Role of tibia interlocking nail in treating distal tibial metadiaphyseal fractures: study of 46 cases

Background: Distal tibial diaphyseal fractures are known for its various challenges that orthopaedicians face while treating. While performing surgery, many principles of fixations are needed to be properly addressed. This study was undertaken to know the efficiency of closed reduction, polar screws and tibia interlocking nail fixation at our Institute.Methods: The data, which were collected from the medical records and Department digitalised storage system and from the HMIS patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and AO classification of distal tibial fracture admitted in Orthopaedics Department from 2007 to 2013. Analyses of 46 cases, 34 males and 12 females, were made to find out the functional, radiological outcome, associated complications in treating distal tibia with ILN. During Analysis, association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P value of <0.05 was considered significant.Results: The average time to union of the closed fracture was 15.4 weeks (range: 12–28 weeks). The healing times for the primarily nailed compound Grade I averaged 17.8 weeks (range: 15-34 weeks). Complications of delayed union occurred in 3 cases, and two cases of non-union. Infection in 6 cases (5 superficial, 1 deep), screw breakage in 4 cases and 3 cases of significant malalignment. The final functional outcome of 33 patients had excellent results, 11 had good results and 2 had fair results as determined by criteria of Johner and Wruh. Conclusions: The dynamic osteosynthesis of distal tibia by interlocking nail and judicious use of poller screws is an effective alternative for the treatment of distal metaphyseal tibial fractures.

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FRACTURE OF SHAFT OF FEMUR

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.04.361 ◽

2018 ◽

Vol 25 (04) ◽

pp. 627-632

Author(s):

Sajjad Rasool ◽

Basharat Manzoor ◽

Muhammad Omer Aslam

Keyword(s):

Deep Infection ◽

Delayed Union ◽

Implant Failure ◽

P Value ◽

Superficial Infection ◽

Non Union ◽

Interlocking Nail ◽

Screw Breakage ◽

Group A ◽

Group B

Introduction: Fracture of the shaft of the femur is among the most commonfractures encountered in orthopedics practice.1 Objectives: The aim of the study was alsocompare the outcome of solid versus canmulated inter locking nails as a method of internalfixation in closed fractures of the shaft of femur in adults. Design: Quasi Experiment design.Setting: Orthopedic Department Allied Hospital P.M.C Faisalabad. Results: We had total of60 cases, 30 in groups of solid I/M nailing and 30 in group B of Cannulated in I/M nailing wehave reported the follow up study up to 9 months. (1) There were 27 (90%) males and 3 (10%)females in group A. (2) If in group B 26 (86.666%) were males 4 (13.333%). (3) The mean agewas 37.4 + 1.61 years. Union: Group A, In 26 (86.666%) patients the fracture uniting within 3months. 3 (10%) patients went into phase of delayed union which ultimately united. 1 (3333%)patient into non-union for which bone grafts has to be done after nine months. Group B: In 26(86.666%) patients the fracture united within 3 months. Patient in group B went into nonuniondue to deep infection, second due to nail breakage an in third no apparent causes was found.Total no of cases of non-union in group B were 3. Infection: In group A one patient in groupB 2 patient had superficial infection which were treated with appropriate antibiotics. In groupB one patient had deep infection and went into non-union due to infection. Implant Failure:In group B one case with nail breakage.. 2 Cases with distal Inter Locking screws breakage& 1 case with proximal interlocking screw breakage were noted. Conclusion: (1) There isno statistical difference in union and infection in both groups (P-Value > 0.05). (2) There issignificant difference in implant failure in both groups no patients in group A went with implantfailure but four patients in group B developed implant failure (P-value < 0..05) so Solid interlocking nail is stronger than cannulated interlocking nail.

