Objective:To explore the effect of magnetic-guided intramedullary nail fixation on bone metabolism and trauma degree in patients with femoral shaft fracture.Methods: A total of 128 patients with femoral shaft fracture...Objective:To explore the effect of magnetic-guided intramedullary nail fixation on bone metabolism and trauma degree in patients with femoral shaft fracture.Methods: A total of 128 patients with femoral shaft fractures who received surgical treatment in the hospital between April 2016 and November 2017 were divided into control group (n=64) and study group (n=64) according to the random number table method. Control group received the traditional intramedullary nail treatment, and study group received magnetic-guided intramedullary nail treatment. The differences in serum levels of bone metabolism indexes and inflammatory factors were compared between the two groups 48 h after surgery.Results: 48 h after surgery, serum bone formation indexes BGP, PⅠNP, PⅠCP and BAP levels of study group were higher than those of control group whereas bone resorption indexesβ-CTX, TRACP5b and NTX levels were lower than those of control group;serum inflammatory factors TGF-β, hs-CRP, IL-1β, IL-6 and IL-17 levels were lower than those of control group.Conclusion:Compared with traditional intramedullary nail therapy, magnetic-guided intramedullary nail fixation can more effectively balance the bone metabolism status and reduce the fracture end trauma in patients with femoral shaft fracture.展开更多
Objective:To analyze the trauma and bone metabolism of magnetic navigation intramedullary nail and traditional intramedullary nail fixation treatment of femoral shaft fracture. Methods:58 patients with femoral shaft f...Objective:To analyze the trauma and bone metabolism of magnetic navigation intramedullary nail and traditional intramedullary nail fixation treatment of femoral shaft fracture. Methods:58 patients with femoral shaft fracture treated in our hospital between December 2011 and December 2015 were divided into observation group and control group by random number table (n=29). Control group received conventional intramedullary nail fixation treatment, and observation group received magnetic navigation intramedullary nail fixation treatment. 24 h after surgery, blood coagulation indexes, enzymology indexes, bone metabolism indexes and angiogenesis indexes were determined;6 months after surgery, bone mineral density levels were determined. Results:24 h after surgery, peripheral blood thrombin time (TT), prothrombin time (PT), and activated partial thromboplastin time (APTT) levels of observation group were significantly higher than those of control group, and serum fibrinogen (FIB), D-Dimer (D-D), lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CKMB), glutamic oxalacetic transaminase (GOT), sex hormone-binding globulin type I (SHBG), collagen cross-linked carboxyl-terminal telopeptide (CTX) and deoxypyridinoline (DPD) content were lower than those of control group while bone gla protein (BGP), insulin-like growth factor (IGF-1), hypoxia-inducible factor-1α (HIF-α), angiogenin 1 (Ang-1), recombinant basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) content were higher than those of control group;6 months after surgery, fracture end bone mineral density (BMD) value of observation group was higher than that of control group. Conclusions:Magnetic navigation intramedullary nail treatment of femoral shaft fracture can more effectively reduce the surgical trauma, improve bone metabolism and increase bone mineral density.展开更多
Objective:To evaluate the bone metabolism balance and traumatic reaction of minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures. Methods:80 patients with femoral shaft f...Objective:To evaluate the bone metabolism balance and traumatic reaction of minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures. Methods:80 patients with femoral shaft fractures who were treated in our hospital between May 2011 and December 2016 were collected and divided into control group (n=40) and observation group (n=40) according to random number table, control group received conventional steel plate internal fixation treatment, and observation group received minimally invasive mippo intramedullary nail internal fixation treatment. Differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors, and pain mediators and so on were compared between two groups of patients before operation and 1 week after treatment.Results: Before operation, differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors and pain mediators were not statistically significant between two groups of patients. After operation, serum bone formation indexes P ICP, BGP, BALP and ALP levels in observation group were higher than those in control group;serum bone resorption indexesβ-CTX and OPG levels were lower than those in control group;serum inflammatory factors IL-1β, IL-6, IL-8 and CRP levels were lower than those in control group;serum pain mediators SP, PGE2 and 5-HT levels were lower than those in control group.Conclusion:Minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures can promote the bone formation, relatively inhibit bone resorption and cause less traumatic reaction.