Bone Nails

We present the results of using the Marchetti±Vicenzi nail in the management of 41 closed and 16 type I±III open tibial fractures in 56 patients. The treatment goals were to achieve stability and fracture alignment allowing early functional treatment of the knee and ankle by immediate partial or full weight-bearing. Early callus formation and rapid mobilisation were obtained in 84% of the patients. The mean time to clinical union was 9.8 weeks (radiological union 28.4 weeks) for closed fractures and also 9.8 weeks for open fractures (radiological union 28.7 weeks). No late rotational deformities were observed. We argue that intramedullary nailing with a Marchetti±Vicenzi nail is a quick and excellent method of treating selected closed and open tibial fractures.

Objectives: Bioabsorbable transcondylar fixation has remained a popular femoral fixation option for anterior cruciate ligament (ACL) reconstruction using hamstring graft. We report the incidence of failure and complications related to this particular fixation device in a single surgeon consecutive series of 56 patients. Methods: Fifty-six consecutive arthroscopic ACL reconstructions using hamstring autograft done by single surgeon between March 2010 and Dec 2011 were reviewed retrospectively after IRB approval. Transcondylar femoral fixation was achieved using Bio-Transfix (Arthrex, Naples, FL) pin in all patients. Mean follow up was 18.2 months. Intra-operative and post-operative follow up data were reviewed to assess failure. Failure was categorized as either graft failure due to re-injury or implant related failure due to persistent pain at pin insertion site and/or pin breakage. Results: 13 (23.2%) patients were deemed as failures following surgery. Five patients needed revision surgery (persistent pain at pin insertion site n= 2, and pin breakage n=3). Two additional patients had a pin breakage and refused surgery and five additional patients had pain at the transfix pin site but opted for conservative treatment. One patient had a mid-substance graft failure due to sports injury unrelated to implant type. Remaining 43 patients did not report any symptoms of pain and or instability following surgery. Conclusion: This single surgeon consecutive series of ACL reconstruction using transcondylar pin fixation device demonstrates a slightly higher failure rate (23.2%) as compared to previous isolated reports of pin breakage or pain at insertion site in literature. Further radiographic studies are necessary to understand the natural history of osteointegration of this bio-device, such as implant thinning, tunnel widening by osteolysis, points of stress risers in implant and possible modification in routine accelerated rehabilitation following this implant as method for ACL reconstruction.

Background: During routine follow-up of patients treated with a three-piece stainless-steel modular femoral nail, osteolysis and periosteal reaction around the modular junctions of some of the nails were noted on radiographs. The purpose of this study was to evaluate the prevalence, etiology, and clinical relevance of these radiographic findings. Methods: Forty-four femoral fractures or nonunions in forty-two patients were treated with a modular stainlesssteel femoral intramedullary nail. Seventeen nails were excluded, leaving twenty-seven intramedullary nails in twenty-seven patients for this study. All patients had had a femoral diaphyseal fracture; nineteen had had an acute fracture and eight, a nonunion. These twenty-seven patients returned for radiographs, a physical examination, assessment of functional outcomes, assessment of thigh pain with a visual analog scale, determination of serum chromium levels, and nail removal if desired. A control group of sixteen patients treated with a one-piece stainless-steel femoral intramedullary nail was evaluated with use of the same outcome measures and was compared with the group treated with the modular femoral nail with regard to prevalence of thigh pain and serum chromium levels. Twelve modular femoral nails were removed according to the study protocol. The modular nail junctions were analyzed for corrosion products, and histopathologic analysis of tissue specimens from the femoral canal was performed. Results: The twenty-seven patients were seen at a mean of twenty-one months after fracture fixation; twenty-six of the twenty-seven fractures healed. Twenty-three femora had at least one of three types of abnormalitiesosteolysis, periosteal reaction, or cortical thickeninglocalized to one or both modular junctions. Eighteen patients had severe reactions, defined as osteolysis of ≥2 mm, cortical thickening of ≥5 mm, and/or a periosteal reaction (group 1). Nine patients had mild or no reactions (group 2). Serum chromium levels in group 1 (mean, 1.27 ng/ mL; range, 0.34 to 3.12 ng/mL) were twice as high as those in group 2 (mean, 0.53 ng/mL; range, 0.12 to 1.26 ng/mL). However, this difference did not reach significance with the numbers available. The differences in serum chromium levels between group 1 and the control group with a one-piece nail (mean, 0.26 ng/mL; range, 0.015 to 1.25 ng/mL) (p < 0.01) and a control group without an implant (mean, 0.05 ng/mL; range, 0.015 to 0.25 ng/ mL) (p < 0.01) were significant. The level of thigh pain recorded on the visual analog scale was also significantly different between group 1 and the control group with a one-piece implant (p = 0.03). Retrieved modular nails had signs of fretting corrosion as well as stainless-steel corrosion products adherent to the junction where the osteolysis occurred. Histologic and spectrographic analysis revealed two types of corrosion products that were consistent with stainless-steel within the peri-implant tissue and were associated with a foreign-body granulomatous response. Conclusions: The presence of corrosion products at the taper junctions suggests that particulate debris was a major factor in the etiology of the radiographic findings of osteolysis, periosteal reaction, and cortical thickening. Serum chromium levels were substantially elevated in the patients with a modular femoral nail, and such levels may serve as a marker of fretting corrosion of these devices.