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The role of osteomedullography in the management of delayed union and non-union of diaphyseal fractures of the long bones: a preliminary report

Injury ◽

10.1016/0020-1383(78)90015-3 ◽

1978 ◽

Vol 9 (3) ◽

pp. 236-244 ◽

Cited By ~ 1

Author(s):

R.C. Gupta ◽

U.S. Mishra ◽

G.R. Agarwal ◽

S.V.Rama Rao

Keyword(s):

Preliminary Report ◽

Delayed Union ◽

Long Bones ◽

Non Union ◽

Diaphyseal Fractures

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INTERNAL FIXATION WITH THE LOW PROFILE PLATE SYSTEM COMPARED WITH KIRSCHNER WIRE FIXATION: CLINICAL RESULTS OF TREATMENT FOR METACARPAL AND PHALANGEAL FRACTURES

Hand Surgery ◽

10.1142/s0218810410004527 ◽

2010 ◽

Vol 15 (01) ◽

pp. 1-6 ◽

Cited By ~ 18

Author(s):

Hidetake Takigami ◽

Hiroaki Sakano ◽

Tomoyuki Saito

Keyword(s):

Kirschner Wire ◽

Clinical Results ◽

Delayed Union ◽

Non Union ◽

Results Of Treatment ◽

Kirschner Wire Fixation ◽

Active Flexion ◽

Low Profile ◽

Screw Breakage ◽

Phalangeal Fractures

A total of 71 patients with 78 metacarpal or phalangeal fractures were treated using one of two different methods of fixation. Thirty-nine fingers were treated using a low profile plate and screw system (LPP group), whereas 39 fingers were treated using Kirschner wire (K-wire group). In the LPP group, three cases of screw breakage were recorded. The LPP group required use of a splint for 0.9 weeks, significantly less than the 4.4 weeks of the K-wire group. The mean of 2.6 ± 1.6 months for the time to union in the LPP group was significantly greater than the 1.6 ± 0.6 months in the K-wire group. There were no instances of non-union in both groups, but one delayed union was observed in the LPP group. Total active flexion was 235° and 243° in the LPP and the K-wire groups, respectively. Total extension loss was 12° and 9° in the LPP and the K-wire groups, respectively. Although use of either method resulted in a good range of motion, LPP fixation required a much shorter time with a splint. However, because of the possibility of screw breakage, we have to exercise caution with post-operative treatment.

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Tipping the Scales for Labour in Ireland? Collective Bargaining and the Industrial Relations (Amendment) Act 2015

Industrial Law Journal ◽

10.1093/indlaw/dwz019 ◽

2019 ◽

Author(s):

Caroline Murphy ◽

Thomas Turner

Keyword(s):

Collective Bargaining ◽

Industrial Relations ◽

Union Density ◽

Anglo Saxon ◽

Social Partnership ◽

Non Union ◽

Two Factors ◽

Missed Opportunity

Abstract Trade union density in Ireland has followed a similar pattern of decline to that of other Anglo-Saxon economies in recent decades. However, two factors make Ireland distinctive within this classification of countries, firstly the system of national social partnership that prevailed from 1987 to 2008, and secondly, the absence of a statutory route to union recognition. In this paper, we examine the extent to which a new piece of legislation, the Industrial Relations Amendment Act 2015, provides unions with a route to securing bargaining rights for workers and extends collective bargaining rights generally. We conclude that the Act represents a missed opportunity to offer mechanisms to secure rights for unions and their members capable of delivering collective bargaining to the non-union sector. We situate the paper within debates concerning the role of labour law in supporting workers rights to collective bargaining.

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Role of PRP injection in delayed union and non union of long bone fractures

Indian Journal of Orthopaedics Surgery ◽

10.18231/j.ijos.2020.007 ◽

2020 ◽

Vol 6 (1) ◽

pp. 35-40

Author(s):

Apser Khan ◽

◽

Suresh Kumar Kaushik ◽

Mrigank Mathur ◽

Milan Jaiswal ◽

...

