distance from articular surface + 1.5 mm radius of PIS) posterior from point A(B). We calculated the angle of screws inserted from point D through to point B in relation to D-C and B-C. In addition, an eccentrically aligned screw was inserted at a standard 20° through the anterior cortex of the ulna in each bone and the articular surface wasobserved macroscopically for any damage.RESULTS: The mean A-C distance was 9.6 mm(mean ± SD, 9.600 ± 0.763 mm), A-B distance was 3.5 mm, C-D distance was 12.500 mm(12.500 ± 1.371 mm) and the mean angle was 25.9°(25.9°± 2.0°). Lack of articular damage was confirmed macroscopically in all bones after the 20.0° eccentrically aligned screws were inserted. Intramedullary nail fixation systems have well known biological and biomechanical advantages for osteosynthesis. However, as well as these well-known advantages, IMN fixation of the ulna has some limitations. Some important limitations are related to the proximal interlocking of the ulna nail. The location of the PIS itself limits the indications for which intramedullary systems can be selected as an implant for the ulna. The new PIS design, where the PIS is aligned 20°eccentrically to the nail body, allows fixing of fractures even at the level of the olecranon without disturbing the joint. It also allows the eccentrically aligned screw to be inserted in any direction except through the proximal radio-ulnar joint. Taking into consideration our results, we now use a 20° eccentrically aligned PIS for all ulnas. In our results, the angle required to insert the PIS was less than 20° for only one bone. However, 0.7° difference corresponds to placement of the screw only 0.2 mm closer to the articular surface. As we assume 2.0 mm to be a safe distance, a placement of the screw 0.2 mm closer to the articular surface may not produce any clinical symptoms.CONCLUSION: The new PIS may give us the opportunity to interlock IMN without articular damage and confirmation by fluoroscopy if the nail is manufactured with a PIS aligned at a 20.0° fixed angle in relation to the IMN.展开更多
BACKGROUND Currently,open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture.However,open reduction is associated with a high risk of complications.This ca...BACKGROUND Currently,open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture.However,open reduction is associated with a high risk of complications.This case of forearm double fracture involved a patient treated using an Acumed intramedullary nail.The patient experienced good follow-up outcomes.The Acumed forearm intramedullary nail enables early functional exercise and hastens healing of the fracture.Few studies have reported on the use of this approach for the treatment of fractures.CASE SUMMARY A 23-year-old male patient was admitted to hospital after 5 h of pain,swelling,and limited activity of left forearm caused by a careless fall.Physical examination showed stable basic vital signs,swelling of the left forearm,and severe pain when pressing on the injured part of the forearm.Further,friction was felt at the broken end of the bone;the skin was not punctured.Movement of the left hand was normal,and the left radial artery pulse was normal.Three-dimensional computed tomography examination showed an ulna fracture of the left forearm and comminuted fracture of the radius.The fracture was located in the upper third of the radius,with significant displacement on the fracture side.Clinical diagnosis further confirmed the left radius comminuted fracture and ulna fracture.After analyzing the fracture pattern,age,and other patient characteristics,we chose an Acumed nail for treatment and achieved good follow-up outcomes.CONCLUSION Acumed forearm intramedullary nail for fixation of ulna and radius fracture reduced complication risk and resulted in good follow-up outcomes.展开更多
Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. In developing countries, patients are admitted to teaching hospitals 6 to 24 hours af...Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. In developing countries, patients are admitted to teaching hospitals 6 to 24 hours after their initial trauma. We sought to evaluate outcomes of nailing and correlations between the risk of infection and the delay in surgery. Materials and methods: Medical files of 48 men and 15 women with a combined total of 63 open fractures of the leg during a 12-year period were reviewed. The mean age was 29 years. Thirty-four type I and 29 type II open fractures according to the classification of Cauchoix and Duparc were treated with Küntscher nail after excision/debridement. Preoperative CRP was performed in 27 patients and in 22 cases it was positive. Twenty-six fractures were treated within a period of 6 to 24 hours, and a further 37 was operated on beyond 24 hours. The average waiting time before surgery was 2 days. Results: The infection was present in 11 patients (17.5%). We failed to establish any correlation between the time of treatment and the occurrence of infection for both type I and type II fractures treated during the same intervals with p = 0.244 (p > 0.05). But we established a correlation between the type of open fracture and the occurrence of infection with p = 0.01 (p < 0.05). There were 10 cases of infection among 22 cases of positive preoperative CRP. We couldn’t find a correlation between the positive value of the preoperative CRP and the occurrence of infection. Seven cases of infection were treated with appropriate antibiotherapy and early revision surgery. Four others cases complicated to bone infection (n = 2) and septic nonunion (n = 2). The average time of hospitalization was 22 days. The average time for fracture healing was 7 months. Conclusion: The rule of six hours is hardly applicable in our contexts. Our study showed no correlation between the preoperative period and the occurrence of infection.展开更多
Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw....Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw. Methods: Forty-three patients who had a fracture of the femoral shaft were managed between 2005 and 2008 with intramedullary nailing and the use of only one screw for distal interlocking. Prospectively we evaluated the union time, possible reoperation, fixation and fracture alignment, range of knee motion and complications. Results: Union occurred within a mean duration of 18.7 weeks. No failures of the fixation and fracture alignment and no more than 1 cm shortness were detected. The knee range of motion was all more than 90 degree. Only one deep venous thrombosis was detected as complication. Conclusions: Compressive nailing using proximal hole and only distal dynamic hole with one screw is a convenient technique for femur fractures.展开更多