The use of intramedullary fixation methods in the tibia is limited by the anatomical characteristics of this bone. In this study, the shape and degree of axial lateral rotation of the medullary canal were determined in 45 human dry cadaver bones using X-ray and computed tomography examinations and direct measurement of rotation in inserted nails. Forty bones (88.8%) had slight and five bones (11.1%) had excessive anterior bowing along the tibial shaft. Six of the 45 bones (13.3%) had an extremely narrow medullary canal. Axial lateral rotation was demonstrated in the middle third of the medullary canal, being on average (± SD) 32.35 ± 16.25° (range 10-75°). This study revealed that extreme narrowing of the medullary canal, axial lateral rotation of the medullary canal, and extreme anterior bowing of the tibial shaft are the anatomical characteristics most likely to cause difficulties when using intermedullary fixation in the tibia.

The purpose of this cadaveric study was to evaluate whether there is any damage to the gluteus medius tendon when reaming through a modified medial trochanteric portal for antegrade intramedullary femoral nailing. Methods: Ten cadaver hips were used in this study. A guidewire was placed in the modified medial trochanteric portal using the assistance of C-arm fluoroscopy and a 14-mm reamer was advanced over the wire. After the reaming was complete, each hip was dissected and the gluteus medius muscle and tendon were inspected to evaluate the amount of intrasubstance and medial tendon damage. Results: Precise localization of the modified medial trochanteric portal was achieved in 9 of 10 cadaver hips. Of those nine hips, the use of the modified medial trochanteric portal did not result in any visible damage to the tendinous insertion of the gluteus medius or the medial aspect of the tendon in any of the specimens. There is no damage to the gluteus medius tendon with the use of the modified medial trochanteric portal. Although the clinical implications of this finding are not known with certainty, the use of the modified medial trochanteric entry portal for antegrade femoral nailing could possibly result in less postoperative morbidity because it does not damage the gluteus medius tendon as compared to the traditional more lateral trochanteric portal.

BACKGROUND: Supracondylar humerus fracture is the most common fracture of the elbow in children. Closed reduction and percutaneous pinning is considered to be the optimal treatment strategy; however, in some instances, open reduction may be necessary. The aim of this retrospective study was to compare clinical and functional results of triceps-splitting posterior versus lateral approach in pediatric supracondylar humerus fracture surgery. A total of 38 patients underwent surgery; Group 1 consisted of 30 patients on whom posterior approach was used, while lateral approach was used on the 8 patients in Group 2. Flynn criteria were used to evaluate cosmetic and clinical results. Fracture healing was assessed with anteroposterior and lateral x-rays. Patients and parents were asked to describe time needed for complete return of full elbow range of motion (ROM) and overall satisfaction. Mean fracture union time was 44.1 days and 46.3 days, and time required to regain complete or near complete elbow ROM was 57.5 days and 55.7 days after splint removal for Group 1 and Group 2, respectively. Twenty-one of 30 (70%) patients (and parents) in Group 1, and 6 of 8 (75%) patients (and parents) in Group 2 were totally satisfied with the results. Twenty-one of 30 (70%) patients in Group 1, and 6 of 8 (75%) patients in Group 2 had excellent cosmetic and functional results according to Flynn outcome criteria. In cases of pediatric supracondylar humerus fracture, early closed reduction and percutaneous pinning is preferred; however, when this method is not applicable, triceps-splitting posterior approach is a safe and comparable method to lateral approach with advantages of easier fracture reduction and shorter operating time.

Las fracturas aisladas del cuboides son patologías raras, generalmente asociadas a otras lesiones traumáticas del pie. En la literatura existen casos reportados en adultos, en los niños, escasos. Sólo el 5% de las fracturas del tarso son de cuboides. El diagnóstico en ocasiones difícil, un estudio por tomografía axial computarizada es muchas veces necesario. Los tratamientos son variados, existen reportes de fijación interna con colocación de injerto y de reducción cerrada. Presentamos el caso de una niña de 4 años de edad, atendida en nuestro hospital. Presentó una fractura aislada de cuboides derecho. La paciente ingresó al Servicio de Urgencias tras dos días de evolución de haber sido prensada en el pie por un automóvil. El tratamiento inmediato consistió en vendaje antiedema tipo Robert Jones, y férula suropodálica. A las 8 semanas se retiró la inmovilización y la paciente reinició la deambulación. A la semana 16, presentaba una marcha normal y buena evolución.

Objectives: To assess the results and clinical outcome of delayed union and nonunion humeral shaft treatment using locked medullary nails. Subjects and Methods: The Russel and Taylor humeral locking nail was used to treat 21 patients with humeral shaft fractures at Al Razi hospital, Kuwait, from 1997 to 2001. Of these, 8 had delayed union and 13 nonunion. Also, 13 had previous operative treatment, while 8 had nonoperative treatment. Antegrade nailing was done in all cases, and all nails were fixed statically. Autogenous iliac bone grafts were used in 17 cases. Results: Of the 21 cases of fractures, 19 were united. Only 2 cases had persistent nonunion. Eighteen cases had satisfactory shoulder function, and 3 lost shoulder abduction between 40 and 65 degrees. Conclusion: Our data showed that humeral locked nails can achieve satisfactory clinical results in treating humeral shaft delayed unions and nonunions.