Keyword(s):

Bone Fractures ◽

Delayed Union ◽

Long Bone ◽

Non Union ◽

Long Bone Fractures

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Comparison study of compound fractures of tibial shaft treated by titanium and stainless steel interlocking nails

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171549 ◽

2017 ◽

Vol 3 (3) ◽

pp. 390 ◽

Cited By ~ 1

Author(s):

Pratik J. Vinchhi ◽

Sharvil H. Gajjar ◽

Tirth Vyas ◽

Yatin Patel

Keyword(s):

Stainless Steel ◽

Functional Results ◽

Tibial Fractures ◽

Non Union ◽

Interlocking Nail ◽

Open Tibial Fractures ◽

Screw Breakage ◽

Compound Fractures ◽

Solid Titanium ◽

Tibia Shaft

Background: The purpose of the present study was to compare the outcomes of compound fractures of tibia shaft managed by Solid Titanium and Stainless Steel interlocking intramedullary nailing.Methods: This is a retrospective study of 45 patients with 45 open fractures of tibia shaft operated primarily by either Solid Titanium or Stainless steel tibia interlocking nail.Results: In Our Study we had 45 patients with 45 open tibial fractures. All were male. 35 patients were from 20-50 years age group. Mean age was 36.4 years. In this study of 45 open tibial fractures following strict protocol of thorough debridement, primary wound closure and Solid Titanium or stainless steel interlocking nailing; it was observed at final follow up that patients operated by titanium nail compared to stainless steel had 6.45% vs. 14.29% infection rate, 12.9% vs. 21.89% rate of non-union and 3.22% vs. 7.14% screw breakage rate. According to modified ketenjian’s criteria in our study out of 31 patients operated by Titanium interlocking nail 17 (54.84%) excellent, 10 (32.26%) Good, 3(9.68%) fair and 1(3.22%) poor functional results while out of 14 patients managed by stainless steel nail 8 (57.14%) excellent, 3 (21.43%) good, 1 (7.14%) fair and 2 (14.28%) poor functional results. Conclusions: In open tibial fractures titanium interlocking implants offer lower complication rate as compared to stainless steel implants and better overall patient outcome.

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Clinical evaluation of diaphyseal femoral fractures operated in lateral decubitus position with interlocking nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213682 ◽

2021 ◽

Author(s):

Syed S. M. Haque ◽

Alaf A. Pathan ◽

Ansari M. A. Aziz ◽

Ayesha Saba

Keyword(s):

Range Of Motion ◽

Femoral Fractures ◽

Lateral Decubitus Position ◽

Easy Access ◽

Additional Advantage ◽

Non Union ◽

Interlocking Nail ◽

Intramedullary Device ◽

Diaphyseal Fractures ◽

Lateral Decubitus

Background: The diaphyseal fractures of femur in adults are conventionally treated in supine position on traction table, which carries risk of compartment syndrome, pudendal nerve palsy, whereas in lateral decubitus position these complications can be avoided with additional advantage of easy access to greater trochanter particularly in obese patients. The aim of this study is to evaluate outcomes of femur diaphyseal fractures treated with intramedullary interlocking nail in lateral decubitus position.Methods: In this study 40 patients with femur diaphysea fractures were treated with intramedullary interlocking nail in lateral decubitus position, were studied for a period of 9 months from September 2019 to May 2020.Results: At the end of our study of 40 patients, outcome is graded according Thoresen’s criteria where 22 (55%) patients had excellent results with full, pain-free, function of the extremity and 11 (27.5%) patients had good result; 10 patients had range of motion 1200 and shortening of femur by 1.5 was observed in 1 patient. There were 6 (15%) patients with fair result; with range of motion 900 and 1 poor result (2.5%) had non-union with range of motion <900.Conclusions: Fixation of femur diaphyseal fracture in lateral decubitus position leads to easy access to the proximal femur making it easy to establish an entry point for an intramedullary device and it significantly eliminates the complications caused by other conventionally used methods.

