Preliminary mechanical evaluation of two novel veterinary angle-stable-threaded interlocking nail systems

ABSTRACT: The interlocking nail represents an excellent option as a surgical approach to treat fractures in long bones in veterinary medicine. However, failures were reported mainly due to a slack present in the interface of the rod with the screws. The present study tested and mechanically compare axial compression loads of two novel models of stable angle interlocking nails with threaded holes. Among the two models, one was uniplanar and the other was multiplanar with orthogonally arranged distal holes. Twenty-one specimens made of polylactic acid were used for the implantation of interlocking nail´s rods, divided into three groups: conventional interlocking nail (G1), novel interlocking nail with a stable angle with holes arranged in a single plane (G2), and novel interlocking nail with a stable angle in two planes, with the penultimate hole at 90 degrees from the others (G3). Biomechanical tests were performed using axial, cyclic, and destructive compression load for comparison between them. All the specimens showed plastic deformation in the screws after destructive tests, in both proximal and distal sides, being highly intense in G1. G2 and G3 of the stable angle rods supported higher loads than G1 in all tests performed (P<0.05). The novel stems did not differ statistically from each other (P>0.05). The initial hypothesis that the novel models would provide increased stability was confirmed; however, no differences were demonstrated between them. The screw locking system on the rods allowed high resistance values in the tests performed, proving to be effective and potentially applicable in real clinical situations.

REMOVAL OF STUCK FEMUR INTERLOCKING NAIL BY LONGITUDINAL OSTEOTOMY OF FEMUR - A CASE REPORT

Introduction:Gerhard Kuntscher first introduced the technique of intramedullary nailing in 1940s . It is a clover leaf shaped hollow tubular nail for intramedullary fixation of long bones. This nailing system has been a technological breakthrough for femur fixation which can be both anterograde or retrograde. Case Report:A 34 year old Male patient resident of Shahapur brought by relatives to JJ hospital, with chief complaint of pain at left knee since 8 days. Patient had A/H/O RTA after fall from bike in 31/12/2012 with head injury with left shaft femur fracture. Patient was operated at JJH with left femur ILN. History of head injury operated in JJ hospital with no details known to patient. There was also history decreased vision in left eye since trauma. Discussion:Interlocking intramedullary nails are used as gold standard treatment in majority of tibial and femoral diaphyseal fractures. It can be removed in certain circumstances when it causes soft tissue irritation, prominent locking screws, implant failure, infection, nonunion, malunion etc. Conclusion:This study shows that in removal of stuck or bent femur interlocking nails in which all other closed techniques have failed, open longitudinal femoral osteotomy with retrograde hitting of the nail can effectively aid in successful removal of nail.

Union in Fracture Tibia Managed with Closed Intramedullary Interlocking Nail, Our Hospital Results

Introduction: The purpose of this research was to present our hospital results in union of fracture Tibia managed with close intramedullary interlocking nail. Methods: This research was carried out at Liaquat University of Medical and Health Science Jamshoro Pakistan from June 2020 to June 2021. A total of 250 patients with a closed tibial shaft fracture were recruited from the emergency room and outpatient clinics for this study. Our study's clinical outcomes were categorized as union, nonunion, delayed union, or malunion based on the criteria. All of the patients were given anesthesia, either general or spinal. All of the patients were tracked for a period of nine months. Results: In 90–150 days, about 88 percent (220/250) of patients had union, with a mean of 110.68. Union occurred in 11.2 percent (28/250) of patients in 95–109 days, with a mean of 103.38. There were 7.2 percent (18/250) delayed unions and 4.8 percent (12/250) non unions treated with dynamization and bone transplant. The outcomes were outstanding in 88 percent (220/250) of the patients and good in 7.2 percent (18/250). Our patients all had full range of motion in their knees and ankles at the time of their examination. Conclusion: We found that this approach is beneficial due to early mobilization (early weightbearing), reduced complexity, good outcomes, and low cost.

MANAGEMENT OF DIAPHYSEAL FRACTURES OF TIBIA BY USED OF CLOSED REAMED INTERLOCKING NAIL

Background: Fracture shaft of tibia is one of the common fracture encountered by the orthopaedic surgeons in their daily practice, Many patients come to Department of Orthopaedics with tibial fractures. It is one of the common injuries occurring in adult agegroup. Material and Methods: A total of 30 patients with closed tibial fractures underwent surgery for the fracture fixation with intramedullary interlocking nail in the Department of Orthopaedics, Patna medical college and Hospital Patna Bihar. Duration of Two years. Patients were selected irrespective of sex. Conclusion: Intramedullary interlocking nail is the reliable, versatile and effective treatment for closed tibial fractures. The advantage of rapid rehabilitation and relatively few complications serves to recommend this procedure. Keywords: intramedullary interlocking nail, complications, rehabilitation.

