Aims. Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at extra cost and with unproven patient outcome benefit. We have used data from the National Hip Fracture Database (NHFD) to examine the use of SHS and IMN for A1 and A2 hip fractures at a national level, and to define the cost implications of management decisions that run counter to national guidelines. Methods. We used the NHFD to identify all operations for fixation of trochanteric fractures in England and Wales between 1 January 2021 and 31 December 2021. A uniform price band from each of three hip fracture implant manufacturers was used to set cost implications alongside variation in implant use. Results. We identified 18,156 A1 and A2 trochanteric hip fractures in 162 centres. Of these, 13,483 (74.3%) underwent SHS fixation, 2,352 (13.0%) were managed with short IMN, and 2,321 (12.8%) were managed with long IMN. Total cost of IMN added up to £1.89 million in 2021, and the clinical justification for this is unclear since rates of IMN use varied from 0% to 97% in different centres. Conclusion. Most trochanteric hip fractures are managed with SHS, in keeping with national guidelines. There is considerable variance between hospitals for implant choice, despite the lack of evidence for clinical benefit and cost-effectiveness of more expensive nailing systems. This suggests either a lack of awareness of national guidelines or a choice not to follow them. We encourage provider units to reassess their practice if outwith the national norm. Funding bodies should examine implant use closely in this population to prevent resource waste at a time of considerable health austerity. Cite this article: Bone Jt Open 2022;3(10):741–745

Introduction. Ankle fractures in the elderly are an increasing problem with our aging population. Options for treatment include non-operative and operative with a range of techniques available. Failure of treatment can lead to significant complications, morbidity and poor function. We compared the outcomes of two operative techniques, intramedullary hindfoot nailing (IMN) and fibular-pro-tibia fixation (FPT). This is the largest analysis of these techniques and there are no comparative studies published. Method. We retrospectively reviewed patients over the age of 60 with ankle fractures who were treated operatively between 2012 and 2017. We identified 1417 cases, including 27 patients treated with IMN and 41 treated with FPT. Age, sex, co-morbidities and injury pattern were collected. Primary outcome was re-operation rate. Secondary outcomes included other complications, length of stay and functional status. Results. The IMN group had a higher average co-morbidity score compared with the FPT group (estimated 10-year survival, 21% vs 53%, p=0.03). Re-operation rate was higher in the IMN group compared with FPT (12 v 1, p< 0.0001). There were more complications in the IMN group compared with the FPT group (23 v 11, p< 0.0001). Length of stay was longer in the IMN group (17 v 29 days, p=0.02). Mobility tended to return to baseline in the FPT patients but decreased in the IMN patients. Conclusion. Outcomes were worse in the IMN group compared with the FPT group in terms of re-operation, complications and length of stay. However, the IMN group tended to have increased comorbidities and poorer soft tissues. We believe that both techniques have a role in the management of elderly ankle fractures, but patient selection is key. We suggest FPT should be the first-choice technique when soft tissues permit. We discuss the indications, risks and benefits of each method based on our experience and literature review

Aims. This study aims to describe a new method that may be used as a supplement to evaluate humeral rotational alignment during intramedullary nail (IMN) insertion using the profile of the perpendicular peak of the greater tuberosity and its relation to the transepicondylar axis. We called this angle the greater tuberosity version angle (GTVA). Methods. This study analyzed 506 cadaveric humeri of adult patients. All humeri were CT scanned using 0.625 × 0.625 × 0.625 mm cubic voxels. The images acquired were used to generate 3D surface models of the humerus. Next, 3D landmarks were automatically calculated on each 3D bone using custom-written C++ software. The anatomical landmarks analyzed were the transepicondylar axis, the humerus anatomical axis, and the peak of the perpendicular axis of the greater tuberosity. Lastly, the angle between the transepicondylar axis and the greater tuberosity axis was calculated and defined as the GTVA. Results. The value of GTVA was 20.9° (SD 4.7°) (95% CI 20.47° to 21.3°). Results of analysis of variance revealed that females had a statistically significant larger angle of 21.95° (SD 4.49°) compared to males, which were found to be 20.49° (SD 4.8°) (p = 0.001). Conclusion. This study identified a consistent relationship between palpable anatomical landmarks, enhancing IMN accuracy by utilizing 3D CT scans and replicating a 20.9° angle from the greater tuberosity to the transepicondylar axis. Using this angle as a secondary reference may help mitigate the complications associated with malrotation of the humerus following IMN. However, future trials are needed for clinical validation. Cite this article: Bone Jt Open 2024;5(10):929–936