Objective: The purpose of this meta-analysis is to determine whether plating or intramedullary nailing(IMN) for adult diaphyseal both-bone forearm fractures(BBFF) provides better clinical outcomes. Methods: MEDLINE, E...Objective: The purpose of this meta-analysis is to determine whether plating or intramedullary nailing(IMN) for adult diaphyseal both-bone forearm fractures(BBFF) provides better clinical outcomes. Methods: MEDLINE, EMBASE, Google Scholar and The Cochrane Library were comprehensively searched until July 31, 2016.Both retrospective study and prospective trails about comparison of dual IMN or hybrid fixation versus dual plating fixation in the treatment of adult diaphyseal BBFF were included. Using Rev Man5.3 software, data of functional recovery, the union time,operating time and complication was extracted for meta-analysis. Results: The pooled analysis showed similar results in the union time, functional recovery and the rates of complications, but showed a significant difference in operating time. Conclusion: This meta-analysis demonstrates similar radiographic outcomes, functional outcomes and complications with plates or IMN used in the treatment of adult diaphyseal BBFF. IMN fixation for these fractures seems to be an alternative and effective treatment with shorter operating times and minimally invasive.展开更多
Purpose:In the surgical treatment of paediatric forearm fractures,plate-screw and titanium elastic nails are used.During the transformation of ligamento-osseous structures from adolescence form into adult form,more st...Purpose:In the surgical treatment of paediatric forearm fractures,plate-screw and titanium elastic nails are used.During the transformation of ligamento-osseous structures from adolescence form into adult form,more stable fixation is required.The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures.Methods:A retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture.The included patients were in the adolescent age group(12-17 years),did not meet conservative follow-up criteria and had unstable fractures(>10 angulation and<50%cortex continuity after plaster casting).Patients were excluded from the study if they were aged>18 years or<12 years,had Gustilo-Anderson type 2/3 open fractures,multitrauma,history of physeal injuries or could not be contacted during follow-up.Patients'age,gender,body mass index,affected side,and the pronation and supination values during follow-up were noted.Functional evaluation of the patients was performed with disabilities of the arm,shoulder and hand score and the surgical outcomes were evaluated according to the Price criteria.The time to union,infection during follow-up,re-fracture and vascular nerve damage were also examined.Data were analyzed using SPSS 22 Windows package program software.Results:The patients comprised 30 males and 6 females(ratio,5:1)with a mean age of(14.7±2.1)years(range,12-18 years).According to the Price criteria,the results of 33 patients were excellent,3 were good and there were no moderate or poor cases.The mean disabilities of the arm,shoulder and hand score was 11.2±6.1(range,4-28).The mean time to union was(8.7±2.2)weeks(range,6-14 weeks),while patients aged>15 years had prolonged time to union([11.1±1.8]weeks).There were no non-unions,re-fractures or infections.No complications were observed during implant removal.None of the patients had sensorial radial nerve injury or tendon damage.Conclusion:The locked intramedullary nailing technique,which is minimally invasive and provides biological fixation,was found to be successful and safe in the treatment of adolescent forearm fractures.展开更多
Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic ...Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.展开更多
Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral...Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.展开更多
Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and </span></span></span></span><span style...Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">frequent</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> crit</span><span style="font-family:Verdana;">ical circulation. We report the case of two-level tibial pseudarthroses in an</span><span style="font-family:Verdana;"> 83</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">- </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">year</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;">old woman caused by multiple myeloma successfully stabilized by a long </span><span style="font-family:Verdana;">ankle arthrodesis nail combined with locking compression plate</span> <span style="font-family:Verdana;">osteosynthesis. This case is unique</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> as to our best knowledge</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> herein</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> diaphyseal fractures were </span><span style="font-family:Verdana;">treated for the first time using a technique reported hitherto primarily for</span><span style="font-family:Verdana;"> fragility ankle and pilon fractures.展开更多
BACKGROUND Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate.In the case of delayed union after antegrade or retrograde intrame...BACKGROUND Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate.In the case of delayed union after antegrade or retrograde intramedullary nail fixation,fracture dynamization is often attempted first.Nonunion after dynamization has been shown to occur due to infection and other aseptic etiologies.We present a unique case of diaphyseal femoral shaft fracture nonunion after dynamization due to intramedullary cortical bone pedestal formation at the distal tip of the nail.CASE SUMMARY A 37-year-old male experienced a high-energy trauma to his left thigh after coming down hard during a motocross jump.Evaluation was consistent with an isolated,closed,left mid-shaft femur fracture.He was initially managed with reamed antegrade intramedullary nail fixation but had continued thigh pain.Radiographs at four months demonstrated no evidence of fracture union and failure of the distal locking screw,and dynamization by distal locking screw removal was performed.The patient continued to have pain eight months after the initial procedure and 4 mo after dynamization with serial radiographs continuing to demonstrate no evidence of fracture healing.The decision was made to proceed with exchange nailing for aseptic fracture nonunion.During the exchange procedure,an obstruction was encountered at the distal tip of the failed nail and was confirmed on magnified fluoroscopy to be a pedestal of cortical bone in the canal.The obstruction required further distal reaming.A longer and larger diameter exchange nail was placed without difficulty and without a distal locking screw to allow for dynamization at the fracture site.Post-operative radiographs showed proper fracture and hardware alignment.There was subsequently radiographic evidence of callus formation at one year with subsequent fracture consolidation and resolution of thigh pain at eighteen months.CONCLUSION The risk of fracture nonunion caused by intramedullary bone pedestal formation can be mitigated with the use of maximum length and diameter nails and close follow up.展开更多