Due to increasing population and changing human habits the number of accidents and high energy trauma is rising. Management of open fracture tibia is a complex problem and is a challenge for both orthopaedic and plastic surgeons. The study was carried out to ascertain the efficacy and safety of interlocked intra-medullary nailing for open shaft tibial fractures in patients presenting at or after 24hr of injury. In this descriptive case series, over a period of 6 moths, 163 consecutive cases of open fracture of tibial shaft were reviewed in terms of clinical profile, time of presentation, and gender distribution. In this study mean age was 30±0.02 years. Males comprised 85% of study population while 15% were females. Gustilo-I type fracture and Gustilo-II type fracture was diagnosed in 90% and 10% patients respectively. Thirty three percent patients had wound infection while fracture union was found in 15% cases. Moreover interlocked intramedullary nailing for open fracture shaft of ...

Background: Background: Background: Background: Background: A deformity in cubitus varus is a well-known complication after a supracondylar fracture of the humerus. The pattern of placement of pins for treatment of these fractures has been the subject of considerable controversy. Objective: Objective: Objective: Objective: Objective: To identify the factors associated with the development of cubitus varus after a supracondylar fracture. Patients and methods: Patients and methods: Patients and methods: Patients and methods: Patients and methods: We reviewed all cases of supracondylar fractures treated between 1997 and 2002; we identified the pattern of pin placement and results were graded using the Flynn criteria, we also measured the carrying angle with a minimum follow-up of 2 years. Results: Results: Results: Results: Results: 34 patients were reviewed; the average age at the time of fracture was 6.55 years (range 3.1 to 10.1). According the Gartland classification 16 type II fractures were found and 18 type III fractures were founds. Fixation was performed with 2 crossed pins in 26 patients and with 2 lateral entry pins in 8 patients. The average follow-up was 2.3 years (range 2.0 to 7.3). The carrying angle in relation to the unaffected elbow changed from an average of 14.88° to 12.26° (p = 0.045). Three cases of cubitus varus were identified, all had been treated with crossed pins; none of the patients treated with lateral entry pins developed cubitus varus (p = 0.115). The reduction in relative risk was 89%. The overall risk of developing a cubitus varus deformity in this study was 8.8%, with the risk being higher in children over the age of 7, Gartland type III fractures and a crossed pin configuration. The only modifiable variable that can reduce the risk of developing a cubitus varus deformity is the pattern of pin placement, with the 2-pin lateral entry configuration being related to the lowest risk of developing the deformity. Level of evi-Level of evi-Level of evi-Level of evi-Level of evidence: dence: dence: dence: dence: Level IV-case series.

Leg lengthening by external fixation is associated with various difficulties. We evaluated eight adolescent patients who underwent leg lengthening with a motorized intramedullary lengthening device. We asked whether this method could reduce the time of hospitalization and rehabilitation and whether the incidence of complications commonly associated with external fixators could be reduced. We compared our preliminary results with those from other reports, with a focus on leg length achieved, time of rehabilitation, and rate of complications. The average leg-length discrepancy was 3.8 cm (range, 3-5 cm). The average lengthening distance was 3.8 cm (range, 2.9-4.7 cm). In six patients, leg lengthening was combined with successful correction of the mechanical axis alignment. The consolidation index averaged 26 days/cm (range, 19-41 days/cm). The average hospital stay was 9.6 days. No bone or soft tissue infections were observed. In comparison to other studies (1.0-2.8 complications/ patient), our results suggest that the difficulties commonly associated with external fixators can be reduced with this method. It also allows good angular correction in patients with mechanical axis deviation. These features combined with a short time of hospitalization and rehabilitation make it a promising procedure for limb lengthening. Level of Evidence: Level IV Therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

Leg lengthening by external fixation is associated with various difficulties. We evaluated eight adolescent patients who underwent leg lengthening with a motorized intramedullary lengthening device. We asked whether this method could reduce the time of hospitalization and rehabilitation and whether the incidence of complications commonly associated with external fixators could be reduced. We compared our preliminary results with those from other reports, with a focus on leg length achieved, time of rehabilitation, and rate of complications. The average leg-length discrepancy was 3.8 cm (range, 3-5 cm). The average lengthening distance was 3.8 cm (range, 2.9-4.7 cm). In six patients, leg lengthening was combined with successful correction of the mechanical axis alignment. The consolidation index averaged 26 days/cm (range, 19-41 days/cm). The average hospital stay was 9.6 days. No bone or soft tissue infections were observed. In comparison to other studies (1.0-2.8 complications/ patient), our results suggest that the difficulties commonly associated with external fixators can be reduced with this method. It also allows good angular correction in patients with mechanical axis deviation. These features combined with a short time of hospitalization and rehabilitation make it a promising procedure for limb lengthening. Level of Evidence: Level IV Therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.

