Intramedullary Nailing of Periarticular Fractures

Plate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nailing reliably leads to excellent outcomes when performed for appropriate indications and when potential difficulties are recognized and addressed

Retrograde Nailing for Treating Femoral Shaft Fractures: A Review

Rigid intramedullary nailing is an effective procedure for treating fractures of the femoral shaft. Although antegrade nailing is the traditionally used technique, retrograde nailing offers various advantages. A companion article published in the seventh volume of The University of New Mexico Orthopaedics Research Journal addressed antegrade femoral nailing. This review will describe retrograde nailing of femoral shaft fractures, including a brief history, indications, detailed technique, outcomes, advice (or “pearls”), and common failures (or “pitfalls”). Retrograde nailing for treating femoral shaft fractures can provide successful results similar to those of antegrade nailing in general and advantages in particular situations such as more distal shaft, bilateral, and certain associated fractures

Flexible intramedullary nailing in the treatment of diaphyseal fractures of the femur in preschool children

Femur fractures in preschool children are mostly treated in a conservative way, by means of spica cast immobilisation or skin traction. In school age children the use of flexible intramedullary nails (FIN) is widely used and promoted. We performed intramedullary nailing in 9 preschool children aged 1.5-6 years. The mean length of postoperative hospital stay was 4 days (range : 3 to 6). The mean time to solid callus formation was 2.5 months (range : 2 to 3). Follow-up was available in all 9 children for a mean period of 18.9 months (range : 3 to 38). No complications were noted. Flexible intramedullary nailing of femur fractures is a valuable technique in this particular age group. However, further study and long-term follow-up are needed

Fluoroscopic freehand and electromagnetic-guided targeting system for distal locking screws of humeral intramedullary nail

Purpose The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation. Materials and methods The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure. Results Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″). Conclusion The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient

Intramedullary nailing versus plating in shaft humerus fractures: a prospective randomized study

Introduction- The two most commonly used modalities of internal fixation in fracture shaft of humerus are Plate osteosynthesis and Intramedullary nailing. The present study aims to analyze and compare both the techniques in terms of functional and radiological outcome. Material and Methods- 43 patients with diaphyseal fracture humerus were treated with Intramedullary nailing and plating between March 2015 and March 2016. The inclusion criteria were patients with closed diaphyseal fracture humerus. Compound fractures, pathological fractures, Non-union, mal-union fractures were excluded from the study. Results- 22 (51.2%) cases were operated using the antegrade nailing technique whereas dynamic compression plating was done in 21 (48.8%) cases. The mean age was 42±4.2 years. Road traffic accident was the most common mechanism of injury with 29 (67.5%) cases. 12-A2 type of fracture pattern were most common involving 23 (53.5%) cases. The mean surgical time was 68 mins in cases where nailing was done and 115 mins in cases with plating (P<0.001). Radiological union was seen at 13±4.8 weeks and 15±3.9 weeks in the nailing and plating group respectively. There were 2 (9.09%) cases in the nailing group and 1 (4.7%) case in the plating group which had delayed union. 3 (13.6%) cases in the nailing group had post-operative shoulder stiffness. The mean ASES score at the end of one year was 31.3 in nailing andBackground: The two most commonly used modalities of internal fixation in fracture shaft of humerus are plate osteosynthesis and intramedullary nailing. The present study aims to analyze and compare both the techniques in terms of functional and radiological outcome.Methods: 43 patients with diaphyseal fracture humerus were treated with Intramedullary nailing and plating between March 2015 and March 2016. The inclusion criteria were patients with closed diaphyseal fracture humerus. Compound fractures, pathological fractures, non-union, mal-union fractures were excluded from the study.Results: 22 (51.2%) cases were operated using the antegrade nailing technique whereas dynamic compression plating was done in 21 (48.8%) cases. The mean age was 42±4.2 years. Road traffic accident was the most common mechanism of injury with 29 (67.5%) cases. 12 A2 type of fracture pattern were most common involving 23 (53.5%) cases. The mean surgical time was 68 minutes in cases where nailing was done and 115 minutes in cases with plating (P <0.001). Radiological union was seen at 13±4.8 weeks and 15±3.9 weeks in the nailing and plating group respectively. There were 2 (9.09%) cases in the nailing group and 1 (4.7%) case in the plating group which had delayed union. 3 (13.6%) cases in the nailing group had post-operative shoulder stiffness. The mean ASES score at the end of one year was 31.3 in nailing and 29.6 in plating group (P =0.327). There were 37 (86.5%) cases with excellent to good results. Conclusions: Nailing and plating have equal functional outcomes in cases with shaft humerus fracture.29.6 in plating group (P=0.327). There were 37 (86.5%) cases with excellent to good results. Conclusion- Nailing and plating have equal functional outcomes in cases with shaft humerus fracture

Seismic Behavior of Nailed Soil Massifs

Soil nailing technology can be successfully applied to strengthen natural soil massifs in seismic regions, provided adequate analysis is available. Conventionally, the design of soil nailing is performed iteratively: firstly parameters of nailing and their distribution are assigned, the safety factor of the nailed massif is calculated, if its value is less than 1 then nailing parameters are reassigned, etc. Such “trial and error” approach is laborious and especially so, because different types of ULSs shall be analyzed. The method, discussed in the paper, is based on assumption that the effect of nailing in soil with internal cohesion c=c(x,y) could be simulated by equivalent internal cohesion Δc=Δc(x,y) (deficit) of unreinforced massif. Formulae for calculating nailing parameters are determined on the basis of deficit distribution. A MathCad code has been developed, examples are given. The method can be easily applied to assess seismic stability of nailed soil massifs

Clinical and financial impacts of flexible intramedullary nailing in pediatric diaphyseal forearm fractures: A case-control study.

Flexible intramedullary nailing is regularly applied for pediatric displaced unstable forearm fractures. When compared to closed reduction and casting (orthopedic treatment), flexible intramedullary nailing decreases malalignment, shortens immobilization time, and should decrease follow-up controls. Comparing flexible intramedullary nailing and orthopedic treatment in the clinical, radiological, and financial managements of these fractures was performed. Retrospective 5 years study of pediatric cases in two pediatric orthopedic university departments. Treatment method, post-operative course, and radiological follow-up were reviewed. Number of radiographs, follow-up controls, type and duration of immobilization, final bone angulation, and reported complications were compared. Extensive financial analysis was completed. Of 73 girls and 168 boys included in the study, 150 were treated by flexible intramedullary nailing and 91 by orthopedic treatment. No difference was noted with regard to total number of radiographs (7.3 vs 7.2, respectively). Total number of follow-ups was 6.4 and 5.5, respectively. Malalignment occurred in two flexible intramedullary nailing and sixteen orthopedic treatments. The least expensive cost was ambulatory orthopedic treatment. Flexible intramedullary nailing treated children had similar numbers of radiographs or follow-up consultation, but less malunion when compared to orthopedic treatment. Orthopedic management was systematically cheaper than flexible intramedullary nailing. Unless post-operative management guidelines decreasing the number of radiographs and follow-ups are implemented, flexible intramedullary nailing will remain a costly procedure when compared to conventional orthopedic treatment. level III case-control retrospective study

An intelligent hammer: a novel concept for automating nail and pile driving

Some interesting novel ideas on how the compliance needs of manipulators may be met by changing the stiffness of a structure have been presented in a paper by Ang and Andeen [1]. The purpose of the present note is to outline a novel concept for another variable-stiffness mechanism that may be useful in automating the process of driving nails or piles