Introduction. The evaluation of treatment modalities for distal femur periprosthetic fractures (DFPF) post-total knee arthroplasty (TKA) has predominantly focused on functional and radiological outcomes in existing literature. This study aimed to comprehensively compare the functional and radiological efficacy of locking plate (LP) and retrograde intramedullary nail (IMN) treatments, while incorporating mortality rates. Method. Twenty patients (15 female, 5 male) with a minimum 24-month follow-up period, experiencing Lewis-Rorabeck type-2 DFPF after TKA were included. These patients underwent either LP (n=10) or IMN (n=10). The average follow-up duration was 48 months (range: 24–192). Treatment outcomes, including functional scores, alignment, union time, complications, and mortality rates, were assessed and compared between LP and IMN groups. Clinical examination findings pre-treatment and at final follow-up, along with two-way plain radiographs, were utilized. Statistical analyses comprised Student's t-test and Kaplan-Meier survival analysis with a 95% confidence interval. Result. At final follow-up, the LP group demonstrated a mean Knee Society score of 67.2 ± 16.1, while the IMN group exhibited a score of 72.8 ± 9.4(P = 0.58). No statistically significant differences were observed in alignment between the groups[aLDFA (anatomical lateral distal femoral angle), P = 0.31; aPDFA (anatomical posterior distal femoral angle), P = 0.73]. The mean time to union was 3.7 ± 0.8 months for LP and 3.9 ± 0.6 months for IMN (P = 0.62). Complications such as infection occurred in 1 LP patient, and non-union was observed in 2 LP patients, while no complications were noted in IMN group(P < 0.01). Mortality rates were notably lower in the IMN group compared to the LP group across various time intervals. Conclusion. Both LP and IMN treatments yielded similar functional scores, alignment, and union time for DFPF post-TKA. However, the lower incidence of complications and mortality rates associated with IMN treatment suggest its superiority in managing DFPF following TKA

Aims. The primary aim of this study was to compare surgical methods (sliding hip screw (SHS) vs intramedullary nailing (IMN)) for trochanteric hip fracture in relation to death within 120 days after surgery and return to independent living. The secondary aim was to assess whether the associations between surgical method and death or ability to return to independent living varied depending on fracture subtype or other patient characteristics. Methods. A total of 27,530 individuals from the Swedish Hip Fracture Register RIKSHÖFT (SHR) aged ≥ 70 years, admitted to hospital between 1 January 2014 and 31 December 2019 with trochanteric hip fracture, were included. Within this cohort, 12,041 individuals lived independently at baseline, had follow-up information in the SHR, and were thus investigated for return to independent living. Death within 120 days after surgery was analyzed using Cox regression with SHS as reference and adjusted for age and fracture type. Return to independent living was analyzed using logistic regression adjusted for age and fracture type. Analyses were repeated after stratification by fracture type, age, and sex. Results. Overall, 2,171 patients (18%) who were operated with SHS and 2,704 patients (18%) who were operated with IMN died within 120 days after surgery. Adjusted Cox regression revealed no difference in death within 120 days for the whole group (hazard ratio 0.97 (95% CI 0.91 to 1.03)), nor after stratification by fracture type. In total, 3,714 (66%) patients who were operated with SHS and 4,147 (64%) patients who were operated with IMN had returned to independent living at follow-up. There was no significant difference in return to independent living for the whole group (odds ratio 0.95 (95% CI 0.87 to 1.03)), nor after stratification by fracture type. Conclusion. No overall difference was observed in death within 120 days or return to independent living following surgery for trochanteric hip fracture, depending on surgical method (SHS vs IMN) in this recent Swedish cohort, but there was a suggested benefit for SHS in subgroups of patients. Cite this article: Bone Jt Open 2024;5(10):843–850