Purpose:Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures,especially in osteoporotic patients.The purpose of this study is to prospecti...Purpose:Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures,especially in osteoporotic patients.The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.Methods:A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017–2019 by distal locked or unlocked long PFNA-II fixation were included in this study.Patients who had multiple injuries or open fractures were excluded.There were 40 female and 18 male patients,with 33 affecting the left side and 25 the right side.Of them,31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B).Surgical procedures and implants used in both groups were similar except for the distal locking of the nails.General data (age,gender,fracture side,etc.) showed no significant difference between two groups (allp > 0.05).The intraoperative parameters like operative time,radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared.Statistical tests like the independent samplest-test Fischer’’s exact and Chi-square test were used to analyze association.Results:The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study.All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year.The operative time (mL,107.1 ± 12.6vs.77.0 ± 12.0,p < 0.001) and radiation exposure (s,78.6 ± 11.0vs.40.3 ± 9.3,p < 0.001) were significantly less among the patients in group B.Fracture consolidation,three months after the operative procedures,was seen in a significantly greater proportion of patients in group B (92.6%vs.67.7%,p = 0.025).Hardware irritation because of distal locking bolt was exclusively seen in group A,however this was not statistically significant (p = 0.241).Conclusion:We conclude that,in fixation of stable intertrochanteric fractures by long PFNA-II nail,distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation,and hence is not required.展开更多
BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fr...BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years.METHODS This retrospective study includes pediatric patients(age range 5-13 years)who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019.Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods[locked intramedullary nailing(IMN),submuscular plating(SMP),and external fixation]and to length stable fractures treated with FIMN.Exclusion criteria included patients who had an underlying predisposition for fractures(e.g.,pathologic fractures or osteogenesis imperfecta),polytrauma necessitating intensive care unit care and/or extensive management of other injuries,incomplete records,or no follow-up visits.Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well.RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups.These three groups are length unstable fractures treated with FIMN(n=21),length stable fractures treated with FIMN(n=45),and length unstable fractures treated with either locked IMN,SMP,or external fixator(n=29).P values<0.05 were considered statistically significant.Patient characteristic differences that were statistically significant between the groups,length unstable with FIMN and length unstable with locked IMN,SMP,or external fixator,were average age(7.4 years vs 9.3 years,respectively),estimated blood loss(29.2 mL vs 98 mL,respectively)and body mass(27.8 kg vs 35.1 kg,respectively).All other patient characteristic differences were statistically insignificant.Regarding complications,length unstable with FIMN had 9 total complications while length unstable with locked IMN,SMP,or external fixator had 10.Grouping these complications into minor or major,length unstable with locked IMN,SMP,or external fixator had 6 major complication while length unstable with FIMN had 0 major complications.This difference in major complications was statistically significant.Lastly,when comparing patient characteristics between the groups,length unstable with FIMN and length stable with FIMN,all characteristics were statistically similar except time to weight bearing(39 d vs 29 d respectively).When analyzing complication differences between these two groups(9 total complications,0 major vs 20 total complications,4 major),the complication rates were considered statistically similar.CONCLUSION FIMN is effective for length unstable fractures,having a low rate of complications.FIMN is a suitable option for length stable and length unstable femur fractures alike.展开更多
BACKGROUND Surgical correction of femoral deformities in polyostotic fibrous dysplasia(PFD)or McCune-Albright syndrome(MAS),such as coxa vara or shepherd’s crook deformity,is a challenge.AIM To evaluate the treatment...BACKGROUND Surgical correction of femoral deformities in polyostotic fibrous dysplasia(PFD)or McCune-Albright syndrome(MAS),such as coxa vara or shepherd’s crook deformity,is a challenge.AIM To evaluate the treatment of patients with femoral deformities caused by PDF or MAS treated by osteotomies and stabilized with different methods,by analyzing the most relevant studies on the topic.METHODS A literature search was performed in Medline database(PubMed).Articles were screened for patients affected by PFD or MAS surgically managed by osteotomies and stabilized with different methods.RESULTS The initial search produced 184 studies,with 15 fulfilling the eligibility criteria of our study.Selected articles(1987-2019)included 111 patients overall(136 femurs).CONCLUSION Based on our results,the preferred method to stabilize corrective osteotomies is intramedullary nailing with neck cross pinning.When the deformity is limited to the proximal part of the femur,a screw or blade plate may be used,although there is a high risk of fracture below the plate.When the femur is entirely involved,a two-stage procedure may be considered.展开更多
BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with min...BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.展开更多
BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging too...BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.展开更多
<b><span>Background</span></b><b><span>: </span></b><span>Bisphosphonate abuse is associated with atypical femur fractures, which despite different fixation method...<b><span>Background</span></b><b><span>: </span></b><span>Bisphosphonate abuse is associated with atypical femur fractures, which despite different fixation methods have increased non-union, delayed union, and re-operation rates. Therefore, there is a need for a surgical technique that may enhance union in such cases. Herein we are introducing a novel technique of sequential multiple vigorous reaming across the fracture site to introduce reaming debris/endosteal bone graft around the fracture site.</span><span> </span><b><span>Materials and Methods</span></b><b><span>: </span></b><span>We present a retrospective analysis of five prospectively treated patients with atypical diaphyseal femur fracture who presented to us from January 2015 to August 2019.</span><span> </span><span>All the patients were followed up at regular intervals and assessed both clinically and radiologically.</span><span> </span><b><span>Results</span></b><b><span>: </span></b><span>All 5 cases operated with our technique showed union at a mean follow-up of 16 weeks (12</span><span> </span><span>-</span><span> </span><span>20 weeks). There were no complications reported in our study at the last mean follow-up of 25 months (12</span><span> </span><span>-</span><span> </span><span>51 months).</span><span> </span><b><span>Conclusion</span></b><b><span>: </span></b><span>This technique of multiple vigorous reaming at and around the fracture site provides a new paradigm in the management of AFF. The autograft around the outer cortex promotes the formation of bridging callus and results in the early union.</span>展开更多
Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial p...Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial part,but fail to buttress the broken lateral wall requiring lateral augmentation.The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures,which was fixed to the femur through hip screw and anti-rotation screw nail.Methods:Of 30 patients,20 had Jensen-Evan typeⅢand 10 had type V fractures.Patients with IT fracture of broken lateral wall and aged more than 18 years,in whom satisfactory reduction was achieved by closed methods,were included in the study.Patients with pathologic or open fractures,polytrauma,prior hip surgery,non-ambulatory prior to surgery,and those who refused to participate were excluded.The operative time,blood loss,radiation exposure,quality of reduction,functional outcome,and union time were evaluated.All data were coded and recorded in Microsoft Excel spread sheet program.SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.Results:The mean age of patients in the study was 60.3 years.The mean duration of surgery(min),mean intra-operative blood loss(mL)and mean number of exposures were 91.86±12.8(range 70-122),144.8±3.6(range 116-208),and 56.6(range 38-112),respectively.The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.Conclusion:Lateral trochanteric wall in IT fractures is significantly important,and needs to be recon-structed adequately.Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment,fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.展开更多
基金Capital’s Funds for Health Improvement and Research(No.2018-1-2072)。
文摘Objective:To compare the outcomes of dynamic hip screws(DHS)and intramedullary nailing(IMN)in the treatment of extra-capsular metastatic carcinoma of the proximal femur.Methods:A retrospective case analysis method was used to examine data of patients with proximal metastatic cancer of the femur who were treated with internal fixation in Department of Orthopaedics,Beijing Friendship Hospital,from January 2007 to December 2018.Blood loss,postoperative pain,functional score,length of stay,and survival rates were compared,and postoperative complications were assessed.Results:Complete follow-up data were available for 33 patients.The mean follow-up period was 12.2±3.6(range:9-32)months and the average age was 72.3±4.7(range:59-83)years old.There were 20 females and 13 males.Twenty-three patients had undergone IMN and 10 DHS,according to bone defects and the patient’s overall condition.The median survival time was 10 months in the IMN group and 11 months in the DHS group.Duration of surgery(t=-7.366,P<0.001)and length of hospital stay(t=-3.509,P<0.001)differed significantly between the two groups.There was one case of breakage of internal fixation in the IMN group.Conclusions:There was no significant difference between DHS and IMN in terms of surgical efficacy.IMN and DHS were different in terms of surgical time and hospital stay.However,due to the limited number of cases in this study,multi-factor analysis has not been performed and needs to be further verified in future analysis.When developing a surgical plan,it is recommended to consider the patient’s condition and the surgeon’s experience.
文摘BACKGROUND Multiple myeloma(MM)bone disease is indicative of MM,and reduces patient life quality.In addition to oncological,antineoplastic systemic therapy,surgical therapy in patients with MM is an essential treatment within the framework of supportive therapy measures and involves orthopedic tumor surgery.Nevertheless,there are few reports on intramedullary(IM)nailing in the treatment of MM-induced proximal humeral fracture to prevent fixation loss.We here describe a case of pathological fracture of the proximal humerus caused by MM successfully treated with IM nailing without removal of tumors and a review of the current literature.CASE SUMMARY A 64-year-old male patient complaining of serious left shoulder pain and limited movement was admitted.The patient was finally diagnosed with MM(IgAλ,IIIA/II).After treatment of the pathological fracture with IM nailing,the patient's function recovered and his pain was rapidly relieved.Histopathological examination demonstrated plasma cell myeloma.The patient received chemotherapy in the Hematology Department.The humeral fracture displayed good union during the 40-mo follow-up,with complete healing of the fracture,and the clinical outcome was satisfactory.At the most recent follow-up,the patient's function was assessed using the Musculoskeletal Tumor Society score,which was 29.CONCLUSION Early surgery should be performed for the fracture of the proximal humerus caused by MM.IM nailing can be used without removal of tumors.Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.
