A dilemma for management of third fragment of shaft femur fracture with closed intramedullary nailing: A retrospective study

Background: The tibia, or shinbone, is the common fracture long bone in body. There are two option includes, reamed and unreamed of surgical treatment of fractures. Reamed nail has some advantage but they significantly harmful the endosteal circulation. Unreamed nail surplus the endosteal circulation but provide a less stable fixation. Afterward, because of ability to lock the nail proximally and distally, closed intramedullary nailing turned into an acknowledged treatment for closed shaft cracks during the ninth decade. Aim: The main objective is to treat the tibia fractures by implanting the Intramedullary nailing system (Interlocking cannulated tibia nail and Expert tibia nail) manufactured by Auxein Medical Private Limited, Sonipat, India. Material and Methods: In this retrospective study, studied the results of intramedullary tibia nail in treatment of tibia fracture. A total of 25 consecutive patients were included in this study (11male, 14 female and average age 42.9 years). Fracture type was classified as per the Muller AO classification of fracture. Results: The outcomes of clinical treatment were obtained in our study; No pain (92%), Mild pain (8%) after 2 year follow up. The follow up of patients were taken on 4-week, 1-year, 2-year according to VAS score. Paired t test was performed for statistical data analysis using Minitab and values of p<.05 were taken to indicate significant value with confidence interval of 95%. No implant related problem have been found like loosening, bending, corrosion etc. Conclusion: Our outcomes with interlocking cannulated and Expert tibial interlocking nailing are empowering and exhibit the advantages of new nailing framework. It has been concluded that intramedullary tibia nailing system is best method for treatment of tibia fracture with good results and outcomes.

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Fracture fixation strategy and specific muscle tissue availability of neutrophilic granulocytes following mono- and polytrauma: intramedullary nailing vs. external fixation of femoral fractures

European Journal of Medical Research ◽

10.1186/s40001-020-00461-y ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Johannes Greven ◽

Klemens Horst ◽

Zhi Qiao ◽

Felix Marius Bläsius ◽

Ümit Mert ◽

...

Keyword(s):

Clinical Practice ◽

External Fixation ◽

Intramedullary Nailing ◽

Muscle Tissue ◽

Femur Fracture ◽

Femoral Fractures ◽

Pig Model ◽

Minor Role ◽

Neutrophil Granulocytes ◽

Concomitant Injuries

Abstract Background In the stabilization of femoral fractures in mono- and polytrauma, clinical practice has shown better care through intramedullary nailing. However, the reason why this is the case is not fully understood. In addition to concomitant injuries, the immunological aspect is increasingly coming to the fore. Neutrophil granulocytes (PMNL), in particular next to other immunological cell types, seem to be associated with the fracture healing processes. For this reason, the early phase after fracture (up to 72 h after trauma) near the fracture zone in muscle tissue was investigated in a pig model. Material and methods A mono- and polytrauma pig model (sole femur fracture or blunt thoracic trauma, hemorrhagic shock, liver laceration, and femur fracture) was used to demonstrate the immunological situation through muscle biopsies and their analysis by histology and qRT-PCR during a 72 h follow-up phase. Two stabilization methods were used (intramedullary nail vs. external fixator) and compared with a nontraumatized sham group. Results Monotrauma shows higher PMNL numbers in muscle tissue compared with polytrauma (15.52 ± 5.39 mono vs. 8.23 ± 3.36 poly; p = 0.013), regardless of the treatment strategy. In contrast, polytrauma shows a longer lasting invasion of PMNL (24 h vs. 72 h). At 24 h in the case of monotrauma, the fracture treated with external fixation shows more PMNL than the fracture treated with intramedullary nailing (p = 0.026). This difference cannot be determined in polytrauma probably caused by a generalized immune response. Both monotrauma and polytrauma show a delayed PMNL increase in the muscle tissue of the uninjured side. The use of intramedullary nailing in monotrauma resulted in a significant increase in IL-6 (2 h after trauma) and IL-8 (24 and 48 h after trauma) transcription. Conclusion The reduction of PMNL invasion into the nearby muscle tissue of a monotrauma femur fracture stabilized by intramedullary nailing supports the advantages found in everyday clinical practice and therefore underlines the usage of nailing. For the polytrauma situation, the fixation seems to play a minor role, possibly due to a generalized immune reaction.

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