Tibial fractures are the most common of all ... ity of displaced tibial shaft fractures is IM nailing. ... position marked as a distance from tip of nail to tibial plateau.
4
SpringerWienNewYork
Volume 42 / Supplement 235 wwrnr.springer.at ISSN 1682-863I
Applyrng the mentioned procedures we are able to thesis of a pertrochanter or intertrochanter frac_ 8-I0 X-ray shots with the total duration of the ure of 0.06-0.12 min per each procedure, without duration of the procedure or the invasiveness. This operating technique could become a stan_ of choice in other hospitals, particularly with more
surgeons.
ve results in osteosynthesis nail with nninirnal ve radiation
proximal femur fractures. There were 9 women and 2 men.
]fgfu mean age was 73 years (range between 50 and 86 years). Eight initial fractures were unstabre intertrochanteric fractures and
3
subtrochanteric fractures.
In
failed fixations
impiants were: 95-degree angled blade plate in
in one case DC plate.
l0
used cases and
Results, All patients were operated on traction table under fluoroscopic control. Failed implant was removed and pFNA was inserted in usual manner. Standard nail length (240mm) was used in 7 patients and long version in 4. Afteidrainage removal (48 hours postoperatively) patients were mobilized. No ,,cutting_ out" is noticed, no breakage of the implant, no deep infection. Most fractures united hetween 4 and 6 months. -213 of the patients are satisfled with thefu walking ability. Conclusions. In our experience pFNA is an excellent implant for reosteosynthesis of proximal femur fractures, provides ade_ quate stability and enables good union rate.
R. Celovic, A. Brkljacic, N. Gusic Hospital, Pula, Croatia
hni.
Unreamed tibial locked nails experiences
ring
M. Jelavic, D. Kristek, l. Lovric, A. Nagy
Since 2007 in the Depafiment of Traumatology Fal Hospital, in addition to the standard pro."dr-,."it I osteosynthesis of pertrochanteric and intertrochan_ ts, a modified technique of this procedure is applied
re
a minimal amount of intraoperative X-rav iadi_ time in rotal durarion ol 0.06-0.12 min pei each
In order to evaluate the benefits and possibilities of of this modified technique, we conducted a and retrospective study of 36 cases of patients with lic fractures and lg cases of patients with intertro_ rctures. The clinical results were compared with a p of patients treated with the standard procedure. divided in different groups regarding the qpe of and comorbidity. Early and late postoperative per_ llowed up by X-ray and physical p*u-"t"... The results of the study are encouraging because rlly significant difference in the postoperative een the patients treated with the standard proce_ : patients treated with the modified procedure has b.
e use
ed.
bns. This operating technique could become a star_ . of choice in other hospitals, particularly with more surgeons.
- our
Clinical Hospital Center Osijek, Department of Surgery, Osijek, Croatia
Background. Tibial fractures are the most common of all long bone fractures. The treatment of choice for the large major_ ity of displaced tibial shaft fractures is IM nailing. Here we pres_ ent our elperience with the sotid tibial nails. Methods. In the period from 2005 to the end of 2007 we have m1le (mean age 40) and 27 lemale parients (mean age lTate.d.46 52) with tibial fractures (21 open/Gustilo _ Anderson gr. _ I 9, gr. II - 8, gr. IIIa - 4land 52 closed fracrures). Mosr of the tibial fractures occurred in traffic incidents. In the group of closed
fractures there were 5 patients with pseuJoarthrosis and with refractures. We performed conversion from exter_ nal fixator to IM nailing in 3 patients with open fractures. patients were operated on traction table; unreamed soiid titalium nail 3 patients
was implanted under fluoroscopic control. Distal locking screws were inserled by free-hand technique.
Results. Average time of fracture union was 19 weeks. in 12% of patients. Breakage of distal locking screws happens in 3 patients. Delayed union in 6 patients was resolved with dynamization. Suplrficial wound infection was observed in 4 cases and I case ofd."p infection. The majority of patients regained their pre_injury mobitity Knee pain was observed
a revision irnplant
status.
l. Lovric, A. Nagy, M. Jelavic
Conclusions. IM tibial nailing with unreamed solid titanium nails is safe method, effective and technically relatively simple with good early and late resr,rlts.
ftal Center Osijek, Depaftment of Surgery ia md. Proximal femur fractures especially in the el_ with poor bone quality still represents a challenge ttologist. Prolonged heeling time in such patients tplant failure. Reosteosynthesis in that case is often demanding.
From February 2002 to December 200g we have rroximal femorai nail antirotation) as a revision I patients with failed primary osteosynthesis of
lntramedurllary nailing of tibial fraetures: An analyze of 54 cases
,
il.42 . Supplement
Nr. 2gS
.