Appropriate surgical management of hip fractures has major clinical and economic consequences. Recently IMN use has increased compared to SHS constructs, despite no clear evidence demonstrating superiority of outcome. We therefore set out to provide further evidence about the clinical and economic implications of implant choice when considering hip fracture fixation strategies. A retrospective cohort study using Scottish hip fracture audit (SHFA) data was performed for the period 2016–2022. Patients ≥50 with a hip fracture and treated with IMN or SHS constructs at Scottish Hospitals were included. Comparative analyses, including adjustment for confounders, were performed utilising Multivariable logistic regression for dichotomous outcomes and Mann-Whitney-U tests for non-parametric data. A sub-group analysis was also performed focusing on AO-A1/A2 configurations which utilised additional regional data. Cost differences in Length of Stay (LOS) were calculated using defined costs from the NHS Scotland Costs book. In all analyses p<0.05 denoted significance. 13638 records were included (72% female). 9867 received a SHS (72%). No significant differences were identified in 30 or 60-day survival (Odds Ratio [OR] 1.05, 95%CI 0.90–1.23; p=0.532), (OR 1.10, 95%CI 0.97–1.24; p=0.138) between SHS and IMN's. There was however a significantly lower early mobilisation rate with IMN vs SHS (OR 0.64, 95%CI 0.59–0.70; p<0.001), and lower likelihood of discharge to domicile by day-30 post-admission (OR 0.77, 95%CI 0.71–0.84; p<0.001). Acute and overall, LOS were significantly lower for SHS vs IMN (11 vs 12 days and 20 vs 24 days respectively; p<0.001). Findings were similar across a sub-group analysis of 559 AO A1/A2 fracture configurations. Differences in LOS potentially increases costs by £1230 per-patient, irrespective of the higher costs of IMN's v SHS. Appropriate SHS use is associated with early mobilisation, reduced LOS and likely with reduced cost of treatment. Further research exploring potential reasons for the identified differences in early mobilisation are warranted

The choice of whether to perform antegrade intramedullary nailing (IMN) or plate fixation (PF) poses a conundrum for the surgeon who must strike the balance between anatomical restoration while reducing elbow and shoulder functional impairment. Most humeral middle third shaft fractures are amenable to conservative management given the considerable acceptable deformity and anatomical compensation by patients. This study is concerned with the patient reported outcomes regarding shoulder and elbow function for IMN and PF respectively. A prospective cohort study following up all the cases treated surgically for middle third humeral fractures from 2016 to 2022 at a single centre. Telephonically an analogue pain score, an American Shoulder and Elbow Society (ASES) score for shoulder function and the Oxford Elbow score (OES) for elbow function were obtained. One hundred and three patients met the inclusion criteria. Twenty four patients participated in the study, fifteen had IMN (62.5%) and nine had PF (37.5%.). The shoulder function outcomes showed no statistical difference with an average ASES score of sixty-six for the IMN group and sixty-nine for the PF group. Women and employed individuals expressed greater functional impairment. Hand dominance has no impact on the scores of elbow and shoulder function post operatively. The impairment of abduction score post antegrade nailing was higher in the antegrade nailing group than the plated group. The OES demonstrated greater variance in elbow function in the PF group with the IMN group expressing greater elbow disfunction. This study confirms that treatment of middle third humerus shaft fractures by plate fixation is marginally superior to antegrade intramedullary nailing in preserving elbow function and abduction ability