文摘AIM: To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw(PIS) for intramedullary nailing(IMN).METHODS: Thirty-six dry cadaver ulnas were split into two equal pieces sagitally. The following points were identified for each ulna: the deepest point of the incisura olecrani(A), the point where perpendicular lines from A and the ideal IMN entry point(D) are intersected(C) and a point at 3.5 mm(2 mm safety distance from articular surface + 1.5 mm radius of PIS) posterior from point A(B). We calculated the angle of screws inserted from point D through to point B in relation to D-C and B-C. In addition, an eccentrically aligned screw was inserted at a standard 20° through the anterior cortex of the ulna in each bone and the articular surface wasobserved macroscopically for any damage.RESULTS: The mean A-C distance was 9.6 mm(mean ± SD, 9.600 ± 0.763 mm), A-B distance was 3.5 mm, C-D distance was 12.500 mm(12.500 ± 1.371 mm) and the mean angle was 25.9°(25.9°± 2.0°). Lack of articular damage was confirmed macroscopically in all bones after the 20.0° eccentrically aligned screws were inserted. Intramedullary nail fixation systems have well known biological and biomechanical advantages for osteosynthesis. However, as well as these well-known advantages, IMN fixation of the ulna has some limitations. Some important limitations are related to the proximal interlocking of the ulna nail. The location of the PIS itself limits the indications for which intramedullary systems can be selected as an implant for the ulna. The new PIS design, where the PIS is aligned 20°eccentrically to the nail body, allows fixing of fractures even at the level of the olecranon without disturbing the joint. It also allows the eccentrically aligned screw to be inserted in any direction except through the proximal radio-ulnar joint. Taking into consideration our results, we now use a 20° eccentrically aligned PIS for all ulnas. In our results, the angle required to insert the PIS was less than 20° for only one bone. However, 0.7° difference corresponds to placement of the screw only 0.2 mm closer to the articular surface. As we assume 2.0 mm to be a safe distance, a placement of the screw 0.2 mm closer to the articular surface may not produce any clinical symptoms.CONCLUSION: The new PIS may give us the opportunity to interlock IMN without articular damage and confirmation by fluoroscopy if the nail is manufactured with a PIS aligned at a 20.0° fixed angle in relation to the IMN.
文摘BACKGROUND Currently,open reduction internal fixation is the conventional surgical method for treatment of double ulna and radius fracture.However,open reduction is associated with a high risk of complications.This case of forearm double fracture involved a patient treated using an Acumed intramedullary nail.The patient experienced good follow-up outcomes.The Acumed forearm intramedullary nail enables early functional exercise and hastens healing of the fracture.Few studies have reported on the use of this approach for the treatment of fractures.CASE SUMMARY A 23-year-old male patient was admitted to hospital after 5 h of pain,swelling,and limited activity of left forearm caused by a careless fall.Physical examination showed stable basic vital signs,swelling of the left forearm,and severe pain when pressing on the injured part of the forearm.Further,friction was felt at the broken end of the bone;the skin was not punctured.Movement of the left hand was normal,and the left radial artery pulse was normal.Three-dimensional computed tomography examination showed an ulna fracture of the left forearm and comminuted fracture of the radius.The fracture was located in the upper third of the radius,with significant displacement on the fracture side.Clinical diagnosis further confirmed the left radius comminuted fracture and ulna fracture.After analyzing the fracture pattern,age,and other patient characteristics,we chose an Acumed nail for treatment and achieved good follow-up outcomes.CONCLUSION Acumed forearm intramedullary nail for fixation of ulna and radius fracture reduced complication risk and resulted in good follow-up outcomes.
文摘Emergency debridement has long been the standard of care for open fractures of the tibia as infection is an important complication. In developing countries, patients are admitted to teaching hospitals 6 to 24 hours after their initial trauma. We sought to evaluate outcomes of nailing and correlations between the risk of infection and the delay in surgery. Materials and methods: Medical files of 48 men and 15 women with a combined total of 63 open fractures of the leg during a 12-year period were reviewed. The mean age was 29 years. Thirty-four type I and 29 type II open fractures according to the classification of Cauchoix and Duparc were treated with Küntscher nail after excision/debridement. Preoperative CRP was performed in 27 patients and in 22 cases it was positive. Twenty-six fractures were treated within a period of 6 to 24 hours, and a further 37 was operated on beyond 24 hours. The average waiting time before surgery was 2 days. Results: The infection was present in 11 patients (17.5%). We failed to establish any correlation between the time of treatment and the occurrence of infection for both type I and type II fractures treated during the same intervals with p = 0.244 (p > 0.05). But we established a correlation between the type of open fracture and the occurrence of infection with p = 0.01 (p < 0.05). There were 10 cases of infection among 22 cases of positive preoperative CRP. We couldn’t find a correlation between the positive value of the preoperative CRP and the occurrence of infection. Seven cases of infection were treated with appropriate antibiotherapy and early revision surgery. Four others cases complicated to bone infection (n = 2) and septic nonunion (n = 2). The average time of hospitalization was 22 days. The average time for fracture healing was 7 months. Conclusion: The rule of six hours is hardly applicable in our contexts. Our study showed no correlation between the preoperative period and the occurrence of infection.