Interlocking nails are commonly performed using an image intensifier. These are expensive and are not readily available in most resource-poor countries of the world. The aim of this study was to achieve interlocking nailing without the use of an image intensifier. This is a prospective descriptive analysis of 40 consecutive cases seen with shaft fractures of the humerus, femur, and tibia. Fracture fixation was done using Surgical Implant Generation Network (SIGN) nails. Forty limbs in 34 patients were studied. There were 12 females and 22 males, giving a ratio of 1:2. The mean age (years) was 35.75± 13.16 and the range was 17-70 years. The studied bones were: humerus 10%, femur 65%, and tibia 25%. The fracture lines were: transverse 40%, oblique 15%, and communited 45%. Fracture grades were: closed 90%, grade I, 5%, grade II, 2.5%, and grade IIIA, 2.5%. Surgical approaches were: antegrade 62.5% and retrograde 37.5%. Indications for fixation were: recent fracture 92.5%, non-union 5%, and malunion 3%. Methods of reductions were: open 85% and closed 15%. The mean follow-up period (years) was

This study aimed to investigate the effect of distance between the femoral head and predicted hip rotation center on clinical and radiological survival of the acetabular implants (Jumbo cups and acetabular cages) retrospectively in patients who had revision hip arthroplasties. The retrospective study included a total of 52 consecutive patients (16 in acetabular cage group I, 36 in Jumbo cup group II). Radiological evaluation was performed by assessing the hip rotation center, polyethylene wear, lateral offset of the hip, and the migration of acetabular component on pelvis AP radiographs. Harris Hip Score (HHS) was used to assess the clinical evaluation at one, three, six, twelve months, and each year. The mean postoperative HHS at the last clinical assessment was 67.0±12.9 in group I and 68.2±11.9 in group II, respectively. The change in the hip rotation center did not affect the HSS scores between the groups (p>0.05), whereas acetabular cup migration and lateral offset comparison between groups were found statistically significant (p: 0.007). There was no significant correlation between lateral offset and acetabular implant migration (p>0.05), however, there was a negative correlation in comparison between lateral offset and polyethylene wear. Our study results suggest that both jumbo porous-coated acetabular components with screw fixation or reinforcement cages can be used in hips with notable bone loss. However, it is concluded that the shorter offset had higher liner wear which may contribute to a higher revision rate after revision hip arthroplasty.

Long bone fractures account for a vast majority
of trauma related emergency surgeries. Tibia is the most commonly fractured long bone with the incidence of tibial shaft fracture being16.9/100,000/year. intramedullary nailing is a common method
for treatment of tibial shaft fractures.’ Intramedullary rods are secured within the bone by screws both above and below the fracture

Objective To report the results of patients with short oblique diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO). The secondary aim was to understand the effect of fracture location (midshaft or distal 1/3) on outcomes. Methods Twenty-eight patients with short oblique (&gt;30°) tibial shaft fractures (AO/OTA 42A2) treated with plate and MIPO technique between 2015 and 2019 were retrospectively assessed. Age, gender, follow-up time, fracture type (open or closed), operation time, postoperative infection rate, union time, ankle joint range of motion, and complications were analyzed. Patients’ radiographs at a minimum 1-year follow-up were evaluated for malunion, nonunion, and implant-related complications. Results Mean age and follow-up time were 47.0 ± 15.7 years and 18.3 ± 12.1 months, respectively. Mean bone union time was 3.66 ± 1.04 months in middle 1/3 diaphysis and 4.23 ± 1.48 months in distal 1/3 tibia fractures. Seven (25%) patients develo...

BACKGROUND Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF) owing to the risk of ulnar nerve injury. AIM To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization. METHODS Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury. RESULTS Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique. CONCLUSIONS Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.

In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip referenc...

Titanium alloy implants are the most used materials for the fixation of lower extremity fractures. Although these implants were thought to be inert materials in vitro, several studies have shown increased serum and remote tissue metal ion levels due to wear of implants and friction of the bone-implant interface in vivo. The aim of this study was to investigate the alteration of serum metal ion levels that are released from intramedullary nails and plates used for the fixation of lower extremity fractures, within the fracture healing period. The study included 20 adult patients, who were treated with intramedullary nail or plate osteosynthesis due to closed lower extremity fractures. Alterations of serum titanium, aluminum, molybdenum, and vanadium levels were evaluated at 6, 12, 18, and 24 weeks postoperatively. A statistically significant increase was determined in serum titanium, aluminum, molybdenum, and vanadium ion levels in the intramedullary nail and plate groups at the end of the follow-up period. Pairwise comparisons of metal ion levels between implant groups revealed no significant difference during a 24-week follow-up period. Compared to the control group, statistically significant increased levels of serum titanium, aluminum, vanadium, and molybdenum ions were determined in the implant groups used for the fixation of lower extremity fractures at the end of 24 weeks. In the current literature, the potential toxic effects of prolonged exposure to low levels of these metal ions are still unknown. It can be predicted that long-term metal ion exposure could result in vivo pathological processes in the future.

This paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. The treatment of distal femoral fractures has improved with the evolution of plating and nailing technologies. The commonly selected surgical approaches are outlined and surgical treatment techniques including both internal and external fixation are discussed. 12/ ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL., 79, 2012 CURRENT CONCEPTS REVIEW SOUBORNÝ REFERÁT The appreciation of deforming forces involved is critical for adequate surgical management. The characteristic deformity is shortening of the fracture with varus and extension of the distal articular segment (48). Shortening is caused by the quadriceps and hamstring muscles. The varus and extension deformities are the result of unopposed pulling of the hip adductors and gastrocnemius muscles respectively. All efforts reducing and retaining distal femoral fractures must respect and adapt to this deformity forces (47). However, a critical aspect of the femoral anatomy represents the shape of the articular block and the anterior bow of the femoral shaft. On axial section, the distal articular segment has a trapezoidal shape. The medial and lateral edges of the condyles are converting ventrally for about 15-25°, and the ventral and dorsal joint lines are not parallel either. Consequently, the length of the introduced implants has to be critically emphasised considering this special shape. Unawareness of this anatomy may lead to anterior displacement, medialisation, and external rotation of the femoral condyles, articular penetration by implants, or excessive penetration of the medial cortex (11).

Temporal distribution of intramembranous and endochondral bone formation was studied in experimental fracture defects in rats under different stability of fracture fixation and fracture environments. Animals were surgically treated with a specially developed external fixation construct: Group 1 had 42 rats with a 0-mm fracture gap with bone ends touching corresponding to an axial stiffness of 265.00 ± 34.00 N/mm and Group 2 had 42 rats with a 2-mm fracture gap corresponding to an axial stiffness of 30.38 ± 2.07 N/mm. From each group, six animals were sacrificed at 4 days and 1, 2, 3, 4, 6, and 12 weeks. Qualitative histologic and morphometric analyses revealed that less fixation rigidity and increased fracture gap induces a later response of bone formation and greater endochondral bone formation leading to prolonged time for full ossification. Furthermore, in the early phase of fracture healing temporal distribution and histologic characteristics of periosteal and intramedullary bone formation are similar and not influenced by rigidity and fracture environment. Results also showed that if tissues associated with the intramedullary region are preserved, intramedullary bone formation is substantial. Finally, histologic data indicate that woven bone might be a prerequisite for the differentiation process of endochondral bone formation.

We reviewed forty patients with forty-two extremities having ipsilateral fracture of femur and tibia at Christian Medical College Ludhiana. Patients were grouped according to type of injury and the method of treatment Three percent femoral and ten percent tibial fractures developed delayed union out of which bone grafting was done in two femoral and seven tibial fractures. Three(7.2%) tibial fractures developed infected gap non union which were subsequently managed by distraction osteoneogenisis. Eight (29.1%) patients had stiffness of knee with range of movement less than 90 degree. Bad results were found in patients having compound injuries and in juxta articular involvement of both fractures. In our study external fixator was the mainstay of treatment in operative group comprising of ten(23%) femoral and twentythree(55%) tibial fractures because of compound nature of injury and many limbs were salvaged which otherwise could have amputated. Patients in whom rigid internal fixation was used to treat both fractures produced excellent results.

Zusammenfassung Hintergrund Proximale Femurfrakturen stellen mit mehr als 20 % die häufigste Frakturentität in Deutschland dar. Gleichzeitig müssen proximale Femurfrakturen aufgrund eines Beschlusses des Gemeinsamen Bundesausschusses (G-BA) von 2019 innerhalb von 24 h operiert werden. Um einen subjektiv wahrgenommen Anstieg des Arbeitspensums in der Unfallchirurgie an einem überregionalen Traumazentrum (ÜTZ) zu quantifizieren, wurde die Anzahl der proximalen Femurfrakturen von 2016 bis 2022 analysiert. Proximale Femurfrakturen wurden hierfür aufgrund ihrer Häufigkeit und der Homogenität in der Behandlung ausgewählt. Methode Anhand der ICD-10-Diagnosen wurden alle operierten proximalen Femurfrakturen der Jahre 2016–2022 mitsamt der Postleitzahl an einem ÜTZ ausgewertet. Ergebnis Die Anzahl der operativ versorgten proximalen Femurfrakturen ist von 2016 bis 2022 um 100 % gestiegen. Der größte Anstieg wurde mit 60 % von 2020 bis 2022 verzeichnet. Gleichzeitig kam es zu einer deutlichen ...

The majority of midclavicular fractures are treated conservatively. Fractures that require internal fixation are treated by plate osteosynthesis as the standard procedure. Elastic stable intramedullary nailing is an increasingly popular alternative for the internal fixation of displaced midclavicular fractures. In a three-year period, 15 fractures of the clavicle were treated by elastic intramedullary nailing. Fracture healing, clinical outcome and complications were assessed. Mean follow-up time was one year All fractures healed clinically and radiologically. Non-union or infections were not observed. Functional results according to the Constant score were excellent. Complications consisted of skin irritation in four cases. One acromioclavicular joint separation was observed postoperatively. Elastic stable intramedullary nailing of displaced midclavicular fractures is a minimally invasive technique with excellent functional results and early pain relief.

