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Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2022There are various distal locking options for the repair of tibia distal diametaphyseal fractures with intramedullary nails. There is no consensus about the superiority...
BACKGROUND
There are various distal locking options for the repair of tibia distal diametaphyseal fractures with intramedullary nails. There is no consensus about the superiority of any of these distal locking options. In our study, comparing nails with distal bolt locking screw (DSBLS) and conventional nails; we aimed to compare the clinical and radiological results of intramedullary nail models in fixing tibial distal diametaphyseal fractures.
METHODS
In our orthopedics and traumatology department, 117 tibial distal diametaphyseal fractures of 116 patients treated with intramedullary nails between August 2007 and May 2015 were retrospectively evaluated. Forty-six tibial distal diametaphyseal fractures of 45 patients who came to regular visits to outpatient clinic controls and who had a minimum follow-up of 18 months and whose fracture distance was between 3 and 12 cm were included in the study. The average follow-up period of the study group consisting of 28 males and 17 females with an average age of 44 (16-76 years) which was 48 months (18-100 months). The group using the DSBLS locking intramedullary nail was considered the first group and the group using the conventional distal locking intramedullary nail was considered the second group. Radiological union times, coronal, sagittal, and axial plan angulations and malunion presence were com-pared between the two groups. In addition, the two groups were compared clinically with length of time spent on weight-bearing and return to work, Olerud-Molander ankle score, and American Orthopedic Foot and Ankle Society Score scores.
RESULTS
We found that the first group was superior in terms of length of time spent on partial and full weight-bearing between the two groups (p=0.00031 and p=0.00007). In addition, the union time of the first group was shorter (p=0.0149). Other radiological or clinical results did not differ significantly between the two groups. In addition, no significant correlation was found between the distance of the fracture from the tibial plate and its angulation. In cases with malunion alone, the fracture line was more distal than those without malunion (p=0.0411).
CONCLUSION
Newly developed DSBLS intramedullary nails give as good results as conventional nails in tibia distal diametaphyseal fractures. Due to its ability to loading bone early and have a shorter union time, DSBLS can be safely preferred in distal diametaphyseal fractures and reduce complications from immobilization.
Topics: Adult; Ankle Fractures; Bone Nails; Female; Fracture Fixation, Intramedullary; Humans; Male; Retrospective Studies; Tibia; Tibial Fractures
PubMed: 35485463
DOI: 10.14744/tjtes.2020.24152 -
The Cochrane Database of Systematic... Jan 2022Hip fractures are a major healthcare problem, presenting a substantial challenge and burden to patients, healthcare systems and society. The increased proportion of... (Review)
Review
BACKGROUND
Hip fractures are a major healthcare problem, presenting a substantial challenge and burden to patients, healthcare systems and society. The increased proportion of older adults in the world population means that the absolute number of hip fractures is rising rapidly across the globe. Most hip fractures are treated surgically. This Cochrane Review evaluates evidence for implants used to treat extracapsular hip fractures.
OBJECTIVES
To assess the relative effects of cephalomedullary nails versus extramedullary fixation implants for treating extracapsular hip fractures in older adults.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, Web of Science, the Cochrane Database of Systematic Reviews, Epistemonikos, ProQuest Dissertations & Theses, and the National Technical Information Service in July 2020. We also searched clinical trials databases, conference proceedings, reference lists of retrieved articles, and conducted backward-citation searches.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs comparing cephalomedullary nails with extramedullary implants for treating fragility extracapsular hip fractures in older adults. We excluded studies in which all or most fractures were caused by a high-energy trauma or specific pathologies other than osteoporosis.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. We collected data for seven critical outcomes: performance of activities of daily living (ADL), delirium, functional status, health-related quality of life, mobility, mortality (reported within four months of surgery as 'early mortality'; and reported from four months onwards, with priority given to data at 12 months, as '12 months since surgery'), and unplanned return to theatre for treating a complication resulting directly or indirectly from the primary procedure (such as deep infection or non-union). We assessed the certainty of the evidence for these outcomes using GRADE. MAIN RESULTS: We included 76 studies (66 RCTs, 10 quasi-RCTs) with a total of 10,979 participants with 10,988 extracapsular hip fractures. The mean ages of participants in the studies ranged from 54 to 85 years; 72% were women. Seventeen studies included unstable trochanteric fractures; three included stable trochanteric fractures only; one included only subtrochanteric fractures; and other studies included a mix of