scholarly journals 505 Failed Femoral Nail with Significant Operative Technical Difficulty: A Practical Solution to Achieve Metalwork Extraction Using Conical Screw Remover

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Paluch ◽  
A Clarke ◽  
S Smith ◽  
S Adams
Keyword(s):  
Revision Surgery ◽  
Femoral Fractures ◽  
Technical Difficulty ◽  
Distal Segment ◽  
Fracture Site ◽  
Practical Solution ◽  
Non Union ◽  
Femoral Nail ◽  
Operative Difficulty ◽  
Im Nailing

Abstract Introduction There is a greater risk of delayed healing and revision surgery in atypical femoral fractures (AFFs). Although non-union in reamed intra-medullary (IM) nailing is relatively uncommon, it can lead to fracture of the nail and present a considerable challenge to the treating surgeon. Case Report We present a case of AFF treated with IM nail fixation. Metalwork failure of the nail prompted removal of distal locking screws and plating of the fracture site at 8 months. Failure of the plate-bone interface 3 months later led to further revision surgery to remove the broken metalwork. We focus on the significant operative difficulty encountered during removal of the failed IM metalwork and provide a novel practical solution to overcome this particular challenge - insertion of a conical cannulated screw remover under fluoroscopy guidance to create an interference fit with the distal segment of the broken nail. Discussion This case is an example of significant and unexpected intra-operative technical difficulty, requiring improvisation and teamwork to manage. We introduce an accessible and uncomplicated alternative to the existing techniques for removal of a broken femoral nail and in doing so hope to benefit peers and colleagues should they encounter similar difficulties in the future.

scholarly journals Clinical outcomes of intramedullary femoral nailing system to treat femoral fracture

2020 ◽  
Vol 6 (3) ◽  
pp. 618
Author(s):  
Pooja Rawat ◽  
Mohit Kumar ◽  
Gaurav Luthra
Keyword(s):  
Bone Fracture ◽  
Femoral Fractures ◽  
Gamma Nail ◽  
Fracture Site ◽  
Complication Rates ◽  
Non Union ◽  
Femoral Nailing ◽  
Operative Outcomes ◽  
Femoral Nail ◽  
American Society

<p class="abstract"><strong>Background:</strong> Femoral fractures are bone fracture involve femur, common injuries in adults. Intramedullary femoral nailing system is the recommended solution or treatment for fractures due to its high union rates.</p><p class="abstract"><strong>Methods:</strong> In this clinical inspection 30 patients were selected with bone fracture of femur, and treated by using intramedullary femoral nailing system (universal intramedullary cannulated femoral nail, expert femoral nail, gamma nail and retrograde femoral nail) manufactured by Auxein Medical Private Limited, Sonepat, Haryana, India. There are two types of patients used in this study, one is male (n=18) and another female (n=12). Patients physical fitness was also observed through American Society of Anesthesiologist.<strong></strong></p><p class="abstract"><strong>Results:</strong> Outcomes record from the patients using visual analog scale. Follow up of the patients were taken on 1<sup>st</sup> month, 6<sup>th</sup> month, and 12 months. Post-operative outcomes were good with none of the patients showing non-union of fracture site. There were no complications noticed related to intramedullary femoral nailing system in this study and hardware related complications were not encountered in this study also.</p><p class="abstract"><strong>Conclusions:</strong> Intramedullary nailing system provide excellent outcomes with high union and low complication rates in the management of bone fracture involve femoral in patients.</p>

scholarly journals Exchange Nailing as Revision Surgery for Post-operative Non-union of Atypical Femoral Fractures: A Case Report and Treatment Strategy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tomohiro Yasuda ◽  
Masayuki Arai ◽  
Daichi Shinohara ◽  
Yuki Samejima ◽  
Koji Kanzaki ◽  
...  
Keyword(s):  
Case Report ◽  
Revision Surgery ◽  
Femoral Fracture ◽  
Callus Formation ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Medullary Canal ◽  
Atypical Femoral Fractures ◽  
Non Union ◽  
Exchange Nailing

Introduction: Atypical femoral fractures account for only 0.5% of femoral shaft fractures, but delayed union or non-union occurs in 50% of atypical femoral fractures accompanied by femoral lateral bowing. Such fractures are difficult to treat. Case Report: The case was an 84-year-old woman. She was diagnosed post-operative non-union of atypical femoral fracture. We planned a revision surgery for post-operative non-union of the atypical proximal femoral fracture. A two-dimensional template was used to simulate the intramedullary nail (IMN). Due to the advanced femoral lateral bowing deformity, a mismatch with the nail was noted when the unaffected femur was used to construct the template. When the opposite side nail was used as a template, the nail was aligned with the medullary canal, and the tip of the nail coincided with the center of the medullary canal; hence, the opposite side nail was chosen. Radiographical assessments of healing of the fracture confirmed callus formation and complete bone union 3 months and 1 year after the operation, respectively. Conclusion: We found that exchange nailing as revision surgery for post-operative non-union of atypical femoral fractures combined with an IMN on the opposite side was useful. Keywords: Alendronate, femoral fracture, osteoporosis, revision surgery.

