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 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 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.

Titanium Elastic Nails for Distal Radius-ulna Fractures in Young Dogs

2021 ◽  
Author(s):  
Harmanpreet Singh Sodhi ◽  
Ashwani Kumar ◽  
Arun Anand ◽  
Vandana Sangwan ◽  
Dhiraj Kumar Gupta
Keyword(s):  
Distal Radius ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Medullary Canal ◽  
Long Term Results ◽  
Long Bone ◽  
Uneventful Recovery ◽  
Fractures In Children ◽  
Ulna Fractures ◽  
Elastic Nails

Background: Radius-ulna is the most frequently fractured bone of the pectoral limb in dogs with high predisposition to distal fractures. The smaller size of the distal fragment and open physis restrict the use of rigid fracture fixation techniques in distal fractures of growing dogs. Titanium elastic nails (TENs) are recommended in medical practice to stabilize long bone fractures in children. There is paucity of literature on TENs for the repair of radius-ulna fractures in dogs. Methods: This clinical study enrolled 10 dogs (7 grey hound and one each of Crossbred, Pomerenarian and Siberian Husky) suffering from distal radius-ulna (6 transverse and 4 short oblique) fractures since a mean ± SD duration of 3.40±4.5 days. The mean ± SD age and body weight of the dogs was 12.60±6.45 months and 14.09±6.41 Kg, respectively. All except one fracture was stabilized with two TENs inserted into the medullary canal of radial bone in a normograde manner from distal to proximal end using open cranio-lateral surgical approach. Result: Majority fractures achieved satisfactory reduction (n=8), radiographically. Weight bearing scores on walking increased gradually from day 12 (1.62 ± 1.51) to 45th (2.57±1.51), day 60th (3.75±0.5) and day 90 (4.0±0). Five dogs had uneventful recovery whereas remaining had major (n=2) or minor (n=3) complications. The length of the operated bone was non-significantly lesser as compared to contralateral healthy bone on day 60. Goniometric assessment of carpal joint of operated limb showed restricted range of motion on day 12 that improved to the near normal as contralateral healthy limb on day 60. Long-term results showed full (9) and acceptable (1) functional outcome. In conclusions, the TENs technique is simple and less invasive alternative fixation technique for distal radius-ulna fractures in young and light weighing dogs. As per authors, this is the first report on the use of TENs for the management of radius-ulna fracture in dogs.

Tibiotalocalcaneal Arthrodesis Using a Novel Retrograde Intramedullary Nail

2019 ◽  
Vol 13 (6) ◽  
pp. 463-469
Author(s):  
John R. Steele ◽  
Alexander L. Lazarides ◽  
James K. DeOrio
Keyword(s):  
High Risk ◽  
Intramedullary Nail ◽  
Weight Bearing ◽  
Bone Defects ◽  
Inclusion Criteria ◽  
Union Rate ◽  
Level Of Evidence ◽  
Retrograde Intramedullary Nail ◽  
Favorable Safety

Background. Tibiotalocalcaneal (TTC) arthrodesis is a common treatment option for complex hindfoot pathology. Overall union rates range from 50% to 86% but can be even lower in certain populations. A novel retrograde intramedullary nail has recently been developed. The purpose of this study was to report fusion rates, time to weight-bearing, and complications with the use of the A3 Fusion Nail. Methods. All patients 18 years or older who underwent TTC arthrodesis with an A3 Fusion Nail at a single institution from 2010 to 2015 with a minimum 3-month follow-up were included in this study. Rates of successful fusion, time to union, time to weight-bearing, and complications were evaluated. A total of 20 patients with an average age of 58.1 years and an average follow-up of 12.5 months met inclusion criteria. Results. Successful TTC arthrodesis was achieved in 14 of 20 patients (70%) overall. Average time to union was 8.1 months, and average time to weight-bearing was 6.8 weeks. Of 20 patients, 17 (85%) required femoral head allograft for bulk bone defects, and the union rate in this subset of patients was 76.5%. The rates of revision surgery (10%) and complications were low. Conclusion. The A3 Fusion Nail demonstrated a favorable safety profile and achieved TTC arthrodesis at a rate consistent with historical data despite being used in a patient population at high risk for nonunion. In patients with bulk bone defects at high risk for nonunion, the A3 Fusion Nail demonstrated superior rates of fusion (76.5%) to those reported in the literature (50%). Level of Evidence: Level III: Retrospective cohort study

