Abstract
Expandable nails were developed in order to eliminate operating time and radiation exposure. The authors present the results of the use of expandable nails in the treatment of long bone fractures.
Material and method: Fifty three patients (males females) 17 to 78 yrs of age, who suffered from 32 femoral, 5 humeral and 16 tibial fractures, were treated with the above technique. Three pts had ipsilateral femoral and tibial fractures, one a femoral and controlateral tibial fractures and three were grade II open. All patients received prophylactic anticoagualation. All but the open fracture patients have had three doses of antibiotics. The suitable candidate was a patient with a two part non comminuted fracture, although some degree of comminution was not a contraindication, provided there was at least 10 cm of intact bone beyond that comminution.
The mean operating time was 50 minutes (20 to 80 min) and fluoroscopy time 22 sec (from 0 to 45 sec). All but one fractures were united by week 16.5 for the femur, 14 for the humerus and 18.5 for the tibia.
Complications: A transient radial nerve palsy, two soft tissue (extra osseous) ossifications, one rotational malaligment, one pseudarthrosis due to failure of the nail to expand distally to the fracture site in a patient with controlateral tibial fracture, 1cm shortening, two fractures NOF and one non fatal massive pulmonary embolism. Fracture propagation was evident in 5 fractures, but further action was not needed.
Conclusions: Expandable nail system is a good alternative to classic locked IM, provided careful patient selection is done as well as thorough checking of nail distal expansion and fracture propagation. The reduction of the operating and fluoroscopy time opposed to lesser stability and greater cost.
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