The proximal humeral fracture occurs very often especially in elderly patients suffering from osteoporosis. Minimally invasive internal fixation with the Targon®-PH proximal humeral nail may lead to quick recovery. Thirty-nine patients with unstable humeral head fractures with two or four fragments were included into this study. The application of the humeral nail was achieved by deltoid split technique. Patients were followed-up clinically and radiologically including a Constant Score. The mean age was 72.9±3.3years of the male and 74.9±1.8years of the female patients. The subjective parameters of the Constant-Murley Score were significantly lowered in both the female and the male sample compared with the healthy side (female 30.0±1.1 vs. 33.7±0.7; P<0.05; and male 30.3±1.4 vs. 34.0±0.7; P<0.05). The objective parameters were significantly lowered also in both the female and the male sample compared with the non-operated side (female 34.5±2.0 vs. 45.2±1.1; P<0.001; and male 37.7±5.4 vs. 50.6±1.7; P<0.05). Even under lowered functionality, the subjective satisfaction was high; therefore, nailing of proximal humeral head fractures may represent a method for early functional recovery in elderly patients

Study Design. A retrospective study of adults with long fusion to the sacrum using three different fixations was performed. Objective. To compare the long-term clinical results and complications associated with three methods of lumbosacral fixation for adult spine deformities: Luque-Galveston, combined iliac and sacral screws, and sacral screws. Summary of Background Data. The preferred technique for long fusion to the sacrum is controversial, and surgery for adult deformity is fraught with significant technical difficulties and high complication rates. No clinical study compares the long-term outcome of long fusion to the sacrum using these different methods of lumbosacral fixation. Methods. This study included 54 consecutive patients who underwent elective combined anterior and posterior surgical reconstruction for adult spine deformity with a minimum follow-up period of 2 years. The patients were divided into three groups on the basis of the surgical method used for the posterior spine instrumentation. Group 1 consisted of 11 patients with smooth L-rod and segmental sublaminar wire instrumentation (Luque-Galveston technique). Group 2 consisted of 36 patients with posterior Isola segmental instrumentation and combined iliac and sacral screws. Group 3 consisted of 12 patients with Isola segmental instrumentation using bicortical sacral screws. Five patients were revised to another fixation group, giving a total of 59 cases. Radiographic, clinical results, and long-term outcome data were obtained using the modified Scoliosis Research Society (SRS) outcome instrument. Results. There were 26 late complications. Pseudarthrosis developed in 10 patients, requiring revision surgery: 4 (36%) in the Group 1, 5 (14%) in Group 2, and 1 (8.5%) in Group 3. Comparison of the modified SRS outcomes showed no difference among the groups. The average SRS grand total score was 73.4% for Group 1, 70.9% for Group 2, and 62.6% for Group 3. Overall, 76% of the patients were satisfied with their outcome. The presence of perioperative complications or pseudarthrosis significantly correlated with a lower satisfaction score (P ϭ 0.012 and P ϭ 0.048, respectively). Sagittal plane decompensation significantly correlated with a higher pain score (P ϭ 0.035). Patients with prior surgeries scored lower on the self-image questions than patients with no prior surgery (P ϭ 0.007). Conclusions. Attention to sagittal balance is critical in these patients. Revision surgery is as safe and effective as primary surgery. According to the current findings, the Luque-Galveston fixation technique has an unacceptably high rate of pseudarthrosis, and this method is not recommended for adult deformities. Currently, the authors are using bicortical and triangulated sacral screws with an anterior interbody support in patients with good bone stock, but only when the spine balance is restored. Otherwise, they recommend using iliac fixation, although there is a higher rate of painful hardware, requiring removal.

Diz protezinde baflar› objektif mi? subjektif mi? Amaç: Diz protezi uygulanan hastalar›n radyolojik ve fonksiyonel sonuçlar› ile hasta memnuniyet oranlar› aras›ndaki iliflkiyi de¤erlendirmek. Gereç ve Yöntem: Diz protezi uygulanan 43 hastan›n 76 dizi geriye dönük olarak de¤erlendirildi. Radyolojik olarak anatomik dizilim, fonksiyonel olarak hareket aç›kl›klar› ölçüldü. Vizüel analog skalas› (VAS) de¤erleri ile a¤r› ölçümü yap›ld›. VAS skorlar› ameliyat olan her diz için ayr› ayr› sorguland›. Bu a¤r› de¤erinin, fonksiyonel ve radyolojik ölçümlerle iliflkisi araflt›r›ld›. Hastalar Oxford diz skoru ile de¤erlendirildi. Bulgular: Çal›flma grubu 37 kad›n, 6 erkek; ortalama yafl 63 (26-76) olan hastalar›n 33 iki tarafl›, 10 tek tarafl› toplam 76 dizi de¤erlendirilerek oluflturuldu. Ortalama takip süresi 16.25 ay (2-29 ay) idi. Son de¤erlendirmede, ameliyat öncesi de¤erlendirmeye göre 23 dizde radyolojik varus deformitesi düzelmifl, belirgin fonksiyonel düzelme olmam›fl, VAS skoru azalm›flt›r. Yirmi bir dizde radyolojik ve fonksiyonel düzelme olmadan VAS azalm›flt›. Onüç dizde radyolojik görüntü de¤iflmemifl, fonksiyonlar kötüleflmifl fakat VAS azalm›flt›. Alt› dizde radyolojik iyileflme görülürken, fonksiyonlar kötüleflmifl, VAS azalm›flt›. Üç dizde radyolojik de¤iflme olmam›fl, fonksiyonlar iyileflmifl, VAS azal-m›flt›. Üç dizde radyolojik kötüleflme olmufl, fonksiyonlar de¤iflmemifl, VAS azalm›flt›. ‹ki dizde radyoloji ve fonksiyon iyileflmifl, VAS azal-m›flt›. ‹ki dizde ameliyat sonras› dönemde enfeksiyon görüldü¤ü halde VAS azalm›flt›. Sadece radyolojik ve fonksiyonel olarak kötüleflme olan 3 dizde VAS de¤erleri de¤iflmemiflti. Ortalama Oxford diz skoru 9.7 bulunmufltur. Sonuçlar: Radyolojik ve fonksiyonel olarak istenen düzeyde sonuç al›nmasa da, uygulanan diz protezi hastan›n a¤r›s›n› azaltmakta, hasta memnuniyetini artt›rmaktad›r.

