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European Journal of Trauma and... Oct 2022ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type...
PURPOSE
ESIN (elastic stable intramedullary nailing) is considered the gold standard for various pediatric fractures. The aim of this study was to analyze the incidence and type of complications during or after TEN (titanium elastic nail) removal.
METHODS
A retrospective data analysis was performed. Metal removal associated complications and preoperative extraosseous length/outlet angle of TENs as possible causes of complications were assessed.
RESULTS
The complication rate in 384 TEN removals was 3.1% (n = 12). One major complication (rupture of M. extensor pollicis brevis) was documented. One refracture at the forearm occurred, however, remodeling prior TEN removal was completed. Ten minor complications were temporary or without irreversible restrictions (3 infections, 5 scaring/granuloma, 2 temporary paraesthesia). In 38 cases (16 forearms, 10 femora, 9 humeri, 3 lower legs), intra-operative fluoroscopy had to be used to locate the implants. In patients with forearm fractures, extraosseous implant length was relatively shorter than in cases without fluoroscopy (p = 0.01), but outlet angle of TENs was not significantly different in these two groups (28.5° vs 25.6°). In patients with femur fractures, extraosseous implant length and outlet angle were tendentially shorter, respectively, lower, but this did not reach statistical significance.
CONCLUSION
Removal of TENs after ESIN is a safe procedure with a low complication rate. Technically inaccurate TEN implantation makes removal more difficult and complicated. To prevent an untimely removal and patient discomfort, nail ends must be exactly positioned and cut. Intraoperative complications may be minimized with removal of TENs before signs of overgrowth.
EVIDENCE
Level III, retrospective.
Topics: Bone Nails; Child; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Healing; Humans; Postoperative Complications; Retrospective Studies; Titanium; Treatment Outcome
PubMed: 34338820
DOI: 10.1007/s00068-021-01763-4 -
American Journal of Veterinary Research Oct 2017OBJECTIVE To compare heat generation and mechanical bone damage for tapered and cylindrical transfixation pins during drilling, tapping, and pin insertion in equine... (Comparative Study)
Comparative Study
OBJECTIVE To compare heat generation and mechanical bone damage for tapered and cylindrical transfixation pins during drilling, tapping, and pin insertion in equine third metacarpal bones. SAMPLE 16 pairs of cadaveric equine third metacarpal bones. PROCEDURES For cylindrical pin insertion, a 6.2-mm hole was drilled and tapped with a cylindrical tap, and then a standard 6.3-mm pin was inserted. For tapered pin insertion, a 6.0-mm hole was drilled, reamed with a tapered reamer, and tapped with a tapered tap, and then a 6.3-mm tapered pin was inserted. Paired t tests and 1-way ANOVAs were used to compare heat generation (measured by use of thermocouples and thermography), macrodamage (assessed by use of stereomicroscopy), and microdamage (assessed by examination of basic fuchsin-stained histologic specimens) between cylindrical and tapered pins and between tapered pins inserted to various insertion torques. RESULTS Tapered pin insertion generated less heat but resulted in more bone damage than did cylindrical pin insertion when pins were inserted to the same insertion torque. Insertion of tapered pins to increasing insertion torques up to 16 N•m resulted in increased heat generation and bone damage. CONCLUSIONS AND CLINICAL RELEVANCE Tapered pin insertion resulted in lower heat production than did cylindrical pin insertion. However, tapered pin insertion resulted in greater bone damage, which likely was attributable to differences in the tapered and cylindrical taps. A tapered pin may be preferable to a cylindrical pin for insertion in equine cortical bone provided that improvements in tap design can reduce bone damage during insertion.
Topics: Animals; Biomechanical Phenomena; Bone Nails; Cadaver; Female; Horses; Hot Temperature; Male; Metacarpal Bones
PubMed: 28945124
DOI: 10.2460/ajvr.78.10.1200 -
Injury Nov 2022The treatment of infected non-unions of the femur and the tibia remains difficult and requires control of the infection and successful bone healing. Antimicrobial...
