Management of Non-Prosthetic Peri-Implant Fracture in a Case of Broken Intramedullary Locking Nail - A Rare Case Report and Review of Literature

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail, NPPIFs are mostly reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but they represent a separate clinical entity with different conceptual and practical considerations1. Our case is a 72-year male with a broken humerus intramedullary Nail in right upper limb who was managed with implant removal and bridge plating with locking plate. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case.

Conventional versus helical blade screw insertion following the removal of the femoral head screw: a biomechanical evaluation using trochanteric gamma 3 locking nail versus PFN antirotation

Objective When a hip screw needs to be changed, choosing between the conventional (C-type) and helical blade (H-type) types is difficult. In this biomechanical study, we compared these two screw types relative to the type of the initial screw used. Methods C- or H-type screws were inserted (leading screw) in three types of polyurethane bone models (Sawbone, Pacific Research Laboratories, Inc., Washington, USA: 130 × 180 × 40 mm) of different bone mineral densities (pounds per cubic feet [PCF] 5, 80 kg/m3; PCF 10, 160 kg/m3; and PCF 15, 240 kg/m3), and then successively or alternately inserted (following screw) after the leading screw removal. An original model (original C and H) of a leading screw without removal was created as a control. The strengths of resistance to pullout (PO) and rotational stress were measured. For each experimental condition, there were 30 experimental models. Results The original C screw was superior in PO strength, and the original H-type screw was superior in rotational strength. When the C- or H-type screw was the leading screw, using the C-type screw again as the following screw (C1-C2, H1-C2) showed the greatest resistance to PO, and using the H-type screw as the following screw (C1-H2, H1-H2) showed superior resistance to rotational strength. However, the rotational strength of the C2 screw decreased by more than 50% compared with that of the original C screw. Moreover, the PO and rotational strengths of the H2 screw decreased to less than 30% overall compared with those of the original H screw. Conclusion The H-type screw should be used for second-time screw insertion procedures in cases where it is difficult to choose between PO and rotational strengths.

Outcome of Fracture Distal Femur Treated with Intramedullary Interlocking Nailing

Objective: To evaluate the functional and radiological outcome of the distal femur fracture treated with a retrograde locking nail. Methods: This is a descriptive study conducted at the Orthopedic department Dibba Hospital Fujairah, United Arab Emirates for one-year duration from March 2019 to March 2020. All patients who met the inclusion criteria were treated with femoral retrograde nailing technique. The postoperative functional score was assessed according to Schatzker and Lambert criteria, which were rated excellent, good, and poor. Radiological union was assessed by X-rays. Results: There were 103 patients with a mean age of 35.20 ± 10.66 (range, 20 to 50 years). There were 78 men (75.72%) and 25 women (24.27%). Most of the fractures (68.9%, n = 71) were caused by car accidents. Fracture of the right side occurred in 70 (67.96%) patients, and the left side fracture in 33 (32.03%) patients. Excellent results were obtained in 75 (72.81%) patients and good results were obtained in 28 patients (28.20%). The nonunion has been documented in one patient. Conclusion: Excellent and good functional and radiological results were obtained in patients with distal femur treated with retrograde locking nails. For some distal femoral fractures, we recommend the use of a retrograde locking nail.

Use of flexible nails in children diaphyseal fractures. Five questions and answers

Introduction More than 40 years after the launch of elastic stable intramedullary nailing (ESIN) as a golden standard of the treatment of some fractures in children and adolescents. Material and methods This review is based on answers to five essential questions: The position of ESIN compared with other methods of treatment; The choice of the implants; The indications for ESIN today; How to avoid complications as much as possible? Do we remove the implants or not? Results The aspects of biomechanics, design, indications for ESIN in comparison to other treatment, surgical techniques depending on fractured bones, complications are presented in the article. Conclusion ESIN is an excellent method to fix long bone fractures in children and adolescents. Top one is definitively the fractures of both bones of the forearm, then the diaphyseal fractures of the femur and the tibia before the age to be eligible for a locking nail. However, some unstable fractures cannot be treated conservatively or with a locking nail, and an ESIN remains unstable. In these cases, we are allowed to propose to add an external fixator for 4 to 6 weeks, waiting for a good stabilisation of the fracture.

Surgical management of critical femoral bone loss by bone transport over intramedullary nail by monorail system: a case report

<p>Present case report is about a male patient who met with a road traffic accident sustained an open crush, contaminated, injury of lower end femur of right side with significant loss of lower thigh bone (8 cm). He had fracture of inter condylar femur with fracture upper end tibia and lower third tibia with impending vascular insufficiency of leg and foot. Operated after correction of anaemia by debridement, fixation of femur with plate and inter condylar screw. Upper end tibia and Lower half tibia were fixed with separate plates and fasciotomy of leg. After 2 months femoral plate was replaced with intramedullary locking nail and superadded with monorail fixator. Corticotomy at proximal femur for bone transportation. Bone gap was corrected within 4 months and bone grafting was done at distal docking site. Union achieved and fixator removed after 4 months of this. Patient showed good results till last follow up 28 months, having good range of motion of knee.so critical bone loss at femur was treated by distraction osteogenesis over intramedullary nail with monorail external fixator system.</p>

Comparative Analysis of Knee Joint Fusion with Long Locking Nail and Ilizarov Apparatus in Patients with Deep Infection after Arthroplasty

Relevance. Deep infection after knee arthroplasty requires radical surgical treatment of the infection site, removal of endoprosthesis components, and an antimicrobial spacer placement. If revision knee arthroplasty is impossible, the «gold standard» for this kind of patients is knee joint arthrodesis. The purpose of the study was the comparative analysis of knee joint fusion by external and internal fixation. Materials and Methods. The analysis of 60 cases of knee arthrodesis was carried out. The patients were divided into two groups with 30 patients in each. In the first group, knee arthrodesis was performed with long locking nail, in the second group — with external ring fixation. We compared the groups by intraoperative and drainage blood loss, the inpatient treatment duration, the terms of fusion and complications registered. The patients quality of life was evaluated using the SF-36 questionnaire before surgery, for the periods of 3, 6, and 12 months after the surgery. Results. The comparison of two methods of knee arthrodesis showed that blood loss in the internal fixation compared with external one, was 2.03 times more, the duration of inpatient treatment was 1.4 times less, and the total number of complications was 4.4 times less. However, the complications that affected the treatment outcome in long nail group were 1.5 times more. The differences in the average time of ankylosis formation were not statistically significant (p<0.05). The functional results of the treatment in 3 months after surgery in the group with internal fixation were much better. In 6 months after surgery the quality of life had no significant differences. In 12 months follow-up the indices in both groups were the same. Conclusion. The results of our study suggests us to think, knee joint arthrodesis by long fusion nail should be prefereble. If the nail insertion is technically impossible, and there is the high risk of deep infection recurrence, the external osteosynthesis should be used.