We aimed to use data from a randomized controlled trial (RCT) comparing the sliding hip screw vs. intramedullary nailing (IMN) for trochanteric fractures to examine complication rates between those managed with a short vs. long IMN. This is a secondary analysis using one arm of an RCT of patients ≥18 years with trochanteric fractures. We examined differences in fracture-related (femoral shaft fracture, implant failure, surgical site infection (SSI), nonunion, limb shortening, and pain) and medical (organ failure, respiratory distress, stroke, deep vein thrombosis [DVT] gastrointestinal upset, pneumonia, myocardial infarction, sepsis, or urinary tract infection) adverse events (AE), and readmission between short vs. long IMNs. We included 412 trochanteric fracture patients, 339 (82.2%) of whom received a short (170mm–200mm) nail, while 73 (17.7%) received a long (260mm–460 mm) nail. Patients in the long group were more likely to be admitted from home (vs. an institution), and have comorbidities, or more complex fracture types. Patients in the long group had higher rates of fracture-related AE (12.3%) vs. the short group (3.5%). Specifically, SSI (5.5% vs. 0.3%) and pain (2.7% vs. 0.0%) were significantly higher in the long group. Patients in the long group were also more likely to develop DVT (2.7% vs. 0.3%), and be readmitted to the hospital (28.8% vs. 20.7%). Following covariable adjustment, long nails remained associated with a higher odds of fracture-related AE (5.11, 1.96–13.33) compared to short nails. We found no association between the adjusted odds of readmission and nail length (1.00, 0.52–1.94). Our analyses revealed that trochanteric fracture patients managed with long IMN nails may have a higher odds of fracture-related AE compared to short nails. Future research is required to validate these findings with larger event rates, and further optimize IMN for trochanteric fracture patients

Surgeons must explain the risk of complications to prospective patients and get informed consent. If a complication that occurred was omitted in the process or given the wrong risk level, culpability of the surgeon is judged in court against what a “reasonable patient” would like to know to give or refuse consent. ObjectivesThe concept “reasonable patient” is widely used, no attempt has been made to define it objectively. We assessed insight of patients, presumed “reasonable”, about risks of certain complications after they underwent one of five orthopaedic procedures. Questionnaire was administered with procedures: femur IMN, tibia IMN, ankle ORIF, distal radius ORIF and hip arthroplasty. Four common/serious complications were chosen per procedure, and matched against life events with documented risk levels. There were 230 participants 163 males and 67 females. We found 19.1% of patients above age 40 and 33.3% with tertiary education wouldn't accept nerve injury as reported in literature. With infection risk, 18.1% above 40 and 52.9% with pre-tertiary education would not accept. All patients below 40 and 7.4% pre-tertiary education wouldn't accept the risk of death as reported. However, 37.1% above 40 and 76.9% with pre-tertiary education would accept that risk at a higher level. It is hard to predict what risk of complication a patient may accept. This study highlights that some patients will not accept risks as reported in literature, even though they need the procedure. Therefore, surgeons need to explain complications fully, so that patients knowingly accepts or refuses consent. The subset of patients who are not willing to accept any level of risk, should be the subject of another study

Background. The optimal treatment of segmental tibial fractures (STF) is controversial. Intramedullary nailing (IMN) and external fixation (EF) have unique benefits and complications. Aim. To compare outcomes for AO/OTA 42C2 and 42C3 fractures treated using IMN with those treated using EF in a University Teaching Hospital. Methods. Retrospective case note and radiograph review of 31 segmental tibial fractures treated between 2010 and 2017. Results. There were 17 42C2 and 14 42C3 fractures. 17 patients underwent IMN and 14 EF, and were matched for age and gender. 9 fractures in each group were open. Median time to radiological union was 7 months for IMN and 8 months for EF. Revision surgery was needed for 4 IMN patients and 3 EF patients. The mean number of unplanned procedures was 1.46 for IMN and 1.1 for EF (p=0.69). Length of stay was 15.5 days for IMN and 16.2 days for EF (p=0.9). There was one compartment syndrome in each group and 2 cases of deep infection in the IMN group. There was no significant difference in coronal and sagittal plane alignment. Conclusions. Notwithstanding the small numbers and the retrospective design, the results show that the results of IMN may be equivalent to EF. Modern techniques using suprapatellar entry and blocking screws, combined with early plastic surgical coverage in open injuries are likely to have improved outcomes. Implications. Modern IM nailing techniques have produced similar clinical and radiological outcomes to that achieved by external fixation in this series