Introduction: Tibial fractures accompanied by radius fractures at typical sites are the most common type of fractures. Objective: The study is aimed at using the examined sample to make an efficient and economically acceptable choice in the treatment of tibial diaphyseal fractures. Material and methods: The series comprises a retrospective and prospective study of the treatment of 131 fresh tibial fractures: 31 in women (23.66%) and 100 in men (76.34%) of the average age of 37.89. Nineteen patients (14.50%) were treated conservatively and 112 (85.50%) surgically: 22 (16.79%) with anti-rotation intramedullary nails, 74 (56.49%) with Mitkovic external fixator type M20, and 16 (12.21%) with locking compression plate. General anaesthesia was used in 46 patients (35.11%), while spinal anaesthesia was used in 85 of them (64.89%). Results: According to the Karlstrom-Olerud scoring system, the treatment results were as follows: for the 22 tibiae treated with anti-rotation intramedullary nails: in 15(68.18%) the results were excellent, in 3 (13.64%) they were good and in 4(18.18%) they were poor. As for the results for the 74 tibiae treated with Mitkovic external fixator type M20, they were as follows: in 62(83.78%) excellent, in 9(12.16%) good, and in 3(4.05%) they were poor. The results for the 16 patients treated with locking compression plate were excellent in 10(62.50%), good in 2(12.50%) and poor in 4 patients (25.00%). The treatment results for the 19 tibiae treated with plaster cast were excellent in 12 patients (63.16%), good in 2(10.53%) and poor in 5 (26.32%). The definite results for the 131 fractured tibiae treated with the aforementioned techniques were as follows: excellent in 99(75.57%), good in 17 (12.98%) and poor in 15 patients (11.45%). Discussion: There is a variety of controversial positions concerning the treatment of the tibial diaphysis. Conclusion: On the basis of the results of surgical treatment for the given series, the number of surgical interventions, the price of osteosynthetic material, my preferences in treating tibial diaphyseal fractures would be as follows: Mitkovic external fixator type M20, anti-rotation intramedullary nails and locking compression plate. Conservative treatment is indicated when the X-ray examination confirms that the fragments have a position acceptable for conservative treatment with plaster cast.

Forty-one cases of chondrosarcoma from varying sites throughout the body, and treated exclusively by one of the authors (R. L. H.) from 1972 to 1990 were reviewed. The symptoms, signs, location of tumours, treatment and progress are presented. Particular attention was paid to modular bone replacement techniques. Excision and reconstruction of the bone or joint were carried out in 17 femora, five tibia and six humeri. Comparison between this method of management and other techniques is discussed. Titanium and alumina prostheses for the hip, femur, tibia, shoulder and humerus have been designed by the senior author. These are both inert and modular, and have been found to be superior to other methods of treatment in both function and cosmesis. They do not possess the same potential donor infection risks and other disadvantages of allograft replacement. Immediate postoperative weight bearing and mobilization are possible with these systems. The Huckstep prostheses allow for bony ingrowth into their porous coated alumina sleeves, spacers and stems. In addition, the titanium alloy locking component for the femoral stems has an elasticity half that of other metal alloys and this was found to minimize stress shielding.

Forty-one cases of chondrosarcoma from varying sites throughout the body, and treated exclusively by one of the authors (R. L. H.) from 1972 to 1990 were reviewed. The symptoms, signs, location of tumours, treatment and progress are presented. Particular attention was paid to modular bone replacement techniques. Excision and reconstruction of the bone or joint were carried out in 17 femora, five tibia and six humeri. Comparison between this method of management and other techniques is discussed. Titanium and alumina prostheses for the hip, femur, tibia, shoulder and humerus have been designed by the senior author. These are both inert and modular, and have been found to be superior to other methods of treatment in both function and cosmesis. They do not possess the same potential donor infection risks and other disadvantages of allograft replacement. Immediate postoperative weight bearing and mobilization are possible with these systems. The Huckstep prostheses allow for bony ingrowth into their porous coated alumina sleeves, spacers and stems. In addition, the titanium alloy locking component for the femoral stems has an elasticity half that of other metal alloys and this was found to minimize stress shielding.

