We evaluated the efficacy of using the expandable nail for treating non-union and malunion of the tibial and femoral shafts. Records of 20 patients were retrospectively reviewed: 12 had femoral non-union, 7 had tibial non-union, and one had tibial malunion. The bones underwent reaming and the largest possible nail sizes were inserted during reoperation. The mean age of the patients was 35 years (26-49) in the tibia group and 53 years (23-85) in the femur group. The fractures were defined according to AO/OTA classification and divided between open and closed. The initial treatment was 6 interlocking intramedullary nails and 2 external fixation in the tibia group, and 6 interlocking intramedullary nails, 3 plates and screws and 2 proximal femoral nails in the femoral group. The respective intervals between the original trauma and re-operation were 12 months and 15 months and the respective operation times were 59 minutes (35-70) and 68 minutes (20-120). All fractures healed satisfactorily without the need for an additional procedure. Healing time was 26 weeks (6-52) and 14 weeks (6-26) in the tibia and femur group, respectively. Limb shortenings of 10cm and 4cm were recorded in one patient each in the tibia group and of 3cm in one patient in the femur group. Using the expandable nail system permitted us to ream the bone and expand the nail to its maximal diameter, i.e. up to 16mm in the tibia and 19mm in the femur. We believe that using a bigger nail diameter contributes to better stabilisation of the fracture and promotes better and faster bone healing. Based on our experience, we recommend the use of the expandable nail system to treat tibia and femur shaft non-unions and malunions

Introduction. We retrospectively evaluated our five years' experience in using Expandable Fixion nail system in tibial diaphyseal fractures. Materials/Methods. Eighteen cases with closed tibial diaphyseal fracture were identified between January 2006 and January 2011, all treated successfully with Fixion intramedullary nail as a primary osteosynthesis device. Results. All patients were followed-up in our department until clinical and radiological fusion was achieved with a mean follow-up of 13 months (range 6–20 months). There was one asymptomatic delayed union at 13 months, treated with regular observation until fusion was achieved. There was no incidence of infection, compartment syndrome or non-union in this group. Conclusion. We conclude from our experience that Expandable Fixion Nail is as effective as traditional locking intramedullary nail system in treating closed tibial shaft fracture with the advantages of shorter theatre time and less radiation exposure

Aim & introduction. Infected knee with bone defect resulting from failed total knee arthroplasty (TKA) or destruction of native joint can necessitate restoration of segmental defect and arthrodesis for therapy of infection and maintenance of walking ability. In segmental knee defect external fixators or KAFO are not suitable, not comfortable and poor tolerated by elderly patients. Both custom-made Femoro-Tibial Nail (FTN) combined with acrylic cement spacer and Knee Arthrodesis Nail System (KANS) offer maintenance of supportive function of extremity and avoidance of leg length discrepance after removal of TKA. Method. The group consists of 13 patients. In 12 cases knee arthrodesis have been performed due to infection with bone defect after removal of infected TKA, and in 1case due to inflammatory destruction of native knee joint. In 7 cases FTN with ALAC spacer and in 6 cases KANS (5 cases Orthopedic Salvage System-OSS; 1 case Link KANS) was used. In cases treated with FTN the gap between distal femur and proximal tibia was filled with hand-made acrylic cement spacer loaded with selected antibiotic (2g per 40 g cement) so that the spacer finally gained cylindrical shape. Results. Stable knee was noted after 7 years in 4 of 7 knees treated with FTN with ALAC spacer and after 2 years in 6 of 6 after KANS. Infection free knee was gained after 7 years in 4 of 7 cases treated with FTN with ALAC spacer and after 2 years in 5 of 6 cases treated with KANS. Amputation was necessary after 6 years in 3 of 7 cases treated with FTN with ALAC spacer and after 2 years in none case treated with KANS. Complications occurred in 2 cases after FTN with ALAC spacer (1x: FTN breackage, 1x: stress fracture of femoral neck) and in 1 case after KANS (OSS implant failure). Replacement of FTN nail and cement spacer in 1 case and respectively revision of OSS KANS in 1 cases was performed. Conclusions. Compared with the KANS, custom-made FTN combined with ALAC spacer proved to be effective up to 6 years, but shoved higher rate of complications and amputations after 6 years. It can be considered as a temporary low-cost salvage procedure for infected TKA with segmental bone defect as 1. st. stage in two-stage arthrodesis for infected knee prosthesis

Background:

In recent times there has been an increasing trend towards surgical intervention in paediatric femoral shaft fractures with widening indications. Titanium elastic nails and external fixation are two widely practiced procedures for such fractures.