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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 &lt;90⁰.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Less Invasive Treatment of 265 Intraarticular Calcaneal Fractures with An Interlocking Nail (C-nail)

Objectives: Less invasive restoration of joint congruity and calcaneal shape in displaced intra-articular calcaneal fractures via a sinus tarsi approach followed by minimally invasive internal fixation with an interlocking nail (C-nail) results in a low rate of soft-tissue complications and good outcomes. Design: Prospective case-control study. Setting: Regional Hospital Trauma Department Patients: A total of 265 calcaneal fractures were treated by using the C-nail between 2011 and 2018 at the Department of Traumatology at the Regional Hospital Pardubice. Intervention: The reduced joint surface was fixed with one or two screws with short thread. All other fragments were fixed after reduction with the C-Nail introduced through the tuberosity. The fragments were fixed with 7 interlocking screws passing through the nail. Main Outcome Measures: Patients were assessed for complications, restoration of Böhler angle, posterior facet reduction with postoperative computed tomography, and weight-bearing radiographs after 6 and 12 months. Results: Wound edge necrosis was seen in three cases (1.1%) and soft tissue infection was observed in one case (0.4%). Böhler’s angle was improved from 5.9° preoperatively to 32.1° postoperatively, measuring 27.6° after 12 months. Conclusions: Two hundred forty-nine patients (222 males and 27 females; mean age 47.3 years) with 265 calcaneal fractures were treated between 2011 and 2018 less-invasively. The sinus tarsi-approach with use of the C-nail shows low risk of infection due to high stability of the fixed fracture.

THE MISSING LINK IN THE HISTORY OF THE LOCKED INTRAMEDULLARY NAIL

ABSTRACT Femoral Shaft intramedullary nails were first described by the Aztecs in 16th century, but the modern use of intramedullary nails as the gold standard treatment for femoral shaft fractures began with Gerald Kuntcher in 1939. From the first Kuntcher’s study in 1939, to the creation of interlocking nail, a long and some minor developments were described around the world. However, a major development is missing: the first nail to have a rotational and vertical stability locking system was described by Flavio Godoy Moreira, but was never published on an indexed journal for the correct historical reference. Level of Evidence V, Therapeutics Studies, Expert Opinion.

Comparison of Retrograde Femoral Interlocking Nail Versus Dynamic Condylar Screw in Distal Femoral Shaft Fractures

Objective: The aim of this study is to compare the effectiveness of retrograde femoral interlocking nail versus dynamic condylar screw in distal femoral shaft fractures. Study Design: Prospective/Randomized comprehensive Place and Duration: Department of Orthopaedic Surgery Bahawal Victoria Hospital (BVH) / QAMC, Bahawalpur for duration of eight months i.e July 2020 to February 2021. Methods: Total 65 patients of both genders were presented in this study with age ranges between 20-40 years. Patients detailed demographics age, sex and BMI were calculated after taking informed written consent. Patients were divided into 2- groups, I and II Group I had 32 patients and underwent for retrograde femoral interlocking nail and group II had 33 patients and received dynamic condylar screw. Mean operative time, mean union time of bones and complications were calculated. Effectiveness among both groups was calculated by HSS score. Complete data was analyzed by SPSS 22.0 version. Results: Most of the patients were males 40 (61.54%) and 25 (38.46%) were females. Mean age of the patients in group I was 26.46±4.28 years and in group II mean age was 30.78±8.22 years. Mean operative time in group I was 82.8±7.14 minutes while in group II it was 90.6±8.19 minutes. Mean union time in group I was 22.7±2.5 weeks and in group II was 26.21±5.3 weeks. According to HSS score in group I 16 (50%) results were excellent, 11 (34.38%) was good, 3 (9.8%) showed moderate and 2 (6.25%) was poor, while in group II excellent results were 15 (45.45%), 10 (30.30%) was good, 5 (15.15%) showed moderate and 3 (9.09%) showed poor results. Complications were observed joint stiffness, delayed union, non union and varus deformity were significantly lower in group I as compared to group II. Conclusion: We concluded in this comparison of study that bothretrograde femoral interlocking nail and dynamic condylar screw was useful and effective methods for trauma in distal femoral shaft fractures. But less union time and good outcomes were observed in interlocking nail as compared to dynamic condylar screw. Keywords: Distal femoral shaft fractures, Trauma, Dynamic condylar, Interlocking nail

Management of Closed Tibal Shaft Fractures with Reamed Interlocking Nail

Objective: The aim of this study is to determine the effectiveness of reamed interlocking nail in the management of closed tibal shaft fractures. Study Design: Descriptive/ Observational study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan for nine months duration from January 2019 to September 2019. Methods: Total 80 patients of both genders were presented in this study. Age ranges of enrolled cases were 20-70 years. Demographically details of enrolled cases were recorded after taking written consent. Patients who had tibial shaft fractures were admitted in emergency ward and underwent for reamed interlocking nail. Postoperatively union time and rate of complications were assessed. Complete follow up of the patients were take place in duration of 14-months. Data was analyzed by SPSS 20.0 version. Results: Mean age of the patients was 28.65±8.77 years with mean BMI 24.16±6.23 kg/m2. Out of 80 patients, 47 (58.6%) were males and 33 (41.4%) were females. Traffic accident was the most common cause of fracture found in 60 (75%) cases, followed by fall from the height 15 (18.75%) and the rest were others 5 (6.25%). Mean united time of simple fractures were 13.14±4.14 weeks while among segmental fractures union time observed 18.13±6.17 weeks. Frequency of union fractures was 62 (77.5%), delayed unions were 13 (16.25%) and non-unions were 5 (6.25%). Satisfaction rate was 72 (90%) among all cases. Conclusion: We concluded in this study that reamed interlocking nail was an effective and safest method for the management of closed tibal shaft fractures. Overall union rate in this study was 93.75% and showed less morbidity among cases. Keywords: Interlocking nail, Tibial shaft fractures, Union