Are inflatable nails an alternative to interlocked nails in tibial fractures?
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ABSTRACT:
SUBMITTER: Blomquist J
PROVIDER: S-EPMC2311493 | biostudies-other | 2008 May
REPOSITORIES: biostudies-other
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Project description:ObjectiveAngle stable interlocking intramedullary nail (ASIN), a novel technique, has rarely been used for treatment of tibial plateau fractures (TPF). This retrospective study was designed to introduce this novel technique, ASIN, as well as to describe the initial experience and verify the effectiveness when ASIN was used for the management for TPF.MethodsA cohort of 19 cases with closed TPF aged from 18-70 years with at least 23 months follow-up from November 2008 to September 2013 was analyzed retrospectively. All patients underwent the ASIN procedure, which was performed by the same group of surgeons. Perioperative and postoperative parameters like the measurement of radiographic pictures, surgical data, and clinical function were recorded including the changes in treatment. A modified Hohl-Luck radiological and functional score combined with the Hospital for Special Surgery (HSS) score were applied to evaluate the final results and to provide reliable data through the whole procedure when applying the ASIN procedure.ResultsThe patients were followed up regularly for an average of 26.3 (range, 23-34) months. All patients achieved a bony union at an average of 15.1 weeks with no incidences of malunion, nonunion, or infection. Anatomical reduction of the articular surface was obtained in 16 patients. No secondary failure of fixation occurred. The mean postoperative knee flexion was 122.9°. The modified Hohl-Luck radiological and functional score was excellent and good, respectively, in 16 patients. The mean HSS score was 89.4.ConclusionThe angle stable interlocking intramedullary nail system turned out to be a viable alternative protocol in the treatment of tibia plateau fractures and provided satisfactory results, with good fracture reduction, biomechanical fixation, low rates of complications, and passable postoperative knee function.
| S-EPMC6594501 | biostudies-literature
Project description:BackgroundSurgeons agree on the benefits of operative treatment of tibial fractures - the most common of long bone fractures - with an intramedullary rod or nail. Rates of re-operation remain high - between 23% and 60% in prior trials - and the two alternative nailing approaches, reamed or non-reamed, each have a compelling biological rationale and strong proponents, resulting in ongoing controversy regarding which is better.Methods/designThe objective of this trial was to assess the impact of reamed versus non-reamed intramedullary nailing on rates of re-operation in patients with open and closed fractures of the tibial shaft. The study to prospectively evaluate reamed intramedullary nails in tibial fractures (S.P.R.I.N.T) was a multi-center, randomized trial including 29 clinical sites in Canada, the United States and the Netherlands which enrolled 1200 skeletally mature patients with open (Gustilo Types I-IIIB) or closed (Tscherne Types 0-3) fractures of the tibial shaft amenable to surgical treatment with an intramedullary nail. Patients received a statically locked intramedullary nail with either reamed or non-reamed insertion. The first strategy involved fixation of the fracture with an intramedullary nail following reaming to enlarge the intramedullary canal (Reamed Group). The second treatment strategy involved fixation of the fracture with an intramedullary nail without prior reaming of the intramedullary canal (Non-Reamed Group). Patients, outcome assessors, and data analysts were blinded to treatment allocation. Peri-operative care was standardized, and re-operations before 6 months were proscribed. Patients were followed at discharge, 2 weeks post-discharge, and at 6 weeks, 3, 6, 9, and 12 months post surgery. A committee, blinded to allocation, adjudicated all outcomes.DiscussionThe primary outcome was re-operation to promote healing, treat infection, or preserve the limb (fasciotomy for compartment syndrome after nailing). The primary outcome was a composite comprising the following re-operations: bone grafts, implant exchanges, and dynamizations, in patients with fracture gaps less than 1 cm post intramedullary nail insertion. Infections and fasciotomies were considered events irrespective of the fracture gap. We planned a priori to conduct a subgroup analysis of outcomes in patients with open and closed fractures. S.P.R.I.N.T is the largest collaborative trial evaluating alternative orthopaedic surgical interventions in patients with tibial shaft fractures. The methodological rigor will set new benchmarks for future trials in the field and its results will have important impact on patient care. The S.P.R.I.N.T trial was registered [ID NCT00038129] and received research ethics approval (REB#99-077).