INTRODUCTION Kirschner wires (K-wires) are immensely versatile in fracture fixation in the paediatric population. Complications associated with the K-wiring procedure vary from minor to a life-threatening. The aim of this study was to analyse the outcome of fracture fixation using K-wires in all types of upper-extremity fractures in children in order to assess the incidence and type of complication critically. PATIENTS AND METHODS Between September 1999 and September 2001, we retrospectively reviewed a consecutive series of 105 fractures in 103 paediatric trauma cases (below 12 years) treated with K-wires in a university teaching hospital. The case notes and radiographs were reviewed by an independent single assessor. All paediatric, acute, upper-extremity, displaced and unstable fractures were included. All elective procedures using K-wires were excluded. RESULTS We observed an overall 32.3% complication rate associated with the K-wiring procedure affecting 34 pins (24 patients). W...

To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones. Thirty-eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non-union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9-70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated. All patients were followed up for 6-20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4-8 months). Infection...

Despite the progress in the operative management of fractures, in general, it seems that fractures of the humeral diaphysis remain the most resistant to operative treatment. Indications for operative management include failure of nonoperative treatment, multiple injuries, open or segmental fractures, fractures with intraarticular extension, pathological fractures, bilateral fractures, 'floating' elbow or shoulder injuries, brachial artery injury and noncompliance with or intolerance of braces. Undoubtedly, modern surgery favours treatment modalities that can be minimally invasive, with low morbidity, providing rapid recovery and prompt return to work and everyday life activities. While intramedullary nailing, in general, satisfies these criteria, it appears that, until recently, the method had not produced the results that one could expect in the management of humeral shaft fractures. The main reasons could be the complexity of the humeral anatomy and the unique biomechanical characteristics of the humerus in comparison to the long bones of the leg. The appearance of modern nails, specifically designed for the humerusalong with improvements in the surgical technique -has contributed to the increasing popularity of this method in the treatment of humeral shaft fractures. However, there is still no consensus with regards to many aspects of the humeral nailing procedure, such as the basic nail design and nail-selection criteria and fundamental principles of the surgical technique (e.g., antegrade/retrograde, reamed/unreamed and static/dynamic). Following guidelines that were set on prior data, the first author (CG) designed a new humeral nail -the 'Garnavos' modular humeral nail (MERETE, Berlin) -that aims to address the problems encountered until now. The present study reports not only the results from the use of this nail in a substantive series of humeral shaft fractures, but also deals with guidelines and principles that, according to the authors, should be considered whenever intramedullary nailing is selected for the treatment of diaphyseal humeral fractures. The nail (made of titanium alloy) is a cannulated square rod with concave sides (Figs. and) and is modular, thus having two different extensions (each being 2 cm in length). One extension, the so-called proximal locking device (PLD), is used with the antegrade technique (Fig. ) and the other, the so-called distal locking device (DLD), is used with the retrograde technique (Fig. ). During the antegrade approach, the PLD is securely screwed onto the nail and is embedded within the humeral head. When it gets to its final position, it can expand up to 2 mm, thus keeping the nail in situ, without the need for additional proximal locking screws. During the retrograde approach, the DLD is securely screwed onto the nail and keeps it in its final position with a single, safe (posteroanterior) screw, which is inserted under direct vision. As the nail is inserted without reaming, the four pointed edges of its sides Injury, Int. J. Care Injured 40 (2009) 604-610

The outcome of 30 proximal femoral fractures and pathological lesions in 29 patients treated with the Russell±Taylor reconstruction nail are reported. Four patients had fractures involving both the femoral neck and shaft (segmental). Fifteen patients had extensive comminuted fractures of the proximal femur and ten patients underwent nailing because of pathological fractures (one bilateral). In nineteen operations there were technical diculties, nail insertion and proximal interlocking being the commonest. In the elderly there was a high post-operative complication rate. Three nails needed to be revised for failure of ®xation. On review, all patients under sixty years of age regained full mobility and returned to their pre-fracture level of activities. Patients with per-trochanteric fractures over the age of sixty had less favourable results. No cancer patient returned to their prefracture mobility level. The Russell±Taylor reconstruction nail proved to be useful in the treatment of segmented and, in a lesser degree, pathological fractures. However, the surgical technique is demanding and there is a high incidence of post-operative complications in the patients over the age of sixty.

The True-Flex nail was used in 23 selected non-pathological and eight pathological fractures/lesions of the humeral shaft. The overall fracture union rate was 69.5 per cent and the patients achieved a good range of movement of the shoulder and elbow. Nailing did not lead to union of established non-unions or fractures which were previously treated unsuccessfully by surgery despite bone grafting. All patients with pathological fractures/ lesions regained good function of the arm and a good range of movement of the shoulder and the elbow. In one case the nail migrated proximally and impinged on the rotator cuff. This was revised. No other technical difficulties or complications were seen. The True-Flex nail is useful in the treatment of difficult and relatively recent humeral shaft fractures. Established non-unions or cases where previous surgery has failed should be treated by alternative methods.