scholarly journals The advent of elastic stable intramedullary nailing for the treatment of long bone fractures in skeletally immature patients

2021 ◽  
Vol 27 (4) ◽  
pp. 406-412
Author(s):  
A. Andreacchio ◽  
◽  
F. Alberghina ◽  
F. Canavese ◽  
◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Bone Fractures ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Early Mobilization ◽  
Elastic Stable Intramedullary Nailing ◽  
Long Bone ◽  
Long Bones ◽  
Skeletally Immature ◽  
Fractures In Children

Introduction Management of pediatric long bones fractures is a complex and rapidly evolving field. Traditionally, casting and conservative techniques played a key-role in the management of fractures in skeletally immature patients. However, the surgical approach has evolved steadily over the past four decades or so and increasing evidence has been published supporting the advantages of fixation techniques over conservative methods. The purpose of this narrative review is to outline how innovations in orthopedic surgery have changed the rationale of treating long bones fractures in children and adolescents with focus on surgical techniques, particularly elastic stable intramedullary nailing (ESIN). Material and methods We aimed to describe the main trends in pediatric long bones fractures management and to identify its specificities and difficulties as well as the best standard of care. Results The introduction of ESIN has profoundly influenced the management of pediatric upper and lower extremity fractures. Overall, in comparison to conservative techniques, advantages of ESIN include minimally invasiveness, short hospital stay, primary bone union, early mobilization and progressive weight bearing, and good outcome with low complication rate. Moreover, the flexible nail can be used as a closed reduction tool itself. Conclusions Irrespective of the technique performed, the key-concepts remain 1) the proper understanding of the injury to treat; 2) the identification the main characteristics of the patient; 3) the pros and cons of each technique; and 4) the potential complications.

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 Intramedullary Nailing Combined With Adjunct Plate or Blocking Screw for Proximal Tibial Fractures

2020 ◽  
Author(s):  
Jie Li ◽  
Qian Wang ◽  
Yao Lu ◽  
Zhong Li ◽  
Kun Zhang
Keyword(s):  
Intramedullary Nail ◽  
Weight Bearing ◽  
Operation Time ◽  
Tibial Fractures ◽  
Plate Versus ◽  
Full Weight Bearing ◽  
Plate Group ◽  
Proximal Tibial Fractures ◽  
Screw Group

Abstract Objective: To compare the traditional approach of intramedullary nail with an extra plate versus the nail combined with blocking screws for proximal tibia fractures without the knee involved.Methods: From January 2013 to January 2017, a total of 36 patients who suffered from proximal tibial fractures unaffecting the knee were enrolled into this prospective study, and divided into two groups by random number table method. Of them, 19 patients received an interlocking intramedullary nail combined with an extra plate for internal fixation of the fractures (the plate group), while the remaining 17 patients had fractures fixed with the nail combined with blocking screws (the screw group). The perioperative, follow-up and radiographic data were compared between the two groups.Results: All the 36 patients underwent operation smoothly without iatrogenic neurovascular injuries. The plate group proved superior the screw group regarding to operation time and intraoperative X-ray exposure (P＜0.05) , nevertheless the former was inferior to the latter in implant cost and hospital stay (P＜0.05) . The follow-up period lasted for 12～24 months with a mean of (15.62±4.71) months. There were no statistically significant differences in the time to return ambulation and the time to full weight-bearing activity between the two groups (P＞0.05) . At the latest follow up, no statistically significant differences were found between the two groups regarding knee range of motion and Johner-Wruhs grades for clinical consequences (P＞0.05) . In terms of anterior knee pain, the difference between the two groups was not statistically significant (P＞0.05) . In respect of radiographic assessment, the plate group had significantly less residual malalignment than the screw group, including anteroposterior and lateral displacements, as well as angulations in coronal and sagittal planes (P＜0.05) . To the latest follow up, all patients in both group got bony healing of the fractures without a statistical difference in fracture healing time between them (P＞0.05) , and no loosening or breaking of the implants were showed on images in anyone of them.Conclusion: Both the nail plus plate and nail plus blocking screw do achieve satisfactory clinical outcomes for proximal tibial fractures unaffecting the knee. By comparison, the nail combined with plate facilitates to regain and maintain better alignment of the leg regardless of higher implant cost.

