Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures

2020 ◽  
Author(s):  
Farzad Amouzadeh Omrani ◽  
Mohsen Elahi ◽  
Mohammad Mahdi Sarzaeem ◽  
Shahram Sayadi ◽  
Hamed Farzaneh
Keyword(s):  
Antibiotic Therapy ◽  
Intramedullary Nailing ◽  
Infection Rate ◽  
Bone Fractures ◽  
Articular Surface ◽  
Standard Of Care ◽  
Open Fractures ◽  
Long Bone ◽  
The Difference ◽  
Im Nailing

Background: Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamed IM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia. Methods: In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate. Results: Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10.8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22.7%). The difference between the groups was not statistically significant. Conclusion: Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.

scholarly journals Immediate Care of Open Extremity Fractures: Where Can We Improve?

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
R. Walton ◽  
J. Manara ◽  
S. E. Elamin ◽  
I. Braithwaite ◽  
E. Wood
Keyword(s):  
Acute Care ◽  
Bone Fractures ◽  
Working Hours ◽  
District General Hospital ◽  
Open Fractures ◽  
Care Staff ◽  
Long Bone ◽  
Initial Management ◽  
Clinical Consequences

Clear guidelines are set by the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133), excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4%) having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.

scholarly journals Comparison of Mechanical Stability of Elastic Titanium, Nickel-Titanium, and Stainless Steel Nails Used in the Fixation of Diaphyseal Long Bone Fractures

Materials ◽  
2018 ◽  
Vol 11 (11) ◽  
pp. 2159 ◽  
Author(s):  
Pei-Yuan Lee ◽  
Yen-Nien Chen ◽  
Jin-Jia Hu ◽  
Chih-Han Chang
Keyword(s):  
Stainless Steel ◽  
Mechanical Stability ◽  
Fe Simulation ◽  
Bone Fractures ◽  
Nickel Titanium ◽  
Long Bone ◽  
Bone Modeling ◽  
Long Bone Fractures ◽  
Elastic Nails ◽  
The Difference

Elastic nails made of the nickel-titanium shape memory alloy (Nitinol) have been reported to control bone modeling in animal studies. However, the mechanical stability of the Nitinol nail in the fixation of long bone fractures remains unclear. This study compared mechanical stability among nails made of three materials, namely Nitinol, titanium, and stainless steel, in the fixation of long bone fractures. These three materials had identical shapes (arc length: π/2 and radius: 260 mm). A cylindrical sawbone with a 10-mm gap and fixed with two C-shaped elastic nails was used to examine the stability of the nails. A finite element (FE) model was developed based on the sawbone model. The end cap for elastic nails was not used in the sawbone test but was considered based on a constraint equation in FE simulation. The results of stability tests appeared to depend on the presence or absence of the end cap. In the sawbone test, the titanium nail yielded a higher ultimate force against the applied load than did the stainless steel and Nitinol nails before the gap completely closed; the difference in linear stiffness between the nails was nonsignificant. In FE simulation, the titanium nail produced smaller gap shortening than did stainless steel and Nitinol nails without the end cap; the difference in gap shortening between the nails was minor with the end cap. The titanium elastic nail should be a better choice in managing diaphyseal long bone fractures when the end cap is not used. For Nitinol and stainless steel nails, the end cap should be used to stop the nail from dropping out and to stabilize the fractured bone.

scholarly journals Clinical and radiological evaluation of minimally invasive intramedullary fixation by titanium elastic nails in paediatric long bone fractures of lower limb: a prospective study

2019 ◽  
Vol 5 (5) ◽  
pp. 816
Author(s):  
A. Sandeep ◽  
Jayant Jain
Keyword(s):  
Intramedullary Nailing ◽  
Complication Rate ◽  
Bone Fractures ◽  
Full Range ◽  
Elastic Stable Intramedullary Nailing ◽  
Long Bone ◽  
Ankle Motion ◽  
Soft Tissue Envelope ◽  
Internal Support ◽  
Diaphyseal Fractures

<p class="abstract"><strong>Background:</strong> Elastic stable intramedullary nailing for the treatment of paediatric femur and tibial diaphyseal fractures was introduced by Prevot and colleagues in 1979. It follows three-point fixation principle that provides internal support in presence of cortical contact and an intact soft-tissue envelope. This technique has many advantages, including better reduction, dynamic axial stabilization, shorter hospitalization with early rehabilitation and low complication rate.</p><p class="abstract"><strong>Methods:</strong> This is a prospective observational study done at Kauvery Medical Centre, Trichy between May 2017 to May 2018 consisting of 39 children between age 5 to 16 years with diaphyseal fractures of femur and tibia. The fractures were treated by closed reduction and internal fixation with titanium elastic intramedullary nailing. The patients were evaluated clinically and radiologically and followed for an average of 6 months. Outcome was assessed using transcutaneous electrical nerve stimulation (TENS) scoring system used by Flynn et al.<strong></strong></p><p class="abstract"><strong>Results:</strong> Our series consisted of 39 patients (22 cases with fracture shaft of femur and 17 cases with fracture shaft of tibia), 33 males and only 6 females. Average time for radiological union was 9.89 weeks. All patients had full range of hip and ankle motion and 2 (5.1%) patients had mild restriction in knee flexion at 12 weeks.</p><p class="abstract"><strong>Conclusions:</strong> Elastic stable intramedullary nailing is an ideal method for treatment of paediatric femoral and tibial diaphyseal fractures due to lower complication rate and good functional outcome in comparison to other methods of treatment.</p>

