Comparision of two kinds of intramedullary nail in fixing femoral fractures in goats
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Objective Toestablish femoral fracture models in goats,and compare the effect of using carmulated interlocking intramedullary nail and intramedullary nail with tail wire.Methods 40 adult male goats were selected,and the bilateral posterior middle femoral fracture models were artificially established.Twenty goats were fixed with cannulated interlocking intramedullary nail (group A),and 20 with intramedullary nail with tail wire (group B).X-ray examination was done at 4th and 8th week postoperatively and the nails were removed after fractures were healed.All the operative data were recorded and analyzed statistically.Results All fractures were healed in about 8 weeks postoperatively.Implanting operative time was (37.9 ± 5.1) min,blood loss was (38.0 + 66.0) mL,intraoperative fluoroscopy time was (6.8 + 3.1) s,and removal operative time was (24.4 + 5.3) min,blood loss was (26.3 ± 7.8) mL in group B,which were significantly different from those in group A (P ＜ 0.05 for all).End cap falls in both groups had no significant differences (P ＞ 0.05).One goat in group B was died after the implanting operation.Conclusion Intramedullary nail with tail wire in fixing femoral fractures has the same effects as cannulated interlocking intramedullary nail,but it has many advantages,including shorter operative time,less blood loss and X-ray exposure,and simple steps.
Key words:
Goats; Femoral fracture; Intramedullary nail with tail wire; Cannulated interlocking intramedullary nail; Intramedullary nail removal operationKeywords:
Femoral shaft
Objective To evaluate the clinical outcomes of closed reduction with interlocking intramedullary nails in treatment of femoral shaft fractures.Methods Data of 48 cases with femoral shaft fractures treated with interlocking intramedullary nails were retrospectively analyzed,of whom 32 patients underwent close reduction with interlocking intramedullary nails(group A) and 16 patients underwent conventional open reduction(group B).The outcomes were compared between two groups.Results A total of 32 cases in group A and 16 cases in group B were followed up for averaged 6 months.The blood loss during surgery was less in group A than that in group B [(196±54) ml vs.(480±63) ml](P0.05).So did the time of union after operation [(4.5±2.1) months vs.(5.8±2.9) months](P0.05).The excellence rate of the joint function after operation was higher in group A than that in group B(90.0% vs.86.7%)(P0.05).There were no significant differences in operative time and rotational stability after surgery.Conclusion Closed reduction with interlocking intramedullary nail is better than conventional open reduction in treating femoral shaft fractures.
Interlocking
Femoral shaft
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Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation exposure. Additionally, difficulties may be encountered when removing nails because of callus formation over the nail tip. We performed a prospective study to compare two types of nails in managing femoral shaft fractures.Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails. Group II consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires. The patients' ages, fracture severity, duration of operation, fluoroscopy time, blood loss and falls of end caps into soft tissue were recorded. Nails were removed after fracture healing. The duration of operation and blood loss during nail removal were recorded.There were no significant differences between groups with respect to age and fracture severity (P > 0.05). End caps fell into soft tissue 17 times in 15 cases in group I and 21 times in 16 cases in group II. An average of seven minutes was spent recovering a lost cap in group I. In group II, all lost caps were recovered immediately. The duration of operation and fluoroscopy time in group II was significantly less than in group I (P < 0.05). Asymptomatic palpable nodules were detected in 4 cases in group II. Nail removals were performed on 58 patients in group I and 69 patients in group II. The duration of operation, blood loss and complications in group II were less than in group I (P < 0.05).Intramedullary nails with tail wires facilitate both fracture fixation and nail removal, which can be used to treat femoral shaft fractures with less radiation exposure, shorter surgical time and fewer complications.
