Top PDF Functional outcome of extrarticular distal tibia fractures treated by Intramedullary nailing

Functional outcome of extrarticular  distal tibia fractures treated by Intramedullary nailing

Functional outcome of extrarticular distal tibia fractures treated by Intramedullary nailing

The functional outcomes assessed, when analysed, revealed the fact that worse functional outcomes were not related with age or associated injuries. It was associated with the quality of reduction of the fracture. The significant clinical correlation of radiological union with valgus malalignment in our study proves this fact. The mean time to radiological union after IM nailing for distal tibia fractures was in a range 17.7-22.6 weeks (54). The mean time to radiological union in our study is 19.88 weeks. This is well within the range recommended in the literature. The radiological union of fractures of patients with more valgus malalignment were comparatively delayed. This explains the need for perfect alignment of fracture intraoperatively to achieve better functional outcomes. This perfect alignment can be achieved by several means. But use of Poller screws is one simple method with no extra inventory needed and no need for any modification in the nail with less soft tissue compromise. The increased rate of malalignment thus can be controlled.
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Fractures of both bones forearm: A Comparative study on fixation techniques and functional outcome between intramedullary nailing and plate osteosynthesis

Fractures of both bones forearm: A Comparative study on fixation techniques and functional outcome between intramedullary nailing and plate osteosynthesis

Fractures of forearm are classified according to the level of fracture, the pattern of fracture, the degree of displacement, the presence or absence of comminution or segmental bone loss and whether they are open or closed. Each of these factors may have some bearing on the type of treatment to be selected and the ultimate prognosis. For descriptive purposes, it is useful to divide the forearm into thirds, based on the linear dimensions of radius and ulna. Disruption of proximal or distal radioulnar joints is of great signifance to the treatment and prognosis. It is imperative to determine whether the fracture is associated with joint injury because effective treatment demands that both the fracture and joint injuries are treated in an integrated fashion.
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A Prospective study of Functional Outcome of Tibial Metaphyseal Fractures treated with Intramedullary Nailing with Blocking Screws (Poller Screws)

A Prospective study of Functional Outcome of Tibial Metaphyseal Fractures treated with Intramedullary Nailing with Blocking Screws (Poller Screws)

Management of metaphyseal fractures of the tibia is a big challenge to the operating surgeon.The treatment aims onreduction of sagittal and coronal mal-alignment, establishment of length and rotational alignment and maintaining the same until fracture union. Intramedullary Interlocking nailing is still the gold standard treatment for closed fractures of the tibial diaphysis. However it is also been used to treat proximal and distal diaphyseo- metaphyseal junctional fractures. Intramedullary nails are currently becoming the effective method in treating extra-articular tibial metaphyseal fractures due to its advantages such as reduced hospital stay,early full weight bearing and time for bony union.Also it spares the extra-osseous blood supply, acts as a load sharing device and more importantly avoids extensive soft tissue dissection.
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Functional Outcome of Interlocking Intramedullary Nailing of Fracture Shaft of Humerus: A Prospective study

Functional Outcome of Interlocking Intramedullary Nailing of Fracture Shaft of Humerus: A Prospective study

Fractures of the shaft of humerus account for approximately 3-5% of all fractures treated. Historically humeral shaft fractures have been classified by fracture location, fracture pattern, associated soft tissue injuries and quality of bone. This fracture has been treated by closed reduction & cast application with/without cast bracing and open reduction & internal fixation using dynamic compression plate. Many authors have documented the general good outcome that occurs after compression plate fixation, which is still considered the gold standard for operative treatment of acute humeral shaft fractures. Though plate fixation has given high rates of union, it involves extensive soft tissue stripping, potential injury to radial nerve and poor fixation in osteoporotic bone. Later flexible nails of many varieties were used. The advantages of intramedullary nailing are minimal surgical exposure, better biological fixation, minimal disturbances of soft tissues and early mobilization of neighboring joints.
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Comparative analysis of outcome of displaced middle third clavicle fractures in patients treated with plate osteosynthesis and intramedullary nailing

Comparative analysis of outcome of displaced middle third clavicle fractures in patients treated with plate osteosynthesis and intramedullary nailing

