scholarly journals Intramedullary Nailing of Paediatric Tibial Fractures: Comparison between Flexible and Rigid Nails

2020 ◽  
pp. 145749692095862
Author(s):  
S. Widbom-Kolhanen ◽  
I. Helenius
Keyword(s):  
Intramedullary Nailing ◽  
Intramedullary Nail ◽  
Patient Characteristics ◽  
Tibial Fractures ◽  
University Hospital ◽  
Elastic Stable Intramedullary Nail ◽  
Flexible Intramedullary Nailing ◽  
Several Variables ◽  
Elastic Intramedullary Nailing

Purpose: To describe patient characteristics and to compare outcomes of children undergoing rigid intramedullary nailing of tibial fractures as compared with those operated on using elastic intramedullary nailing. Methods: A retrospective review of 26 children who have undergone flexible intramedullary nailing of tibial fractures and 30 children with rigid nailing at our university hospital between 2008 and 2017. The patient charts and radiographs were evaluated to identify demographic characteristics and several variables were measured preoperatively, as well as 6–12 weeks postoperatively in addition to final follow-up radiographs. Results: Twenty-six patients (26/26, 100%) treated with a flexible nail and 14 patients (14/30, 46.7%) treated with a rigid nail had open proximal tibial physis (p < 0.001). An acceptable postoperative alignment was obtained in 20 patients (20/26, 76.9%) in the elastic stable intramedullary nail group and in 29 patients (29/30, 96.7%) in the rigid group (p = 0.026). Some complications occurred in four patients (4/26, 15%) in the elastic stable intramedullary nail population and seven patients (7/30, 23%) in the rigid intramedullary nail population (p = 0.46). Malunion occurred in six patients (6/26, 23%) in the elastic stable intramedullary nail group and in none of the patients treated with a rigid intramedullary nail (p = 0.005). Conclusion: Younger children with tibial fractures who weight 50 kg or less and with proximal tibial growth plates wide open can be treated with elastic stable intramedullary nail while more mature adolescents benefit from rigid intramedullary nailing.

scholarly journals Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

2021 ◽  
Vol 13 (5) ◽  
pp. 95-97
Author(s):  
Augustin Delange Hendrick ◽  
Almenord Pharol ◽  
Khawly Clifford PG ◽  
Augustin Delange ◽  
Pierre Marie Woolley
Keyword(s):  
Hospital Stay ◽  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Patient Morbidity ◽  
Duration Of Hospitalization ◽  
The Cost ◽  
The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

scholarly journals PSU32 INTRAMEDULLARY NAILING OF TIBIAL FRACTURES: PATIENT CHARACTERISTICS ASSOCIATED WITH POSTOPERATIVE COMPLICATIONS

2019 ◽  
Vol 22 ◽  
pp. S897
Author(s):  
A.S. Chitnis ◽  
J. Ruppenkamp ◽  
M. Vanderkarr ◽  
C. Sparks ◽  
Y. Grebenyuk ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intramedullary Nailing ◽  
Patient Characteristics ◽  
Tibial Fractures

scholarly journals Operative Choice for Open Tibial Shaft Fracture in Children: A Comparative Study of External Fixator Vs. Elastic Stable Intramedullary Nail

2021 ◽  
Author(s):  
Pan Hong ◽  
Saroj Rai ◽  
Xin Tang ◽  
Ruikang Liu ◽  
Jin Li
Keyword(s):  
Clinical Outcomes ◽  
External Fixator ◽  
Intramedullary Nail ◽  
Shaft Fracture ◽  
Tibial Fractures ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Elastic Stable Intramedullary Nail ◽  
Open Tibial Fractures ◽  
Significant Difference

Abstract IntroductionExternal fixator (EF) is a preferred choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.Material and methodsPatients aged 5-11 years old with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF (n = 55) and ESIN (n = 37) group. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow up less than 24 months or incomplete medical records were also excluded. ResultsIn all, fifty-five patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no patient of nonunion and malunion in either group. The incidence of implant prominence was higher in the ESIN group (16%) than those in the EF group (0), P < 0.001. The angulation was higher in the EF group than ESIN group in coronal and sagittal plane, P < 0.001. The radiological union was faster in the ESIN group (7.0 ± 0.9, weeks) than those in the EF group (9.0 ± 2.2), P < 0.001. Limb length discrepancy (LLD) was significantly longer in the EF group (12.1 ± 4.4, mm) than those in the ESIN group (7.3 ± 4.3, mm), P < 0.001. ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator, but with less complications including superficial infection, residual angulation and refracture after hardware removal.

