Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current rev...Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.展开更多
Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is...Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.展开更多
BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce compli...BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.展开更多
Screw connection is a type most commonly applied to timber structures.As important commercial tree species in China,Masson pine and Chinese fir have the potential to prepare wood structures.In this study,the effects o...Screw connection is a type most commonly applied to timber structures.As important commercial tree species in China,Masson pine and Chinese fir have the potential to prepare wood structures.In this study,the effects of the diameter of the self-tapping screw and the guiding bores on the nail holding performance on different sections of Masson pine and Chinese fir dimension lumbers were mainly explored.The results showed that:(1)The nail holding strength of the tangential section was the maximum,followed by that of the radial section,and that of the cross section was the minimum.(2)The nail holding strength of Masson pine was higher than that of Chinese fir.(3)The nail holding strength grew with the increase in the diameter of self-tapping screws,but a large diameter would lead to plastic cracking of the timber,thus further affecting the nail holding strength.Masson pine and Chinese fir reached the maximum nail holding strength when the diameter of self-tapping screws was 3.5 mm.(4)Under a large diameter of screws,prefabricated guiding bores could mitigate timber cracking and improve its nail holding strength.(5)Prefabricated guiding bores were more necessary for the screw connection of Masson pine.The results obtained could provide a scientific basis for the screw connection design of Masson pine and Chinese fir timber structures.展开更多
BACKGROUND The femoral neck dynamic intersection system(FNS)is mechanically more stable than other internal fixation techniques.Current studies have confirmed that the structural design of FNS has good biomechanical p...BACKGROUND The femoral neck dynamic intersection system(FNS)is mechanically more stable than other internal fixation techniques.Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations.However,whether the suitability of the FNS's 130°main nail angle design for Asian populations has been thoroughly investigated remains unclear.AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations.METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur.The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles.Afterward,the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software.Subsequently,they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures.RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120°group and 7.416 millimeters in the 125°group;in the 130°,135°,and 140°FNS fixation groups,the peak displacement was 7.324 millimeters,8.138 millimeters,and 8.246 millimeters,respectively.In the 120°and 125°FNS fixation groups,the maximum stresses were concentrated at the main nail and the anti-rotation screw,which intersected the fracture line of the femur neck,resulting in peak stresses of 200.7 MPa and 138.8 MPa,respectively.Peak stresses of 208.8 MPa,219.8 MPa,and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°,135°,and 140°fixation groups.CONCLUSION FNS has significant stress distribution properties,a minimal proximal femoral displacement,and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130°main nail angle.展开更多
BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechani...BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.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
Nail connection is widely used in engineering and construction fields.In this study,bamboo nail was proposed as a novel connector for timber assemblies.Penetration depth of bamboo nail into wood was predicted and test...Nail connection is widely used in engineering and construction fields.In this study,bamboo nail was proposed as a novel connector for timber assemblies.Penetration depth of bamboo nail into wood was predicted and tested.The influence of nail parameters(length,radius and ogive radius)on penetration depth were verified.For both tested and predicted results,the penetration depth of bamboo nail increased with the increasing length,radius or ogive radius.In addition,the effect of densification on penetration depth or mechanical properties was evaluated.1.12 g/cm^(3) was a critical density when densification was needed,and further increment of density would decrease the penetration depth of nail.The results of this study manifests that the proposed model is capable to predict the penetration depth of bamboo nail.These findings may provide new insight into efficiently utilization of bamboo resources.展开更多
BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture...BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture(PFF)in elderly patients.AIM To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.METHODS One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included.Seventy-three patients underwent fixation with PFN,whereas 85 were fixed with PFNA.The mean follow-up was 2.4 years(range,1-7 years).Clinical outcome was measured in terms of operation time,postoperative function at each follow-up visit,and mortality within one year.Radiographic evaluation included reduction quality after surgery,Cleveland Index,tip-apex distance(TAD),union rate,time to union,and sliding distance of the screw or blade.Complications including nonunion,screw cutout,infection,osteonecrosis of the femoral head,and implant breakage were also investigated.RESULTS Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN(P=0.033).Radiologically,the sliding difference was greater in PFN than in PFNA patients(6.1 and 3.2 mm,respectively,P=0.036).The rate of screw cutout was higher in the PFN group;eight for PFN(11.0%)and two for PFNA patients(2.4%,P=0.027).There were no differences between the two groups in terms of operation time,mortality rate at one year after the operation,adequacy of reduction,Cleveland Index,TAD,union rate,time to union,nonunion,infection,osteonecrosis,or implant breakage.CONCLUSION Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.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
Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retr...Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.展开更多