scholarly journals Systematic review on the outcomes of poller screw augmentation in intramedullary nailing of long bone fracture

2020 ◽  
Vol 5 (3) ◽  
pp. 189-203
Author(s):  
Maria Tennyson ◽  
Matija Krkovic ◽  
Mary Fortune ◽  
Ali Abdulkarim
Keyword(s):  
Systematic Review ◽  
Intramedullary Nailing ◽  
Long Bone ◽  
Screw Augmentation ◽  
Inverse Variance ◽  
Long Bone Fracture ◽  
Secondary Procedures ◽  
Im Nailing ◽  
Poller Screw ◽  
Coronal Malalignment

Various technical tips have been described on the placement of poller screws during intramedullary (IM) nailing; however studies reporting outcomes are limited. Overall there is no consistent conclusion about whether intramedullary nailing alone, or intramedullary nails augmented with poller screws is more advantageous. We conducted a systematic review of PubMed, EMBASE, and Cochrane databases. Seventy-five records were identified, of which 13 met our inclusion criteria. In a systematic review we asked: (1) What is the proportion of nonunions with poller screw usage? (2) What is the proportion of malalignment, infection and secondary surgical procedures with poller screw usage? The overall outcome proportion across the studies was computed using the inverse variance method for pooling. Thirteen studies with a total of 371 participants and 376 fractures were included. Mean follow-up time was 21.1 months. Mean age of included patients was 40.0 years. Seven studies had heterogenous populations of nonunions and acute fractures. Four studies included only acute fractures and two studies examined nonunions only. The results of the present systematic review show a low complication rate of IM nailing augmented with poller screws in terms of nonunion (4%, CI: 0.03–0.07), coronal plane malunion (5%, CI: 0.03–0.08), deep (5%, CI: 0.03–0.11) and superficial (6%, CI: 0.03–0.11) infections, and secondary procedures (8%, CI: 0.04–0.18). When compared with the existing literature our review suggests intramedullary nailing with poller screws has lower rates of nonunion and coronal malalignment when compared with nailing alone. Prospective randomized control trial is necessary to fully determine outcome benefits. Cite this article: EFORT Open Rev 2020;5:189-203. DOI: 10.1302/2058-5241.5.190040

SECONDARY INTRAMEDULLARY NAILING OF OPEN LOWER EXTREMITY LONG BONE FRACTURES AFTER EXTERNAL FIXATION

1993 ◽  
Vol 86 (Supplement) ◽  
pp. 80
Author(s):  
Thomas Calton ◽  
Stephen L. Henry ◽  
Zack Stearns ◽  
David Seligson
Keyword(s):  
Lower Extremity ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
Bone Fractures ◽  
Long Bone ◽  
Long Bone Fractures

scholarly journals Outcome of shaft fractures among children treated with elastic stable intramedullary nailing

2020 ◽  
Vol 8 (5) ◽  
pp. 1662
Author(s):  
Mahmood Ahmad ◽  
Tahir El Tahir ◽  
Saba Ahmad ◽  
Umair Ahmad
Keyword(s):  
Intramedullary Nailing ◽  
Bone Fractures ◽  
Elastic Stable Intramedullary Nailing ◽  
Postoperative Treatment ◽  
Long Bone ◽  
Bony Union ◽  
Orthopedic Injury ◽  
Long Bone Fractures ◽  
Shaft Fractures ◽  
Fractures In Children