scholarly journals Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

2020 ◽  
Author(s):  
Hong-An Zhang ◽  
Chun-Hao Zhou ◽  
Xiang-Qing Meng ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Intramedullary Nailing ◽  
Distraction Osteogenesis ◽  
Intramedullary Nail ◽  
Calcium Sulfate ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Bone Transport ◽  
Complication Rates ◽  
Nail Removal

Abstract Background: The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods: We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results: A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion: Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

scholarly journals Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong-An Zhang ◽  
Chun-Hao Zhou ◽  
Xiang-Qing Meng ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Intramedullary Nailing ◽  
Distraction Osteogenesis ◽  
Intramedullary Nail ◽  
Calcium Sulfate ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Bone Transport ◽  
Complication Rates ◽  
Nail Removal

Abstract Background The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

scholarly journals Intramedullary reaming and irrigation in associated with antibiotic-loaded calcium sulfate implantation in the treatment of infection after intramedullary nailing: A retrospective study of 19 cases.

2020 ◽  
Author(s):  
Hong-An Zhang ◽  
Chun-Hao Zhou ◽  
Xiang-Qing Meng ◽  
Jia Fang ◽  
Cheng-He Qin
Keyword(s):  
Intramedullary Nailing ◽  
Distraction Osteogenesis ◽  
Intramedullary Nail ◽  
Calcium Sulfate ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Medullary Canal ◽  
Nail Removal ◽  
Treatment Of Infection

Abstract Background The incidence of intramedullary infection is increasing with the frequent application of intramedullary fixations on long bone fractures in latest decades. However, appropriate treatment for those special infection remains a challenge. The aims of this study were to assess the efficiency of our treatment protocols: intramedullary nail removal, medullary canal reaming and irrigation, followed by antibiotic-loaded calcium sulfate implantation with or without distraction osteogenesis, for the treatment of infection after intramedullary nailing. Methods From 2014 to 2017, a total of 19 patients with intramedullary infection were treated in our center, with means of intramedullary nail removal, distal diaphysis fenestration, medullary canal reaming and irrigation, antibiotic-loaded calcium sulfate implantation, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate and post-operative complications rate were assessed during the follow-up. Results All of patients gained satisfactory outcomes with an average follow-up of 38.1 (24 to 55months). 94.7% (18/19) patients achieved infection remission after surgical treatment. 5.3% (1/19) patient developed reinfection, but healed at the end of follow up with re-debridement. 9 patients with surgery-related bone defects received bone transport and successfully restored the length of involved limbs, with a mean transport duration of 10.7 months (range, 6.7 to 19.5months). Majority of patients achieved pain free and full weight bearing during the follow-up. Postoperative complications mainly included prolonged aseptic draining (36.8%, 7/19) and refracture (5.3%, 1/19), which were successfully managed by regular dressing and refixation. Conclusion Intramedullary nail removal, canal reaming and irrigation in associated with antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) were effective in the treatment of infection after intramedullary nailing.

scholarly journals Fixation of adolescent diaphyseal tibial fractures with flexible intramedullary nailing

2017 ◽  
Vol 21 (1) ◽  
pp. 191-194
Author(s):  
Mohamed Ahmed ◽  
Ashraf Ahmed ◽  
abdelrahman khalifa
Keyword(s):  
Intramedullary Nailing ◽  
Tibial Fractures ◽  
Flexible Intramedullary Nailing

scholarly journals DIAPHYSEAL TIBIAL FRACTURES;

2018 ◽  
Vol 21 (02) ◽  
pp. 395-399
Author(s):  
Allah Nawaz Abbasi ◽  
Karam Ali Shah ◽  
Muhammad Azeem Akhund
Keyword(s):  
Hospital Stay ◽  
Road Traffic ◽  
Tibial Fractures ◽  
University Hospital ◽  
High Rate ◽  
Time Of Arrival ◽  
X Rays ◽  
Non Union ◽  
Early Return