This is a prospective study undertaken in the department of orthopaedics, Coimbatore medical college hospital, Coimbatore from May 2011 to October 2013.Within the period of study,20 patients with displaced middle third clavicle fractures were operated alternatively with plating nailing(titanium elastic nail).We had 11 patients who were operated with plating (6-RECONSTRUCTION plate and 5- PRECONTOURED CLAVICLE PLATE) and 9 patients who were operated with nailing(titanium elastic nail).Outcome measures like Blood loss, operative time, wound size, union rate and union time and complications like infection, Non union, implant irritation and shortening were compared between the two groups. Functional outcome was based on Quick DASH score.
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External Fixation versus Unreamed Interlocking Intramedullary Nailing for Open Tibia Fracture

External Fixation versus Unreamed Interlocking Intramedullary Nailing for Open Tibia Fracture

Three fractures ended with amputation (EF = 3; IMN = 0), indicating that the incidence of amputation was reduced by IMN compared to EF. Hardware failure was evaluated in two fractures (EF = 0; IMN = 2), indicating that the incidence of hardware failure was reduced by EF compared to IMN." Hardware failure remains the most reported complication of IMN, with an incidence of up to 3–16%. The most common hardware failure is the breakage of locking screws. However, Alberts et al.’s research showed that locking screw failure’s long-term effect is minor because in most cases this complication could not be noticed in the first eight weeks and did not result in more than 5 mm of shortening. Generally speaking, these failures are related to fracture patterns, fracture locations and the patients’ weight bearing statuses. Unlike the compound system of nail and bone in reamed nails, IMN functions as a splint in the medullary cavity. The load is transmitted directly to the locking screws. Awareness of this function and adherence to a strict protocol concerning patient mobilization and weight-bearing status appear to be the most important factors for avoiding this kind of failure." [54-56] . However, there is no consensus on the best method of bony stabilization. EF and IMN are two well-accepted techniques, and they are also associated with the most controversy over which is the optimal treatment. The functional outcome is also a focus after fracture surgery. An obvious advantage of IMN is that is can allow for early range of motion after surgical intervention. In contrast the EF technique where passing of wires and pins through muscles may limit motion and lead to joint contracture [57,58] .
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A Comparative study on the Functional Outcome in the Management of Extra Articular Distal Femur Fractures by Retrograde Intramedullary Interlocking Nailing Vs Distal Femoral Locking Plate

A Comparative study on the Functional Outcome in the Management of Extra Articular Distal Femur Fractures by Retrograde Intramedullary Interlocking Nailing Vs Distal Femoral Locking Plate

In 1960s, because of the lack of adequate internal fixation of the fractures, conservative methods such as traction of involved limb and cast bracing, produced better results than operative management, With the development of improved internal fixation devices, treatment options begin to change in 1980s. The blade plate designed by the AO group was one of the first used device and gain wide acceptance. Due to technical complications, a less technically demanding device Dynamic Condylar screw was introduced. The intramedullary nailing were used in the treatment of distal femoral fractures, because of their biological fixation. Nails have been designed specifically for retrograde insertion through inter condylar notch for the treatment of supracondylar and inter condylar femoral fractures. External fixation was used as temporary (or) definitive fixation in severe open distal femur fractures especially those associated with vascular injury. Management of distal femur fracture can be divided into two broad categories.
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Functional outcome of extra-articular distal tibia fractures treated with minimally invasive plate osteosynthesis

Functional outcome of extra-articular distal tibia fractures treated with minimally invasive plate osteosynthesis

However, each of these treatment modalities is associated with certain advantages and disadvantages. Conservative management may be complicated by loss of reduction and subsequent malunion (51)(52) . Similarly, external fixation of distal tibia fractures may result in insufficient reduction, malunion, and pin tract infections (53) . Intramedullary nailing is considered the ‘‘gold standard’’ for the treatment of tibial midshaft fractures, but there are concerns about their use in distal tibia fractures. This is because of technical difficulties with a stable distal nail fixation ( discrepancy between the narrow triangular diaphyseal diameter and wide circular metaphyseal diameter of the intramedullary canal) and the risk of propagating an existing distal tibia fracture into the ankle joint (54)(55) . Open reduction and internal plate fixation results in extensive soft tissue dissection/devitalisation and may be associated with wound complications and infections (56) . The optimal treatment of unstable distal tibia without articular involvement still remains controversial till date.
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Functional Outcome of Expert Tibial Intramedulary Nailing for Metaphyseal Distal One Third Fractures of Tibia