| S-EPMC2446397 | biostudies-literature
Project description: Not available
| S-EPMC10835205 | biostudies-literature
Project description:OBJECTIVES:This study was performed to determine (1) the incidence of humeral shaft fractures within the Medicare noncancer population, (2) the trends in utilization of humeral shaft fixation techniques by plate-and-screw devices and intramedullary nails, (3) differences in procedure times, and (4) the outcomes of individuals as measured by rate of secondary operations and 1-year mortality. DESIGN/SETTING:Retrospective comparative cohort analysis. A cancer-free Medicare part B claims sample derived from a 5% sample from the years 1993 to 2007 was analyzed. PATIENTS/INTERVENTION:Our cohorts were generated by diagnostic and procedural codes for humeral shaft fractures. MAIN OUTCOME MEASUREMENT:The incidence of humeral shaft fracture and trend in operative fixation were evaluated for all years of data. Surgical times were assessed by anesthesia Current Procedural Terminology codes. Outcomes and complications were assessed by Current Procedural Terminology codes. The proportion of individuals experiencing complications and 1-year mortality were compared by proportion hazards. RESULTS:We identified 1385 claims for humeral shaft fractures over 15 years, with an adjusted rate of between 12.0 and 23.4 fractures per 100,000 beneficiaries. We identified 511 individuals who received surgical treatment for humeral shaft fractures, 451 of whom had complete 1-year follow-up data. Nail fixation was more prevalent than plate fixation most years and had shorter anesthesia time by 27.1 minutes (P < 0.0001). There were no significant differences in the complication rates between the 2 groups as measured by incidence of secondary operations and 1-year mortality. CONCLUSIONS:Intramedullary nails are used for the majority of operative humeral shaft fractures among Medicare beneficiaries. Nailing has a shorter mean operative time. The 2 surgical techniques had no significant differences in terms of risk of secondary procedures and 1-year mortality. LEVEL OF EVIDENCE:: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
| S-EPMC3399046 | biostudies-literature
Project description:PurposeTo examine the condition and triggers of stress fractures of the lateral tibial plateau (LTP) similar to type III lateral hinge fractures (LHFs) after open wedge high tibial osteotomy (OWHTO).MethodsOWHTO was performed in 118 knees. They were examined for LHFs by computed tomography (CT). Patients were divided into the stress fracture group (Group SF) if they showed fracture lines on CT performed after starting weight-bearing walking and the normal group (Group N) for others.ResultsThe mean age was significantly older in Group SF (P?=?0.022). Preoperatively, Group SF showed a significantly higher tibio-femoral angle (TFA, P?=?0.014). No significant differences were observed in TFA and weight-bearing line ratio after surgery. Correction angle was significantly higher in the SF group. And all of the SF were more than 13 degrees. There was no significant difference in LHF incidence between groups, whereas stress fracture incidence differed significantly for each type of LHF (chi-squared test, P?=?0.0001): 14.6% of type I cases, 100% of type II cases, 0% of type III cases, and 6.1% of those without LHF.DiscussionThe load on the LTP is assumed to act as a shearing force in type II fractures, which may contribute greatly to stress fractures. In type III, stress fractures may not occur because of the load dispersed at the fracture part. The stress fracture site is similar to type III LHF, and this kind of fracture is thought to be a delayed type III because it occurs after patients start weight-bearing walking. Moreover, they are observed in type I cases with a stable hinge and in 6% of cases without LHF. This study showed that high varus knees corrected with a large correction angle may develop stress fractures. OWHTO requires attention to stress fractures of the LTP, which can be regarded as delayed type III, in those developing LHFs postoperatively or having a high varus knee preoperatively.ConclusionThese results indicated the possibility of stress fracture in LTP during weight-bearing exercise after OWHTO, which was regarded as a delayed type III fracture. The results showed that Correction angle was more than 13 degrees, and lateral hinge fracture type II of the Takeuchi classification was an inducement of this stress fracture.Level of evidenceLevel IV.
| S-EPMC6864358 | biostudies-literature
Project description:The purpose of this technical note and accompanying video is to describe a modified arthroscopic suture fixation technique to treat tibial spine avulsion fractures. Twenty-one patients underwent arthroscopic treatment for tibial spine avulsion with our technique; they were clinically and biomechanically evaluated at 2 years' follow-up and showed optimal clinical and radiographic outcomes. Repair with this arthroscopic technique provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the anterior cruciate ligament: suture methods based on the avulsed bone fragment are technically impossible, but sutures through the base of the ligament itself provide secure fixation, reducing the risks of comminution of the fracture fragment and eliminating the time for hardware removal. This arthroscopic technique restores the length and the integrity of the anterior cruciate ligament and provides a simplified, reproducible method of treating patients, including young patients, with low hardware costs in comparison to sutures using anchors or other hardware.
