Defining length stability in paediatric femoral shaft fractures treated with titanium elastic nails

Introduction Optimal paediatric femoral shaft fracture patterns or lengths amenable to titanium elastic nail stabilization have not been well defined. The purpose of this study is to identify radiographic parameters predictive of treatment failure with flexible intramedullary nails based upon fracture morphology. Methods A retrospective review was performed of all femoral shaft fractures treated with flexible intramedullary nails over a five-year period. All patients with at least six weeks of postoperative radiographic imaging were included. Fracture characteristics included location, pattern, length, obliquity, angulation, translation and shortening. Postoperative radiographs were reviewed to determine shortening and angulation. Results There were 58 patients with 60 femoral shaft fractures stabilized with titanium nails, with 46 healing within acceptable parameters and 14 considered malunions. Six of the 14 malunions developed complications requiring early unplanned intervention. No patients in the treatment success group had a complication. Between the treatment success and failure groups, fracture pattern, location, length, obliquity, angulation, translation or shortening were not statistically different. Mean nail canal fill was significantly lower in the failure group (0.72 versus 0.81; p = 0.0146), with a receiver operating characteristic curve identifying canal fill 76% as the optimal threshold. Conclusion This is the first study to measure the length and obliquity of paediatric femoral shaft fractures and to determine their relationship to radiographic alignment after healing. None of the preoperative fracture characteristics were predictive of malalignment or shortening. We recommend the use of larger nail sizes in the treatment of paediatric femoral shaft fractures, especially if there is concern for residual instability. Level of evidence IV

Intramedullary nail holes laser indicator, a non-invasive technique for interlocking of intramedullary nails

Interlocking of intramedullary nails is a challenging procedure in orthopedic trauma surgery. Numerous methods have been described to facilitate this process. But they are exposed patient and surgical team to X-rays or involves trial and error. An accurate and non-invasive method has been provided to easily interlocking intramedullary nails. By transferring a safe visible light inside the nail, a drilling position appears which use to drilling bone toward the nail hole. The wavelength of this light was obtained from ex-vivo spectroscopy on biological tissues which has optimal transmission, reflectance, and absorption properties. Moreover, animal and human experiments were performed to evaluate performance of the proposed system. Ex-vivo performance experiments were performed successfully on two groups of cow and sheep samples. Output parameters were procedure time and drilling quality which there were significant differences between the two groups in procedure time (P < 0.05). But no significant differences were observed in drilling quality (P > 0.05). Moreover, an In-vivo performance experiment was performed successfully on a middle-aged man. To compare the provided method, targeting-arm, and free-hand techniques, two human experiments were performed on a middle-aged and a young man. The results indicate the advantage of the proposed technique in the procedure time (P < 0.05), while the drilling quality is equal to the free-hand technique (P = 0.05). Intramedullary nail holes laser indicator is a safe and accurate method that reduced surgical time and simplifies the process. This new technology makes it easier to interlocking the intramedullary nail which can have good clinical applications.

TP9.1.3The Effect of Hip Fracture Anatomy and Surgical Modality on the Rate of Red Blood Cell Transfusion and Mortality: A Retrospective Analysis

Aims This study assesses the effect of hip fracture anatomy and operation performed on transfusion rates within our centre. We aim to identify patients most likely to require transfusion early, to improve outcomes. Methods A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from patient records, local transfusion laboratory and the national hip fracture database. Results 324 hip fractures were categorised as 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75). 75 (23%) patients received a blood transfusion. 15% of intracapsular, 35% of intertrochanteric and 33% of subtrochanteric fractures received transfusions. 47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions. One-year mortality was higher in the transfused cohort at 52% compared to 30.5% in non-transfused, with an odds ratio of 2.466 (95% CI 1.4555 to 4.178, p = 0.0008). Conclusions Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an almost two and a half times increased risk of one-year mortality. Extracapsular (intertrochanteric and subtrochanteric) fractures most commonly led to transfusions. Long intramedullary nailings were most associated with transfusions and total hip arthroplasties the least. Patients more likely to require transfusion and subsequently have a higher one-year mortality risk can therefore be identified at presentation.

Clinical study of intramedullary nailing fixation for the treatment of Danis-Weber B in lateral malleolus fracture

Objective To compare the clinical effects between anatomical locking plates and interlocking intramedullary nails in patients with Danis-Weber B lateral malleolus fractures. Methods This retrospective study enrolled patients with Danis-Weber B fractures of the lateral malleolus. All the operations were completed by the same group of surgeons. The reduction effect, operation time, intraoperative blood loss, hospital stay, fracture healing time and ankle functional outcomes (Olerud-Molander Ankle Score [OMAS]) were compared. Postoperative complications, including incision infections, fixation discomfort and internal fixation loosening, were also compared. Results This study enrolled 73 patients that were treated with either an anatomical locking plate (locking plate group; n = 37) or an interlocking intramedullary nail (intramedullary nail group; n = 36). There was no significant difference between the two groups in terms of reduction effect, hospital stay and OMAS. The intramedullary nail group had significantly lower operation time, intraoperative blood loss and fracture healing time compared with the locking plate group. Postoperative complications in the intramedullary nail group were significantly lower compared with the locking plate group. Conclusion Using intramedullary nails resulted in more satisfactory functional outcomes compared with using locking plates in patients with Danis-Weber B fractures of the lateral malleolus.

Outcomes of Using Different Generations of Telescopic Intramedullary Nails in Lower Limbs in Management of Osteogenesis Imperfecta Patients. A Systematic Review

Background Osteogenesis imperfecta is a group of heterogeneous disorders with a common characteristic of congenital bone fragility caused by mutations in genes encoding procollagen type I. (COL1A1 and COL1A2). Objectives This study aims to review the outcomes of the use of different generations of telescopic intramedullary nails in lower limbs for management of children with osteogenesis imperfecta (OI) and evaluate the functional outcomes of them. Patients and Methods Methodology: Criteria for considering studies for this review, types of studies: we will include: case series studies, retrospective cohort studies and we will exclude: case reports, cross sectional studies, non English studies. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/ exclusion criteria. Results One of the highest complications that have been very challenging for the orthopedic surgeons is migration and displacement of the telescopic intramedullary nails and FassierDuval nail has showed to have the lowest migration and displacement incidence rate (10.3%) which was clinically significant according to our statistics which supports the previous literature. On the other hand according to our statistics we found that there is no statistical significance in the cortical perforation of the telescopic nails between the different generations despite it might have been thought before that Bailey-Dubow nail has higher cortical perforation rate as the P value = 0.413. Post operative fractures and telescopic nail bending have shown no statistical significance according to our statistics which differ from each study when taken separately with P value = 0.252 and P value = 0.059 respectively. For the bending results we think that more studies are needed to increase the number of patients as it might show statistical significance according to its P value. Conclusion Fassier-Duval telescopic nail has good outcomes with the least complication rates and a promising generation of telescopic nail but needs a multicenter randomized control trials to conduct a level I evidence based on meta-analysis.