The treatment of infected non-unions of the femur and the tibia remains difficult and requires control of the infection and successful bone healing. Antimicrobial coating of intramedullary nails promises both infection control and stabilization for subsequent bone healing. Both results for custom-made and commercially available antimicrobial coating for intramedullary nails have been published in the past mainly consisting of retrospective case series. The purpose of this work is to review the published literature on techniques and clinical outcome of antimicrobial coatings for intramedullary nails for the treatment of infected long bone non-unions. A systematic literature research in Medline, PubMed, Embase and Cochrane Library was performed in accordance to the PRISMA guidelines. Articles reporting on antimicrobial-coated intramedullary nails for the treatment of infected long bone non-unions were eligible for inclusion. In total, 22 publications were found reporting on 506 infected non-unions of the tibia and femur treated with an antimicrobial-coated nail. Most of them consisted of retrospective case series (72.7%). 469 and 37 patients were treated with an individual antibiotic-loaded PMMA-coating and commercially available gentamicin-coating for intramedullary nails, respectively. The overall infection eradication rate was 90.0% (range 68.7-100%) and the bone consolidation rate was 85.5% (range 57.9-100%). Coating specific side effects were not reported. In conclusion, the treatment of infected long bone non-unions with antimicrobial-coated nails is associated with a high infection control and bone consolidation rate and seems to be a reasonable treatment options with minimal side effects. However, scientific quality of the publications is low and randomized controlled trials are needed.
Topics: Anti-Bacterial Agents; Bone Nails; Fracture Fixation, Intramedullary; Fracture Healing; Gentamicins; Humans; Polymethyl Methacrylate; Retrospective Studies; Treatment Outcome
PubMed: 35613970
DOI: 10.1016/j.injury.2022.05.008 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Sep 2019To explore the application of individualized transiliac crest nail-grafting guide plate prepared by computer-aided design and three-dimensional (3D) printing technology...
OBJECTIVE
To explore the application of individualized transiliac crest nail-grafting guide plate prepared by computer-aided design and three-dimensional (3D) printing technology in deep pelvic external fixator implantation.
METHODS
Five patients with pelvic fractures were collected between May 2017 and February 2018. There were 4 females and 1 male with an average age of 52 years (range, 29-68 years). Pelvic fractures were classified as type B in 3 cases and type C in 2 cases by Tile classification. The interval between injury and operation was 6-14 days (mean, 9 days). The preoperative CT images of pelvic fractures were collected. The data was reconstructed by 3D imaging reconstruction workstation. An individualized transiliac crest nail-grafting guide plate was designed on the virtual 3D model. The individualized transiliac crest nail-grafting guide plate and the solid pelvic model were produced with the 3D printing technology. The individualized transiliac crest nail-grafting guide plate was used for intraoperative deep pin position on iliac crest after the preoperative simulation. The follow-up CT scans were used to determine the differences in distance from anterior superior iliac spine, convergence angle, and caudal angle between the preoperative plan and postoperative measurement.
RESULTS
During the operation, the individualized transiliac crest nail-grafting guide plate was used to guide the placement of 20 pins. X-ray film and CT examination showed that all pins were well positioned. The average depth of pins was 83.16 mm (range, 70.13-100.53 mm). Fitted 3D reconstruction images showed that the entry point and orientation of the pins were all consistent with preoperative schemes. Compared with the planned nail path, there was no significant difference in the distance from anterior superior iliac spine, convergence angle, and caudal angle in the actual nail path ( >0.05). No loosening and rupture of pin, no damage of blood vessels and nerve, and shallow or deep infection occurred during 3 months follow-up, and the incisions healed by first intention. All patients were satisfied with the treatment process. The ranges of motion of hip and knee were normal, and the visual analogue scale (VAS) score was 0-3 (mean, 0.5).
CONCLUSION
The individualized transiliac crest nail-grafting guide plate technique is the improvement of traditional technique. It can increase accuracy and effective depth of pin position, enable patients to obtain pelvic mechanical stability quickly after operation, and reduce the risk of complications related to nail path.
Topics: Adult; Aged; Bone Nails; External Fixators; Female; Fracture Fixation; Fractures, Bone; Humans; Male; Middle Aged; Pelvic Bones
PubMed: 31512455
DOI: 10.7507/1002-1892.201903102 -
The Journal of International Medical... Sep 2019This study was performed to investigate the efficacy and safety of percutaneous antegrade nailing with a reductor-T tape pin in the treatment of ipsilateral...
OBJECTIVE
This study was performed to investigate the efficacy and safety of percutaneous antegrade nailing with a reductor-T tape pin in the treatment of ipsilateral multisegmental femoral shaft fractures (IMFSFs).
METHODS
Nineteen patients with IMFSFs underwent antegrade nailing with a reductor-T tape pin by percutaneous techniques. The operation time, reduction time, fluoroscopy time, blood loss, fracture union time, and complications were recorded.
RESULTS
All 19 patients (100%) achieved technical success. The mean and median operation time were 62.42±16.27 and 60 (range, 40–105) minutes, respectively; the mean and median reduction time were 11.47±3.78 and 10 (range, 8–22) minutes, respectively; the mean and median fluoroscopy time were 16.63±6.10 and 15 (range, 10–35) s, respectively; and the mean and median blood loss were 185.26±62.75 and 180 (range, 110–350) mL, respectively. Additionally, all 19 patients (100%) achieved fracture union within a mean and median time of 3.95±1.75 and 3 (range, 3–9) months, respectively; most patients [n=14 (73.7%)] achieved fracture union within 3 months. No obvious complications occurred during the study.
