Ankle Arthrodesis Nail Combined with Locking Compression Plate to Stabilize Two-Level Pathologic Tibial Fractures

Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and frequent critical circulation. We report the case of two-level tibial pseudarthroses in an 83- year-old woman caused by multiple myeloma successfully stabilized by a long ankle arthrodesis nail combined with locking compression plate osteosynthesis. This case is unique, as to our best knowledge, herein diaphyseal fractures were treated for the first time using a technique reported hitherto primarily for fragility ankle and pilon fractures.

Bone metabolism and trauma degree of magnetic-guided intramedullary nail fixation for 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.

Trauma and bone metabolism of magnetic navigation intramedullary nail and traditional intramedullary nail fixation treatment of femoral shaft fracture

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.

Treatment of femur supracondylar fracture with retrograde interlocking intramedullary nails in elderly patients

Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.

Risk Assessment of Retrograde Intramedullary Nailing for Proximal Humeral Fracture

In proximal humeral fracture except AO classification 11A1, fixations with a locking plate and nails are recommended. We performed mechanical tests to investigate whether retrograde intramedullary nailing has fixation stability comparable to those of anterograde intramedullary nailing and locking plate which achieve clinically favorable outcomes. In retrograde intramedullary nailing, a nail entry point is made in the diaphysis, for which reduction of stiffness of the humerus is of concern. Thus, we investigated the influence of a nail entry point made in the diaphysis on humeral strength. Retrograde intramedullary nailing had fixation stability against bending and a force loaded in the rotation direction comparable to those of anterograde intramedullary nail and locking plate. Displacement by the main external force loaded on the humerus, compressive load, was less than half in the bone fixed by retrograde intramedullary nailing compared with that in the bone fixed with a locking plate, showing favorable fixation stability. It was clarified that stiffness of the humerus against rotation and a load in the compression direction is not reduced by a nail entry point made by retrograde intramedullary nailing.

Strategies and outcomes in severe open tibial shaft fractures at a major trauma center: A large retrospective case-series

BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.

Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures

Purpose:Open tibia fracture is prone to infection,consequently causing significant morbidity and increasing the hospital stay,occupational loss and onset of chronic osteomyelitis.Intramedullary nailing is one choice for treating tibia shaft fractures.To improve the delivery of antibiotics at the tissue-implant interface,many methods have been proposed as a part of prophylaxis against infection.This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking(IMIL)nail in the prevention of infection in Gustilo typeⅠandⅡopen tibia fractures and to compare the results with regular intramedullary nail.Methods:The study included 28 patients with open tibia fractures(Gustilo type 1 or type 2);of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing.Randomization was done by alternate allocation of the patients.Follow-up was done postoperatively(day 1),1 week,6 weeks,and 6 months for bone union,erythrocyte sedimentation rate(ESR),hemoglobin and C?reactive protein(CRP).Statistical significance was tested using unpaired t-test.A p value less than 0.05 was considered significant.Results:There were 4 cases of infection in controls(regular IMIL nail)and no infection among patients treated with gentamicin-coated nail during the follow up(Х^2=4.66,p=0.031).At 6 months postoperatively,CRP(p=0.031),ESR(p=0.046)and hemoglobin level(p=0.016)showed significant difference between two groups.The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up(p=0.016).Conclusion:Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo typeⅠandⅡopen tibia fractures.

THE MORPHOLOGICAL MEASURE OF THE TIBIAL MEDULLARY CAVITY AND ITS SIGNIFICANCE

Objective To provide morphological reference for the designing of the intramedullary nail fixation which suitable for Chinese by investigating the morphological characteristics of tibial medullary cavity. Methods The morphological parameters of the 113 normal adult tibiale were measured on the X-ray photographs with the image analysis software. Results The total lengths of tibial medullary cavities were 299.49±11.03 mm(male) and 274.60± 6.77 mm(female), and the lengths of the narrow part were 66.36±3.90 mm(male) and 51.57±3.92mm(female). The end-points of narrow part were about 29.9 mm(male) and 26.09 mm(female)below the midpoints of medullary cavities. The radians of the longitudinal axes of medullary cavities were 2.53±1.27°(male) and 2.57±1.16°(female). The proximal opening K were 9.47±2.71(male) and 8.59±2.46(female). The distal opening K were 8.21± 2.93(male)and 7.65±2.87(female). Conclusion The morphology of tibial medullary cavity, the characteristic variety of radian and the opening K were very important references for designing the Chinese intramedullary nail fixation.