Failure of cephalomedullary fixation for proximal femur fractures is an uncommon event associated with significant morbidity to the patient and cost to the healthcare system. This institution changed nailing system from the PFNA (DePuy Synthes) to InterTan (Smith and Nephew) in February 2020. To assess for non-inferiority, a retrospective review was performed on 247 patients treated for unstable proximal femur fractures (AO 31 A2; A3). Patients were identified through manual review of fluoroscopic images. Stable fracture patterns were excluded (AO 31 A1). Pre/post operative imaging, demographic data, operative time and ASA scores assessed. Internal/external imaging and national joint registry data were reviewed for follow up. No significant difference was found in overall failure rate of PFNA vs InterTan (4.84% vs 3.23%; p = 0.748). Overall, short nails were more likely to fail by cut-out than long nails (7.5% vs 1.2%; p = 0.015). Nails which failed by varus cut-out had a higher tip/apex distance (TAD) (26.2mm vs 17.0mm; p < 0.001). Of concern, varus cut-out occurred in two InterTan nails with TAD of <25mm. The PFNA enjoyed a shorter operative time for both the short (59.1 vs 71.8 mins; p = 0.022) and long nails (98.8 vs 114.3 mins; p = 0.016) with no difference in 120-day survival rate. Overall failure rates of the PFNA and InterTan nailing systems were comparable. However, the failure rate of short nails in this study is concerning. Using long nails with a lag screw design for unstable intertrochanteric femoral fractures may reduce failure rates. Cumulative frequency analysis suggests stringent tip-apex distances of less than 21mm may reduce failure rates in lag-screw design cephulomedullary nails. This dataset suggests that unstable intertrochanteric fractures may be more reliably managed with a long cephalomedullary device

Purpose. To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty in reverse oblique intertrochanteric hip fracture in elderly patients. Materials and Methods. From January 2005 to July 2012, we reviewed 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and been followed up on for a minimum of 2 years. The patients, all over 70 years old, were divided into two groups for retrospective evaluation: one group was treated with open reduction and internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with bipolar hemiarthroplasty (22 cases). Results. Early ambulation postoperatively and less pain at postoperative three months were significantly superior in the bipolar hemiarthroplasty group. However, by 24 months postoperatively, the open reduction and internal fixation group had higher Harris scores and correspondingly less pain than the bipolar hemiarthroplasty group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the open reduction and internal fixation group underwent reoperation. Conclusions. In the treatment of intertrochanteric fracture of the reverse oblique type, if the patient's health and bone quality are good, open reduction and internal fixation is considered to be the better choice. However, in cases of severe communition of fracture and poor bone quality along with high risk of early reduction failure, bipolar hemiarthroplasty is an alternative offering advantages in terms of early ambulation, less pain at early stages, and lower risk of reoperation

We would like to present this case series of 10 adolescent patients with displaced, closed diaphyseal tibial fractures managed using the Taylor Spatial Frame. Management options for these injuries include non-operative treatment, antegrade nailing, flexible nailing systems, plating and external circular fixation. External circular fixation allows anatomical reduction avoiding potential complications such as growth arrest associated with antegrade nailing and retained metal work with plating. Flexible nailing system and cast immobilisation are unreliable for precise anatomical reduction. With limited evidence as to the extent of post-traumatic deformity that is acceptable, combined with the limited remodeling potential that this patient group possess, the precision of percutaneous fixation with the Taylor Spatial Frame system has clear advantages. This is a retrospective analysis of 10 adolescent patients with a mean age of 14.5 years (range 13 to 16 years). Data collected includes fracture configuration, deformity both pre and post operatively compared to post frame removal, length of time in frame and complications. The data was gathered using the patient case notes and the Picture Archiving and Communications System. The mean time in frame was 15.5 weeks (range 11 to 22 weeks). One non-union in a cigarette smoker was successfully managed with a second Taylor Spatial Frame episode. Our conclusion was that with careful patient selection the Taylor Spatial Frame allows successful treatment of closed tibial fractures in adolescents, avoiding complications such as growth arrest and post-traumatic deformity as well as avoiding retained metalwork

