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.

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) and 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 of 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 10 cm and 4 cm were recorded in one patient each in the tibia group and of 3 cm 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 16 mm in the tibia and 19 mm in the femur. We believe that using a bigger nail diameter contributes to better stabilization 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.

In the last years there has been a new enthusiasm for the use of resurfacing THA. With the experience gained we have learned that there are some absolute and relative contraindications (i.e. inflammatory arthritis, AVN, poor bone stock, sever distortion of thehip anatomy, varus neck, small head). In order to over come those contraindications and in the light of the fact that reliable long-term effectiveness of hip replacement in young active patients remains problematic we have started to use metaphyseal prosthesis. The metaphyseal implant minimizes bone resection, violets less the native bone of the proximal femur, has favorable remodeling characteristics and facilitate revision once needed. Due to its small size and the varus orientation limited or minimal approach is easy and safe.

Material and methods: The Mayo Conservative hip was used in 65 patients during the years 2000–2005. 3 patients were lost to follow-up and were not included. Avrage age was average 44.6. The basic etiology was osteoarthritis (38), AVN (12), RA (4), DDH (4), distorted proximal femur (2) and revision after failed resurfacing THA (2). Follow-up was 6–58 months (average 45.2). XR were taken each time and clinical examination was done, gait pattern was noted as well as ROM and muscle strength Patient satisfaction was noted based on their function ability, using of waking aids and the amount of pain.

Results: We had 2 cases of intraoperative proximal femur crack that were treated with tension wire; no other intraoperative complication was noted. None of the patients developed infection and no one had dislocation. Pain was reduced from sever in all patients to mild or none in 90% (56/62), moderate in 8% (5/62) and sever in one patient (2%). Pre operative ROM was reduced and painful. Painless, near normal ROM was achieved in all patients and only 5 needed walking stick (all of them between 6–12 month post operative). Follow-up XR showed no sign of bone subsidence or loosening

Conclusions: Metaphyseal prosthesis can be a good alternative to resurfacing arthroplasty. Our experience show that the procedure is safe and medium term results are good to excellent.

Objective: To evaluate and present our experience using the expandable nail system for the treatment of tibial shaft fractures.

Design: Retrospective study.

Setting: Level 1 Trauma Center – University teaching hospital.

Methods: Fifty-nine consecutive patients treated by this nail system for tibia fracture, fifty-four were acute fractures and five non-unions that were not included in the study. Two nail diameters were used, 8.5mm and 10mm. Operation, hospitalization and healing times, reaming versus non-reaming, isolated versus multiple injuries and re-operations were recorded and analyzed statistically.

Results All fractures healed in an average time of 72 days. The average healing times for patients treated with an 8.5 mm and 10 mm nail were 77.2 days and 63.4 days respectively. Average operative time was 103 minutes if reamed and 56 minutes if unreamed. Average healing times were 65.4 if reamed and 79.5 days if unreamed. Hardware was removed in 6 patients, and one patient underwent exchange nailing due to a delayed union. Operative time was shorter in the motor-vehicle group, 74 minutes in comparison to 80 and 84 minutes for the fall and pedestrian group.

Conclusion: The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. This study demonstrates satisfactory healing and alignment for the treatment of tibial shaft fractures using this device.

Introduction: Long bone fracture treatment with interlocking intramedullary nails is associated with long operative procedures, re-operations and long periods of infirmity. We assessed the clinical and economical factors associated with tibial fracture fixation with interlocking nails in comparison to fixation with an expandable stainless steel intramedullary nail.

Methods: Eighty diaphysial tibial fractures were consecutively treated with either an interlocking intramedullary nail (n=53 patients) or an expandable nail (n=27 patients).

Results: The duration of surgery was 139 minutes with interlocking nails and 52.9 minutes with expandable nails (p< 0.001). Re-hospitalization and re-operations were required in 51% and 42% of patients with interlocking nails respectively, compared to one patient (3%) with an expandable nail (p< 0.0001). Complications related to the introduction of interlocking screws (e.g., neurological deficits, screw breakage and delayed or non-union requiring dynamization) occurred in 19 interlocking nail patients and in none of the expandable nail patients. Union was achieved after 17.5 weeks (mean) with the interlocking nails compared to 11.5 weeks for expandable nails (p=0.071). The beneficial economic ramifications of using expandable nails were a 39% reduction in hospital expenses.

Conclusions: The use of an expandable stainless steel intramedullary nail is associated with a substantial reduction in clinical complications and hospital costs. An expandable nail features a unique fixation modality, which has superior mechanical fixation strength and is better adapted to the physiological bone healing process.

Based on these advantages, as well as its simplicity in use and short surgical technique, we recommend it for treatment of long bone fractures.

Purpose of Study: To evaluate the results of our first consecutive cases using Fixion nail for treatment of femoral shaft fractures.

Materials and Methods: Thirty consecutive patients treated at our department with the expandable Fixion nail for femoral fractures were evaluated in a prospective study. Demographic, preoperative, operative and follow-up data was collected from admission and out-patients files. The pre- and post-operative X-rays were evaluated by two senior authors to determine fracture classification (AO/ASIF-CCF), union and healing. This data was inserted into excel file for statistics and evaluation.

Results: The average age was 36 years. Fourteen fractures were due to MVA, 10-falls, 2-crush injuries, 2-non-unions, 1-pathological and one from gunshot wound. Six fractures were open. Twenty eight were middle shaft fractures and two were distal. Three primary nail diameters were used 8.5mm, 10mm and 12mm.

All fractures healed at an average time of 9.2 weeks (5–26) and for the open fractures 19 (12–26) weeks. Hardware was removed in 8 cases with no complications. In two cases re-operation was needed. In one early case the nail was fractured and replaced. In the second case the bone was circlaged due to fragmentation around the fracture site and a bigger nail was inserted few days later (wrong smaller nail was inserted previously).

Conclusions: This preliminary clinical study demonstrates our experience treating femoral fractures with Fixion nail. We find this nail to be simple for use and with satisfactory healing and alignment results.