The debate continues over the management of diaphyseal fractures of the humerus. There are a variety of extramedullary as well as intramedullary implants. We aim to propose a technique of passing the screw intramedull...The debate continues over the management of diaphyseal fractures of the humerus. There are a variety of extramedullary as well as intramedullary implants. We aim to propose a technique of passing the screw intramedullary nails and achieve union with least trauma to the shoulder and the rotator cuff. The multiple elastic screw nails achieve the inherent stability based on the principle of “three point fixation”. We aim to propose that the screw intramedullary nail is an effective implant to facilitate uneventful fracture union, with rapid recovery, low morbidity and low learning curve capable of being replicated in any smaller operative set up.展开更多
BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intr...BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails.The use of these nails has increased over the last few years.AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.METHODS Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation.The outcomes included amount of gained length,healing index,complications and patient reported outcomes.RESULTS Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were included.In both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group.Both devices achieved the target length.Prevalence of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)group.None of the studies presented patient reported outcomes.CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients.The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.展开更多
Reinforcement of slopes using soil nailing can effectively improve slope stability, and it has been widely used in upgrading cut slopes. Based on the assumptions of stresses on the slip surface, a new method for analy...Reinforcement of slopes using soil nailing can effectively improve slope stability, and it has been widely used in upgrading cut slopes. Based on the assumptions of stresses on the slip surface, a new method for analyzing the stability of a slope reinforced with soil nails was established in the limit equilibrium theory framework, by considering that slope sliding occurs owing to shear failure of the slip surface, which subjects to Mohr–Coulomb(M–C) strength criterion. Meanwhile, in order to easily analyze the stability of a soil nailed slope in actual engineering and facilitate optimum design of parameters for soil nailing, factor of safety(FOS) contour curve charts were drawn on the basis of the established linear proportional relationship between the spacing of soil nails and slope height, and the length of soil nails and slope height. Then, by analyzing and verifying the results obtained from classic examples, some conclusions can be got as follows: 1) The results obtained from the current method are close to those obtained from the traditional limit equilibrium methods, and the current method can provide a strict solution for the slope FOS as it satisfies all the static equilibrium conditions of a sliding body, thus confirming the feasibility of the current method; 2) The slope FOS contour curve charts can be used not only to reliably analyze the stability of a soil nailed slope, but also to design optimally the parameters of soil nailing for the slope with a certain safety requirement.展开更多
AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients an...AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001). However, there was no significant difference between the success rates of the two procedures for delayed union fractures(25/27 EN, 45/55 dynam, P = 0.3299). Nevertheless, dynamization was more efficient in the treatment of delayed unions(at rates comparable to exchange nailing) than in the treatment of non-unions.CONCLUSION In conclusion, after examination of factors, dynamization is recommended treatment of delayed femur fractures, while exchange nailing is the treatment of choice for non-unions.展开更多
AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures ...AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.展开更多
Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a scr...Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in our hospital with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared. Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFN and DHS group, respectively. In PFN there was more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes. Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFN group has less blood loss and less operating time compared to DHS group. In PFN group patients have started early ambulation compared to DHS group.展开更多
Osteogenesis imperfecta(OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformi...Osteogenesis imperfecta(OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformities. While the treatment for these fractures was recommended as using intramedullary fixation for minimizing stress concentration, the selection of the best implant in the adolescent OI patients for the surgical reconstruction of femur was still problematic, due to anatomy distortion and implant availability. We are reporting the surgical modification by using a humeral nail for femoral fixation in three adolescent OI patients with favorable outcomes.展开更多
BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss du...BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.展开更多
文摘Introduction: The management of fractures of the tibia shaft is an important aspect of orthopaedic care, and the selection of the surgical method for fixation can substantially impact patient outcomes. The current review aims to compare the outcomes of adult tibia fractures treated with solid nails to those treated with hollow nails. Methods: A search on Scopus, PubMed, and Cochrane Library, using three keywords (Outcome, Tibia shaft fractures, Nail) was conducted in April 2023. Results were compiled and two independent reviewers screened and selected eligible articles After removing duplicates, titles and abstracts were read to exclude ineligible studies. Full-text articles of the remaining papers were read to select eligible studies which were further critically appraised to ascertain their methodological quality. The data extracted from the selected papers were synthesized using a combination of pooling of results, tests of statistical difference (t-test and chi-square) and narrative synthesis methods. Results: A total of 2295 articles were obtained from the databases and citation searching. A total of 9 papers were identified as eligible and included in the review. Findings revealed that there is no statistical difference in the outcomes of tibia fractures treated with either solid or hollow nail groups such as duration of surgery (p = 0.541), rate of delayed and non-union (p = 0.342), and rate of surgical site infections (p = 0.395). Conclusion: Intramedullary nailing of tibia shaft fractures with either solid or hollow nails have similar functional outcomes.