文摘Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw. Methods: Forty-three patients who had a fracture of the femoral shaft were managed between 2005 and 2008 with intramedullary nailing and the use of only one screw for distal interlocking. Prospectively we evaluated the union time, possible reoperation, fixation and fracture alignment, range of knee motion and complications. Results: Union occurred within a mean duration of 18.7 weeks. No failures of the fixation and fracture alignment and no more than 1 cm shortness were detected. The knee range of motion was all more than 90 degree. Only one deep venous thrombosis was detected as complication. Conclusions: Compressive nailing using proximal hole and only distal dynamic hole with one screw is a convenient technique for femur fractures.
文摘Objective: The purpose of this meta-analysis is to determine whether plating or intramedullary nailing(IMN) for adult diaphyseal both-bone forearm fractures(BBFF) provides better clinical outcomes. Methods: MEDLINE, EMBASE, Google Scholar and The Cochrane Library were comprehensively searched until July 31, 2016.Both retrospective study and prospective trails about comparison of dual IMN or hybrid fixation versus dual plating fixation in the treatment of adult diaphyseal BBFF were included. Using Rev Man5.3 software, data of functional recovery, the union time,operating time and complication was extracted for meta-analysis. Results: The pooled analysis showed similar results in the union time, functional recovery and the rates of complications, but showed a significant difference in operating time. Conclusion: This meta-analysis demonstrates similar radiographic outcomes, functional outcomes and complications with plates or IMN used in the treatment of adult diaphyseal BBFF. IMN fixation for these fractures seems to be an alternative and effective treatment with shorter operating times and minimally invasive.
文摘Purpose:In the surgical treatment of paediatric forearm fractures,plate-screw and titanium elastic nails are used.During the transformation of ligamento-osseous structures from adolescence form into adult form,more stable fixation is required.The aim of this study was to evaluate the results of locked intramedullary nail fixation in adolescent forearm fractures.Methods:A retrospective examination was made on 36 adolescent patients who underwent surgery with locked intramedullary nail fixation due to a forearm fracture.The included patients were in the adolescent age group(12-17 years),did not meet conservative follow-up criteria and had unstable fractures(>10 angulation and<50%cortex continuity after plaster casting).Patients were excluded from the study if they were aged>18 years or<12 years,had Gustilo-Anderson type 2/3 open fractures,multitrauma,history of physeal injuries or could not be contacted during follow-up.Patients'age,gender,body mass index,affected side,and the pronation and supination values during follow-up were noted.Functional evaluation of the patients was performed with disabilities of the arm,shoulder and hand score and the surgical outcomes were evaluated according to the Price criteria.The time to union,infection during follow-up,re-fracture and vascular nerve damage were also examined.Data were analyzed using SPSS 22 Windows package program software.Results:The patients comprised 30 males and 6 females(ratio,5:1)with a mean age of(14.7±2.1)years(range,12-18 years).According to the Price criteria,the results of 33 patients were excellent,3 were good and there were no moderate or poor cases.The mean disabilities of the arm,shoulder and hand score was 11.2±6.1(range,4-28).The mean time to union was(8.7±2.2)weeks(range,6-14 weeks),while patients aged>15 years had prolonged time to union([11.1±1.8]weeks).There were no non-unions,re-fractures or infections.No complications were observed during implant removal.None of the patients had sensorial radial nerve injury or tendon damage.Conclusion:The locked intramedullary nailing technique,which is minimally invasive and provides biological fixation,was found to be successful and safe in the treatment of adolescent forearm fractures.
文摘Introduction: Pseudarthrosis (PSA) of the diaphysis of long bones still remains a current problem, despite improvements in the treatment of these fractures. Our study aims to study the epidemiological and therapeutic aspects of PSA of the diaphysis of long bones. Method: This retrospective work concerns 30 cases of non-union of the diaphysis of long bones treated in the orthopedic and trauma surgery department at Donka National Hospital, during a period of 18 months from January 1, 2019 to June 30, 2020. Results: We recruited 30 patients, 80% of whom were male, with an average age of 39.9 years. Public road accidents (AVP) represented the main cause of fractures of the diaphysis of long bones 87%, they were open in 25 cases or 83%. The fractures were located in the middle 1/3 of the diaphysis of the long bones in 50% of cases. Treatment of initial fractures was traditional in 21 cases, orthopedic in 2 cases and surgical in 7 cases. It was aseptic nonunion in 28 cases (93%) and septic nonunion in 2 cases. They were hypertrophic in 7 cases, slightly hypertrophic in 5 cases, oligotrophic in 11 cases, atrophic in 6 cases and with bone defect in 1 case. The treatment was based on osteosynthesis including 16 cases of screwed “PV” plate: 7 cases of centromedullary “ECM” nailing, 2 cases of external fixator, 1 case of broaching and 4 cases of Plastering. The results according to ASAMI criteria on an anatomical level were excellent in 19 cases, good in 3 cases and poor in 3 cases, with a union rate of 76%. And 5 patients undergoing consolidation. Conclusion: Based on the literature data and the experience of our department, the true treatment of PSA requires correct management of the initial fracture without forgetting the interest in preventing AVP which appears to be an element essential, making it possible to reduce the incidence of fractures of the diaphysis.
