Intramedullary is a form of The ability recovery is more surely in comparison with and reduce maximum infection ricks. The administration of Osteosynthesis with intramedullary nail by femoral nailing of Grosse and Kemf is broken of thigh from 1/3 high to 1/3 low, multi-bone broken. The administration of Osteosynthesis with intramedullary nail is
Fracture Fixation ; Intramedullary ; Fracture Fixation ; Internal ; Fractures ; Bone

OBJECTIVE: To evaluate the efficacy and safety of proximal femoral nail antirotation(PFNA) vs InterTAN nail in treating the elderly intertrochanteric femoral fractures. METHODS: Data of the randomized controlled trials(RCTs) about PFNA vs InterTAN for the treatment of the elderly intertrochanteric femoral fractures were searched in as the Cochrane Library, PubMed, EMbase, Wanfang, CNKI, CBM and VIP from their establishment to January 2018 for collecting. After study selection, assessment and data extraction conducted by two reviewers independently, meta-analyses were performed by using the RevMan 5.3 sofware. The level of evidence was assessed by using the GRADEpro system. RESULTS: Twelve studies involving 1 015 patients were included. The results of meta, analyses showed that: (1)safety indicator: compared with the InterTAN, PFNA had shorter operation time, and less intraoperative bleeding. But InterTAN had less total postoperative complications and internal fixation failure, but there was no significant difference in the operative incision lengths, fracture healing time and other postoperative complications. (2)efficacy indicator: compared with the InterTAN, the Harris hip score was lower after 3 months, but Harris hip score had no significant difference between the two groups after 6, 12 months. Based on GRADEpro system, all the evidence was at level C and weak recommendation(2C). CONCLUSIONS The current evidence indicates that PFNA had a similar effect compared with the InterTAN. But InterTAN could provide better stability against rotation and axial pressure effect, can allow patients do functional exercise early such as ambulation to recovery the hip function. It also had less total postoperative complications and internal fixation failure for the poor quality of the original studies and the limited number of studies, a prudent choice is suggested and more high-quality, large-sample studies are need.
Aged ; Bone Nails ; Femoral Fractures ; surgery ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Humans ; Treatment Outcome

OBJECTIVE: To investigate the relationship between the shape of the lateral wall and the early failure of internal fixation in the fracture of the femoral trochanteric region(FFT). METHODS: Total 295 patients with femoral trochanteric fracture underwent internal fixation from January 2015 to January 2020 were selected. The patients were divided into two groups according to whether there was early internal fixation failure after surgery, 19 patients in the failure group and 276 patients in the normal group. Gender, affected side, age, AO classification, body mass index(BMI), preoperative hemoglobin, X-ray measurement of lower lateral wall thickness, preoperative internal diseases, intraoperative blood loss, postoperative tip apex distance(TAD), postoperative neck shaft angle, operation time and other data were compared between two groups. The shape of the lateral wall was compared between two groups, and the correlation between the shape of the lateral wall and the early internal fixation failure of femoral trochanteric fracture was analyzed. RESULTS: All patients were followed up for more than 1 year. There was no significant difference between two groups in terms of intraoperative blood loss, operation time, postoperative TAD, and postoperative neck shaft angle(P>0.05). At the latest follow-up, the visual anaglue scale (VAS) of the failure group was higher than that of the normal group(P<0.01), and the Harris score of the failure group was lower than that of normal group(P<0.05). The receiver operator characteristic (ROC) curve between shape of lateral wall and failure of early internal fixation of femoral trochanteric fracture was drawn. The critical value of the midpoint lateral wall thickness was 16.5 mm, and the area under the ROC curve was 0.845;The critical value of average sidewall thickness was 16.5 mm, and the area under ROC curve was 0.838;The critical value of the axial area of the sidewall was 7.5 mm, and the area under the ROC curve was 0.826. CONCLUSION The shape of the lateral femoral wall measured by CT could be used as a predictive factor for the early failure of internal fixation of femoral trochanteric fractures. For patients at risk, more reasonable surgical plans and postoperative preventive measures should be developed.
Humans ; Treatment Outcome ; Fracture Fixation, Intramedullary ; Bone Nails ; Retrospective Studies ; Hip Fractures/surgery* ; Fracture Fixation, Internal