fracture types. More than half of the studies were conducted before 2010. Owing to limitations in the quality of reporting, we could not easily judge whether care pathways in these older studies were comparable to current standards of care. We downgraded the certainty of the outcomes because of high or unclear risk of bias; imprecision (when data were available from insufficient numbers of participants or the confidence interval (CI) was wide); and inconsistency (when we noted substantial levels of statistical heterogeneity or differences between findings when outcomes were reported using other measurement tools). There is probably little or no difference between cephalomedullary nails and extramedullary implants in terms of mortality within four months of surgery (risk ratio (RR) 0.96, 95% CI 0.79 to 1.18; 30 studies, 4603 participants) and at 12 months (RR 0.99, 95% CI 0.90 to 1.08; 47 studies, 7618 participants); this evidence was assessed to be of moderate certainty. We found low-certainty evidence for differences in unplanned return to theatre but this was imprecise and included clinically relevant benefits and harms (RR 1.15, 95% CI 0.89 to 1.50; 50 studies, 8398 participants). The effect estimate for functional status at four months also included clinically relevant benefits and harms; this evidence was derived from only two small studies and was imprecise (standardised mean difference (SMD) 0.02, 95% CI -0.27 to 0.30; 188 participants; low-certainty evidence). Similarly, the estimate for delirium was imprecise (RR 1.22, 95% CI 0.67 to 2.22; 5 studies, 1310 participants; low-certainty evidence). Mobility at four months was reported using different measures (such as the number of people with independent mobility or scores on a mobility scale); findings were not consistent between these measures and we could not be certain of the evidence for this outcome. We were also uncertain of the findings for performance in ADL at four months; we did not pool the data from four studies because of substantial heterogeneity. We found no data for health-related quality of life at four months. Using a cephalomedullary nail in preference to an extramedullary device saves one superficial infection per 303 patients (RR 0.71, 95% CI 0.53 to 0.96; 35 studies, 5087 participants; moderate-certainty evidence) and leads to fewer non-unions (RR 0.55, 95% CI 0.32 to 0.96; 40 studies, 4959 participants; moderate-certainty evidence). However, the risk of intraoperative implant-related fractures was greater with cephalomedullary nails (RR 2.94, 95% CI 1.65 to 5.24; 35 studies, 4872 participants; moderate-certainty evidence), as was the risk of later fractures (RR 3.62, 95% CI 2.07 to 6.33; 46 studies, 7021 participants; moderate-certainty evidence). Cephalomedullary nails caused one additional implant-related fracture per 67 participants. We noted no evidence of a difference in other adverse events related or unrelated to the implant, fracture or both. Subgroup analyses provided no evidence of differences between the length of cephalomedullary nail used, the stability of the fracture, or between newer and older designs of cephalomedullary nail.
AUTHORS' CONCLUSIONS
Extramedullary devices, most commonly the sliding hip screw, yield very similar functional outcomes to cephalomedullary devices in the management of extracapsular fragility hip fractures. There is a reduced risk of infection and non-union with cephalomedullary nails, however there is an increased risk of implant-related fracture that is not attenuated with newer designs. Few studies considered patient-relevant outcomes such as performance of activities of daily living, health-related quality of life, mobility, or delirium. This emphasises the need to include the core outcome set for hip fracture in future RCTs.
Topics: Aged; Aged, 80 and over; Bone Nails; Female; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Middle Aged; Nails; Systematic Reviews as Topic
PubMed: 35080771
DOI: 10.1002/14651858.CD000093.pub6 -
Contrast Media & Molecular Imaging 2022In order to explore the clinical application value of intelligent health care knowledge combined with closed reduction intramedullary nail fixation in elderly patients...
In order to explore the clinical application value of intelligent health care knowledge combined with closed reduction intramedullary nail fixation in elderly patients with intertrochanteric fracture of the femur, a retrospective analysis is performed on 80 elderly patients who received intertrochanteric surgery from January 2019 to January 2021. All patients were divided into study group and control group based on intelligent medical knowledge received or not. During the phase of treatment, both the two groups were treated with closed reduction and intramedullary nailing. The control group received conventional knowledge training and rehabilitation before and after the surgery, and the research group received additional intelligent medical knowledge health care. Observations of patients after bed and ground time are compared and the VAS score is used to evaluate the pain degree at 12 h, 24 h, and 48 h after surgery. Besides, the incidence of postoperative complications in the two groups is observed. From the clinical follow-up results, it is clearly evident that intramedullary nail fixation based on medical care knowledge can effectively improve the hip function and quality of life in patients, reduce postoperative pain, and improve the prognosis of elderly patients with femoral trochanteric fracture.