文摘Treatment of reverse oblique trochanteric femoral fractures poses a lot of challenges. There have been proponents of intramedullary devices as well as extramedullary devices. We present the results of proximal femoral nailing surgery performed for reverse obliquity intertrochanteric fractures using two proximal lag screws and a nail of 250 mm. There is prospective study of fifty three patients with AO/OTA 31 A-A3 fractures being treated by proximal femoral nailing in our institute after seeking approval from the Hospital ethics board. The quality of the reduction, the operative time, complications and the functional status of the patients were the parameters on which the results were evaluated. The mean Harris hip score was 76.66 (range 70 - 93) and the mean Barthel activity score was 16.21 (range 12 - 20). The average surgical time was 50 minutes and the mean consolidation time was 11.5 weeks. Intramedullary nailing with proximal femoral nails seems to be a good option in the treatment of reverse obliquity intertrochanteric fractures as against the various existing options available for the management.
文摘Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">frequent</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> crit</span><span style="font-family:Verdana;">ical circulation. We report the case of two-level tibial pseudarthroses in an</span><span style="font-family:Verdana;"> 83</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">- </span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">year</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;">old woman caused by multiple myeloma successfully stabilized by a long </span><span style="font-family:Verdana;">ankle arthrodesis nail combined with locking compression plate</span> <span style="font-family:Verdana;">osteosynthesis. This case is unique</span></span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> as to our best knowledge</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">,</span></span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> herein</span></span></span></span></span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> diaphyseal fractures were </span><span style="font-family:Verdana;">treated for the first time using a technique reported hitherto primarily for</span><span style="font-family:Verdana;"> fragility ankle and pilon fractures.
文摘BACKGROUND Femoral shaft fracture is a commonly encountered orthopedic injury that can be treated operatively with a low overall delayed/nonunion rate.In the case of delayed union after antegrade or retrograde intramedullary nail fixation,fracture dynamization is often attempted first.Nonunion after dynamization has been shown to occur due to infection and other aseptic etiologies.We present a unique case of diaphyseal femoral shaft fracture nonunion after dynamization due to intramedullary cortical bone pedestal formation at the distal tip of the nail.CASE SUMMARY A 37-year-old male experienced a high-energy trauma to his left thigh after coming down hard during a motocross jump.Evaluation was consistent with an isolated,closed,left mid-shaft femur fracture.He was initially managed with reamed antegrade intramedullary nail fixation but had continued thigh pain.Radiographs at four months demonstrated no evidence of fracture union and failure of the distal locking screw,and dynamization by distal locking screw removal was performed.The patient continued to have pain eight months after the initial procedure and 4 mo after dynamization with serial radiographs continuing to demonstrate no evidence of fracture healing.The decision was made to proceed with exchange nailing for aseptic fracture nonunion.During the exchange procedure,an obstruction was encountered at the distal tip of the failed nail and was confirmed on magnified fluoroscopy to be a pedestal of cortical bone in the canal.The obstruction required further distal reaming.A longer and larger diameter exchange nail was placed without difficulty and without a distal locking screw to allow for dynamization at the fracture site.Post-operative radiographs showed proper fracture and hardware alignment.There was subsequently radiographic evidence of callus formation at one year with subsequent fracture consolidation and resolution of thigh pain at eighteen months.CONCLUSION The risk of fracture nonunion caused by intramedullary bone pedestal formation can be mitigated with the use of maximum length and diameter nails and close follow up.
文摘Purpose:Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures,especially in osteoporotic patients.The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures.Methods:A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017–2019 by distal locked or unlocked long PFNA-II fixation were included in this study.Patients who had multiple injuries or open fractures were excluded.There were 40 female and 18 male patients,with 33 affecting the left side and 25 the right side.Of them,31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B).Surgical procedures and implants used in both groups were similar except for the distal locking of the nails.General data (age,gender,fracture side,etc.) showed no significant difference between two groups (allp > 0.05).The intraoperative parameters like operative time,radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared.Statistical tests like the independent samplest-test Fischer’’s exact and Chi-square test were used to analyze association.Results:The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study.All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year.The operative time (mL,107.1 ± 12.6vs.77.0 ± 12.0,p < 0.001) and radiation exposure (s,78.6 ± 11.0vs.40.3 ± 9.3,p < 0.001) were significantly less among the patients in group B.Fracture consolidation,three months after the operative procedures,was seen in a significantly greater proportion of patients in group B (92.6%vs.67.7%,p = 0.025).Hardware irritation because of distal locking bolt was exclusively seen in group A,however this was not statistically significant (p = 0.241).Conclusion:We conclude that,in fixation of stable intertrochanteric fractures by long PFNA-II nail,distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation,and hence is not required.