Aims. The aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures. Methods. Initial search strategy incorporated MEDLINE, PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs). Four treatment arms were created: nonoperative (NO); intramedullary nailing (IMN); reconstruction plating (RP); and compression/pre-contoured plating (CP). A Bayesian NMA was conducted to compare all treatment options for outcomes of nonunion, malunion, and function using the Disabilities of the Arm Shoulder and Hand (DASH) and Constant-Murley Shoulder Outcome scores. Results. In all, 19 RCTs consisting of 1,783 clavicle fractures were included in the NMA. All surgical options demonstrated a significantly lower odds ratio (OR) of nonunion in comparison to nonoperative management: CP versus NO (OR 0.08; 95% confidence interval (CI) 0.04 to 0.17); IMN versus NO (OR 0.07; 95% CI 0.02 to 0.19); RP versus NO (OR 0.07; 95% CI: 0.01 to 0.24). Compression plating was the only treatment to demonstrate significantly lower DASH scores relative to NO at six weeks (mean difference -10.97; 95% CI -20.69 to 1.47). Conclusion. Surgical fixation demonstrated a lower risk of nonunion compared to nonoperative management. Compression plating resulted in significantly less disability early after surgery compared to nonoperative management. These results demonstrate possible early improved functional outcomes with compression plating compared to nonoperative treatment. Surgical fixation of mid-shaft clavicle fractures with compression plating may result in quicker return to activity by rendering patients less disabled early after surgery. Cite this article: Bone Jt Open 2021;2(8):646–654

Introduction. This study aimed to compare MIPO and IMNr in the treatment of supracondylar femur fracture following TKA in respect of fracture healing, complications and functional results. Materials and Methods. A retrospective analysis was made of 32 supracondylar femur fractures classified according to the Rorabeck classification, comprising 20 cases treated with MIPO and 12 with IMNr. The two techniques were compared in respect of ROM, KSS, SF-12 scores, intraoperative blood loss, surgery time, and radiological examination findings. Results. No significant difference was determined between the two groups in respect of age, gender and fracture type, or in the median time to union (MIPO 4.3 months, IMNr 4.2 mths) (p >0.05). In the MIPO group, 2 patients had delayed union, so revision surgery was applied. The mean postoperative ROM was comparable between IMNr and MIPO (86.2 °vs 86 °, p > 0.05). The mean Knee Society Score (KSS) and SF-12 score did not differ between the IMN and MIPO groups. (p>0.05). Reduction quality in the sagittal plane was better in the MIPO group and no difference was determined in coronal alignment. Greater shortening of the lower extremity was seen in the IMNr group than in the MIPO group. (20.3 vs 9.3mm, p<0.05). Perioperative blood loss was greater (2 units vs.1.2 units) and mean operating time was longerin the MIPO group. (126.5 min vs 102.2 min, p<0.05). Conclusion. In patients with good bone stock, supracondylar femur fracture following TKA can be treated successfully with IMN or MIPO. IMN has the advantage of less blood loss and a shorter operating time. Reduction quality may be improved with the MIPO technique. Both surgery techniques can be successfully used by orthopaedic surgeons taking a case-by-case approach