Femoral shaft
Femoral fracture
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Malunion
Delayed union
Tibia Fracture
Closed Fracture
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Objective To compare the clinical curative effect of locking compression plate and retrograde intramedullary nails for distal femur fractures. Methods The clinical data of 58 cases of distal femoral fracture treated in Department of Orthopaedics of Jingzhou City Third People's Hospital from Apr. 2009 to Apr. 2012 was collected,which were divided into steel plate group of 23 cases and intramedullary nail group of 35 cases according to the coin method. The plate group received locking compression plate internal fixation,while the intramedullary nail group underwent retrograde intramedullary nails internal fixation. The operation time,blood loss,fracture healing time,full weight bearing time and the incidence of postoperative complications of the two groups were recorded and the postoperative knee function recovery of two groups was evaluated. Results The operation time,bleeding,full weight bearing time of intramedullary nail group were significantly less than those of the control group[( 381. 3 ± 76. 8) m L vs( 479. 5 ± 89. 3) m L,( 123. 2 ±18. 6) min vs( 164. 7 ± 27. 4) min,( 9. 4 ± 2. 6) weeks vs( 11. 4 ± 3. 9) weeks,P 0. 05]; according to the standard of Kolment assessment of knee joint,the good and excellent rate of intramedullary nail group was significantly higher than the steel plat group( 88. 57% vs 69. 57%,P 0. 05). There was 1 case of postoperative incisional infection occurred,1 case of nonunion of fracture,and 2 cases of varus knee deformity in the steel plate group; there was 1 case of wound infection,1 case of nonunion,and no knee varus deformity in intramedullary nail group; the incidence of postoperative complications of the intramedullary nail group was significantly lower than that in the steel plate group( 14. 29% vs 26. 09%,P 0. 05). Conclusion Retrograde intramedullary nail in the treatment of distal femoral fracture is featured with less blood loss,significantly shortened operation time,better recovery of knee joint function after operation,and significantly lower complication rate.
Dynamic compression plate
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Objective
To compare the effect of proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures.
Methods
Data of 42 patients with ipsilateral femoral neck and shaft fractures who were admitted in our hospital from January 2007 to January 2016 were retrospectively analyzed. According to different fixation methods, the patients were divided into two groups: single intramedullary nail group (SIN group) (20 cases, treated with single proximal femoral intramedullary nail, 15 males and 5 females with an average age of 39.4); combined internal fixation group (CIF group) (22 cases, treated with femoral distal intramedullary nail combined with femoral neck hollow lag screw, 17 males and 5 females with an average age of 42.2 years). In the SIN group, 4 cases were type A, 9 cases type B, 7 cases type C according to AO classification. And 14 cases belonged to I or II (stable fracture), 6 cases of type III or IV (unstable fracture) according to Garden classification. In the CIF group, 3 cases were type A, 10 cases type B, 9 cases type C according to AO classification. And 16 cases belonged to type I or type II, 6 cases type III or IV according to Garden classification. The incision length, operation time, intraoperative blood loss, fracture healing time, postoperative weight time, stability of internal fixation, hip function score, pain in the knee and postoperative complication rate were compared between the two groups.
Results
There was no significant difference in gender, age and fracture classification between the two groups. The operation time (75.0±10.2 min), intraoperative blood loss (150.6±80.4 ml), hip Harris score excellent rate (80%) of incidence of knee pain in postoperative 3 months (10.0%) of the SIN group were significantly lower than those of the CIF group (105.2±18.4 min, 180.0±56.8 ml, 86.4% and 31.8%). The length of incision (8.3±1.4 cm) in the SIN group was significantly longer than that in the CIF group (4.0±0.6 cm). There was no significant difference in fracture healing time (SIN group 20.0±4.0 weeks, CIF group 19.6±4.2 weeks) and postoperative weight time (SIN group 8.2±4.0 weeks, CIF group 8.0±4.2 weeks) between the two groups. The main complications of the two groups were delayed union (3 cases of SIN group and 1 case of CIF group), nonunion of fracture (1 case of SIN group) and, coxa vara (1 case of SIN group). The complication of SIN group (30%) was significantly higher than that of CIF group (4.5%), which occurred mainly in unstable femoral neck fracture cases.
