Abstract
Between the years 1999 and 2001, approximately 3000 expandable intramedullary nails were used worldwide in various surgical procedures. From this number, 250 of these nails were used for traumatic fractures and are the focus of the study presented here. The subjects consisted of 160 males and 90 females with a mean age of 41 years. Initial radiographs were obtained for all subjects. Additional X-rays and follow-up data were reported for only 75 patients (30%) with follow-up time averaging 18 weeks. Most of the fractures occurred in the midshaft (64%), followed by distal thirds (22%), and then proximal (14%). The group was then divided according to fracture location: humerus, tibial and femur.
The nail was used in 92 humerus fractures. Follow-up data was available for 35 patients with a follow-up time averaging 16 weeks. The nail was inserted retrograde in 61% of the patients and antigrade in 39% of the patients. Partial reaming was done in 42% of the cases. Mean operating time was 52 minutes and fluoroscopy time was 3.8 minutes. Anatomical reduction was achieved in 96% of the cases and in 4% of the cases, acceptable reduction was achieved with a varus < 10°. Surgical outcomes included 28 complete bone union, and 7 partial union. Eight nails were removed after complete union was achieved.
In addition, the inflatable nail was used for treatment of 114 tibial fractures. In 39% of the cases a partial reaming was done. Average operating time was 39 minutes and fluoroscopy time was 3.4 minutes. All the fractures were reduced anatomically. In 25 patients with mean follow-up of 18 weeks, 14 united completely and 11 united partially. Nine nails were removed after completion of the union.
Data on 44 patients with femoral fractures treated by the inflatable nail were also reported. Only 15 patients were available for follow-up with an average of 21 weeks follow-up time.
Nail insertion by the antegrade approach was used in 89% of the patients and the retrograde approach was used in 11% of the patients. Partial reaming was done in 44% of the cases.
Mean operating time was 60 minutes and fluoroscopy time 7.5 minutes. Anatomical reduction was achieved in all with the exception of two patients with mild valgus deformity (< 10°). By the end of the study period, 8 had complete union, 7 had partial union.
In summary, the nail was found to be very effective and safe. The surgeons who performed the surgery reported that surgical and fluoroscopy time were both reduced by half. Reaming was not mandatory and this contributed to the shortened operating time. No complications were encountered during extraction of all the nails after completion of union, even in those patients in whom the nail developed an hour glass configuration according to the size of the medullary canal.
It is still too early to conclude if this nail will produce better or equal results to the conventional interlocking nails. Nevertheless, the lack of reaming, locking, and the low contact area of the nail with the medullary canal, may explain the rapid healing observed in some cases.
The abstracts were prepared by Orah Naor. Correspondence should be addressed to him at the Israel Orthopaedic Association, PO Box 7845, Haifa 31074, Israel.