| S-EPMC3986477 | biostudies-literature
Project description:UNLABELLED: The indications for intramedullary nailing have expanded to include most tibial shaft fractures. Nail design has improved since their first introduction, but distal locking remains a difficult part of the procedure, resulting in radiation exposure to the patient and the surgeon and increased operation time. To address these issues, we describe an alternative surgical technique using a newly designed distal targeting device that consists of a proximally mounted aiming arm, and we report the preliminary data from its use in all tibial shaft fractures amenable to surgery for a 2-year period. Sixty-three tibial shaft fractures were treated with this method. The mean duration of the distal locking was 6.5 minutes, and in all successful cases, radiation exposure for distal locking was two shots (one shot before targeting and another for the confirmation of proper screw insertion). Radiation exposure was on average 0.85 seconds (range, 0.4-1.2 seconds) and 1.4 mGy (range, 0.8-1.9 mGy). There were no major intraoperative complications related to the technique. The method has certain advantages and can reduce radiation exposure and operation time. Nonetheless, familiarity with the instrumentation is a prerequisite for accurate distal locking. LEVEL OF EVIDENCE: Level IV Therapeutic study.
| S-EPMC2505307 | biostudies-other
Project description:OBJECTIVE:Unstable femoral neck fractures are typically high-angled shear fractures caused by high-energy trauma. Internal fixation of femoral neck fractures with placement of parallel cannulated screws in an inverted triangle configuration is commonly performed in the clinical setting. This study was performed to investigate the primary results of intramedullary nailing with cannulated screws for the treatment of unstable femoral neck fractures in young and middle-aged patients. METHODS:In total, 96 consecutive patients with no history of hip surgery using inverted triangular cannulated compression screws or construction nails with cannulated screws were reviewed. Their demographic and radiological data were retrospectively collected from our institutional database. RESULTS:Inverted cannulated screws had an excellent effect on decreasing the blood loss volume and incision size, but intramedullary nails exhibited superior advantages in decreasing screw exit and shortening the hospital stays. The Harris hip scores were comparable between the two groups. CONCLUSIONS:Intramedullary fixation with cannulated screws has advantages in treating complicated femoral neck fractures. Besides cannulated screws, intramedullary fixation with cannulated screws might be another method to treat unstable femoral neck fractures in young and middle-aged patients. The study was registered in ClinicalTrials.gov. Unique Protocol ID: 11156458. The ClinicalTrial number is NCT03550079.
| S-EPMC6381514 | biostudies-literature
Project description:This study retrospectively analysed 34 patients with ipsilateral hip and femoral shaft fractures treated over a period of 10 years between January 1995 and January 2005. They had an average age of 35 years. Twenty-six (76.47%) of these cases suffered high-velocity trauma (RTA); six others had fallen from a height (17.65%), and two had suffered only minimal trauma (5.88%). Twenty were extracapsular (58.82%) and 14 were intracapsular. They were evaluated with an average follow-up of 28 months, both clinically and radiologically; 26 patients (76.47%) had a good result (Friedman and Wyman score). When the intracapsular fracture was detected postperatively, there was one delayed union and one non-union. When the fracture is diagnosed preoperatively, we recommend reconstruction nail fixation. If the hip fracture is diagnosed intra- or postoperatively following nailing of the shaft, we propose the miss-a-nail technique as an option.
| S-EPMC2267537 | biostudies-other
Project description:Tibial intercondylar eminence fractures that are displaced and non-reducible require open or arthroscopically assisted repair. Ideally, fracture reduction and fixation would be performed with a technique that has low morbidity, allows easy visualization and reduction, provides firm fixation, does not violate the proximal tibial physis, avoids metal hardware, and does not require a second procedure for implant removal. The suture bridge technique, used in the shoulder for rotator cuff tears and greater tuberosity fracture repair, has the ability to produce high contact pressures with rigid fixation. We describe an all-inside and all-epiphyseal arthroscopic suture bridge technique for tibial intercondylar eminence fracture repair performed with PushLock anchors (Arthrex, Naples, FL). One or 2 anchors preloaded with No. 2 FiberWire (Arthrex) are placed in the posterior fracture bed, followed by fracture reduction. The suture limbs are shuttled through and around the anterior cruciate ligament and over the fracture fragment in crossing fashion and are secured by use of additional anchors placed at the anteromedial and anterolateral fracture margin. The anchors are placed obliquely to avoid the proximal tibial physis in the pediatric population. Anatomic reduction and secure fixation allow more aggressive rehabilitation and faster restoration of joint function.
| S-EPMC3882679 | biostudies-literature