Objective To evaluate the results of the treatmenton femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail . Methods From Jun. 1999 to Sep. 2003, 74 patients with femoralfractures were treated by intramedullary interlocking nail (inverse limited marrow cavity rasping) .There were 62 males and 12 females. Among them, 5 caseswere type 32A1, 7 cases were type 32A2, 12 cases were type 32A3, 35 cases were type 32B2, and 15 cases were type 32C2. Results Seventyfour patients were followed up for 13 to 29 months(15.4 months in average). Thetime for fracture union ranged from 3 to 5 months(3.8 months in average). The overall rate of excellence was 98.7% by Wuyuesong grading. There was 1 case of non-union, 1 case of delayed infection, and 2 cases of bent screw. Conclusion The treatment on femoral fractures with inverse limited marrow cavity rasping intramedullary interlocking nail is easy to operate and has minimum impairment to local circulation. It also promotes the healing and early function.
Objective To investigate the advantages and the clinical outcomes of the treatment of comminuted inferior femoral fractures with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. Methods From June 2002 to December 2004, 12 cases of comminuted inferior femoral fractures were treated(9 males, 3 females). Of them, 5 cases were classified as type B and 7 cases as type C according to AO classification . All cases were treated with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. In 12 cases of one-stage bone grafting, there 5 of autologous cancellous bone grafting and 7 allo-freeze drying bone grafting.Results With a follow-up of 6 to 18 months, all fractures healed within 3 to 6 months. There were no infection and nonunion. The function of all the knees joint was excellent. According to Noye’s criterion for knee scoring, the results were excellent in 9 cases and good in 3 cases; the excellent and good rate was 100%. Conclusion It is a good method to treat comminuted inferior femoral fractures with combination of supracondylar locked intramedullary nail and shape memory block hoop internal fixator under arthroscopy. It has many advantages of less injury to knee joint, good anatomic reduction and reliable fixation.
Objective To explore the value of electromagnetic navigation interlocking intramedullary nail in the treatment of femoral shaft fracture. Methods Between July 2012 and October 2013, 53 cases of femoral shaft fracture were treated. There were 40 males and 13 females, aged 16-52 years (mean, 38.3 years). The causes of injury were traffic accident in 28 cases, falling from height in 11 cases, falling in 7 cases, crush injury in 4 cases, and other in 3 cases. Of 53 cases, there were 3 cases of open fracture (Gustilo I degree) and 50 cases of closed fracture. Fracture was located in the proximal femur in 17 cases, middle femur in 29 cases, and distal femur in 7 cases. According to Winquist classification, 7 cases were rated as type I, 8 cases as typeⅡ, 22 cases as typeⅢ, and 16 cases as type IV; according to AO classification, 18 cases were rated as type 32-A, 28 cases as type 32-B, and 7 cases as type 32-C. The time from injury to operation was 3-11 days (mean, 5 days). Distal interlocking intramedullary nail was implanted using electromagnetic navigation. Results The distal locking nail operation with interlocking intramedullary nail was successfully completed under electromagnetic navigation; the one-time success rate of distal locking nail operation reached 100%; and the locking nail time was 5.0-9.5 minutes (mean, 7.0 minutes). Healing of incision by first intention was obtained after operation, and no complication of skin necrosis, infection, and sinus tract occurred. Fifty-three cases were all followed up 5-12 months (mean, 9 months). One case had hip pain and weaken middle gluteal muscle strength, and the symptoms disappeared after removing the nail. During the follow-up period, no broken nails, nail exit, infection, or re-fracture occurred. All fractures achieved clinical healing, and the healing time was 8-22 weeks (mean, 14.5 weeks). In 49 patients followed up 8 months, the Lysholm score was excellent in 44 cases, good in 4 cases, and acceptable in 1 case, with an excellent and good rate of 98%. Conclusion Electromagnetic navigation system is safe and reliable, with the advantages of high positioning accuracy, short operation time, and no radiation, the clinical application of the system for distal locking nail operation can obtain excellent short-term effectiveness.