Conclusion
Both proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw can effectively treat femoral ipsilateral femoral neck and shaft fracture. Femoral retrograde intramedullary nail combined with hollow lga screw has more therapeutic advantages for unstable femoral neck fractures (Garden III and IV).
Key words:
Femoral fractures; Femoral neck fractures; Fracture fixation, intramedullary; Bone screws
Femoral shaft
Lag screw
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To compare the clinical effects of interlocking intramedullary nail and micro-invasive internal fixation with plate for the treatment of multiple segmental tibiofibular fractures.The clinical data of 39 patients with multiple segmental tibiofibular fractures received treatment from January 2010 to June 2013 were retrospectively analyzed. In the 39 patients, 18 cases were treated by the interlocking intramedullary nail (intramedullary nail group), there were 12 males and 6 females with the mean age of (40.6 ± 9.7) years old (ranged, 24 to 60 years);7 cases were type C2.1, 11 were type C2.2 according to the AO classification. The other 21 cases were treated by micro-invasive internal fixation with plate(plate group), there were 13 males and 8 females with the mean age of (41.7 ± 8.1) years old (ranged, 22 to 52 years), 7 cases were type C2.1, 13 were type C2.2, 1 was type C2.3. Preoperative preparation time, operation time, intraoperative blood loss, postoperative complications, fracture healing time were compared between two groups. Johner-Wruhs evaluation criteria was used to evaluate the clinical effect at last follow-up.All the patients were followed up from 10 to 28 months with an average of 15.2 months. Operative time, intraoperative blood loss in intramedullary nail group were (62.1 ± 5.8) min, (70.9 ± 7.1) ml, respectively; in plate group were (64.3 ± 7.7) min, (74.1 ± 8.5) ml,respectively. There was no significant difference in operation time and intraoperative blood loss between two groups (P > 0.05). However, preoperative preparation time, fracture healing time in intramedullary nail group were (5.3 ± 0.7) days, (11.1 ± 1.9) months, in plate group were (7.1 ± 0.8) days, (14.1 ± 2.2) months, respectively. No postoperative complications were found in intramedullary nail group, and five cases developed with complications in plate group. There was significant difference in preoperative preparation time, postoperative complications and fracture healing time between two groups (P < 0.05). According to Johner-Wruhs criteria at last follow-up, 11 cases got excellent results, 4 good, 3 fair in intramedullary nail group; 11 excellent, 5 good, 2 poor in plate group.Interlocking intramedullary nail has advantages of shorter preoperative preparation time, less postoperative complications and faster fracture healing time in treating multiple segmental tibiofibular fractures. But the application scope of interlocking intramedullary nail was inferior to micro-invasive internal fixation with plate , and its indications should be strictly controlled.
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[Objective] To analyze the treatment of humeral fracture fixed with the plate or the intramedullary nail.[Method] Seventy-five cases of humeral fractures fixed with the plate or intramedullary nail were observed.The type of humeral fractures,the amount of operative time,the amount of bleeding during operation and from the wound after operation,complications,the recovery of the shoulder and elbow function and the time of the union were caculated.The results were analyzed with t test and Kolmogorov-Smirnov test.[Result]All kinds of humeral fractures could be fixed with the plate or the intramedullary nail,and there was no difference in the average amount of operative time which was 162.11 minutes in plate group and 143.5 minutes in nail group.The average amount of bleeding during operation and the blood from the wound after operation were 541.73ml and 130.4ml in the plate group and 225.67 ml and 67.22 ml in the nail group,which had difference between two groups.All fractures united and the union time were 13.58 weeks in plate group and 12.97 weeks in nail group.The score of the recovered shoulder and elbow were 90.89 and 89.69 in the plate group,and 89.70 and 90.10 in the nail group,there were no difference between two groups.There were 12 cases(26.67%) injuried the radial nevers and 1 case(2.22%) infected in the plate group,and there was no complication in the nail group.[Conclusion]All kinds of humeral fractures were fixed with the plate or the intramedullary nail.The radial nerve might be injuried and the amount of bleeding during operation and after operation were more in the plate group.The operation in which the humeral fracture was fixed with the nail by closed manipulation is safer.The operative time,the rate of union,and the recovery of shoulder and elbow function are similar between two methods.