Compression Test and Finite Element Analysis for Failure Criterion of the Tibial Post of a Posterior-Stabilized Knee Prosthesis

Post cam mechanism of Posterior Stabilized (PS) knee prostheses is useful to realize intrinsic stability for cases with severe degeneration. However, some retrieval studies report severe failure of the polyethylene tibial post. We thought that severe failures were caused by high loads during daily activities. In the current study, we performed a compression test and a finite element analysis of the mechanical forces produced in the tibial post in posterior-stabilized knee prostheses in order to develop a specification for the tibial posts found in the polyethylene inserts of PS knee prostheses. Anterior tibial post impingement and posterior tibial post impingement were simulated. The surface pressure values detected in the compression test were consistent with those obtained in the FE analysis. Of the three designs, the lowest von Mises stress values were generated inside the round tibial post;therefore, tibial posts should be round. The risk of tibial post failure was low when 500 or 1000 N was loaded onto the knee joint. It was suggested that tibial post failure occurs when the shear strain at the base of the tibial post exceeds 0.1.

Comparison of two kinds of intramedullary nails in the treatment of femoral shaft fractures in adults

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.

Intramedullary bone pedestal formation contributing to femoral shaft fracture nonunion:A case report and review of the literature

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.

Titanium Elastic Nails for Pediatric Femur Fractures: Clinical and Radiological Study

Background: Management of femoral diaphyseal fractures in the age group 616 years is controversial. There has been a resurgence worldwide for operative fixation. Material and methods: Twenty children (15 boys, 5 girls) aged 616 years with femoral diaphyseal fractures (20 fractures, one in each) were stabilized with Titanium Elastic Nail (TEN). Patients underwent surgery within ten days of their injury. The results were evaluated using Flynn’s Scoring Criteria.Two nails were used in each fracture. Results: All 20 patients were available for evaluation and follow up for a mean duration of 24 months (1532 months). Radiological union in all cases was achieved in a mean time of 8 weeks. Full weight bearing was possible in a mean time of 10 weeks (812 weeks). The results were excellent in 14 patients (70%) and successful in 6 patients (30%). Few complications that occurred were infection (in 2 cases), knee joint stiffness(in 4 cases), angulation less than 10 degrees( in 4 cases), shortening less than 10 mm(in 4 cases). Conclusion: Intramedullary fixation by TEN is an effective treatment of fracture of femur in properly selected patients of the 616 years age group.

耳穴压豆联合穴位贴敷治疗老年股骨粗隆间骨折术后便秘临床观察

目的分析行股骨近端防旋髓内钉内固定术的老年股骨粗隆间骨折患者,应用耳穴压豆联合穴位贴敷治疗的效果及对术后便秘的影响。方法回顾性选取2020年2月—2022年2月南城县中医院行股骨近端防旋髓内钉内固定术的老年股骨粗隆间骨折患者70例,分为联合治疗组和常规治疗组,各35例。联合治疗组行耳穴压豆联合穴位贴敷治疗,常规治疗组行常规治疗,观察临床效果。结果联合治疗组术后便秘发生率为8.57%(3/35),低于常规治疗组的31.43%(11/35);各围术期指标均优于常规治疗组;治疗总有效率为91.43%(32/35),高于常规治疗组的71.43%(25/35);术后并发症发生率为2.86%(1/35),低于常规治疗组的25.71%(9/35)(P<0.05)。治疗后,联合治疗组便秘患者症状自评量表(PAC-SYM)评分、视觉模拟量表(VAS)评分、焦虑评分、抑郁评分均低于常规治疗组,骨折断端骨痂生长评分、Harris评分均高于常规治疗组(P<0.05)。结论行股骨近端防旋髓内钉内固定术的老年股骨粗隆间骨折患者应用耳穴压豆联合穴位贴敷治疗,效果显著,术后便秘发生率明显降低。

Fragility of statistically significant findings from randomized clinical trials of surgical treatment of humeral shaft fractures:A systematic review

BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.

不同髓内钉内固定术在胫骨远端关节外骨折治疗中的效果比较

目的 比较不同髓内钉内固定术治疗胫骨远端关节外骨折的效果。方法 前瞻性选择2021年1月至2022年6月濮阳市人民医院骨科收治的80例胫骨远端关节外骨折患者,以随机数字表法分为A组与B组,各40例。A组接受逆行髓内钉内固定术,B组接受交锁髓内钉内固定术。比较两组术后3个月的临床疗效。比较两组围手术期指标、踝关节功能、术后并发症发生情况。结果 两组术后3个月的临床效果差异无统计学意义(P>0.05)。A组手术时间短于B组(P<0.05);两组术中出血量、骨折愈合时间差异无统计学意义(P>0.05)。术后3个月,两组踝后足功能评分(AOFAS)评分均升高,但B组低于A组(P<0.05)。B组术后并发症发生率高于A组(P<0.05)。结论 逆行髓内钉与交锁髓内钉固定术治疗胫骨远端关节外骨折均可获得理想疗效,且应用逆行髓内钉可有效缩短手术时间,并能够加速踝关节功能恢复,降低并发症发生率。