Simultaneous arthrodesis of the ankle and subtalar joints is an established treatment option for combined ankle and subtalar arthritis or complex hindfoot deformities. The use of a curved intra medullary nail has potential advantages in terms of stability, hindfoot alignment and avoidance of the lateral neurovascular bundle. We devised a comparative description of the results of hindfoot fusion using a curved locking nail before and after the introduction of anatomically specific modifications to the device through a retrospective review of notes and radiographs of patients undergoing simultaneous ankle and subtalar fusion by retrograde intramedullary nailing using an ACE¯ (Humeral Nail. Patients undergoing the same procedure using the Tibiotalocalcaneal [TTC] Nail System [DePuy] were recruited and studied prospectively. The outcome was assessed by a combination of notes review, clinical examination and telephone questionnaire. Between 1996 and 2004, 71 arthrodeses in 67 patients have been performed. The average follow up is 27 months [3-73] and mean age 58 years. Fifty-two arthrodeses utilised the ACE humeral nail and nineteen used the newer TTC nail. Both nailing systems are locked proximally and distally and provide a short radius laterally directed distal curve. Mean time to union is 4.3 months [3-10]. Average AOFAS hindfoot score post-operatively is 65, with a mean improvement of 40 points from the pre-operative score in the TTC nail group. Post-operative complications included deep infection, amputation and a non-union rate of 10% overall. In the humeral nail group, four symptomatic stress reactions [8%] and three fractures of the tibia [6%] occurred at the tip of the nail. No stress-riser effect has to date been seen in the TTC nail group. Prominent metalwork removal has also been significantly reduced in the TTC nail group. Our results show hindfoot fusion using a curved intramedullary nail to be an effective technique in complex cases of hindfoot arthritis and deformity. Anatomically specific alterations to the nail have resulted in a significant reduction in certain complications. Alternate proximal locking options in the TTC nail have reduced prominent metalwork and, more significantly, the incidence of stress reactions and fractures appears to have been eliminated

Purpose. To perform comparative analysis between the results of internal fixation using proximal femoral nail system and bipolar hemiarthroplasty in pantrochanteric hip fracture in elderly patients. Materials and Methods. From January 2006 to February 2012, we reviewed 43 patients, who were treated surgically for pantrochanterichip fractures, with a minimum of 2 years follow up. The patient's age was older than 70 year old. The patients were divided into three groups and evaluated, retrospectively. The fracture reduction were regarded as satisfactory in S-OR-IF group(17 cases) and unsatisfactory in US-OR-IF group(9 cases) and the other group was treated with bipolar hemiarthroplasty (BHA group, 17 cases.). Results. At 24 months post-operation, S-OR-IF group had higher Harris scores, less pain, and better walking ability than S-OR-IF and BHA group. Six patients in the internal fixation group (one with S-OR-IF and five with US-OR-IF) had got reoperation. Conclusion. For pantrochanteric fractures of old-aged patient over 70 years old, bipolar hemiarthroplasty has few of severe complications which needs reoperation, and has good results of early ambulation. However, satisfactory reduction and internal fixation makes better clinical results in long term follow-up

Background. During cephalomedullary nail stabilisation of subtrochanteric femoral fractures, damage to the distal anterior femoral cortex by the nail is a recognised cause of periprosthetic fracture. Currently available cephalomedullary devices vary widely in anteroposterior curvature, though all are less curved than the mean anatomic human femur. This study tests the hypothesis that a cephalomedullary device with greater anteroposterior curvature will achieve a more favourable position in the distal femur, with greater distance of the nail tip from the anterior cortex, and therefore lower risk of cortical damage. Methods. Retrospective analysis of postoperative radiographs from patients undergoing subtrochanteric femoral fracture stabilisation with either a)Stryker Long Gamma Nail (radius of curvature 2.0m, 19 patients) or Synthes long PFNα (1.5m, 19 patients) was performed. Distance from the anterior femoral cortex to the anterior part of the distal nail was measured, using the known diameter of the nail as a radiographic size marker. Results. The mean distance from nail to anterior cortex was significantly higher for the PFNα group than the Long Gamma Nail Group (7.31mm vs 4.73mm, unpaired t-test p=0.003). Conclusion. Using a cephalomedullary device with a tighter anteroposterior curvature resulted in a distal nail position better-centred in the sagittal plane, thus decreasing the risk of anterior femoral cortex damage and periprosthetic fracture. We strongly recommend consideration of anteroposterior curvature when choosing a cephalomedullary nailing system