Humeral fracture
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Objective To compare clinical efficacy of intramedullary nail fixation following two-step closed reduction or limited open reduction for femoral subtrochanteric fractures. Methods Forty six patients with femoral subtrochanteric fractures were analyzed retrospectively from January 2014 to April 2020. Twenty four patients which including 16 males and 8 females, aged from 34 to 91 years old with an average of (55.42±18.25) years old, were treated with two step closed reduction and intramedullary nail fixation on supine position. Twenty-two patients which including 15 males and 7 females, aged from 33 to 87 years old with an average of (56.31±14.77) years old, were performed limited open reductionand intramedullary nail fixation. Operation time, intraoperative blood loss, complications and fracture healing time were recorded and compared between two groups. Postoperative Harris hip score at 8 months was applied to evalaute joint function. Results All patients were successfully complete operation without incision infection. All patients were followed up from 8 to 36 months with an average of (18.2± 6.1) months. Introperation blood loss, operation time in closed reduction group were (157.92±51.07) ml, (82.08±13.43) min respectively, while in limited open reduction group were (230.91±87.88) ml, (92.73±12.79) min respectively; while there were statistical difference between two groups (P 0.05). There were 2 patients in each groups occurred pulmonary infection and healed after medical treatment. No statistical difference in postoperative Harris score at 8 months between closed reduction group (88.42±6.85) and limited open reduction group (88.55±6.31)(P>0.05). Conclusion Femoral subtrochanteric fractures could be effectively treated by both methods. Two-step closed reduction and intramedullary nail fixation may be more advantageous in less tissue damage, shorter operation time and less intraoperative bleeding.
Supine position
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To analyze and compare the hidden blood loss of minimally invasive percutaneous plate osteosynthesis(MIPPO) combined with locking plate fixation and intramedullary nail fixation in the treatment of tibial shaft fracture.One hundred and ninety-one cases of tibial shaft fracture treated from January 2017 to January 2019 were analyzed retrospectively. The patients were all treated with closed reduction and divided into two groups:group A (110 cases) and group B (81 cases). In group A, 78 males and 32 females were treated with MIPPO combined with locking plate. The age ranged from 19 to 74 (45.32±11.79) years old. According to AO classification, 42cases were type 42-A, 45 were type 42-B and 23 were type 42-C fractures. Group B was treated with intramedullary nail, including 65 males and 16 females, aged 19 to 84 (45.44± 14.32) years old. According to AO classification, there were 39 cases of type 42-A, 29 cases of type 42-B and 13 cases of type 42-C. The operation time, intraoperative blood loss and hidden blood loss were observed and compared between the two groups.On the first day, the hidden blood loss was (155.27±47.89) ml in group A and (160.43±131.42) ml in group B, the difference was statistically significant (P<0.001);on the third day, the hidden blood loss was (102.70±94.79) ml in group A and (338.23±85.24) ml in group B, the difference was statistically significant (P<0.001). There was no significant difference between the two groups in gender, age, height, weight, fracture type and preoperative Hct (P>0.05).In the treatment of tibial shaft fracture with intramedullary nail, there is obvious hidden blood loss, which is much higher than expected.