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
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
Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation ...Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation exposure. Additionally, difficulties may be encountered when removing nails because of callus formation over the nail tip. We performed a prospective study to compare two types of nails in managing femoral shaft fractures. Methods Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails. Group II consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires. The patients＇ ages, fracture severity, duration of operation, fluoroscopy time, blood loss and falls of end caps into soft tissue were recorded. Nails were removed after fracture healing. The duration of operation and blood loss during nail removal were recorded. Results There were no significant differences between groups with respect to age and fracture severity （P 〉0.05）. End caps fell into soft tissue 17 times in 15 cases in group I and 21 times in 16 cases in group I1. An average of seven minutes was spent recovering a lost cap in group I. In group II, all lost caps were recovered immediately. The duration of operation and fluoroscopy time in group II was significantly less than in group I （P 〈0.05）. Asymptomatic palpable nodules were detected in 4 cases in group I1. Nail removals were performed on 58 patients in group I and 69 patients in group I1. The duration of operation, blood loss and complications in group II were less than in group I （P〈0.05）. Conclusion Intramedullary nails with tail wires facilitate both fracture fixation and nail removal, which can be used to treat femoral shaft fractures with less radiation exposure, shorter surgical time and fewer complications.展开更多
Background： Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Childre...Background： Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. Methods： There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. Results： We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. Conclusion： Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.展开更多
目的探讨长骨牵开器在弹性髓内钉治疗儿童股骨干骨折中的应用效果。方法采用长骨牵开器辅助复位弹性髓内钉治疗15例儿童股骨干骨折。记录手术情况、骨折愈合情况、关节活动度及并发症发生情况,根据Flynn et al提出的下肢骨折评分标准评...目的探讨长骨牵开器在弹性髓内钉治疗儿童股骨干骨折中的应用效果。方法采用长骨牵开器辅助复位弹性髓内钉治疗15例儿童股骨干骨折。记录手术情况、骨折愈合情况、关节活动度及并发症发生情况,根据Flynn et al提出的下肢骨折评分标准评估疗效。结果手术时间31~65 min,术中出血量5~15 ml,术中透视7~15次,住院时间2~6 d。术中无血管神经以及肌肉牵拉伤,牵拉置入斯氏针处无骨折以及渗出感染。患儿均获得随访,时间5~18个月。骨折均愈合,时间9~18周。末次随访时,患儿均可下地完全负重行走,无跛行,内固定无失效断裂,下地负重后无大腿疼痛、局部压痛以及纵向叩击痛;髋关节屈曲130°~135°,膝关节伸直0°~5°、屈曲120°~140°;根据Flynn et al提出的下肢骨折评分标准评估疗效:优13例,良2例。结论弹性髓内钉治疗儿童股骨干骨折中采用长骨牵开器辅助复位操作简便,复位质量可靠,同时能维持骨折断端复位,方便弹性髓内钉的置入,疗效较好。展开更多
文摘Objective:To explore the effect of magnetic-guided intramedullary nail fixation on bone metabolism and trauma degree in patients with femoral shaft fracture.Methods: A total of 128 patients with femoral shaft fractures who received surgical treatment in the hospital between April 2016 and November 2017 were divided into control group (n=64) and study group (n=64) according to the random number table method. Control group received the traditional intramedullary nail treatment, and study group received magnetic-guided intramedullary nail treatment. The differences in serum levels of bone metabolism indexes and inflammatory factors were compared between the two groups 48 h after surgery.Results: 48 h after surgery, serum bone formation indexes BGP, PⅠNP, PⅠCP and BAP levels of study group were higher than those of control group whereas bone resorption indexesβ-CTX, TRACP5b and NTX levels were lower than those of control group;serum inflammatory factors TGF-β, hs-CRP, IL-1β, IL-6 and IL-17 levels were lower than those of control group.Conclusion:Compared with traditional intramedullary nail therapy, magnetic-guided intramedullary nail fixation can more effectively balance the bone metabolism status and reduce the fracture end trauma in patients with femoral shaft fracture.