Objective To explore the effectiveness of interlocking intramedullary nail fixation system for Sanders type Ⅱ and Ⅲ calcaneal fractures by comparing with open surgery. Methods Forty patients (40 feet) with Sanders type Ⅱ and Ⅲ calcaneal fractures, who were admitted between May 2020 and December 2022 and met the selection criteria, were included in the study. They were randomly allocated into control group and minimally invasive group using a random number table method, with 20 cases in each group. The patients were treated with the interlocking intramedullary nail fixation system in the minimally invasive group and with steel plate internal fixation via a lateral L-shaped incision in the control group. There was no significant difference between the two groups (P>0.05) in terms of gender, age, fracture classification and side, cause of injury, time from injury to admission, and preoperative width, length, height, Böhler angle, and Gissane angle of the calcaneus. The operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time, incidence of complications, as well as pre- and post-operative imaging indicators (Böhler angle, Gissane angle, width, height, and length of the calcaneus) and American Orthopaedic Foot and Ankle Society (AOFAS) score of foot were recorded and compared between the two groups. Results The incision length, operation time, and hospital stay of the minimally invasive group were significantly shorter than those of the control group, and the intraoperative blood loss significantly reduced (P<0.05). All patients of the two groups were followed up, with the follow-up time of 8-12 months (mean, 10.2 months) in the minimally invasive group and 8-12 months (mean, 10.4 months) in the control group. No complication occurred in the minimally invasive group after operation. One case of incision epidermal necrosis and 1 case of traumatic arthritis occurred in the control group after operation. However, there was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS score was significantly higher in the minimally invasive group than in the control group (P<0.05). Imaging examination showed that the calcaneal fractures of the two groups healed, and there was no significant difference in healing time between the two groups (P>0.05). Compared with preoperative conditions, the Böhler angle and Gissane angle of the calcaneus in the two groups significantly increased, the width narrowed, and the height and length increased at 3 days after operation and the last follow-up, with significant differences (P<0.05). There was no significant difference between 3 days after operation and last follow-up (P>0.05). There was no significant difference between the two groups at each time point (P>0.05). ConclusionThe interlocking intramedullary nail fixation system in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of minimal trauma, shortened hospital stay, reliable fracture reduction and fixation, and satisfactory foot function recovery.
To provide the scientific theoretical basis for cl inical practice by comparing biomechanicalcharacteristics of single compressed plate with intramedullary pin, locking intramedullary nail and simple arm externalfixator with simple internal fixation devices. Methods Eighteen wet humeral bone specimens of adult cadaver were madecompl icated fracture models of humeral shaft and divided into 3 groups according to fixation methods. Fracture was fixed by single compressed plate with intramedullary pin in plate group, by locking intramedullary nail in intramedullary nail group and by external fixator with simple internal fixation devices in external fixator group. The intensity and rigidity of compl icated fracture models of humeral shaft was measured in compress test and torsion test. Results In compress test, the maximum load in plate group (6 162.09 ± 521.06) N and in intramedullary nail group (6 738.32 ± 525.89) N was significantly larger than that in external fixator group (2 753.57 ± 185.59) N (P lt; 0.05); but there was no significant difference between plate group and intramedullary nail group (P gt; 0.05). Under 600 N physiological compress load, the rigidity was (171.69 ± 6.49) N/mm in plate group, (333.04 ± 36.85) N/mm in intramedullary nail group and (132.59 ± 2.93) N/mm in external fixator group; showing no significant difference between plate group and external fixator group (P gt; 0.05), and showing significant difference between intramedullary nail group and plate, external fixator groups (P lt; 0.05). In torsion test, the maximum torque in plate group (38.24 ± 7.08) Nm was significantly larger than those in intramedullary nail group (17.12 ± 5.73) Nm and external fixator group (20.26 ± 6.42) Nm (P lt; 0.05), but there was no significant difference between intramedullary nail group and external fixator group (P gt; 0.05). Under 0.80 Nm physiological torque, the rigidity was (16.36 ± 2.07) Ncm/° in plate group and (18.79 ± 2.62) Ncm/° in external fixator group, which was significantly larger than that in intramedullary nail group (11.45 ± 0.22) Ncm/° (P lt; 0.05); but there was no significant difference between plate group and external fixator group (P gt; 0.05). Conclusion Those fracture models fixed by single compressed plate with intramedullary pin have better compress and torsion intensity, they also have better torsion rigidity but less compress rigidity. Those fracture models fixed by locking intramedullary nail have better compress intensity but less torsion intensity, they also have better compress rigidity but less torsion rigidity. Those fracture models fixed by external fixator with simple internal fixation device have less compress and torsion intensity, they also have less compress rigidity but better torsion rigidity.
Objective To explore the effect of blocking screws on the breakage of interlocking intramedullary nails. Methods From January 2003to August 2005, 56 patients with fresh and close fracture of long shafts were treated by interlocking intramedullary nails. Among them, there were 32 males and 24 females, including 26 femoral fracture and 30 tibial fracture. Fracture of femoral and tibialshaft was fixed with interlocking intramedullary nails normally in group Ⅰ(n=32). And long oblique, spiral, proximal or distal fracture of bone shaft was fixed with interlocking intramedullary nails and blocking screws in group Ⅱ(n=24). Results All cases were followed up 12 to 21 months(16 months on average). In group Ⅰ, fracture healing failed and the intramedullary nails broke in 3 cases, breakage site was the middle femoral fracture area in 1 case and the first distal interlocking nail hole in 2 cases of distal 1/3 tibial fracture. Fractures healed 6 to 12 months after operations in the other cases, but more bony callus occurred in fracture area. In group Ⅱ, fractures healing and good alignment were achieved, and no breakage was found in all 24cases. Conclusion The use of blocking screws added to interlocking intramedullary nails could improve the stability of fracture areas distinctively, and hence reduce the breakage of intramedullary nails.