文摘Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3<sup>rd</sup> of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.
基金Supported by The Clinical Medical Science and Technology Development Fund Project of Jiangsu University,No.JLY2021185.
文摘BACKGROUND The traditional Gamma3 nail is a mainstream treatment for femoral intertrochanteric fractures.Literature reports that the Gamma3U-blade system can increase the stability of the Gamma3 nail and reduce complication incidence.However,comparative studies between the Gamma3U-blade and Gamma3 systems are limited;hence,this meta-analysis was performed to explore the clinical efficacy of these two surgical methods.AIM To investigate the clinical efficacy of Gamma3 and Gamma3 U-blade for intertrochanteric fractures.METHODS A computerized search for Chinese and English literature published from 2010 to 2022 was conducted in PubMed,Cochrane,CNKI,Wanfang,and VIP databases.The search keywords were gamma 3,gamma 3 U blade,and intertrochanteric fracture.Additionally,literature tracking was performed on the references of published literature.The data were analyzed using Revman 5.3 software.Two individuals checked the inputs for accuracy.Continuous variables were described using mean difference and standard deviation,and outcome effect sizes were expressed using ratio OR and 95%confidence interval(CI).High heterogeneity was considered at(P<0.05,I2>50%),moderate heterogeneity at I2 from 25%to 50%,and low heterogeneity at(P≥0.05,I2<50%).RESULTS Following a comprehensive literature search,review,and analysis,six articles were selected for inclusion in this study.This selection comprised five articles in English and one in Chinese,with publication years spanning from 2016 to 2022.The study with the largest sample size,conducted by Seungbae in 2021,included a total of 304 cases.Statistical analysis:A total of 1063 patients were included in this meta-analysis.The main outcome indicators were:Surgical time:The Gamma3U blade system had a longer surgical time compared to Gamma3 nails(P=0.006,I2=76%).Tip-apex distance:No statistical significance or heterogeneity was observed(P=0.65,I2=0%).Harris Hip score:No statistical significance was found,and low heterogeneity was detected(P=0.26,I2=22%).Union time:No statistical significance was found,and high heterogeneity was detected(P=0.05,I2=75%).CONCLUSION Our study indicated that the Gamma3 system reduces operative time compared to the Gamma3 U-blade system in treating intertrochanteric fractures.Both surgical methods proved to be safe and effective for this patient group.These findings may offer valuable insights and guidance for future surgical protocols in hip fracture patients.
基金funded by the National Natural Science Foundation of China (32160348)Forestry Science and Technology Research Project of Guizhou Forestry Bureau (J[2022]21 and[2020]C14)+1 种基金Department Program of Guizhou Province ([2020]1Y128)the Cultivation Project of Guizhou University of China ([2019]37).
文摘Screw connection is a type most commonly applied to timber structures.As important commercial tree species in China,Masson pine and Chinese fir have the potential to prepare wood structures.In this study,the effects of the diameter of the self-tapping screw and the guiding bores on the nail holding performance on different sections of Masson pine and Chinese fir dimension lumbers were mainly explored.The results showed that:(1)The nail holding strength of the tangential section was the maximum,followed by that of the radial section,and that of the cross section was the minimum.(2)The nail holding strength of Masson pine was higher than that of Chinese fir.(3)The nail holding strength grew with the increase in the diameter of self-tapping screws,but a large diameter would lead to plastic cracking of the timber,thus further affecting the nail holding strength.Masson pine and Chinese fir reached the maximum nail holding strength when the diameter of self-tapping screws was 3.5 mm.(4)Under a large diameter of screws,prefabricated guiding bores could mitigate timber cracking and improve its nail holding strength.(5)Prefabricated guiding bores were more necessary for the screw connection of Masson pine.The results obtained could provide a scientific basis for the screw connection design of Masson pine and Chinese fir timber structures.
