The introduction of the strong clover-leafed nail combined with the principle of reaming out the medullary canal and the development of image intensifiers has been extended the indications of the in tramedullary nailing. In this report, an attempt was made to introduce the method and to verify the indications and advantage of retrograde intramedullary nailing of humeral shaft fractures, as compared with the conventionally accepted methods.
Fracture Fixation, Intramedullary ; Humerus ; Methods

Background: Leg bone fracture is common seen in orthopedic trauma. Currently, the trend of treatment is using a less invasive technique. Especially, with application of C-Arm in surgery, closed Kuntscher nailing technique has made the treatment of leg bone fractures achieving more new improvements. Objectives: To summarize the experiences in the technical implementation process and to assess results of treatment. Subjects and method: A descriptive, retrospective study was conducted on 112 patients was confirmed diagnosed with leg bone fractures (81 males, 31 females, the average aged 29\xb15.3), were operated in Da Nang General Hospital from January, 2004 to June, 2006. All of them were performed with Kuntscher intramedullary nail in tibia without opening fracture cavity, in condition of without C-Arm. Results: The patients with combined injuries included 5 cases of 2 legs fracture, 2 cases of hip fracture, 5 cases of leg fracture in 2 stages, 1 case of collabone fracture. Postoperative observations: no case of infection, patients were discharged after 2-7 days, the average length of hospitalization was 3\xb12.4 days. Complication: 1 case of secondary deviation, no case of any delay to heal bone, broken nails. Recording a case of nail was rise up to cause painfully and synovial capsule inflammation of knee joint. Conclusion: The implementation of this less invasive technique should be orderly done. The most ideal indication was tibial shaft fractures in stage of middle 1/3. Because of a minimally invasive technique so patients were less painful, fracture healing quickly, early mobilization could be set, surrounding joints were not affected.
Tibial Fractures/surgery ; Fracture Fixation ; Intramedullary/ methods ;

Intramedullary (IM) nailing for humeral shaft fracture has provided excellent outcomes in terms of fracture biology and cosmetic appearance because of the relatively small incision involved. However, antegrade nailing causes issues such as iatrogenic rotator cuff injury. Retrograde nail fixation method could avoid cuff injury, but has shortcomings such as the need for the prone or lateral decubitus position during surgery. We report that the retrograde IM nail fixation technique performed in a supine position and some ancillary techniques for minimizing scars or complications can provide the advantages of both retrograde nailing and supine position during surgery.
Biology ; Cicatrix ; Fracture Fixation ; Fracture Fixation, Intramedullary* ; Humeral Fractures ; Humerus* ; Methods ; Rotator Cuff ; Supine Position*

OBJECTIVETo investigate the effects of closed reduction and ulna intramedullary nail fixation for the treatment of fresh Monteggia fractures of Bado type I and II in children.

METHODSTwenty-three children patients with Monteggia fracture during July 2010 to September 2013 were treated by closed reduction and ulna intramedullary nail fixaion including 18 boys and 5 girls with an average age of 9.3 years old ranging from 6 to 13 years old. Among them,15 cases were Bado type I and 8 cases were Bado type II. There were 9 cases with radial nerve injury. The operation time,the recovery of nerve injury, the fracture healing and the function of elbow were observed and recorded.

RESULTSAll patients were followed up for 6 to 24 months (12 months on average). All patients were obtained bone healing. According to Anderson standard, at the final follow-up, 20 cases got excellent result, 2 cases got good result, and one case got fair result.

CONCLUSIONTreatment of the fresh Monteggia fractures in children by closed reduction and ulna intramedullary nail fixation has advantages of simple operation, less trauma and good results.

Adolescent ; Child ; Female ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; Humans ; Male ; Monteggia's Fracture ; surgery ; Ulna ; surgery

BACKGROUNDNowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age.

METHODSThere were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture.

RESULTSWe were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening.

CONCLUSIONPatients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.

Adolescent ; Child ; Child, Preschool ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; Humans ; Male

Intramedullary nailing has become the most popular fixation method in the treatment of the shaft fractures of long bones especially of tibia and femur because it affords most rigid fixation of fracture via closed method which makes early rehabilitation possible. Nowadays intramedullary nailing of the humeral shaft is being performed by many surgeons with good results. Newer implants and better surgical techniques are being developed, which suggests application of this method can be widened. Purpose of this study was aimed to define whether intramedullary nailing could be an effective method or not in the treatment of humeral shaft fractures by documenting the practical points in the application of intramedullary nailing of humerus, effectiveness in fracture healing, any complications or obstacles. We managed thirteen humeral shaft fractures with closed locked intramedullary nailing with distal fanning devices(Seidel nail) from March 1993 to April 1994. Average follow-up period was 14 months(12 months-18 months). The results were as follows; 1, Union of the fracture was obtained at average 12.9 weeks(9 weeks-20 weeks) postoperatively except one case of nonunion, in which case, union was obtained at postoperative 10 months finally. 2. Among the 13 cases, painful limitation of shoulder motion remained in 6 cases. This complication was more common in the cases with protruded proximal end of the nail. Above results suggest that locked intramedullary nailing seemed to be one of the useful method in the treatment of the humeral shaft fractures. However, destruction and irritation of shoulder by the nail was found to be a grave problem, and we found that further investigations should solve this problem.
Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Fracture Healing ; Humerus ; Methods ; Rehabilitation ; Shoulder ; Surgeons ; Tibia

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

OBJECTIVETo discuss the curative effect of bone graft from trochanter with interlocking intramedullary nail for comminute fracture of femur.

METHODSFrom January of 2009 to January of 2010, fifty patients with comminute fracture of femur were treated by the therapy of bone graft from trochanter with interlocking intramedullary nail, included 35 males and 15 females with an average age of 38.4 years old ranging from 28 to 50 years. According to AO/ASIF classification system, there were 15 cases of type B1, 20 of type B2, 8 of type B3, 7 of type C1.

RESULTSAll the patients were followed up for 12 to 24 months, averaged 14.4 months. All the broken femurs knitted in 4 to 6 months, the average period of knit was 5.6 months. The injured legs with normal movement in knees,which had no infection, vascellum-nerve injury and anchylosis in knees. According to Merchan knee rating scale, the results were excellent in 25 cases, good in 20, fair in 3 and poor in 2, and the excellent and good rate was 90%.

CONCLUSIONBone graft from trochanter with interlocking intramedullary nail, which has a virtue of small injury, less blood loss, high rate of bone knit, perfect functional recovery, is a preferable therapy of fresh fracture of femur.

Adult ; Bone Transplantation ; methods ; Female ; Femoral Fractures ; surgery ; Fracture Fixation, Intramedullary ; methods ; Humans ; Male ; Middle Aged

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

External Fixators ; Female ; Femoral Fractures - diagnostic imaging Femoral Fractures - surgery ; Femoral Fractures - therapy ; Fracture Fixation, Internal - methods ; Fracture Fixation, Intramedullary - methods ; Fracture Healing - physiology