OBJECTIVEUnstable intertrochanteric fractures (ITFs) are mostly treated by proximal femoral nail antirotation (PFNA), Inter-Tan, Asian Hip, and other new internal fixation devices. But for complex unstable fractures, such as crushed lateral wall of the greater trochanter, the loss of fixation point on lateral wall slightly reduces the fixing effect. This study aimed to compare the biomechanical strengths between reversed less invasive stabilization system (LISS) and PFNA for treatment of unstable ITFs.

METHODSForty synthetic femurs were used to simulate unstable ITFs in vitro and were fixed using the reversed LISS or PFNA. These fractures were divided into two groups depending on whether the lateral wall of the greater trochanter is intact or not (AO classification: 31-A2.3 and 31-A3.3, respectively). The load-displacement of femur, stiffness, ultimate load, and cyclic fatigue resistance were detected using an incremental load test and a dynamic fatigue test through an MTS 858 test system.

RESULTSFor both 31-A2.3 and 31-A3.3, the vertical sinking displacement (VSD) of the femoral head under 500 N load was insignificantly smaller after treatment with reversed LISS than with PFNA, and when the displacement was 5 mm, the femoral head bore insignificantly greater load. The fixation with reversed LISS resulted in greater axial stiffness of the femur but smaller ultimate load. During the same cycle in the dynamic fatigue test, the VSD was insignificantly smaller with the fixation of reversed LISS.

CONCLUSIONReversed LISS and PFNA have similar biomechanical strength for unstable ITFs. This conclusion should be supported by additional large-size research on basic biomechanics and clinical application. This is the first comparative biomechanical study comparing reversed LISS and PFNA for unstable ITFs.

Biomechanical Phenomena ; Bone Nails ; Femur ; surgery ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; methods ; Hip Fractures ; surgery ; Humans

BACKGROUNDPostoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior (A-P) view in detecting distal locking screw penetrations during retrograde femoral nailing.

METHODSThe angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography (CT) images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were left 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not.

RESULTSAccording to the results of CT scan, the lateral condyle view was 20.88 ± 0.98° and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% (lateral condyle screw) and 25.0% (medial condyle screw) at 4 mm, and 41.7% (lateral condyle screw) and 58.3% (medial condyle screw) at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 mm. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 mm. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths (2, 4, and 6 mm) compared with the A-P view (P < 0.05).

CONCLUSIONSThe femoral condyles tangential views increased the accuracy of detecting screw penetrations on the medial and lateral condyles. Routine clinical use of the femoral condyles tangential views has the potential to increase accuracy in detecting distal locking screw penetration during retrograde femoral nailing.

Bone Screws ; Femoral Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Humans ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the clinical effect of titanium cable assisted fixation combined with lengthened Gamma nail in the treatment of subtrochanteric fracture of femur. METHODS: From January 2010 to January 2018, 45 patients with long subtrochanteric fractures were retrospectively analyzed, and they were divided into two groups according to the operation plan. There were 24 cases of titanium cable assisted fixation combined with lengthened Gamma nail (observation group), including 14 males and 10 females, with an age of (54.2±12.8) years; 21 patients (control group) were treated with simple lengthened Gamma nail (control group), including 12 males and 9 females, with an age of (51.4±15.9) years. The operation time, intraoperative blood loss, hospital stay, hemoglobin decrease and fracture healing time were observed and recorded in the two groups. Harris hip function score was used to evaluate the postoperative curative effect, and the occurrence of complications was observed. RESULTS: All patients were followed up for 14 to 36 months. There was significant difference in operation time, intraoperative blood loss, hospital stay between two groups( CONCLUSION Lengthened Gamma nail fixation is reliable in the treatment of subtrochanteric fracture. Limited incision titanium cable assisted fixation can improve the reduction rate and fixation strength of long segment fracture, which is conducive to early functional exercise.
Bone Nails ; Female ; Femur ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Hip Fractures/surgery* ; Humans ; Male ; Retrospective Studies ; Titanium ; Treatment Outcome