Background: Long bone fractures are frequent occurrence among children and considered a frequent pediatric orthopedic injury requiring hospitalization. Authors aimed to retrospectively analyze the outcome of fixation of long bone fractures with elastic stable intramedullary nailing (ESIN) among children and adolescents.Methods: From 2010 to 2018, ESIN was performed on 128 children aged 2 to 17 years having single shaft fractures of long bones. The data related to associated injuries, postoperative complications, postoperative treatment, till bony union or removal of rods, mal-union, functional deficit, need for secondary surgical intervention and subjective complaints at follow-up originated from postoperative clinical and radiological consultations carried out regularly. The primary end points were time of complete radiological union or removal of rods.Results: The mean age at the time of accident was 9.5 years. There were 37 (28.9%) femoral fractures, 16 (12.5%) of the lower leg, 51 (39.8%) fractures of radius/ulna and 24 (18.8%) of the humerus. In 2 (2.3%) children, reoperation was necessary due to prominent ends of elastic rods and 6 (4.7%) had early removal of rods due to same reasons. End point of the study, removal of rods noted in 126 (82.8%), radiological evidence of union in 7 (5.5%) and 15 (11.7%) cases were lost at follow-up.Conclusions: ESIN fixation of diaphyseal fractures in children and adolescents is safe. ESIN was found to be minimally invasive method, noted to produce excellent functional as well as cosmetic outcomes.

scholarly journals Management of Open Fractures in Low-Income Countries: a Daunting Task

2021 ◽  
Vol 2 (3) ◽  
pp. 9-16
Author(s):  
Jean Baptiste Ramampisendrahova ◽  
Mamisoa Bodohasina Rasamoelina ◽  
Tsiahoana Jean Floris Tata ◽  
Rado Razafimahatratra ◽  
Gaëtan Duval Solofomalala
Keyword(s):  
Low Income ◽  
Bone Fractures ◽  
Insurance Coverage ◽  
Open Fractures ◽  
University Hospital ◽  
Low Income Countries ◽  
Long Bone ◽  
Definitive Treatment ◽  
Long Bones ◽  
Daunting Task

Abstract The management of open fractures was a challenge from antiquity to the present day. The objective of this study is to report the difficulties of the management of open fractures of long bones in low-income countries. This was a retrospective cohort study of the files of patients admitted for open fracture of long bones in the Department of Orthopedic Surgery and Traumatology of the Anosiala University Hospital Center for four years. Forty-two open long bone fractures were collected. The average age of the patients was 36.3 years of which 73.8% were subject of working age in the age group of 20 to 60 years and 73.8% of the cases were following the accident of the road. Most of the wounded had arrived at the hospital by bush taxi. The tibia was the most affected bone (71.4%). Gustilo IIIA type open fractures were the most observed (38.1%). Only 26.3% of patients had received surgical debridement before the sixth hour. 76.2% had no care before arriving at the hospital, 14.3% had emergency care at the basic health center and 9.5% were already being treated by the traditional healer. Definitive treatment of the fracture was dominated by the external fixator (38.1%) and orthopedic treatment (26.2%).               In low-income countries, the management of open fractures remains a daunting task. The main factors limiting the management of open fractures were the poverty of the population, the lack of health insurance coverage and the retard in arriving at the hospital. Keywords: open fractures, management, low-income, country 

scholarly journals Comparison of Interleukin-1β Levels In Open and Closed Fracture Patients of The Long Bone In Padang

2021 ◽  
Vol 5 (4) ◽  
pp. 1058-1066
Author(s):  
Iqbal Arnif ◽  
Roni Eka Sahputra ◽  
Hendra Maska
Keyword(s):  
Open Fractures ◽  
Interleukin 1Β ◽  
Long Bone ◽  
Primary Data ◽  
Long Bones ◽  
Inflammatory Phase ◽  
Significant Difference ◽  
Closed Fractures ◽  
The Mean ◽  
The Difference

Background and Purpose. Trauma is a significant burden on causes of death, disability, and financing in least developed or "third world" countries. Fracture healing, especially in wounds and tissues, begins with a hemostatic and inflammatory phase triggered by inflammatory mediators such as cytokines, particularly IL-1β and TNF-. The purpose of this study was to determine the difference in levels of interleukin-1β in open and closed fractures of long bones in PadangMethod. This type of research is analytic observational with cross sectional design with primary data. The data were taken from the examination of IL-1β levels in long bone fracture patients at RSUP Dr. M. Djamil, RSKB Ropanasuro and RST Reksodiwiryo Padang for 4 months starting from March 2021 to July 2021. The sampling technique in this study used non-probability sampling with the consecutive sampling method. The analysis was carried out using the Independent sample T-Test to see the difference in mean IL-1 which would be calculated for open fractures and closed fractures of long bones.Results. The results showed that most (92.9%) of the patients were male, 50% had open fractures, and 50% closed fractures. The mean value of the patient's age was 34 years and the mean level of IL-1β was 555,951 pq/L. Most of the fracture sites in patients were tibia and fibula (35.7%) and femur (35.7%) and 28.6% were radius and ulna. The results showed that there was a significant difference in the mean levels of IL-1β in patients with open and closed fractures of long bones (p-value = 0.007)Conclusion. There are differences in the levels of interleukin-1β in open and closed fractures of long bones in Padang. This research is expected to provide consideration to support examinations in health services, in this case in fracture patients

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