Group B
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To develop a new type of tail cap for closing the tail of the central hole of the interlocking intramedullary nail so as to reduce difficulty in implantation of the tail cap into intramedullary nail, and ensure the accuracy of implantation, as well as reduce unnecessary operation time.In 2014, the new type of intramedullary nail tail cap ("new tail cap" for short) was successfully developed, and has been granted national utility model patent. A randomized controlled clinical trial was conducted in 34 patients with non pathological femoral shaft fractures treated between August 2014 and March 2016. The patients were randomly divided into groups A and B, 17 patients each group. There was no significant difference in gender, age, side, body mass index, cause of injury, injury to operation time, and fracture AO classification between groups ( P>0.05), with comparability. All patients underwent fixation with interlocking intramedullary nail, and the new tail cap and original tail cap were used in groups A and B respectively. The blood loss and operation time during tail cap implantation, fracture healing time, and complications were recorded and compared between 2 groups; the limb function was evaluated by Klemm function evaluation standard.The blood loss and operation time during tail cap implantation of group A [(3.5±0.8) mL and (10.57±3.15) s] were significantly less than those of group B [(5.5±1.7) mL and (21.99±6.90) s] ( t=-8.281, P=0.010; t=-10.743, P=0.009). All new tail caps were successfully implanted by one-time in group A, and the one-time success rate was 100%; the original tail cap exfoliation occurred in 3 cases of group B, and the one-time success rate was 82.4%. All the patients were followed up 6-16 months (mean, 9.7 months); there was no deep infection, loosening or breakage of internal fixation, and other serious complications. The time of fracture healing was (16.4±3.2) weeks in group A and (15.8±3.5) weeks in group B, showing no significant difference ( t=0.514, P=0.611). At last follow-up, according to the Klemm function evaluation standard, the results were excellent in 14 cases and good in 3 cases in group A, and were excellent in 11 cases and good in 6 cases in group B, showing no significant difference between 2 groups ( χ2=0.142, P=0.707).The new type of femoral intramedullary nail tail cap can simplify operation, shorten operation time, and reduce blood loss, and it has satisfactory effectiveness.研制一种用于封闭股骨交锁髓内钉中心孔尾端的新型尾帽，以减小尾帽植入髓内钉的难度，保证植入准确性，减少不必要的手术时间。.2014 年成功研制出一种新型股骨髓内钉尾帽（以下简称“新型尾帽”）并获国家实用新型专利。采用临床随机对照研究，将 2014 年 8 月—2016 年 3 月收治的符合选择标准的 34 例非病理性股骨干骨折患者随机分为 A、B 两组，每组 17 例。两组患者性别、年龄、侧别、体质量指数、致伤原因、伤后至手术时间、骨折 AO 分型等一般资料比较差异均无统计学意义（ P>0.05），具有可比性。两组患者均行交锁髓内钉固定术，A、B 组分别采用新型尾帽和原配尾帽。术中测量并比较两组植入尾帽的出血量和手术时间，术后比较两组并发症发生情况和骨折愈合时间，采用 Klemm 功能评定标准评价两组患肢功能。.A 组植入尾帽过程的出血量和手术时间分别为（3.5±0.8）mL 和（10.57±3.15）s，均显著少于 B 组的（5.5±1.7）mL 和（21.99±6.90）s，差异有统计学意义（ t=–8.281， P=0.010； t=–10.743， P=0.009）。A 组新型尾帽均一次性植入成功，成功率 100%；B 组中 3 例原配尾帽旋入时脱落，一次性成功率 82.4%。两组患者均获随访，随访时间 6～16 个月，平均 9.7 个月。所有患者均无深部感染、内固定物松动或断裂以及其他严重并发症发生。A、B 组达骨折临床愈合时间分别为（16.4±3.2）周和（15.8±3.5）周，差异无统计学意义（ t=0.514， P=0.611）。末次随访时，根据 Klemm 功能评定标准，A 组优 14 例、良 3 例，对照组优 11 例、良 6 例，差异无统计学意义（ χ2=0.142， P=0.707）。.新型股骨髓内钉尾帽使术中操作简便，手术时间缩短，出血量减少，治疗效果满意。.
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