基金Supported by Tianjin Science and Technology planning Project,No.21JCQNJC01060Key Project of Tianjin Natural Science Foundation,No.22JCZDJC00340National Key Research and Development Project of China,No.2022YFC3601904.
文摘BACKGROUND The femoral neck dynamic intersection system(FNS)is mechanically more stable than other internal fixation techniques.Current studies have confirmed that the structural design of FNS has good biomechanical properties in European and American populations.However,whether the suitability of the FNS's 130°main nail angle design for Asian populations has been thoroughly investigated remains unclear.AIM To compare the biomechanical stability differences among different main nail angles of the FNS in the treatment of femoral neck fractures in Asian populations.METHODS Computed tomography data of the femur of healthy adult male volunteers were imported into Mimics software to create a three-dimensional model of the femur.The model was adapted to the curve using Geomagic software and imported into Solidworks software to construct the Pauwels I femoral neck fracture model and design the FNS internal fixation model using different main nail angles.Afterward,the models were assembled with the FNS fracture model and meshed using the preprocessing Hypermesh software.Subsequently,they were imported into Abaqus software to analyze and evaluate the biomechanical effects of different angles of the FNS main nail on the treatment of femoral neck fractures.RESULTS The peak displacement of the proximal femur under different angles of FNS fixation under stress was 7.446 millimeters in the 120°group and 7.416 millimeters in the 125°group;in the 130°,135°,and 140°FNS fixation groups,the peak displacement was 7.324 millimeters,8.138 millimeters,and 8.246 millimeters,respectively.In the 120°and 125°FNS fixation groups,the maximum stresses were concentrated at the main nail and the anti-rotation screw,which intersected the fracture line of the femur neck,resulting in peak stresses of 200.7 MPa and 138.8 MPa,respectively.Peak stresses of 208.8 MPa,219.8 MPa,and 239.3 MPa were observed on the angular locking plate distal to the locking screw in the 130°,135°,and 140°fixation groups.CONCLUSION FNS has significant stress distribution properties,a minimal proximal femoral displacement,and an optimal stability for treating femoral neck fractures in Asian populations when performed with a 130°main nail angle.
文摘BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.
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.
基金This work was financially supported by the National Natural Science Foundation of China(No.32071700).
文摘Nail connection is widely used in engineering and construction fields.In this study,bamboo nail was proposed as a novel connector for timber assemblies.Penetration depth of bamboo nail into wood was predicted and tested.The influence of nail parameters(length,radius and ogive radius)on penetration depth were verified.For both tested and predicted results,the penetration depth of bamboo nail increased with the increasing length,radius or ogive radius.In addition,the effect of densification on penetration depth or mechanical properties was evaluated.1.12 g/cm^(3) was a critical density when densification was needed,and further increment of density would decrease the penetration depth of nail.The results of this study manifests that the proposed model is capable to predict the penetration depth of bamboo nail.These findings may provide new insight into efficiently utilization of bamboo resources.
文摘BACKGROUND There are few studies in the literature comparing the clinical outcomes and radiographic results of proximal femoral nail(PFN)and proximal femoral nail antirotation(PFNA)for pertrochanteric femoral fracture(PFF)in elderly patients.AIM To evaluate both clinical and radiographic outcomes after fixation with PFN and PFNA in an elderly patient population.METHODS One hundred fifty-eight patients older than 65 years with PFF who underwent fixation with either PFN or PFNA were included.Seventy-three patients underwent fixation with PFN,whereas 85 were fixed with PFNA.The mean follow-up was 2.4 years(range,1-7 years).Clinical outcome was measured in terms of operation time,postoperative function at each follow-up visit,and mortality within one year.Radiographic evaluation included reduction quality after surgery,Cleveland Index,tip-apex distance(TAD),union rate,time to union,and sliding distance of the screw or blade.Complications including nonunion,screw cutout,infection,osteonecrosis of the femoral head,and implant breakage were also investigated.RESULTS Postoperative function was more satisfactory in patients who underwent PFNA than in those who underwent PFN(P=0.033).Radiologically,the sliding difference was greater in PFN than in PFNA patients(6.1 and 3.2 mm,respectively,P=0.036).The rate of screw cutout was higher in the PFN group;eight for PFN(11.0%)and two for PFNA patients(2.4%,P=0.027).There were no differences between the two groups in terms of operation time,mortality rate at one year after the operation,adequacy of reduction,Cleveland Index,TAD,union rate,time to union,nonunion,infection,osteonecrosis,or implant breakage.CONCLUSION Elderly patients with PFF who underwent PFNA using a helical blade demonstrated better clinical and radiographic outcomes as measured by clinical score and sliding distance compared with patients who underwent PFN.