Topics: Aged; Bone Nails; Delivery of Health Care; Hip Fractures; Humans; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 35854781
DOI: 10.1155/2022/3556330 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Oct 2023To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail...
OBJECTIVE
To evaluate effectiveness of proximal femur bionic nail (PFBN) in treatment of intertrochanteric fractures in the elderly compared to the proximal femoral nail antirotation (PFNA).
METHODS
A retrospective analysis was made on 48 geriatric patients with intertrochanteric fractures, who met the selection criteria and were admitted between January 2020 and December 2022. Among them, 24 cases were treated with PFBN fixation after fracture reduction (PFBN group), and 24 cases were treated with PFNA fixation (PFNA group). There was no significant difference in baseline data such as age, gender, cause of injury, side and type of fracture, time from injury to operation, and preoperative mobility score, American Society of Anesthesiologists (ASA) score, Alzheimer's disease degree scoring, self-care ability score, osteoporosis degree (T value), and combined medical diseases between the two groups ( >0.05). The operation time, intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, occurrence of complications, weight-bearing time after operation, and postoperative visual analogue scale (VAS) score, walking ability score, mobility score, self-care ability score were recorded and compared between the two groups. And the radiographic assessment of fracture reduction quality and postoperative stability, and fracture healing time were recorded.
RESULTS
The operations in both groups were successfully completed. All patients were followed up 6-15 months with an average time of 9.8 months in PFBN group and 9.6 months in PFNA group. The operation time was significantly longer in PFBN group than in PFNA group ( <0.05), but there was no significant difference in intraoperative blood loss, number of blood transfusions, transfusion volume, length of hospital stay, change in activity ability score, and change in self-care ability score between the two groups ( >0.05). The weight-bearing time after operation was significantly shorter in PFBN group than in PFNA group ( <0.05), and the postoperative VAS score and walking ability score were significantly better in PFBN group than in PFNA group ( <0.05). Radiographic assessment showed no significant difference in fracture reduction scores and postoperative stability scores between the two groups ( >0.05). All fractures healed and there was no significant difference in fracture healing time between the two groups ( >0.05). The incidence of complications was significantly lower in PFBN group (16.7%, 4/24) than in PFNA group (45.8%, 11/24) ( <0.05).
CONCLUSION
Compared with PFNA, PFBN in the treatment of elderly intertrochanteric fractures can effectively relieve postoperative pain, shorten bed time, reduce the risk of complications, and facilitate the recovery of patients' hip joint function and walking ability.
Topics: Humans; Aged; Retrospective Studies; Fracture Fixation, Intramedullary; Bionics; Blood Loss, Surgical; Treatment Outcome; Bone Nails; Hip Fractures; Femur
PubMed: 37848313
DOI: 10.7507/1002-1892.202305083 -
Hand (New York, N.Y.) Nov 2022The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius...
BACKGROUND
The purpose of this study was to examine the outcomes and return to play with early rehabilitation in athletes who sustained unstable extra-articular distal radius fractures treated with a purpose-designed threaded pin technique.
METHODS
This prospective study examined athletes with displaced and unstable distal radius fractures treated surgically with purpose-designed threaded pins. Patients were enrolled in an early rehabilitation protocol, with formal therapy initiated on postoperative days 1 to 3. Range of motion and strength measurements were documented throughout the postoperative period, noting the time until return to athletic competition. These results were compared with historical values using other forms of fixation.
RESULTS
Nineteen athletes, average age of 35 years, were treated with threaded pin technique with early rehabilitation; all had complete healing and maintained alignment based on radiographic evaluation. The average time span between surgery and release to competition was 8 weeks, with all but 1 patient returning to sport within 12 weeks of injury. Average postoperative flexion measured 58°, extension was 57°, pronation was 81°, and supination was 74°. JAMAR grip strength in position 3 measured 25.22 kg, which equated to 73% of the uninjured side's grip strength at the time of release to play.