顶棒支撑法复位髓内钉固定治疗难复性股骨转子间骨折的临床效果

目的分析顶棒支撑法复位髓内钉固定治疗难复性股骨转子间骨折的临床效果。方法于2020年8月至2022年8月在南阳市中心医院收集病例展开研究,将严格按照纳排标准筛选的106例难复性股骨转子间骨折患者作为研究对象,根据随机数字表法分为研究组与对照组,各53例。对照组接受切开或有限切开复位结合髓内钉固定治疗,研究组接受顶棒支撑法复位髓内钉固定。统计对比两组患者围手术期情况、骨折复位质量、术后恢复情况;对比两组患者术前、术后6个月髋关节功能评分;对比两组并发症发生率。结果研究组手术时间、骨折复位时间较对照组短,手术出血量较对照组少(P<0.05)。研究组骨折复位质量优于对照组(P<0.05)。研究组骨折愈合、开始负重和住院时间较对照组短(P<0.05)。术后6个月,两组髋关节功能评分均较术前提高,研究组高于对照组(P<0.05)。研究组并发症发生率[5.66%(3/53)]较对照组[18.87%(10/53)]低(P<0.05)。结论采用顶棒支撑法复位髓内钉固定治疗难复性股骨转子间骨折可减轻对机体的创伤,降低并发症发生率,提高复位效果,促进骨折愈合和髋关节功能恢复。

闭合复位钛制弹性髓内钉内固定治疗MasonⅡ型桡骨头骨折疗效分析

目的探讨闭合复位钛制弹性髓内钉内固定治疗MasonⅡ型桡骨头骨折的临床效果。方法选取2019年6月至2021年6月郑州市第七人民医院收治的80例MasonⅡ型桡骨头骨折患者作为研究对象,按照随机数表法将其随机分为观察组(40例)和对照组(40例),观察组患者采用闭合复位钛制弹性髓内钉内固定治疗,对照组患者采用手法复位联合石膏外固定治疗,对比观察两组患者临床疗效、肘关节活动度及并发症发生情况。结果术后6个月,观察组患者肘关节功能恢复为优者30例、良者8例、可者2例,明显优于对照组患者的肘关节功能恢复为优者14例、良者17例、可者7例、差者2例(Z=-3664,P<0001);术后6个月,观察组患者肘关节屈曲、伸展及前臂旋前、旋后活动度均明显大于对照组(t=3643、2868、3366、3588,P=0001、0005、0001、0001);术后随访1年,观察组患者均未出现并发症,其并发症发生率明显低于对照组患者的并发症发生率100%(χ^(2)=4211,P=0040)。结论与手法复位联合石膏外固定相比,闭合复位钛制弹性髓内钉内固定能够明显提高MasonⅡ型桡骨头骨折患者的肘关节功能恢复效果,改善肘关节活动度,减少术后并发症的发生,值得临床推广应用。

髓内钉在下肢骨折患者内固定治疗中的应用

目的探讨在下肢骨折患者内固定治疗中应用髓内钉的效果。方法选取2022年1月—2023年5月麻城市人民医院收治的210例下肢骨折患者为研究对象,按照不同的手术方法分为对照组和研究组,各105例。对照组行常规加压钢板内固定治疗,研究组行带锁髓内钉治疗。比较两组术后骨折愈合情况、手术相关参数、术后并发症发生情况。结果研究组术后骨折愈合优良率为93.33%(98/105),高于对照组的81.90%(86/105),差异有统计学意义(χ^(2)=6.321,P<0.05)。研究组手术时间、切口长度均短于对照组,术中出血量、术后引流量均少于对照组,差异有统计学意义(P均<0.05)。研究组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论髓内钉应用在下肢骨折中可取得显著的效果,能减少手术对患者的创伤,且术后骨折愈合的优良率更高。

髌上入路和髌下入路髓内钉内固定治疗胫骨骨折的效果

目的:探讨髌上入路和髌下入路髓内钉内固定治疗胫骨骨折的效果。方法:选取2019年1月—2023年10月靖江市人民医院收治的60例胫骨骨折患者为研究对象。根据随机抽签将其分为对照组和观察组,各30例。对照组给予髌下入路髓内钉内固定,观察组给予髌上入路髓内钉内固定。比较两组围手术期指标,术前及术后膝关节功能,并发症。结果:观察组手术时间及术后消肿时间、住院时间、骨折愈合时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。术后3个月,观察组功能、活动度、肌力、屈曲畸形评分均高于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:治疗胫骨骨折可采取髓内钉固定术方式,选择髌上入路相较髌下入路效果更佳,可促进患者术后膝关节功能的恢复,且减少并发症。