Functional Outcome of Expert Tibial Intramedulary Nailing for Metaphyseal Distal One Third Fractures of Tibia

Introduction: In Orthopaedics fractures of tibia remains the commonest and most challenging fractures to be treated. Various modes of treatment are described for the fixation of fractures of lower third shaft tibia. When the aim is stable fixation with early restoration of function without use of plaster, intramedullary nailing offers an attractive treatment option. Newer expeet tibia nail design have been developed for the osteosynthesis of fractures of lower third tibia. The main purpose of the study was to study functional outcomes of expert interlocking nai for management of lower third tibia shaft fractures.
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Evaluating Outcome of Distal Tibia and Fibula Fractures Treated with Intra Medullary Nailing

Evaluating Outcome of Distal Tibia and Fibula Fractures Treated with Intra Medullary Nailing

This cross- sectional study was conducted in Firoozgar hospital, which is a general hospital, between 2012 and 2014. Fifty patients with distal tibiofibular fractures who was candidate for reamed, locked IM nailing were followed up for this study. Inclusion criteria were patients ≤18 year, tibiofibular fracture line which extends to 4 to 11 cm proximal to the articular surface of bone, type 43 or distal 42 fractures based on AO/ Or thopaedic Trauma Association (AO/OTA) classification 9 , large enough

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A Prospective study on Analysis of Functional Outcome of Internal Fixation of Fibula by Closed Tens Nailing in Addition to Tibia in Distal both Bone Leg Fractures

A Prospective study on Analysis of Functional Outcome of Internal Fixation of Fibula by Closed Tens Nailing in Addition to Tibia in Distal both Bone Leg Fractures

The distal third of the fibula has a major role in the structural integrity of the ankle joint. It is securely attached to the distal end of tibia through the ligaments of the anklesyndesmosis- the anterior and posterior distal tibiofibular ligaments, the inferior transverse ligament, and the interosseous ligament – as well as through the distal interosseous membrane. Disruption of these ligaments 19,38 , with resultant loss of fibular support for the talus, may occur in association with tibial shaft fractures. Therefore the integrity of the ankle joint should always be assessed in patients with tibial fractures.
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Comparison of intramedullary nailing and plate fixation in distal tibial fractures with metaphyseal damage: a meta-analysis of randomized controlled trials

Comparison of intramedullary nailing and plate fixation in distal tibial fractures with metaphyseal damage: a meta-analysis of randomized controlled trials

The optimal type of internal fixation for treatment of a dis- tal radius fracture is still under debate. The tibia is an im- portant weight bearing bone in the lower limb, which articulates proximally with the femur at the knee and distally with the talus at the ankle. Fractures of the distal tibial metaphysis, diaphysis, and adjacent diaphysis are commonly seen in road traffic accidents or sports injuries. These metadiaphyseal fractures are distinct in terms of their management from articular impaction “pilon” type fractures and middle third diaphyseal injuries [1]. The over- all incidence of tibial fractures is 51.7 per 100,000 a year, and the incidence of diaphyseal and distal tibia fractures is 15.7 and 9.1 respectively per 100,000 a year [2]. Common definitions of distal tibial fractures include distal extra-articular tibial fractures which are located between 4 and 12 cm from the tibial plafond (AO 42A1 and 43A1). Further subdivisions are made on the basis of the morph- ology and degree of comminution of the fracture: 43-A1 are non-comminuted extra-articular fractures, 43-A2 are wedge fractures, and 43-A3 are comminuted extra-articular fractures. Simple extension of the fracture into the joint without depression of the joint surface are classified as 43-B1 and are often treated in the same way as 43-A fractures [3–5].
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A Study of Functional Outcome of Paediatric Femoral Diaphyseal Fractures treated with Titanium Elastic Nailing

A Study of Functional Outcome of Paediatric Femoral Diaphyseal Fractures treated with Titanium Elastic Nailing