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Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis.
文摘The debate continues over the management of diaphyseal fractures of the humerus. There are a variety of extramedullary as well as intramedullary implants. We aim to propose a technique of passing the screw intramedullary nails and achieve union with least trauma to the shoulder and the rotator cuff. The multiple elastic screw nails achieve the inherent stability based on the principle of “three point fixation”. We aim to propose that the screw intramedullary nail is an effective implant to facilitate uneventful fracture union, with rapid recovery, low morbidity and low learning curve capable of being replicated in any smaller operative set up.
基金Supported by Children’s Hospital Charity and Industry(Nuvasive,CA,United States),No.5431.
文摘BACKGROUND Femoral lengthening is a procedure of great importance in the treatment of congenital and acquired limb deficiencies.Technological advances have led to the latest designs of fully implantable motorized intramedullary lengthening nails.The use of these nails has increased over the last few years.AIM To review and critically appraise the literature comparing the outcome of femoral lengthening in children using intramedullary motorized lengthening nails to external fixation.METHODS Electronic databases(MEDLINE,CINAHL,EMBASE,Cochrane)were systematically searched in November 2019 for studies comparing the outcome of femoral lengthening in children using magnetic lengthening nails and external fixation.The outcomes included amount of gained length,healing index,complications and patient reported outcomes.RESULTS Of the 452 identified studies,only two(retrospective and non-randomized)met the inclusion criteria.A total of 91 femora were included.In both studies,the age of patients treated with nails ranged from 15 to 21 years compared to 9 to 15 years for patients in the external fixation group.Both devices achieved the target length.Prevalence of adverse events was less in the nail(60%-73%)than in the external fixation(81%-100%)group.None of the studies presented patient reported outcomes.CONCLUSION The clinical effectiveness of motorized nails is equivalent or superior to external fixation for femoral lengthening in young patients.The available literature is limited and does not provide evidence on patient quality of life or cost effectiveness of the interventions.
基金Project(2015M580702)supported by the Postdoctoral Science Foundation of ChinaProject(51608541)supported by the National Natural Science Foundation of ChinaProject(2014122066)supported by the Guizhou Provincial Department of Transportation Foundation,China
文摘Reinforcement of slopes using soil nailing can effectively improve slope stability, and it has been widely used in upgrading cut slopes. Based on the assumptions of stresses on the slip surface, a new method for analyzing the stability of a slope reinforced with soil nails was established in the limit equilibrium theory framework, by considering that slope sliding occurs owing to shear failure of the slip surface, which subjects to Mohr–Coulomb(M–C) strength criterion. Meanwhile, in order to easily analyze the stability of a soil nailed slope in actual engineering and facilitate optimum design of parameters for soil nailing, factor of safety(FOS) contour curve charts were drawn on the basis of the established linear proportional relationship between the spacing of soil nails and slope height, and the length of soil nails and slope height. Then, by analyzing and verifying the results obtained from classic examples, some conclusions can be got as follows: 1) The results obtained from the current method are close to those obtained from the traditional limit equilibrium methods, and the current method can provide a strict solution for the slope FOS as it satisfies all the static equilibrium conditions of a sliding body, thus confirming the feasibility of the current method; 2) The slope FOS contour curve charts can be used not only to reliably analyze the stability of a soil nailed slope, but also to design optimally the parameters of soil nailing for the slope with a certain safety requirement.
