Secondary radial neuropathy after closed intramedullary nailing of humeral shaft fractures. Results over a 10-year period

Background. Retrospective study to examine secondary radial nerve palsy after humeral shaft fixation with closed locked intramedullary nailing. Materials and methods. Patients were identified from the hospitals’ registration systems for humeral shaft fractures, nerve lesions, plating, nailing and external fixation during a 10-year period from January 2007 to December 2016. All radial nerve lesions were registered and followed-up in patient files. Results. 89 patients with locked intramedullary nailing were available for an outpatient follow-up. Mean age was 67 years at the time of injury. 72 fractures were non-pathological. Of these, 31 were nonunions. 28, 61 and zero were identified in the proximal, middle and distal thirds of the humeral shaft respectively. 76 procedures were closed and 13 were with open reduction. Six radial nerves had nerve exploration. Eight patients developed immediate postoperative radial nerve palsies. Of these, six developed after closed surgery, two after nerve exploration. Of seven available patients with a radial nerve palsy, six of these remitted. Two patients were later surgically explored. One patient out of 89 sustained a verifiable permanent radial nerve paralysis. Conclusions. In this study, the risk of a radial nerve palsy was 7.9 % with closed locked intramedullary nailing. This study suggests that exploration of the radial nerve is not necessary routinely in order to prevent radial nerve lesions when performing closed intramedullary nailing for humeral shaft fractures in adults with a preoperative normal radial nerve function. Level of Evidence : Level IV.

Clinical Application of Immediate Results of Closed Intramedullary Nailing with Three-Component Antibacterial Coating in Infected Fractures and Nonunion of Long Tubular Bones

Цель. Оценить в ходе проспективного исследования эффективность и безопасность остеосинтеза интрамедуллярным блокируемым фиксатором с антибактериальным покрытием при инфицированных переломах и несращениях длинных трубчатых костей нижних конечностей. Материал и методы. В исследование были включены 8 пациентов с инфицированными переломами и несращениями бедренной и большеберцовой костей. В качестве имплантатов использовали солидные титановые стержни с отверстиями для блокирования. Покрытие требуемой толщины наносили вакуумно-плазменным методом из активной газовой фазы. Методика хирургического вмешательства включала два основных компонента: санацию очага инфекции и установку стержня в костномозговой канал. После операции все пациенты получали антибактериальную терапию с учетом результатов микробиологического исследования. Контрольные визиты для оценки активности инфекционного процесса и степени консолидации костных отломков назначались через 6, 12, 24 недели. Результаты. На момент написания данной статьи средняя продолжительность наблюдения за пациентами после операции составляла 4,4± 1,0 месяца (M±σ). Ни у одного из пациентов после операции и завершения курса антибактериальной терапии не наблюдалось каких-либо признаков рецидива инфекции, что свидетельствует об эффективности и безопасности применения данной методики. Не позднее 2,5 месяца после операции все 8 (100%) пациентов приступили к полной нагрузке на оперированную конечность. Рентгенография подтвердила наличие костного сращения у 5 пациентов, еще у 3 пациентов на рентгенограммах стояние конструкции и положение удовлетворительные, наблюдаются начальные признаки консолидации перелома. Заключение. Интрамедуллярный остеосинтез стержнем с блокированием и трехкомпонентным антибактериальным покрытием позволил добиться эрадикации инфекции и сращения костных отломков у большинства пациентов. Данная методика эффективна и ее применение не сопряжено с трудностями, характерными для интраоперационного изготовления антибактериальных покрытий. Научная новизна статьи Впервые изучена эффективность и безопасность интрамедуллярного остеосинтеза с новым трехкомпонентным антибактериальным покрытием при инфицированных переломах и несращениях длинных трубчатых костей нижних конечностей. Установлено, что данная методика позволяет добиться эрадикации инфекции и сращения костных отломков у большинства пациентов и при этом не сопряжена с трудностями, характерными для интраоперационного изготовления антибактериальных покрытий.

Effect of early protected weight bearing in fractures of shaft of femur

<p class="abstract"><strong>Background: </strong>Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. The purpose of this study was to evaluate the effectiveness of early protected weight bearing in fractures of shaft of femur.</p><p class="abstract"><strong>Methods: </strong>This was observational study conducted on 35 patient’s hospital with transverse fracture mid-shaft of femur, between March 2007 and July 2011. Patients with high velocity trauma, with transverse fracture of mid shaft of femur amenable to closed reduction and interlocking intramedullary nailing and otherwise healthy individuals were included in this study. The preoperative parameters were recorded included age, gender, side of the fracture and medical history. All patients were operated on second day of admission.</p><p class="abstract"><strong>Results: </strong>A total of 35 consecutive cases were included, 34 patients were males and 1 was female. In 74% cases closed intramedullary nailing given excellent healing of fracture, in 14% cases healing was good, in 6% cases it was average and 6% cases poor healing was observed.</p><p class="abstract"><strong>Conclusions: </strong>Our study demonstrate that this method provides anatomical reduction and maintenance of femur length and early ambulation which promotes fracture healing by a stable internal fixation allowing micro motion at fracture site enhancing callous formation.</p>

Primary interlocking nailing for open fractures of tibial shaft: a clinical study

<p class="abstract"><strong>Background:</strong> The excellent method for treating fractures of the tibial shaft was the closed intramedullary nailing technique. But because of limited references related to the results, incidence of infection, non-union of open injury. Hence, it was decided to analyse open tibial fractures treatment by primary interlocking nailing.</p><p class="abstract"><strong>Methods:</strong> 50 Patients with open fractures of the tibial shaft which were treated with primary interlocking nail were studied in the period of 14 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In present study 18 (36%) type I, 22 (44%) type II and 10 (20%) type IIIA Gustilo open fractures were treated. The average duration of time between injury and nailing was 3.5 hours (range was 1.5 hours to 4 hours). After reaming, 40 (80%) fractures were fixed, without reaming, 10 (20%) of fractures were fixed. The average time to union was 27 weeks for type I fractures, 30 weeks for type II fractures and 33 weeks for type IIIA fractures. There was 1 non-union. There were 4 deep infections.</p><p class="abstract"><strong>Conclusions:</strong> The best mode of therapy was primary interlocking intramedullary nailing for open fractures.</p>

Clinical Performance of Intramedullary Nailing system for Tibia Fractures: 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.