文摘BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years.METHODS This retrospective study includes pediatric patients(age range 5-13 years)who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019.Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods[locked intramedullary nailing(IMN),submuscular plating(SMP),and external fixation]and to length stable fractures treated with FIMN.Exclusion criteria included patients who had an underlying predisposition for fractures(e.g.,pathologic fractures or osteogenesis imperfecta),polytrauma necessitating intensive care unit care and/or extensive management of other injuries,incomplete records,or no follow-up visits.Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well.RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups.These three groups are length unstable fractures treated with FIMN(n=21),length stable fractures treated with FIMN(n=45),and length unstable fractures treated with either locked IMN,SMP,or external fixator(n=29).P values<0.05 were considered statistically significant.Patient characteristic differences that were statistically significant between the groups,length unstable with FIMN and length unstable with locked IMN,SMP,or external fixator,were average age(7.4 years vs 9.3 years,respectively),estimated blood loss(29.2 mL vs 98 mL,respectively)and body mass(27.8 kg vs 35.1 kg,respectively).All other patient characteristic differences were statistically insignificant.Regarding complications,length unstable with FIMN had 9 total complications while length unstable with locked IMN,SMP,or external fixator had 10.Grouping these complications into minor or major,length unstable with locked IMN,SMP,or external fixator had 6 major complication while length unstable with FIMN had 0 major complications.This difference in major complications was statistically significant.Lastly,when comparing patient characteristics between the groups,length unstable with FIMN and length stable with FIMN,all characteristics were statistically similar except time to weight bearing(39 d vs 29 d respectively).When analyzing complication differences between these two groups(9 total complications,0 major vs 20 total complications,4 major),the complication rates were considered statistically similar.CONCLUSION FIMN is effective for length unstable fractures,having a low rate of complications.FIMN is a suitable option for length stable and length unstable femur fractures alike.
文摘BACKGROUND Surgical correction of femoral deformities in polyostotic fibrous dysplasia(PFD)or McCune-Albright syndrome(MAS),such as coxa vara or shepherd’s crook deformity,is a challenge.AIM To evaluate the treatment of patients with femoral deformities caused by PDF or MAS treated by osteotomies and stabilized with different methods,by analyzing the most relevant studies on the topic.METHODS A literature search was performed in Medline database(PubMed).Articles were screened for patients affected by PFD or MAS surgically managed by osteotomies and stabilized with different methods.RESULTS The initial search produced 184 studies,with 15 fulfilling the eligibility criteria of our study.Selected articles(1987-2019)included 111 patients overall(136 femurs).CONCLUSION Based on our results,the preferred method to stabilize corrective osteotomies is intramedullary nailing with neck cross pinning.When the deformity is limited to the proximal part of the femur,a screw or blade plate may be used,although there is a high risk of fracture below the plate.When the femur is entirely involved,a two-stage procedure may be considered.
文摘BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.
文摘BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.
文摘<b><span>Background</span></b><b><span>: </span></b><span>Bisphosphonate abuse is associated with atypical femur fractures, which despite different fixation methods have increased non-union, delayed union, and re-operation rates. Therefore, there is a need for a surgical technique that may enhance union in such cases. Herein we are introducing a novel technique of sequential multiple vigorous reaming across the fracture site to introduce reaming debris/endosteal bone graft around the fracture site.</span><span> </span><b><span>Materials and Methods</span></b><b><span>: </span></b><span>We present a retrospective analysis of five prospectively treated patients with atypical diaphyseal femur fracture who presented to us from January 2015 to August 2019.</span><span> </span><span>All the patients were followed up at regular intervals and assessed both clinically and radiologically.</span><span> </span><b><span>Results</span></b><b><span>: </span></b><span>All 5 cases operated with our technique showed union at a mean follow-up of 16 weeks (12</span><span> </span><span>-</span><span> </span><span>20 weeks). There were no complications reported in our study at the last mean follow-up of 25 months (12</span><span> </span><span>-</span><span> </span><span>51 months).</span><span> </span><b><span>Conclusion</span></b><b><span>: </span></b><span>This technique of multiple vigorous reaming at and around the fracture site provides a new paradigm in the management of AFF. The autograft around the outer cortex promotes the formation of bridging callus and results in the early union.</span>
文摘Purpose:Intramedullary implants are well accepted fixation of all types of intertrochanteric(IT)frac-tures,both stable and unstable types.Intramedullary nails have an ability to effectively support the posteromedial part,but fail to buttress the broken lateral wall requiring lateral augmentation.The aim of this study was to evaluate the outcome of proximal femoral nail augmented with trochanteric buttress plate for broken lateral wall with IT fractures,which was fixed to the femur through hip screw and anti-rotation screw nail.Methods:Of 30 patients,20 had Jensen-Evan typeⅢand 10 had type V fractures.Patients with IT fracture of broken lateral wall and aged more than 18 years,in whom satisfactory reduction was achieved by closed methods,were included in the study.Patients with pathologic or open fractures,polytrauma,prior hip surgery,non-ambulatory prior to surgery,and those who refused to participate were excluded.The operative time,blood loss,radiation exposure,quality of reduction,functional outcome,and union time were evaluated.All data were coded and recorded in Microsoft Excel spread sheet program.SPSS 20.0 was used for data analysis and normality of the continuous data was checked using Kolmogorv Smirnov test.Results:The mean age of patients in the study was 60.3 years.The mean duration of surgery(min),mean intra-operative blood loss(mL)and mean number of exposures were 91.86±12.8(range 70-122),144.8±3.6(range 116-208),and 56.6(range 38-112),respectively.The mean union time was 11.6 weeks and the mean Harris hip score was 94.1.Conclusion:Lateral trochanteric wall in IT fractures is significantly important,and needs to be recon-structed adequately.Nail-plate construct of trochanteric buttress plate fixed with hip screw and anti-rotation screw of proximal femoral nail can be successfully used to augment,fix or buttress the lateral trochanteric wall giving excellent to good results of early union and reduction.