Infected nonunion of the femur or tibia diaphysis requires resection of infected bone, stabilization of bone and reconstruction of bone defect. External fixation of the femur is poorly tolerated by patients. In 2004 authors introduced in therapy for infected nonunions of tibia and femur diaphysis coating of IMN with a layer of antibiotic loaded acrylic cement (ALAC) containing 5% of culture specific antibiotic. Seven patients with infected nonunion of the diaphysis of femur (2) and tibia (2) were treated, aged 20–63 years, followed for 2–9 years (average 5,5 years). All have been infected with S. aureus (MSSA: 2 and MRSA: 4) or Staph. epidermidis (1) and in one case with MRSA and Pseudomonas aeruginosa. All patients underwent 3 to 6 operations before authors IMN application. Custom-made IMN coated with acrylic cement (Palamed) loaded fabrically with gentamycin with admixture of 5% of culture-specific antibiotic: vancomycin (7 cases) and meropeneme (1 case) was used for bone stabilization. Static interlocking of IMN was applied in 4 cases and dynamic in 2 cases. In 1 case the femur was stabilized with IMN without interlocking screws. In 2 cases IMN was used for fixation of nonunion at docking site after bone transport. In 3 cases ALAC was used as temporary defect filling and dead space management. In one case after removal of IMN coated with ALAC, a new custom made Gamma nail and tubular bone allograft ranging 11 cm was used for defect reconstruction. Infection healing was achieved in all 7 cases, bone union was achieved in 4 from 7 cases. In 1 case of segmental diaphyseal defect ranging over 12 cm infection was healed, but bone defect was not reconstructed. This patient is waiting for total femoral replacement. In another case of segmental defect of 11 cm infection is healed, but allograft substitution and remodeling by host bone is poor. In the 3rd case of lacking bone healing, the 63 year old patients was noncooperative and not willing to walk in walker with weight bearing. This patient refused further treatment. Custom-made intramedullary nail coated with a layer of acrylic cement loaded with 5% of culture specific antibiotic can provide local infection control, offer comfortable bone stabilization, and replace standard IM nail in therapy for difficult to treat infected diaphyseal nonunion of femur or tibia

Due to its popularity of intramedullary nails (IMN) high success rate, newer design (titanium) IMN system have been introduced to replace stainless steel system. However the stability provided by the titanium IMN. may not be adequate, there by influencing the union rate. We aimed to compare the results of both IMN systems via prospective clinical study and biomechanical testing using RSA. Biomechanical study. This study was done in an experimental set-up which consisted of a physically simulated femoral shaft fractures models fixed with a stainless steel (Russell Taylor) or Titanium (Trigen) IM nailing system. Two common fracture configurations with stimulated weight bearing conditions were used and the axis of fragment movements recorded. Clinical study. The data on two groups of patients were collected as part of a prospective cohort study. Details of the implant, such as size of nail, cross screw lengths, screw thickness, etc. was collected. Patients were followed up for a minimum of 4 months and details of clinical complications recorded. Biomechanical study. The degree of translation movement in comminuted fracture, using titanium IMN system, was 6 times more compared to stainless steel IMN system. Clinical study. The results show that there is a 5.7% of non union and 14% hardware problems with titanium based IMN system when compared to 2.2% non union in the stainless steel IMN system. Titanium based IM nailing system have a potential to inherent mechanical instability when used to treat comminuted fractures. This may explain some of the clinically observed delayed or non-union of femoral fractures

Extracapsular Hip Fractures (EHF's) are a significant health burden on healthcare services. Optimal treatment is controversial with conflicting evidence being reported. Currently treatment is undertaken with Intramedullary Nail (IMN) or Dynamic Hip Screw (DHS) constructs with a recent increase in IMN use (1). This study aims to conduct a systematic review of Randomised Control Trials published between 2020 and 2023 with particular focus on patient demographics and holistic patient outcomes. Using a unified search-protocol, RCT's published between 2020 and 2023 were collected from CENTRAL, PubMed, MEDLINE and EMBASE. Rayyan software screened duplicates. Using the CASP and Cochrane Risk of Bias Tool papers were critically examined twice, and Blood Loss, Infection and Mobility described the patient journey. Patient demographics were recorded and were contrasted with geographically diverse cohort studies to compare population differences. Parametric tests were used to determine significance levels between population demographics, namely Age and Sex. Eleven papers were included, representing 908 patients (436 Male). The mean age for patients was 64.39. There was considerable risk of bias in 7/11 studies owing to the randomization process and the recording of data. Four Cohort studies were selected for comparison representing 14314 patients. Mean age was significantly different between Cohort Studies and RCT's (Independent T-Test, df 13, t=7.8, p = <0.001, mean difference = 19.251, 95% CI = 13.888, 24.613). This was also true for sex ratios included in the studies (df 13, t = -2.268, p = 0.024, Mean Difference = -0.4884, 95% CI = -0.9702, -0.0066). To conclude, RCT's published in the post COVID-19 era are not representative of patient demographics. This has the potential to provide inaccurate information for implant selection. Additionally further research must be conducted in how to better improve RCT patient inclusion so as to be more representative of patients whilst balancing the risks of operations