CONCLUSION
Antegrade nailing with a reductor-T tape pin by a percutaneous technique is effective and well tolerated in patients with IMFSFs.
Topics: Adult; Bone Nails; Female; Femoral Fractures; Fracture Fixation, Intramedullary; Humans; Male; Postoperative Complications; Treatment Outcome
PubMed: 31307257
DOI: 10.1177/0300060519857857 -
Journal of Orthopaedic Trauma Jun 2017Compression techniques seem to be the primary factor in determining the success of both plating and nailing techniques for the management of acute fractures and for...
Compression techniques seem to be the primary factor in determining the success of both plating and nailing techniques for the management of acute fractures and for delayed and nonunion management of these fractures. An intramedullary nail that can provide continual compression (like a plate) and mechanical manipulation of the callous throughout the course of treatment is an ideal device that provides all the advantages of plating and nailing and avoids the noted limitations of both. The UNYTE compression humeral nail is based on the PRECICE intramedullary limb lengthening system. This nail provides the ability to intraoperatively compress a humeral fracture immediately and continue compression in the outpatient setting with the external remote controller. This compression nail allows the surgeon to continually modulate stability through controlled compression and the ability to relengthen if necessary. The capacity to achieve constant compression at the fracture site has demonstrated rapid healing of the "at risk" humerus fracture in this series. We review the current indications for use of this device after its early introduction. In most cases, this was the failure of conservative brace management that presented with a progressive distraction gap and minimal callous formation or those fractures that could not be adequately controlled in the brace with malalignment greater than 20 degrees. The protocol for intraoperative compression using the external remote controller is detailed, as is the outpatient protocol for follow-up. The compression algorithm for progression to full fracture healing is also reviewed.
Topics: Bone Nails; Fracture Fixation, Internal; Humans; Humeral Fractures
PubMed: 28486287
DOI: 10.1097/BOT.0000000000000846 -
Annals of the Royal College of Surgeons... Feb 2023
Topics: Humans; External Fixators; Fracture Fixation; Bone Nails
PubMed: 35446697
DOI: 10.1308/rcsann.2021.0343 -
Journal of Orthopaedics and... Sep 2014Femoral fracture in adolescents is a significant injury. It is generally agreed that operative fixation is the treatment of choice, and rigid intramedullary nail... (Review)
Review
BACKGROUND
Femoral fracture in adolescents is a significant injury. It is generally agreed that operative fixation is the treatment of choice, and rigid intramedullary nail fixation is a treatment option. However, numerous types of rigid nails to fix adolescent femoral fractures have been described. Hence, the aim of this paper was to collate and evaluate the available evidence for managing diaphyseal femoral fractures in adolescents using rigid intramedullary nails.
MATERIALS AND METHODS
A literature search was undertaken using the healthcare database website ( http://www.library.nhs.uk/hdas ). Medline, CINAHL, Embase, and the Cochrane Library databases were searched to identify prospective and retrospective studies of rigid intramedullary nail fixation in the adolescent population.
RESULTS
The literature search returned 1,849 articles, among which 51 relevant articles were identified. Of these 51 articles, 23 duplicates were excluded, so a total of 28 articles were reviewed. First-generation nails had a high incidence of limb length discrepancy (Küntscher 5.8 %, Grosse-Kempf 9 %), whilst second-generation nails had a lower incidence (Russell-Taylor 1.7 %, AO 2.6 %). Avascular necrosis was noted with solid Ti nails (2.6 %), AO femoral nails (1.3 %) and Russell-Taylor nails (0.85 %). These complications have not been reported with the current generation of nails.
CONCLUSIONS
Rigid intramedullary nail fixation of femoral fractures in adolescents is a useful procedure with good clinical results. A multiplanar design and lateral trochanteric entry are key to a successful outcome of titanium alloy nail fixation.
Topics: Adolescent; Age Factors; Bone Nails; Femoral Fractures; Fracture Fixation, Intramedullary; Humans; Treatment Outcome
PubMed: 24077687
DOI: 10.1007/s10195-013-0270-y -
BMC Musculoskeletal Disorders Sep 2022Hip fractures are common in elderly populations and can be life threatening. Changes in healthcare delivery and outcomes for patients with hip fracture treated with...