The femur is the longest bone in the body. It is cylindrical in shape in most of its length and bowed with forward convexity. The radius of curvature is approximately 120 cm. The upper extremity has a articular head, projecting medially formed by the medial inclination of the upper part of the shaft. The distal femur has condyle articulating with tibia. The relevant proximal osseous structures include femoral head, femoral neck, calcar, greater trochanter, lesser trochanter and distal osseous structures include medial and lateral condyles and articulation of the distal femur.
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A study on outcome of surgical treatment of compound tibia fractures by intramedullary nailing after preliminary external fixation: short term retrospective and prospective analysis

A study on outcome of surgical treatment of compound tibia fractures by intramedullary nailing after preliminary external fixation: short term retrospective and prospective analysis

3. Radio opaque ruler is useful to measure the distance between anterior edge of the entry portal to a point 0.5 to 1 cm proximal to ankle joint. Nail diameter is selected 1 mm less than the last reamer used. Now the appropriate nail mounted in the Jig and it is inserted over the guide wire under C-arm control. The subchondral bone of the ankle joint, approximately 0.5 to 2 cm from the ankle joint line should be the position of the distal tip of the nail. Impaction of the fracture is achieved by releasing the traction. Proximally counter sinking of nail has to be done up to 0.5 to 1 cm to the proximal nail end to avoid anterior knee pain and early arthritis. Now the distal locking is done under C-arm control as free hand technique. Proximal locking is done with Jig. Before insertion of proximal locking fracture site is checked and if it is distracted reverse jamming is done.
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Functional Outcome of Intertrochanteric Fractures Treated by Proximal Femoral Nailing Anti-Rotation-II

Functional Outcome of Intertrochanteric Fractures Treated by Proximal Femoral Nailing Anti-Rotation-II

straight incision is made from tip of the greater trochanter extending proximally for 4 to 6 cm; the gluteus medias muscle is dissected in line with its fibers. If an open reduction is required, one can extend the incision distally, incising the iliotibial band in the line with the skin incision. In this case, the vastus lateralis muscle is reflected anteriorly to expose the proximal femoral shaft. The entry point for an intramedullary hip screw is at the posteromedial tip of the greater trochanter, halfway between its anterior and posterior extent. In younger individuals, particularly those with subtrochanteric fractures, it may be necessary to ream the femoral isthmus to accommodate the intramedullary nail; a ball tipped guide wire can be placed down the femoral shaft and a flexible cannulated reamer used to enlarge the proximal shaft to the appropriate diameter. In the elderly who have larger diameter medullary canals, this step is usually not necessary. The appropriately sized intramedullary nail is then assembled with its corresponding intramedullary angle guide attachment. It is imperative that the appropriate angle guide targets the proximal and distal holes in the nail using the drill sleeves and guide pin prior to device insertion. The nail is inserted by hand through the greater trochanter into the proximal femur. One should avoid use of excessive force, which may produce comminution of the proximal femoral shaft. It is also important to use frequent fluoroscopic evaluation to follow the progression of the nail as it is inserted.
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Results of Dynamic Interlock Nailing in Distal Tibial Fractures

Results of Dynamic Interlock Nailing in Distal Tibial Fractures

A study was performed in adults to determine the efficacy of closed reduction and intramedullary nailing in dynamic mode on union, implant failure and incidence of malalignment in patients who sustained an extra-articular fracture of the distal tibia. Methods: Between January 2007 and De- cember 2013, one hundred and twelve patients of distal tibia that involved the distal 6 cm of the tibia were treated at our hospital with reamed intramedullary nailing with use of two distal inter- locking screws and one proximal screw in dynamic mode. The augmentation was done with poller screws whenever it was necessary. The nailing of fibular fractures was done in 27 cases. There were 85 males and 27 females with a mean age of 30.9 (range: 20 to 72). Eighty fractures were closed whereas 32 were grade 1 open fractures. Results: The average time to union of the closed fracture was 15.4 weeks (range: 12 – 28 weeks). The healing times for the primarily nailed com- pound Grade I averaged 17.8 (range: 15 - 34 weeks). After minimum follow-up of one year, rate of primary union was in 97.32%. One case of broken nail required revision surgery. There were three cases of delayed union and two cases of non union. In one case there was deep infection which required exchange nailing with antibiotic impregnated nail. There was breakage of inter- locking screws in three cases but fracture had united. In twenty two cases acceptable malalign- ment of the tibia was observed after union. The outcome was determined at a minimum of one year in our study based on the criteria of Johner and Wruhs. Out of 112 patients, 79 patients had excellent results, 29 had good results and 4 had fair results. Conclusions: The dynamic osteosyn- thesis of distal tibia by interlocking nail and judicious use of poller screws is an effective alterna- tive for the treatment of distal metaphyseal tibial fractures.
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Intramedullary nailing for correction of post-traumatic deformity in late-diagnosed distal radius fractures