Aim. The purpose of the study was to evaluate the results of Expert tibial nailing for distal tibial fractures. Methods. All patients who had a distal third or distal end fracture of the tibia treated with the Expert tibial nail over a three year period at our institution were included in the study. A total of 44 distal tibial fractures in the same number of patients were treated with the nailing system. One patient died in the immediate post operative period from complications not directly related to the procedure and 3 were lost to follow up leaving a cohort of 40 patients for evaluation. 31 of the fractures were closed while the remaining 9 were open. The average age group of the cohort was 46.8 years with 26 males and 14 females. Results. All 40 patients were followed up to full radiological union of their tibia fractures. The average time to radiological union was 12.5 weeks for the closed fracture group and 15.1 weeks for the open fractures. The difference in time to union between the two groups was not statistically significant. There was infection around a distal locking screw in a closed fracture which settled with screw removal. Three patients in the closed fracture group required dynamisation to hasten union while none required dynamisation in the open fracture group. No bone grafting was performed on any of the patients. One patient had non union of a distal fibula fracture which required plating of as an additional procedure. On follow-up none of the patients reported knee pain or had limitation of ankle movements. Conclusion. The Expert tibial nail is an effective implant for the treatment of both open and closed distal tibial fractures with a low complication rate

The Fixion expandable nailing system provides an intramedullary fracture fixation solution without the need for locking screws. Proponents of this system have demonstrated shorter surgery times with rapid fracture healing, but several centres have reported suboptimal results with loss of fixation. This is the largest comparative series to be reported to date. We compared outcomes between 50 consecutive diaphyseal tibial fractures treated with a Fixion device at our institution to an age, sex and fracture configuration matched series of 57 fractures at a neighbouring hospital treated with a conventional interlocked intramedullary nail. Minimum follow up time was 2 years. Operating time was significantly reduced in the Fixion group (mean 61 minutes, range 20–99) compared to the interlocked group (88 minutes, 52–93), p< 0.00001. The union rate was no different between the Fixion group (93.9%) and the interlocked group (96.5%), p=0.527. Time to clinical and radiological union was significantly faster in the Fixion group (median 85 days, range 42–243) compared to the interlocked group (119, 70–362), p< 0.0001. The overall reoperation rate was lower in the Fixion series (24.5% vs 38.6%, p=0.121), although the majority of reoperations in the interlocked group were more minor, for screw removal. 3 Fixion nails were revised for fixation failure and 2 manipulations were required for rotational deformities after falls; all of these patients were non-compliant with post-operative instructions. There were no fixation failures in the interlocked group. 3 fractures were noted to propagate during inflation of Fixion nails. The Fixion nail is faster to implant and allows more physiological loading of the fracture, with a faster union time. However, these advantages are offset by a reduction in construct stability. Our results have demonstrated a learning curve with a reduction in complications as our indications were narrowed, avoiding osteoporotic, multifragmentary, unstable fractures and non-compliant patients

Aims

The aim of this study was to present the first retrieval analysis findings of PRECICE STRYDE intermedullary nails removed from patients, providing useful information in the post-market surveillance of these recently introduced devices.

Aims

The STRYDE nail is an evolution of the PRECICE Intramedullary Limb Lengthening System, with unique features regarding its composition. It is designed for load bearing throughout treatment in order to improve patient experience and outcomes and allow for simultaneous bilateral lower limb lengthening. The literature published to date is limited regarding outcomes and potential problems. We report on our early experience and raise awareness for the potential of adverse effects from this device.