BACKGROUND
Hip fractures are common in elderly populations and can be life threatening. Changes in healthcare delivery and outcomes for patients with hip fracture treated with intramedullary nails are not well characterized. The objectives of our study were: 1) the characterization of patients treated with the Trochanteric Fixation Nail -Advanced™(TFNA) Proximal Femoral Nailing System or comparable nails (index) and estimate 12-month all-cause readmissions (ACR) and reoperations following index; and 2) the evaluation of 10-year healthcare utilization (HCU) trends for treatment of femoral fractures with femoral nails.
METHODS
This is a retrospective database analysis using the Premier hospital database. All adults with femoral fracture treated with an intramedullary nail, from 2010 to Q3 2019, in the inpatient setting, were identified. Exclusion criteria included patients with bilateral hip surgery and presence of breakage at time of initial surgery. The primary outcome was ACR and reoperation, the secondary outcomes were healthcare utilization metrics. Variables included demographics, comorbidities (Elixhauser Index (EI)), surgical intervention variables and hospital characteristics.
RESULTS
Forty-one thousand one hundred four patients were included in the study, of which 14,069 TFNA patients, with average age 77.9 (Standard deviation (SD): 12.0), more than 60% with 3 or more comorbidities (more than 64% for TFNA), 40% with severe or extreme disease severity and one third with severe or extreme risk for mortality. ACR reached 60.1% (95% confidence interval (CI): 59.6%-60.5%) - for TFNA: 60.0% (95%CI: 59.2%-60.8%). The reoperation rate was 4.0% (95%CI: 3.8%-4.2%) - for TFNA: 3.8% (95%CI: 3.5%-4.1%). Length of stay (LOS) averaged 5.8 days (SD: 4.8), and 12-month hip reoperation was 4.0% (3.8%-4.2%), in TFNA cohort: 3.8% (3.5%-4.1%). From 2010 to 2019: the percentage patients operated within 48 h of admission significantly increased, from 75.2% (95%CI: 74.3%-76.1%) to 84.3% (95%CI: 83.9%-84.6%); LOS significantly decreased, from 6.2 (95%CI: 6.0-6.4) to 5.6 (95%CI: 5.5-5.7) days; discharge to skilled nursing facilities (SNF) increased from 56.0% (95%CI: 54.8%-57.2%) to 61.5% (95%CI: 60.8%-62.2%); ACR rates decreased but reoperation rates remained constant.
CONCLUSIONS
ACR and reoperation rates were similar across device types and averaged 60.1% and 4.0%, respectively. Ten-year analyses showed reductions in hospital HCU and greater reliance on SNF.
Topics: Adult; Aged; Bone Nails; Demography; Femoral Fractures; Fracture Fixation, Intramedullary; Hip Fractures; Humans; Retrospective Studies; Treatment Outcome
PubMed: 36050685
DOI: 10.1186/s12891-022-05772-1 -
Veterinary and Comparative Orthopaedics... Sep 2022The main aim of this study was to compare the biomechanical properties of caudal cervical vertebral stabilization using bicortical transpedicular pins with...
Comparison of Cervical Stabilization with Transpedicular Pins and Polymethylmethacrylate versus Transvertebral Body Polyaxial Screws with or without an Interbody Distractor in Dogs.
OBJECTIVE
The main aim of this study was to compare the biomechanical properties of caudal cervical vertebral stabilization using bicortical transpedicular pins with polymethylmethacrylate (PMMA) versus transvertebral body polyaxial screws and connecting rods with or without an interbody distractor.
STUDY DESIGN
Ten canine cervical vertebral columns (C2-T3) were used. Four models (intact, transvertebral body polyaxial screw with interbody distractor [polyaxial + distractor], transvertebral body polyaxial screw without interbody distractor [polyaxial - distractor] and bicortical transpedicular pins/polymethylmethacrylate [pin-PMMA]) were applied to C6-7 sequentially on the same specimens. Angular range of motion (AROM) in the form of flexion and extension was measured at C4-5, C5-6 and C6-7 in all groups.
RESULTS
Treated vertebral specimens had significantly less AROM than unaltered specimens. There was no significant difference in AROM between the experimental groups at C6 and C7. Angular range of motion ratio in flexion-extension was 80.8, 72.7 and 78.3% for polyaxial + distractor, polyaxial - distractor and pin-PMMA groups, respectively, which were less than the intact group. There was no significant increase in the range of motion of the adjacent vertebrae after stabilization.
CONCLUSION
Stabilization obtained with transvertebral body polyaxial screws was comparable to that from the well-established bicortical pins/PMMA construct. Association of an intervertebral distractor did not change AROM of the polyaxial screw constructs.
Topics: Dogs; Animals; Polymethyl Methacrylate; Biomechanical Phenomena; Bone Nails; Bone Screws; Cervical Vertebrae; Range of Motion, Articular; Spinal Fusion
PubMed: 35772728
DOI: 10.1055/s-0042-1744490