Intramedullary nailing for correction of post-traumatic deformity in late-diagnosed distal radius fractures

Distal radius fractures are one of the most common upper extremity injuries, accounting for about 8–15 % of all skeletal injuries treated by orthopedic surgeons [1–3]. Late- diagnosed fractures are frequently complicated with many sequelae; among them, malunion and post-traumatic wrist arthritis due to post-traumatic distal radius deformity are most frequently seen [4–6]. Common deformities follow- ing an extra-articular distal radius fracture include loss of the normal volar tilt of the articular surface in the saggital plane, decreased ulnar inclination in the frontal plane, and loss of length relative to the ulna [6]. Post-traumatic deformity results in alteration of normal anatomy, biome- chanics of distal radius, and functional impairment in hand and wrist [6–8]. Many surgical modalities in the treatment of acute fractures of the distal radius have been proposed [9, 10]. Intramedullary nailing is currently used to treat unstable extra-articular fractures of the distal radius [11]. Bearing the advantages of allowing load transfer across the fracture site and lessening soft-tissue dissection, intrame- dullary fixation can be used to stabilize the fracture bones through a less invasive approach and maintain periosteal vascular blood supply to promote fracture healing [12]. The purposes of this retrospective study were to describe our experience with mini-open osteotomy, local bone grafting, and fracture stabilization with the intramedullary nail
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Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

Intramedullary nailing for pertrochanteric fractures of proximal femur: a consecutive series of 323 patients treated with two devices

PFs represent the most frequent cause of hospitalization in an orthopedic department [11]. The treatment of these fractures must be aimed to early assisted walking restor- ation, to reduction of hospitalization time and of morbid- ity of the patient. Factors associated with a better outcome are an early treatment, an anatomical reduction of frag- ments, a stable osteosynthesis, an early mobilization, and a full weight bearing and walking [21, 22]. Following these principles, we carried out a randomized prospective study and we compared functional and radiological outcomes and complication rate in patients treated with two differ- ent proximal femoral nail for a pertrochanteric fracture.
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Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis

Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis

Statistical analysis was performed using RevMan software (version 5.1; Cochrane Collaboration, Copenhagen, Denmark) for outcome measurements. A value of p < 0.05 was considered statistically significant. Heterogeneity was evaluated by visually inspecting the forest plot (ana- lysis) combined with the results of the test for hetero- geneity and the I 2 statistic [42]. I 2 > 50 % was considered to be substantial heterogeneity. A fixed-effects model was used in the meta-analysis unless significant hetero- geneity existed among the studies. Otherwise, the random-effects model of DerSimonian and Laird [43] was used. Continuous variables were presented as the mean difference (MD), whereas dichotomous variables were presented as the relative risk (RR). Both variables had 95 % confidence intervals (CIs). Sensitivity analysis was performed by deleting a single study at each step to examine the influence of individual data sets on the pooled RRs in the random-effects model. Subgroup analysis was stratified according to the study design. Publication bias was tested using funnel plots whenever possible.
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Functional outcome analysis of management of compound fractures of tibia with Ilizarov Fixator

Functional outcome analysis of management of compound fractures of tibia with Ilizarov Fixator

Mr. Murugan, 22 yrs, Male, student had sustained grade I compound communited fracture both bone left leg due to R.T.A. He also sustained ipsilateral extra articular distal radius fracture. On day one distal radius fracture was treated with CMR and AE slab. Tibial fracture was debrided. Ilizarov fixator was applied after 7 days. Compression was done for 5 days from 10thP.O.day. Patient had good union by 26 weeks. Patient had no pin tract infection. He was put on PTB cast and mobilized to bear weight as able at 22 weeks after removal of ilizarov fixator. Follow up was available up to 12 months.
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