scholarly journals Histopathological Finding of Microdamage Accumulation in Atypical Subtrochanteric Femoral Fracture

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yo Watanabe ◽  
Naoki Kondo ◽  
Tomomi Fukuhara ◽  
Norio Imai ◽  
Masahiko Yamada ◽  
...  
Keyword(s):  
Fracture Healing ◽  
Revision Surgery ◽  
Femoral Fracture ◽  
Femoral Fractures ◽  
Fracture Site ◽  
Atypical Femoral Fractures ◽  
Histopathological Findings ◽  
Primary Surgery ◽  
Microdamage Accumulation ◽  
Subtrochanteric Femoral Fracture

Atypical femoral fracture is a low-energy stress fracture in the subtrochanteric region or the femoral shaft and is a complication of the long-term use of bisphosphonates. Histopathological findings of atypical femoral fractures have not been clarified. Herein, we report the case of a 61-year-old woman who fell while walking, which prompted her to visit our facility. She had a 7-year history of alendronate use to treat osteoporosis. A radiograph showed an atypical subtrochanteric femoral fracture, following which she underwent a primary surgery, where an intramedullary femoral nail was used. Implant breakage was discovered 8 weeks after the primary surgery. The patient underwent a revision surgery in which the entry point for the revised intramedullary hole was created to prevent varus position. The lag screw was successfully inserted into the center of the femoral head. Cancellous bone, isolated from the right ilium, was autogenously implanted into the fracture site. Fracture healing was promoted using low-intensity pulse ultrasonography. Callus formation was detected on a radiograph, and full weight-bearing was advised 12 weeks after the revision surgery. The fracture had healed completely at 13 months after the revision surgery. The patient was able to walk without support and could independently perform activities of daily life. Laboratory findings suggested that the concentrations of her bone formation markers were normal, while those of bone resorption markers were elevated. Iliac bone histomorphometry did not reveal severely suppressed bone turnover. In the cortex of fracture site, the lacunar density was markedly lower than the osteocyte density, and microcracks were detected, suggesting impaired osteocyte function and a low potential for fracture healing. This case is notable because it helps to clarify the histopathological findings of atypical femoral fractures.

Proximal Femoral Nail - A Minimally Invasive Method for Stabilization of Subtrochanteric Femoral Fractures

2012 ◽  
Vol 3 (1) ◽  
pp. 20-22
Author(s):  
Dr. Dhaval J Patel ◽  
◽  
Dr. Bipin B Chhajed ◽  
Dr. Dhaval R Modi ◽  
Dr. Nirav P Trivedi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Femoral Fractures ◽  
Proximal Femoral Nail ◽  
Femoral Nail ◽  
Invasive Method

scholarly journals Failure analysis and recommendations for treatment of posttraumatic non-unions of the distal humerus during childhood

2021 ◽  
Vol 47 (2) ◽  
pp. 313-324 ◽  
Author(s):  
Dirk Walther Sommerfeldt ◽  
Peter Paul Schmittenbecher
Keyword(s):  
Failure Analysis ◽  
Revision Surgery ◽  
Distal Humerus ◽  
Implant Removal ◽  
Supracondylar Fractures ◽  
Stable Fixation ◽  
Non Union ◽  
Pediatric Traumatology ◽  
Clinical Cases

Abstract Purpose Non-unions of the distal humerus are rare complications of common children’s fractures such as radial condyle fractures and supracondylar fractures. The aim of this paper was to update the knowledge about etiology, reasons, management, and results of these troublesome, and sometimes debilitating entities. Methods The sparse literature concerning nonunions following condylar or supracondylar fractures was analyzed together with the presentation of some typical clinical cases. Results In most of the cases, non-unions were induced by neglect, unstable fixation, too early implant removal, too much revision surgery, and an inconsequent transfer of follow-up algorithms, or combinations of the above. Treatment of non-union should start as early as possible because the effort of required surgery increases with time that the nonunion has been neglected. Often a combination of stable fixation of the pseudarthrosis and correction of the elbow axis are necessary to achieve a satisfying outcome. Conclusion In pediatric traumatology, qualified and consequent care for children’s fractures of the distal humerus can prevent rare complications such as non-unions in almost any situation. If such a disturbance of healing is noticed, immediate and adequate, i.e. children specific surgical consequences achieve best results.

scholarly journals Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

2018 ◽  
Vol 9 (7) ◽  
pp. 92-99 ◽  
Author(s):  
Jacob E Vaughn ◽  
Ronit V Shah ◽  
Tarek Samman ◽  
Jacob Stirton ◽  
Jiayong Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoral Fractures ◽  
Non Union ◽  
Exchange Nailing
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