Objective: To determine the outcome and consequences of close intramedullaryinterlocking nailing in diaphyseal tibial fractures and to observe the hospital stay & complicationsin this method of treatment. Place & Duration: The study was conducted in department oforthopaedic unit-I at Liaquat University Hospital Jamshoro/Hyderabad during Jan 2011 to June2012. Patients & Method: The present study constituted on 43 patients, 3 cases were droppedduring follow up and the rest 40 cases completed 1 year post operative follow up. After havingroutine laboratory investigations and necessary x – rays, the stable patients were operated forintramedullary interlocking nailing on routine operating days. The patients were assessedaccording to the criteria mentioned in follow up proforma from date and time of arrival to final visitin review clinic and results were tabulated. Results: Among 40 patients, 38 (95%) were males and02 (5%) females. The age ranges from 17 to 50 years with mean age of 32.23 years. There were 25close fractures (62.5%) 15 open fractures (37.5%), among these 13 (32.5%) were Gustilo type Iand 2 (5%) were of type II. The mode of injury in majority (75%) of cases was road traffic accident.Good union achieved in 39 cases (97.5%) in 17.53 weeks. But only 1 (2.5%) case unfortunatelywent in infected non union and was converted into Illizarove external Fixation. The maincomplication observed after surgery was loosening of screw in 3 (7.5%) cases. Deep infectionwas observed in the medullary cavity in 3(7.5%) cases (table-V). It has been observed inanalyzing the functional outcome of these patients that majority (80%) of cases was able to sit onbed in 12-24 hours and was able to stand in 24-48 hours. In next 24 hours after surgery 75% ofpatients were pain free. The mean hospital stay in these cases was 8.53 days and by the 48thweek all of cases were able to join their job except one case in which non union observed due toinfection. Conclusions: The data from the current study reveals that intramedullary interlockingnailing of closed and open grade I and II fractures is a safe technique. It combines a high rate ofunion with a low complication rate, less hospitalization and early return to job.

Patient characteristics, treatment received, and outcomes of non-metastatic breast cancer patients in Haiti: Report from retrospective cohort.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18196-e18196
Author(s):  
Temidayo Fadelu ◽  
Ruth Damuse ◽  
Liz Pecan ◽  
Cyrille Dubuisson ◽  
Lauren Greenberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Metastatic Breast ◽  
Patient Characteristics ◽  
University Hospital ◽  
Rank Test ◽  
Er Status

e18196 Background: Few studies have reported outcomes of breast cancer (BC) patients in Haiti. Since 2013, University Hospital Mirebalais, a tertiary government hospital, has offered treatment for BC, in partnership with Dana-Farber Cancer Institute and Zanmi Lasante, a Haitian non-profit. Standard chemotherapy and hormone therapy are available, but HER2 therapies and radiation are not. Here, we comprehensively describe patient characteristics, treatments delivered and outcomes of non-metastatic BC patients in this program. Methods: We conducted a retrospective observational study including 339 patients with non-metastatic BC, who presented between January 1, 2013 and June 30, 2016. We conducted detailed chart abstraction of patient characteristics, clinical diagnostic and treatment data, and outcomes. Our endpoint was disease-free survival (DFS) defined as time from presentation to cancer recurrence, progression or death. We used Kaplan-Meier estimation to plot survival curves, censoring at the time of last follow-up. Log-rank test was used to examine subgroup differences. Results: The median age in the cohort was 49, inter-quartile range of 42 to 58; 35.7% were post-menopausal. Invasive ductal carcinoma was the most common histology (65.5%). At presentation, 52.8% had T3/T4 disease, while 54.6% had locally advanced disease, and 37.5% were poorly differentiated. There was incomplete documentation of stage (18.3%), ER status (44.2%) and histologic grade (39.5%). 156 patients received neoadjuvant therapy with hormonal therapy (26.2%), chemotherapy (67.9%), or both (5.8%), while 227 received adjuvant therapy (25.5%, 26.5% and 48.0% respectively). 275 patients (81%) completed surgical resection. Median follow up time for the cohort was 24.8 months. 23 patients died; 75 had recurrences; and 9 had progression. Median DFS was 50.8 months (95% CI, 40.6 to 57.0). There was no DFS difference by ER status. Median DFS for early-stage patients was not reached compared to locally advanced patients of 40.4 months (95% CI, 34.0 to 49.7), P-value < 0.0001. Conclusions: Non-metastatic BC patients in Haiti present with more advanced disease and have poorer prognostic factors compared to high-income countries. Although these patients have comparatively worse outcome, curative treatment is feasible in Haiti.

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