CONCLUSIONS
Surgical fixation using a purpose-designed threaded pin is a useful alternative to volar plating for isolated radial styloid and extra-articular distal radius fractures in athletes. The purpose-designed threaded pin may afford athletes rapid recovery during the early postoperative period, preserving strength and dexterity and minimizing time lost before return to play.
Topics: Humans; Adult; Radius Fractures; Prospective Studies; Fracture Fixation, Internal; Bone Nails; Athletes
PubMed: 33345609
DOI: 10.1177/1558944720975135 -
Journal of Orthopaedic Surgery and... Feb 2023To explore the preoperative radiographic features and reduction methods of irreducible trochanteric and subtrochanteric fractures of the femur and to compare the...
AIM
To explore the preoperative radiographic features and reduction methods of irreducible trochanteric and subtrochanteric fractures of the femur and to compare the perioperative characteristics and prognoses of irreducible and reducible fractures.
METHODS
The data of 1235 patients with femoral trochanteric fractures surgically treated in our hospital between January 2010 and January 2021 were retrospectively analyzed. According to the inclusion criteria and exclusion criteria, 1163 cases of femoral trochanteric and subtrochanteric fractures were included in this study. Fractures in which good or acceptable reduction could not be reached by closed manipulation were defined as irreducible fractures. The preoperative radiographic features, fracture displacement patterns after closed manipulation and intraoperative reduction methods used to treat irreducible fractures were analyzed, and the perioperative characteristics and prognoses of irreducible fractures and reducible fractures were compared.
RESULTS
There were 224 patients in the irreducible group and 939 patients in the reducible group. According to the radiographic features of fractures, irreducible fractures could be divided into four types: those with interlocking of the fracture, sagging of the femoral shaft, splitting of the lateral wall or medial wall, and comminution of the subtrochanteric area. Various kinds of reduction techniques were needed for different types.
CONCLUSIONS
The incidence of irreducible trochanteric fractures was 15.4%, while the incidence of irreducible subtrochanteric fractures was 84.6%. According to the radiographic features of fractures, they can be divided into four types. It is important to identify irreducible fractures preoperatively and make comprehensive plans to the greatest extent possible to shorten the operation time, reduce intraoperative blood loss, and reduce the incidence of complications.
Topics: Humans; Retrospective Studies; Hip Fractures; Femur; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Bone Nails; Treatment Outcome
PubMed: 36843011
DOI: 10.1186/s13018-023-03635-6 -
Medicina (Kaunas, Lithuania) Jun 2022Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail...
Freehand distal interlocking of intramedullary nails is technically demanding and prone to handling issues. It requires precise placement of a screw through the nail under fluoroscopy guidance and can result in a time consuming and radiation expensive procedure. Dedicated training could help overcome these problems. The aim of this study was to assess construct and face validity of new Digitally Enhanced Hands-On Surgical Training (DEHST) concept and device for training of distal interlocking of intramedullary nails. Twenty-nine novices and twenty-four expert surgeons performed interlocking on a DEHST device. Construct validity was evaluated by comparing captured performance metrics-number of X-rays, nail hole roundness, drill tip position and drill hole accuracy-between experts and novices. Face validity was evaluated with a questionnaire concerning training potential and quality of simulated reality using a 7-point Likert scale. Face validity: mean realism of the training device was rated 6.3 (range 4-7). Training potential and need for distal interlocking training were both rated with a mean of 6.5 (range 5-7), with no significant differences between experts and novices, ≥ 0.234. All participants (100%) stated that the device is useful for procedural training of distal nail interlocking, 96% wanted to have it at their institution and 98% would recommend it to colleagues. Construct validity: total number of X-rays was significantly higher for novices (20.9 ± 6.4 versus 15.5 ± 5.3, = 0.003). Success rate (ratio of hit and miss attempts) was significantly higher for experts (novices hit: = 15; 55.6%; experts hit: = 19; 83%, = 0.040). The evaluated training device for distal interlocking of intramedullary nails yielded high scores in terms of training capability and realism. Furthermore, construct validity was proven by reliably discriminating between experts and novices. Participants indicate high further training potential as the device may be easily adapted to other surgical tasks.