文摘AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: "nonunion", "delayed union", "ununited", "femur fracture", "femoral fracture", "exchange nailing", "dynaiz(s)ation", "secondary nailing", "dynamic", "static", and "nail revision". The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients. RESULTS Exchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union(5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo(P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN, 24/57 dynam, P < 0.0001). However, there was no significant difference between the success rates of the two procedures for delayed union fractures(25/27 EN, 45/55 dynam, P = 0.3299). Nevertheless, dynamization was more efficient in the treatment of delayed unions(at rates comparable to exchange nailing) than in the treatment of non-unions.CONCLUSION In conclusion, after examination of factors, dynamization is recommended treatment of delayed femur fractures, while exchange nailing is the treatment of choice for non-unions.
文摘AIM To report the clinical and radiographic results of titanium elastic nail(TEN) in diaphyseal femoral fractures of children below age of six years.METHODS A retrospective analysis of 27 diaphyseal femoral fractures in children younger than six years treated with TEN between 2005 and 2015 was conducted. Patients were immobilized in a cast for 5 wk and the nails were removed from 6 to 12 wk after surgery. Twenty-four cases were clinically and radiographically re-evaluated using the Flynn's scoring criteria, focusing on: Limb length discrepancy, rotational deformity, angulation, hip and knee range of motion(ROM), functional status, complications, and parent's satisfaction.RESULTS Sixteen males and eight females with a mean age of 3.2 years at the time of treatment were re-evaluated at an average follow-up of 58.9 mo. No cases of delayed union were observed. The mean limb lengthening was 0.3 cm. Four cases experienced limb lengthening greater than 1 cm and always minor than 2 cm. Twelve point five percent of the cases showed an angulation < 10°. Complete functional recovery(hip and knee ROM, ability to run and jump on the operated limb) occurred in 95.7% of cases. Complications included two cases of superficial infection of the TEN entry point, one case of refracture following a new trauma, and one TEN mobilization. According to the Flynn's scoring criteria, excellent results were obtained in 79.2% of patients and satisfactory results in the remaining 20.8%, with an average parent's satisfaction level of 9.1/10.CONCLUSION TEN is as a safe, mini-invasive and surgeon-friendly technique and, considering specific inclusion criteria, it represents a useful and efficacy option for the treatment of diaphyseal femoral fractures even in patients younger than six years of age.
文摘Background: Internal fixation is appropriate for most intertrochanteric fractures. Optimal fixation is based on the stability of fracture. The mainstay of treatment of intertrochanteric fracture is fixation with a screw slide plate device or intramedullary device. So it is a matter of debate that which one is the best treatment, dynamic hip screw or proximal femoral nailing. Method: A prospective randomized and comparative study of 2 years duration was conducted on 60 patients admitted in the Department of Orthopedics in our hospital with intertrochanteric femur fracture. They were treated by a dynamic hip screw and proximal femoral nail. Patients were operated under image intensifier control. The parameters studied were functional outcome of Harris hip score, total duration of operation, rate of union, amount of collapse. These values were statistically evaluated and two tailed p-values were calculated and both groups were statistically compared. Result: The average age of our patient is 67.8 years. Among the fracture, 31% were stable, 58% were unstable, 11% were reverse oblique fracture. The average blood loss was 100 and 250 ml in PFN and DHS group, respectively. In PFN there was more no. of radiation exposure intraoperatively. The average operating time for the patients treated with PFN was 45 min as compared to 70 min in patients treated with DHS. The patients treated with PFN started early ambulation as they had better Harris Hip Score in the early period (at 1 and 3 months). In the long term both the implants had almost similar functional outcomes. Conclusion: In our study we have found that the unstable pattern was more common in old aged patients with higher grade of osteoporosis and PFN group has a better outcome in this unstable and osteoporotic fracture. PFN group has less blood loss and less operating time compared to DHS group. In PFN group patients have started early ambulation compared to DHS group.
文摘Osteogenesis imperfecta(OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformities. While the treatment for these fractures was recommended as using intramedullary fixation for minimizing stress concentration, the selection of the best implant in the adolescent OI patients for the surgical reconstruction of femur was still problematic, due to anatomy distortion and implant availability. We are reporting the surgical modification by using a humeral nail for femoral fixation in three adolescent OI patients with favorable outcomes.
文摘BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.