Aim. The aim of this study was to compare the results of humerus intramedullary nail (IMN) and dynamic compression plate (DCP) for the management of diaphyseal fractures of humerus. Material & methods. 47 patients with diaphyseal fracture of shaft humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion were Grade 1.2a compound fractures; Polytrauma; Early failure of conservative treatment; Unstable fracture. Patients with pathological fracture, Grade 3 open fracture, refracture or old neglected fracture of humerus were excluded from the study. 23 patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach. Results. The outcome was assessed in terms of union time, union rate, functional outcome and incidence of complications. Functional outcome was assessed using the American Shoulder and Elbow Surgeons Score (ASES). On comparing the results by independent samples t test, there was no significant difference in ASES score between the two groups. The average union time was found to be significantly lower for IMN compared to DCP(P<.05). The union rate was found to be similar in both the groups. Complications like infection were found to be higher with DCP compared to IMN, while shortening of the arm (1.5-4cm) and restriction of shoulder movements due to impingement of the nail were found to be higher with DCP compared with IMN. However, this improved in all patients following removal of the nail once the fracture healed. Conclusion. This study proves that IMN can be considerd as a better surgical option for these fractures as it offers shorter union time and less incidence of serious complications like infection. However, there appears to be no difference between two groups in union rate and functional outcome

The aim of this study was to compare the results of humerus intramedullary nail(IMN) and dynamic compression plate DCP) for the management of diaphyseal fractures of humerus. Material & Methods- 47 patients with diaphyseal fracture of shaft humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion was Grade 1,2a compound fractures, polytrauma, early failure of conservative treatment, unstable fracture. The patient with pathological fracture, Grade 3 open fracture, refracture, old neglected fracture of humerus were excluded from the study. 23 patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach. Results -The outcome was assessed in terms of functional outcome and the incidence of complications. Functional outcome was assessed using the Americans Shoulder and Elbow Surgeons Score (ASES). On comparing the results, there was no significant difference in ASES score between the two groups. The rate of complications was found to be higher in patients treated with IMN than with DCP. The complications that were encountered with IMN were non union, shortening of the arm, impingement of the shoulder, implant failure. The rate of secondary surgery was also found to be significantly higher with IMN. Conclusion – There is sufficient evidence to suggest that DCP still remains to be the operative treatment of choice for diaphyseal fractures of humerus. IMN may be indicated only in specific situations like segmental fractures, pathological fratures though this study did not aim to look into that aspect

