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 classifi...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.展开更多
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...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.展开更多
Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw....Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw. Methods: Forty-three patients who had a fracture of the femoral shaft were managed between 2005 and 2008 with intramedullary nailing and the use of only one screw for distal interlocking. Prospectively we evaluated the union time, possible reoperation, fixation and fracture alignment, range of knee motion and complications. Results: Union occurred within a mean duration of 18.7 weeks. No failures of the fixation and fracture alignment and no more than 1 cm shortness were detected. The knee range of motion was all more than 90 degree. Only one deep venous thrombosis was detected as complication. Conclusions: Compressive nailing using proximal hole and only distal dynamic hole with one screw is a convenient technique for femur fractures.展开更多
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
<b><span>Background</span></b><b><span>: </span></b><span>Bisphosphonate abuse is associated with atypical femur fractures, which despite different fixation method...<b><span>Background</span></b><b><span>: </span></b><span>Bisphosphonate abuse is associated with atypical femur fractures, which despite different fixation methods have increased non-union, delayed union, and re-operation rates. Therefore, there is a need for a surgical technique that may enhance union in such cases. Herein we are introducing a novel technique of sequential multiple vigorous reaming across the fracture site to introduce reaming debris/endosteal bone graft around the fracture site.</span><span> </span><b><span>Materials and Methods</span></b><b><span>: </span></b><span>We present a retrospective analysis of five prospectively treated patients with atypical diaphyseal femur fracture who presented to us from January 2015 to August 2019.</span><span> </span><span>All the patients were followed up at regular intervals and assessed both clinically and radiologically.</span><span> </span><b><span>Results</span></b><b><span>: </span></b><span>All 5 cases operated with our technique showed union at a mean follow-up of 16 weeks (12</span><span> </span><span>-</span><span> </span><span>20 weeks). There were no complications reported in our study at the last mean follow-up of 25 months (12</span><span> </span><span>-</span><span> </span><span>51 months).</span><span> </span><b><span>Conclusion</span></b><b><span>: </span></b><span>This technique of multiple vigorous reaming at and around the fracture site provides a new paradigm in the management of AFF. The autograft around the outer cortex promotes the formation of bridging callus and results in the early union.</span>展开更多
Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supraco...Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supracondylar femoral fracture were treated with arthroscopically assisted implantation of retrograde interlocking intramedullary nail and close reduction. Results: More than 6 month follow up study after operation in 11 patients revealed that the average healing time was 3 months. Average range of the knee motion for all the patients was more than 90 degrees. There was no implant breakage and infection. Conclusions: This new method, combining the advantage of arthroscope and retrograde interlocking intramedullary nail, can provide a stable and reliable fixation, and meanwhile is less invasive to the soft tissue and knee, less operative time and blood loss, minimal disruption of the blood supply in fracture site. It is conducive to the fracture healing and the functional recovery of the knee joint and worthwhile to be recommended.展开更多
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 ti...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.展开更多
文摘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.
文摘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.
文摘Objectives: In this study we aimed to present our treatment results of intramedullary nailing of femoral shaft fractures with compressive nailing using proximal static hole and only distal dynamic hole with one screw. Methods: Forty-three patients who had a fracture of the femoral shaft were managed between 2005 and 2008 with intramedullary nailing and the use of only one screw for distal interlocking. Prospectively we evaluated the union time, possible reoperation, fixation and fracture alignment, range of knee motion and complications. Results: Union occurred within a mean duration of 18.7 weeks. No failures of the fixation and fracture alignment and no more than 1 cm shortness were detected. The knee range of motion was all more than 90 degree. Only one deep venous thrombosis was detected as complication. Conclusions: Compressive nailing using proximal hole and only distal dynamic hole with one screw is a convenient technique for femur fractures.
文摘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<b><span>Background</span></b><b><span>: </span></b><span>Bisphosphonate abuse is associated with atypical femur fractures, which despite different fixation methods have increased non-union, delayed union, and re-operation rates. Therefore, there is a need for a surgical technique that may enhance union in such cases. Herein we are introducing a novel technique of sequential multiple vigorous reaming across the fracture site to introduce reaming debris/endosteal bone graft around the fracture site.</span><span> </span><b><span>Materials and Methods</span></b><b><span>: </span></b><span>We present a retrospective analysis of five prospectively treated patients with atypical diaphyseal femur fracture who presented to us from January 2015 to August 2019.</span><span> </span><span>All the patients were followed up at regular intervals and assessed both clinically and radiologically.</span><span> </span><b><span>Results</span></b><b><span>: </span></b><span>All 5 cases operated with our technique showed union at a mean follow-up of 16 weeks (12</span><span> </span><span>-</span><span> </span><span>20 weeks). There were no complications reported in our study at the last mean follow-up of 25 months (12</span><span> </span><span>-</span><span> </span><span>51 months).</span><span> </span><b><span>Conclusion</span></b><b><span>: </span></b><span>This technique of multiple vigorous reaming at and around the fracture site provides a new paradigm in the management of AFF. The autograft around the outer cortex promotes the formation of bridging callus and results in the early union.</span>
文摘Objective: To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing under arthroscopy on supracondylar femoral fractures. Methods: From June 1999 to December 2000, 17 patients with supracondylar femoral fracture were treated with arthroscopically assisted implantation of retrograde interlocking intramedullary nail and close reduction. Results: More than 6 month follow up study after operation in 11 patients revealed that the average healing time was 3 months. Average range of the knee motion for all the patients was more than 90 degrees. There was no implant breakage and infection. Conclusions: This new method, combining the advantage of arthroscope and retrograde interlocking intramedullary nail, can provide a stable and reliable fixation, and meanwhile is less invasive to the soft tissue and knee, less operative time and blood loss, minimal disruption of the blood supply in fracture site. It is conducive to the fracture healing and the functional recovery of the knee joint and worthwhile to be recommended.
文摘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.