OBJECTIVE: To evaluate the biomechanical stability of elastic intramedullary nail in the treatment of pubic ramus fractures by finite element analysis, and to compare the stability of elastic intramedullary nail with cannulated screw intramedullary fixation. METHODS: The CT data of the pelvis of a volunteer were selected, and the three-dimensional model of the pelvis was reconstructed by reverse engineering software and the fracture of the pubic ramus fractures was simulated by osteotomy. The hollow nail model, single elastic nail model and double elastic nailmodel were assembled with different implants respectively. The mesh division, material assignment loading and other steps were carried out in the ANSYS software, and then the calculation was submitted. RESULTS: The overall displacement of the pelvis of the elastic nail model was smaller than that of the cannulated screw model, in which the double elastic nail model had the smallest overall displacement, but the cannulated screw model had the smallest plant displacement and the single elastic nail model had the largest plant displacement. Although the stress of cannulated screw was small, there was obvious stress concentration, the stress of elastic nail was large, but there was no obvious stress concentration, especially the stress distribution of double elastic nail was more uniform and the overall stress of pelvis was the smallest. CONCLUSION All the three fixation methods can effectively improve the stability of the anterior ring of the pelvis. Among them, there is no significant difference in the overall biomechanical propertiesof hollow nail fixation and double elastic nail fixation, which is better than that of single elastic nail fixation. Elastic nail fixation has the advantages of minimally invasive surgery and good biomechanical stability, so it can be used as a better surgical method for the treatment of pubic ramus fractures.
Biomechanical Phenomena ; Bone Screws ; Finite Element Analysis ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Fractures, Bone/surgery* ; Humans ; Spinal Fractures

OBJECTIVE: To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic. METHODS: The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed. RESULTS: Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient's condition is still a major difficulty in the surgical treatment of tibial plateau fractures. CONCLUSION Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.
Humans ; Biomechanical Phenomena ; Bone Plates ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Tibial Fractures/surgery* ; Tibial Plateau Fractures

OBJECTIVE: To observe the clinical effect of elastic intramedullary nail in minimally invasive treatment of floating knee injury in children. METHODS: From January 2009 to September 2017, 11 children with floating knee injury were treated with one-off open reduction and elastic intramedullary nail or external fixator fixation, including 7 males and 4 females, aged 5.0 to 11.0 years, with an average age of 8.3 years. The treatment results were evaluated according to karlstrom's standard. RESULTS: Eleven patients were followed up for 8 to 48 months, with an average of 28 months. All the fractures healed at one time, and there were no complications such as nonunion, malunion and serious dysfunction of knee joint. The length of the affected limb in 2 cases was 1.2 to 1.5 cm longer than that in the opposite side without shortening. According to Karlstrom scoring standard, 8 cases were excellent, 1 case was good and 2 cases were middle. CONCLUSION Elastic intramedullary nail minimally invasive treatment of floating knee injury in children is a safe and effective treatment, which can effectively reduce the fracture and promote bone healing, which is conducive to early functional recovery.
Bone Nails ; Child ; Child, Preschool ; External Fixators ; Female ; Fracture Fixation ; Fracture Fixation, Intramedullary ; Fracture Healing ; Humans ; Internal Fixators ; Knee Injuries ; surgery ; Male ; Treatment Outcome

PURPOSE: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods. METHODS: This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0). RESULTS: Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001). CONCLUSION Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.
Bone Plates/adverse effects* ; Fracture Fixation, Internal/methods* ; Fracture Fixation, Intramedullary/methods* ; Fracture Healing ; Humans ; Minimally Invasive Surgical Procedures/methods* ; Prospective Studies ; Tibia/surgery* ; Tibial Fractures ; Treatment Outcome