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Osteosynthesis distal tibial metadiaphyseal fractures with intramedullary nailing versus plating

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20171851 ◽

2017 ◽

Vol 5 (5) ◽

pp. 2104

Author(s):

Deepak Vashisht ◽

Manjit S. Daroch ◽

Sanjeev Sreen ◽

Kuldeep Rathi

Keyword(s):

Intramedullary Nailing ◽

Weight Bearing ◽

Operating Time ◽

Distal Tibia ◽

Full Weight Bearing ◽

P Value ◽

Operative Care ◽

Diaphyseal Fractures ◽

Time Required ◽

Early Restoration

Background: The management of the tibial fracture remains controversial despite advances in both non-operative and operative care. Plates and intramedullary nails are two well-accepted and effective methods, but each has been historically related to complications. The present study was conducted to compare the results of displaced extra-articular distal tibia meta-diaphyseal fractures OTA/AO Type 42A- C (distal) and 43-A treated with intramedullary nailing versus plating with respect to union of fracture, early Restoration of function, the axial alignment and Complications, if any.Methods: In this study 30 patients of extra-articular distal tibia fracture AO type 42 A-C (distal) and 43 A were randomly selected and 15 were operated with intramedullary nailing and remaining 15 with plating. The patients were regularly followed up for a period of 9 months with radiological and clinical examination. Final assessment was done by Tenny and Wiss clinical assessment criteria.Results: In Interlocking group, average time for union was 20.33 weeks in Interlocking nail group compared to 23.21 weeks in plating group which was significant (p value 0.011). Also, the average time required for partial and full weight bearing in the nailing group was 7.2 weeks and 13.2 weeks respectively which was significantly less as compared to 9.33 weeks and 16.64 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness and infection (superficial and deep) were seen in Interlocking group as compared to plating group.Conclusions: In present study ILN showed better outcome as it offers advantage in terms of mean operating time, less invasive surgery, hospital stay, partial and full weight bearing time and union time.

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Teriparatide in fracture healing: Case series and review of literature

IP International Journal of Orthopaedic Rheumatology ◽

10.18231/j.ijor.2021.021 ◽

2022 ◽

Vol 7 (2) ◽

pp. 93-100

Author(s):

S S Jha ◽

Amit B Jain ◽

Nilanj Dave ◽

Alok Chaturvedi ◽

Sandesh Warudkar

Keyword(s):

Fracture Healing ◽

Case Reports ◽

Case Series ◽

Femoral Fractures ◽

Delayed Union ◽

Published Data ◽

Mechanical Instability ◽

Mineral Density ◽

Non Union

Teriparatide (TPTD) (recombinant Parathyroid Hormone 1-34) is one of the pioneer osteo-anabolic agents approved for management of osteoporosis. Being an anabolic agent, it increases bone mineral density by inducing formation of new bone by the action on osteoblasts. As new bone formation is an important aspect of fracture healing as well, Teriparatide has long been a product of interest with respect to its effect on the process of fracture healing. Though fracture healing is not an approved indication for Teriparatide, there is quite a substantial amount of published data related to its effectiveness in fracture healing. With an intent to better understand the role of teriparatide in fracture, we share few case reports of successful fracture healing after giving Teriparatide and also review the published evidences of union taking place in difficult delayed union and non-union cases secondary to mechanical instability, inadequate fixation support or other reasons. This article thus, intended to summarize the accumulating preclinical and clinical evidence for role of TPTD in accelerating fracture healing in various conditions like conservative management of fractures, vertebral fractures, non-unions, delayed unions and atypical femoral fractures.

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Health outcomes of delayed union and non-union of diaphyseal fractures

Injury Extra ◽

10.1016/j.injury.2009.03.039 ◽

2009 ◽

Vol 40 (8) ◽

pp. 145

Author(s):

Wei-Han Tay ◽

Martin Richardson ◽

Russell Gruen ◽

Richard de Steiger

Keyword(s):

Health Outcomes ◽

Delayed Union ◽

Non Union ◽

Diaphyseal Fractures

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