2O1O
Z. Korac, B. Bakota, A. Jankovic, N. B. Bozic General Hospital Karlovac, Karlovac, Croatia
(j
Springer-Verlag Bg
Background. Tibial fracture treatment developed from nonoperative approach to a variety of operative techniques. Introduction of interlocking nails has shor'r,n good results and became a standard of care for most displaced dlaphyseal tibial fractures. This case series evaluates early outcome of tibial nailing. Methods. We prospectively followed 54 consecutive adults with 55 tibial fractures [9 open) r,vho were treated rvith locked IM nail on our department between Jan. 1 2006 and June 30 2009. All fiactures were classified b1, the AO and Gustillo-Andersen classiflcation. Results. Thirty-iour fractures wer-e treated by static and 21 by dynamic reamed locking nail. We report the dynamics of union rate and associated complications using this tecl-tnique. There r'vere 43 males and 11 females with an average age of 46.1 years (range 17 74 yearsJ. Thirty-four patients $'ere treated in the emergency, 17 't-I2 days after initiai injury, 3 due to nonunion. Fibuia fixation rvas done in 15 cases. Average operating time was 105min. Follolrrup ranged fiom 6 months to 4 years with an average of 2 years and irrcluded all patients. Primary union occulred in all patients. Two fractures were fixed in greater than 5' of angulation. Pneumonia occurred
in I
case and skin inlectiort in orte. Conclusions. Reamed intrarnedullary nailirrg of tibial diaphyseal and metaphl,seal fractures is safe procedure with a 1ow rate of early complications with good dynamics of union rate.
Nail position has influenee CIn anterior knee pain atten tibial intnanneduNNary
Intnarnedurltary fixatisn of forearmr fraetunes initial experienee
-
L Benci6 University Hospital of Traumatology Zagreb, Zagreb, Croa:
Background. In |anua4r 2009, intramedullarT fixatior forearm fractures r,vas introduced into everyday practice in :' llniversity Hospital of Traumatology Zagreb. Indicatiuns for -.- method include diaphyseal fractures of the radius and ulna, '"'' ;. the exception of fractures of the distal radial diaphysis. In aCl tion to treatment of acute fractures, secondary operative pro..dures are performed to treat malunions or pseudoarthroses. Methods. We apply 4 and 5 mm titalium nails manufactu:-: b-v Troy (Germanfl rvl'rich offer the possibilitv of intrafragmenrcornpression and prorimal anchorage using a gr.ride and a di.-'
.
free
hald. Results. So far, we have treated flve patients using this me:,-
od: three acute fbrearm fractures, one relracture of the thu:: : and an isolared elbou fractule. Conclusions. Intramedullary flration rnay be used to tre. forearm fractures.
r- ,- l, -r: - -- -J !
!Frvr\
intramed ullary osteosynthesi oroximal fernur fractures
naiNing
r..^ ^t*
N. Darabos, l. Bencic, T. Cuti, D. Hudetz, E. Elabjer
M. Fontanal, L, Pernar, M. Pasinil, S. Giannini2
University Clinic for Traumatology, Tagreb, Croatia
tFaenza, ltaly; 2Bologna, ltaly
Background. Anterior knee pain (AKP) is common com-
plication following intramedullary nailing of tibial shaft fracture. Methods. We evaluated postoperative outcome results of 215 patients, operated in last 4 yeam, with healed fiactures initially treated with irrtramedullary reamed na.ils with 2 or 3 interlocking scre\{s on both parts of nail and with use of medial paratendinous incision for nail entry portal. Our aim r'vas to analyze possible relationship betw'een AI(P according to tl"re VAS scale, and nail position marked as a distance from tip of nail to tibial plateau (NP) and to tuberositas tibiae (NT), rneasured postoperatively on L-L knee X rays. Results. T$ro groups ol patierrts were formed on the basis of presence of pain related to AIG (the ler.el of pain was neglected):
with pain Group A and nithout pain Gror-rp B. The difference between two groups concerning NP and NT measurements appeared and it rvas statistically significant concerning NT measurement (p < 0.05), with high accuracy according to the Classification tree. Conclusions. We presume that a position of a proximal tip of tl're nail and its negative influence on the innervation pattern of the area dorsal to patellar tendon could be the key factor of AKP. We conclude that the symptoms of AKP r'vill
not appear if a tip of the nail position shall be more than 5.5mm frorn tibial plateau (NP) ancl more than 2.5mm from tuberositas tibiae (NT).
90 rl
Springer-Vellag
=
s
^ ^{
Background. Authors investlgate the evolution of cephalicintramedullary nails. Authors experience starts on 1997 using a generation nail named Supernail. Authors made a prospecti'= comparative non-randomised study iu order to investigate thl: nail: thelr compared 40 Gamma nails with 40 Supernail analizin. sr,rrgical time, X-rays cxposition, blood loos, fractures consolidation. Difficult use (dr-re to major surgical time and X-rays expo.-tion), major complications incidence (like iatrogenic fracture' and implant fatigue fractures) and undemanding storage (aslrrrnetric nails) led Authors to invent a 2' generatiot-t nail nanreC Uninail. Methods and results. Eighty patients with lateral femur fiactures (AO 3l and 32) undentent an operation of osteosl''nthesi. using Gamma 3 nail (40 patients) and Supernail (40 patients This prospective non-randomised study analized surgical time. X-rays exposition, blood loos, fractures consolidation. Ilesults rvere slightly better lor Gamma 3 (3' generation naii. smaller and shorter) but not statistically significative. The second study involr,es 33 patients with intenrochanteric and subtrochanteric fractures treated r'vith Long Supernail (rtlth an intermediate slot to flx lragments beklv the lesser trochanter Thirtv-one patients healed, I patient doesn't heal because .
.
of technical error, 1 patient undenvent another operation
oI
osteosynthesis r,r'ith graft-plate. Four patients had minor cornplications and healed. The multicenter studv nrith Uninail is still in progress.
Eur
Surg . Vol.42 . Supplement Nr.235 2010