文摘Objective:To analyze the trauma and bone metabolism of magnetic navigation intramedullary nail and traditional intramedullary nail fixation treatment of femoral shaft fracture. Methods:58 patients with femoral shaft fracture treated in our hospital between December 2011 and December 2015 were divided into observation group and control group by random number table (n=29). Control group received conventional intramedullary nail fixation treatment, and observation group received magnetic navigation intramedullary nail fixation treatment. 24 h after surgery, blood coagulation indexes, enzymology indexes, bone metabolism indexes and angiogenesis indexes were determined;6 months after surgery, bone mineral density levels were determined. Results:24 h after surgery, peripheral blood thrombin time (TT), prothrombin time (PT), and activated partial thromboplastin time (APTT) levels of observation group were significantly higher than those of control group, and serum fibrinogen (FIB), D-Dimer (D-D), lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase isoenzyme (CKMB), glutamic oxalacetic transaminase (GOT), sex hormone-binding globulin type I (SHBG), collagen cross-linked carboxyl-terminal telopeptide (CTX) and deoxypyridinoline (DPD) content were lower than those of control group while bone gla protein (BGP), insulin-like growth factor (IGF-1), hypoxia-inducible factor-1α (HIF-α), angiogenin 1 (Ang-1), recombinant basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) content were higher than those of control group;6 months after surgery, fracture end bone mineral density (BMD) value of observation group was higher than that of control group. Conclusions:Magnetic navigation intramedullary nail treatment of femoral shaft fracture can more effectively reduce the surgical trauma, improve bone metabolism and increase bone mineral density.
文摘Objective:To evaluate the bone metabolism balance and traumatic reaction of minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures. Methods:80 patients with femoral shaft fractures who were treated in our hospital between May 2011 and December 2016 were collected and divided into control group (n=40) and observation group (n=40) according to random number table, control group received conventional steel plate internal fixation treatment, and observation group received minimally invasive mippo intramedullary nail internal fixation treatment. Differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors, and pain mediators and so on were compared between two groups of patients before operation and 1 week after treatment.Results: Before operation, differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors and pain mediators were not statistically significant between two groups of patients. After operation, serum bone formation indexes P ICP, BGP, BALP and ALP levels in observation group were higher than those in control group;serum bone resorption indexesβ-CTX and OPG levels were lower than those in control group;serum inflammatory factors IL-1β, IL-6, IL-8 and CRP levels were lower than those in control group;serum pain mediators SP, PGE2 and 5-HT levels were lower than those in control group.Conclusion:Minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures can promote the bone formation, relatively inhibit bone resorption and cause less traumatic reaction.
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Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation exposure. Additionally, difficulties may be encountered when removing nails because of callus formation over the nail tip. We performed a prospective study to compare two types of nails in managing femoral shaft fractures. Methods Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails. Group II consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires. The patients＇ ages, fracture severity, duration of operation, fluoroscopy time, blood loss and falls of end caps into soft tissue were recorded. Nails were removed after fracture healing. The duration of operation and blood loss during nail removal were recorded. Results There were no significant differences between groups with respect to age and fracture severity （P 〉0.05）. End caps fell into soft tissue 17 times in 15 cases in group I and 21 times in 16 cases in group I1. An average of seven minutes was spent recovering a lost cap in group I. In group II, all lost caps were recovered immediately. The duration of operation and fluoroscopy time in group II was significantly less than in group I （P 〈0.05）. Asymptomatic palpable nodules were detected in 4 cases in group I1. Nail removals were performed on 58 patients in group I and 69 patients in group I1. The duration of operation, blood loss and complications in group II were less than in group I （P〈0.05）. Conclusion Intramedullary nails with tail wires facilitate both fracture fixation and nail removal, which can be used to treat femoral shaft fractures with less radiation exposure, shorter surgical time and fewer complications.
文摘Background： Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. Methods： There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. Results： We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. Conclusion： Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.
文摘目的探讨长骨牵开器在弹性髓内钉治疗儿童股骨干骨折中的应用效果。方法采用长骨牵开器辅助复位弹性髓内钉治疗15例儿童股骨干骨折。记录手术情况、骨折愈合情况、关节活动度及并发症发生情况,根据Flynn et al提出的下肢骨折评分标准评估疗效。结果手术时间31~65 min,术中出血量5~15 ml,术中透视7~15次,住院时间2~6 d。术中无血管神经以及肌肉牵拉伤,牵拉置入斯氏针处无骨折以及渗出感染。患儿均获得随访,时间5~18个月。骨折均愈合,时间9~18周。末次随访时,患儿均可下地完全负重行走,无跛行,内固定无失效断裂,下地负重后无大腿疼痛、局部压痛以及纵向叩击痛;髋关节屈曲130°~135°,膝关节伸直0°~5°、屈曲120°~140°;根据Flynn et al提出的下肢骨折评分标准评估疗效:优13例,良2例。结论弹性髓内钉治疗儿童股骨干骨折中采用长骨牵开器辅助复位操作简便,复位质量可靠,同时能维持骨折断端复位,方便弹性髓内钉的置入,疗效较好。
