Radiation-free Insertion of Interlocked Intramedullary Tibial Nail in Closed Extra-articular Displaced Tibial Shaft Fractures in an Emergency Setup

Background. Interlocking nailing is considered a gold standard surgical treatment of mid-shaft closed diaphyseal tibial fractures. With increasing exposure of orthopaedic surgeons to radiation, we propose a solution to this health hazard through a study wherein we perform the surgery without any radiation or C-arm exposure. Material and methods. This prospective study was done at GMC Jammu from January 2017 to February 2020 and included 218 patients, with 18 patients having bilateral tibia fractures in the age group 15 to 58 years (mean of 37.6 years), including 63.7% males (n=139) and 36.3% females (n=79). The 236 extra-articular closed tibial mid-diaphyseal fractures were operated on and intramedullary tibial nailing was performed without a single C-arm exposure. Postoperative x-rays were done and reduction assessed by standard acceptable criteria. Results. Among 236 cases in which nailing was done, 227 (96%) patients were successfully distally locked, including 128 (56.3%) locked through the jig and 99 (43.6%) by “hit and trial method.” All cases met acceptability criteria set for management of tibia by nailing. Conclusions. 1.This study strengthens the proof that closed extra-articular diaphyseal fractures of the tibia can be managed by nailing without using the C-arm with excellent results. 2.The C-arm is always available for cases where distal locking could not be achieved. 3. The technique has a great role in centres with limited facilities of intra-operative radiography in emergency operation theatres.

Prognostic factors for surgical site infection following intramedullary nailing of diaphyseal fractures of the femur and tibia in adult patients at a tertiary hospital in Lusaka, Zambia

Our study aimed to identify prognostic factors for surgical site infection following long bone fracture intramedullary nailing at a tertiary hospital in a low-resource setting. This was a longitudinal observational study involving 132 participants enrolled over a one-year period with femoral and tibial diaphyseal fractures scheduled for ORIF. Participant median age was 30 years (range: 26 – 42). The prevalence of surgical site infection was 16%. Male sex (AOR=0.26, 95% CI [0.70–0.98]; p = 0.047) was associated with lower odds of surgical site infection while associated non-musculoskeletal injuries were associated with higher odds of developing surgical site infection. Our study confirms a higher surgical site infection rate than normally accepted. However, intramedullary nailing in our setting is justified as it allows an early return to a pre-injury state. These interventions must be carried out in the best possible circumstances. Future studies could explore alternative methods of fracture fixation.

REMOVAL OF STUCK FEMUR INTERLOCKING NAIL BY LONGITUDINAL OSTEOTOMY OF FEMUR - A CASE REPORT

Introduction:Gerhard Kuntscher first introduced the technique of intramedullary nailing in 1940s . It is a clover leaf shaped hollow tubular nail for intramedullary fixation of long bones. This nailing system has been a technological breakthrough for femur fixation which can be both anterograde or retrograde. Case Report:A 34 year old Male patient resident of Shahapur brought by relatives to JJ hospital, with chief complaint of pain at left knee since 8 days. Patient had A/H/O RTA after fall from bike in 31/12/2012 with head injury with left shaft femur fracture. Patient was operated at JJH with left femur ILN. History of head injury operated in JJ hospital with no details known to patient. There was also history decreased vision in left eye since trauma. Discussion:Interlocking intramedullary nails are used as gold standard treatment in majority of tibial and femoral diaphyseal fractures. It can be removed in certain circumstances when it causes soft tissue irritation, prominent locking screws, implant failure, infection, nonunion, malunion etc. Conclusion:This study shows that in removal of stuck or bent femur interlocking nails in which all other closed techniques have failed, open longitudinal femoral osteotomy with retrograde hitting of the nail can effectively aid in successful removal of nail.

MANAGEMENT OF DIAPHYSEAL FRACTURES OF TIBIA BY USED OF CLOSED REAMED INTERLOCKING NAIL

Background: Fracture shaft of tibia is one of the common fracture encountered by the orthopaedic surgeons in their daily practice, Many patients come to Department of Orthopaedics with tibial fractures. It is one of the common injuries occurring in adult agegroup. Material and Methods: A total of 30 patients with closed tibial fractures underwent surgery for the fracture fixation with intramedullary interlocking nail in the Department of Orthopaedics, Patna medical college and Hospital Patna Bihar. Duration of Two years. Patients were selected irrespective of sex. Conclusion: Intramedullary interlocking nail is the reliable, versatile and effective treatment for closed tibial fractures. The advantage of rapid rehabilitation and relatively few complications serves to recommend this procedure. Keywords: intramedullary interlocking nail, complications, rehabilitation.

The experience of use the bioactive coated intramedullary flexible nailiing in treatment of long bone fracture

The study concerns a new method of treatment of bone fractures of upper and lower limbs based on osteogenesis stimulation by intramedullary implants with bioactive organic hydroxyapatite (HA). The method decreases consolidation period of diaphyseal fractures to 2-4 times. A technology of osteosynthesis and bone formation dynamics at the fracture zone and around the implant is described.

Comparing titanium elastic nailing and plate osteosynthesis in treating both bone diaphyseal fractures of forearm in children

<p class="abstract"><strong>Background:</strong> The present study aimed to compare the outcome of fixation of diaphyseal fractures of both bones of forearm using plate osteosynthesis (PO) and titanium elastic nail (TEN).</p><p class="abstract"><strong>Methods:</strong> This comparative non-randomized clinical trial was done on children aged 5 to 15 years, with diaphyseal fractures of both bone forearm fractures, operated and managed at the department of orthopedics, Assam Medical College and Hospital, Dibrugarh. Intra- and post-operative findings were compared between PO and TEN group patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Duration of hospital stay was significantly lower in patients in the TEN group (44.75±6.38 minutes) as compared to those in the PO group (69.71±5.91 minutes), p value &lt;0.01. Similarly, duration of hospital stay was significantly lower in patients in the TEN group (5.01±0.67 days) as compared to those in the PO group (8.32±1.44 days), p value &lt;0.05. Based on price criteria, 80% of the patients in the PO group and 85% in TEN group had excellent functional outcome. Radiological union time, maximum radial bow and location of maximal radial bow were found to be statistically similar in the two groups. Complication rate was similar in the two study groups.</p><p class="abstract"><strong>Conclusions:</strong> Based on the results of the present study, we conclude that both PO and TEN are be safely performed in children with diaphyseal both bone forearm fractures. With comparable functional and radiological outcomes, future studies are required before one technique can be recommended over the other.</p>