Topics: Bone Nails; Bone Screws; Fluoroscopy; Fracture Fixation, Intramedullary; Humans; Radiography
PubMed: 35744036
DOI: 10.3390/medicina58060773 -
Injury Nov 2022The use of the intramedullary lengthening nail has gained in popularity over the last decade. The reduction in complications associated with the use of external fixators... (Review)
Review
The use of the intramedullary lengthening nail has gained in popularity over the last decade. The reduction in complications associated with the use of external fixators and excellent patient outcomes has resulted in the largest change in management of limb length discrepancy since the concept of distraction osteogenesis was accepted by the Western world in the 1980s. Success following "simple" limb lengthening has led to surgeons extending the indications for the lengthening nail, including different bone segments, lengthening associated with potential joint instability and lengthening combined with acute deformity correction. There has been a drive for further implant modification to reduce complications, and enable full weight bearing during the lengthening process. This would offer the opportunity to consider simultaneous limb lengthening. The aim of this review is to evaluate the literature published over the last five years and highlight important learning points and technical tips for these expanding indications.
Topics: Bone Lengthening; Bone Nails; External Fixators; Femur; Humans; Leg Length Inequality; Osteogenesis, Distraction; Treatment Outcome
PubMed: 35851475
DOI: 10.1016/j.injury.2022.06.024 -
The Canadian Veterinary Journal = La... Jan 2023A 10-week-old Yorkshire terrier had lameness of the right forelimb with complete lateral radioulnar luxation at the humerus, consistent with Type III congenital elbow...
A 10-week-old Yorkshire terrier had lameness of the right forelimb with complete lateral radioulnar luxation at the humerus, consistent with Type III congenital elbow luxation; this is rarely treated in the presence of multiple skeletal deformities. Lateral subluxation of the radial head at the left elbow was diagnosed as Type I congenital elbow luxation. Procurvatum, distal valgus, and external torsion were present in both antebrachiae. Surgical stabilization of the right elbow was performed with temporary transarticular pins in the humeroulnar and radioulnar joints. A custom-made orthosis was applied to support the surgical reduction for 20 wk. Recurrent luxation was not observed. After complete right-sided function was established, the left forelimb showed noticeable instability in the antebrachium, and the puppy frequently fell while running. The lateral collateral ligament of the left elbow was augmented using screws and synthetic ligaments 22 wk after the right-side surgery. Congruity of the left elbow joint improved, and the puppy could bear full weight on the left forelimb, although slight deficits in movement and falling were observed. We demonstrate the effectiveness of combining a temporary transarticular pin and custom-made orthosis while treating Type III congenital elbow luxation and the inadequacy of collateral ligament augmentation alone for treating Type I congenital elbow luxation with antebrachium deformities. Key clinical message: Herein, we observed that a combination of a temporary transarticular pin and a custom-made orthosis was effective for the treatment of Type III congenital elbow luxations.
Topics: Animals; Dogs; Bone Nails; Dog Diseases; Forelimb; Joint Dislocations; Joints
PubMed: 36593940
DOI: No ID Found -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Dec 2019To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation. (Review)
Review
OBJECTIVE
To review the history, current situation, and progress of augmentation plate (AP) for femoral shaft nonunion after intramedullary nail fixation.
METHODS
The results of the clinical studies about the AP in treatment of femoral shaft nonunion after intramedullary nail fixation in recent years were widely reviewed and analyzed.
RESULTS
The AP has been successfully applied to femoral shaft nonunion after intramedullary nail fixation since 1997. According to breakage of the previous nailing, AP is divided into two categories: AP with retaining the previous intramedullary nail and AP with exchanging intramedullary nail. AP is not only suitable for simple nonunion, but also for complex nonunion with severe deformity. Compared with exchanging intramedullary nail, lateral plate, and dual plate, AP has less surgical trauma, shorter healing time, higher healing rate, and faster returning to society. However, there are still some problems with the revision method, including difficulty in bicortical screw fixation, lack of anatomic plate suitable for femoral shaft nonunion, and lack of postoperative function and quality of life assessment.
CONCLUSION
Compared with other revision methods, AP could achieve higher fracture healing rate and better clinical prognosis for patients with femoral shaft nonunion. However, whether patients benefit from AP in terms of function and quality of life remain uncertain. Furthermore, high-quality randomized controlled clinical studies are needed to further confirm that AP are superior to the other revision fixations.
Topics: Bone Nails; Bone Plates; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Healing; Fractures, Ununited; Humans; Quality of Life; Treatment Outcome
PubMed: 31823542
DOI: 10.7507/1002-1892.201903073