scholarly journals Spontaneous Distal Extrusion of Kuntscher Intramedullary Nail

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
W. B. Teh ◽  
R. Kuharajan ◽  
A. H. Noor Shafika ◽  
I. G. Nur Azhani
Keyword(s):  
Case Report ◽  
Clinical Outcome ◽  
Intramedullary Nail ◽  
Rare Complication ◽  
Sudden Onset ◽  
Left Knee ◽  
Good Clinical Outcome ◽  
Kuntscher Nail ◽  
Nail Removal

Migration of femoral Kuntscher intramedullary nail (K-nail) proximally or distally within the femoral medullary cavity is a well-known documented complication, but spontaneous extrusion of a distally migrated K-nail is a rare complication. This is a case report of a 33-year-old lady who complained of sudden onset left knee pain and presented with spontaneous extrusion of a Kuntscher nail 12 years postinsertion. She underwent a successful K-nail removal surgery and showed a good clinical outcome after 6 months of outpatient follow-up.

Charcot Ankle Fusion with a Retrograde Locked Intramedullary Nail

1997 ◽  
Vol 18 (11) ◽  
pp. 699-704 ◽  
Author(s):  
Michael S. Pinzur ◽  
Armen Kelikian
Keyword(s):  
Intramedullary Nail ◽  
Weight Bearing ◽  
Early Postoperative Period ◽  
Medial Malleolus ◽  
Time Of Surgery ◽  
Ankle Fusion ◽  
Insulin Dependent ◽  
Sufficient Magnitude ◽  
Average Body

Twenty patients with severe neuropathic (Charcot) ankle deformities underwent 21 attempted ankle fusions with a retrograde locked intramedullary nail as an alternative to amputation. All had insensate heel pads and had failed at nonoperative methods of accommodative ambulatory bracing. In 11, the talus was either absent, or the deformity was of sufficient magnitude to require talectomy to align the calcaneus under the tibia for plantigrade weightbearing. Ages ranged from 28 to −68 (average 56.3) years. Nineteen were diabetic, 12 being insulin-dependent. Their average body weight was 102 kg, with 11 greater than 90 kg at the time of surgery. Eight had chronic large full thickness ulcers overlying, but not involving bone of the medial malleolus, medial midfoot, or proximal fifth metatarsal, at the time of surgery. At a follow-up of 12 to 31 months, 19 achieved bony fusion. In the 10 patients where talectomy was not required, fusion was achieved at an average of 5.3 months without complications. In the patients who required talectomy, six of the patients required eight additional operations to achieve fusion. Three achieved fusion following removal of the nail and prolonged bracing. One opted for ankle disarticulation for chronic persistent infection, rather than attempt reoperation. One died of unrelated causes during the early postoperative period. Retrograde locked intramedullary ankle fusion is a reasonable alternative to amputation in the neuropathic (Charcot) ankle that cannot be controlled with standard bracing techniques. The potential for morbidity requiring reoperation is greatly increased when the deformity is of sufficient magnitude to require talectomy to achieve alignment of the calcaneus in a plantigrade weight-bearing position under the tibia or when there are large open ulcers.

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