Purpose: The popularity of intramedullary nails (IMN) for trochanteric hip fractures has grown substantially with little supportive evidence that IMN are superior to conventional sliding hip screws (SHS). We aimed to assess the impact of SHS or IMN intramedullary nailing on functional outcomes and rates of re-operation in elderly patients with fractures. Method: We conducted a multi-center, pilot randomized trial including three clinical sites across Sweden, Denmark, and Canada. We randomized 85 elderly patients with stable and unstable trochanteric hip fractures to either SHS or an IMN. The primary outcome, revision surgery, was independently adjudicated at one year. Secondary functional outcomes included the Parker Mobility Score (PMS), the Merle D’Aubigne Score, the Short Form-12 (SF-12) and the Euroquol-5D. Results: Eighty five patients were enrolled. Fifteen patients died prior to the one year follow up. Across treatment groups, patients did not differ in age, gender and fracture type. The overall revision risk was 11.6% (8/69) and did not differ significantly between groups (IMN: 5; SHS: 3). Patients treated with IMN had significantly higher Merle D’Aubigne function subscores at 6 (p=0.01) and 12 months (p=0.05). Gamma3 nails approached significantly higher scores in the Parker mobility score at 6 (p=0.08) and 12 months (p=0.056). Non-significant differences were identified in the SF-12 and Euroquol-5D quality of life measures; however, in both scores, the Gamma3 nailed trended to higher scores than the sliding hip screw. Conclusion: Our findings of early functional gains without increased risk of revision surgery support the increased popularity of IMN for the management of trochanteric hip fractures in elderly patients

The aim of this study was to compare the results of humerus intramedullary nail(IMN) and dynamic compression plate(DCP) for the management of diaphyseal fractures of humerus. Material & Methods: 47 patients with diaphyseal fracture of shaft humerus were randomised prospectively and treated by open reduction and internal fixation with IMN or DCP. The criteria for inclusion was Grade 1,2a compound fractures Polytrauma Early failure of conservative treatment Unstable fracture. The patient with pathological fracture, Grade 3 open fracture, refracture, old neglected fracture of humerus were excluded from the study. 23 patients underwent internal fixation by IMN and 24 by DCP. Reamed antegrade nailing was done in all cases. DCP was done through an anterolateral or posterior approach. Results: The outcome was assessed in terms of functional outcome and the incidence of complications. Functional outcome was assessed using the Americans Shoulder and Elbow Surgeons Score (ASES).On comparing the results, there was no significant difference in ASES score between the two groups. The rate of complications was found to be higher in patients treated with IMN(p< .05). The complications that were encountered with IMN were non union, shortening of the arm,impingement of the shoulder, implant failure. The rate of secondary surgery was also found to be significantly higher with IMN(p< .05). Conclusion: There is sufficient evidence to suggest that DCP still remains to be the operative treatment of choice for diaphyseal fractures of humerus as use of IMN is associated with long learning curve, technical difficulties and higher complication rate. IMN may be indicated in specific situations like segmental fractures,pathological fratures though this study did not aim to look into that aspect

Aims of study. To assess and compare the functional, radiological and cosmetic results as well as patient satisfaction in patients treated with the IMN Device Vs Volar Locking Plate. Method. All patients who presented to our institution with extra articular distal radius fractures and met the inclusion criteria were invited to take part in the study. The patients were randomly allocated to two groups, those who underwent intramedullary (IMN) distal radius fixation using the Sanoma Wrx Distal radius nail and those who underwent fixation using a volar locking plate. The patients were then followed up at 2 weeks, 6 weeks, 3 months, 6 months and 1 year. The radiological parameters, ie radial height, inclination and tilt were compared as well as the functional outcomes by means of DASH score. The range of motion of the wrist was compared as well as the scar size. Complications were reviewed. Results. We present our early results. Currently we have included 9 patients in the IMN group and 7 patients in the volar plate group with follow-ups longer than 3 months. Results show smaller scars (2.5 vs 6.7cm), comparable flexion and extension (40 vs 40 and 45 vs 40), slight improvements in pronation and supination (80 vs 75 and 85 vs 80) in the IMN compared to the volar plate. Radial and ulnar deviation is comparable. The radiological parameters showed slight improvements in the radial height (2.5 vs 2.2 mm), inclination (3.6 vs 3.2 degrees) and tilt 13,7 vs 12 degrees) with the IMN. Dash scores will be compared at 6 months. Conclusion. Intra medullary nailing of the distal radius seems to compare to volar plating in terms of radiological parameters and rotational stability but has the added benefit of early range of motion, minimal invasive technique, less post op pain and less complications such as tendon irritation. NO DISCLOSURES