摘要:

Recent laboratory investigations have led to clinically useful information about intramedullary nailing. These studies have identified several mechanical variables that are important during nail insertion. In particular, a high degree of bending stiffness of the nail combined with an anterior position of the starting hole can cause the femur to burst. Other studies of nail-bone constructs have demonstrated that a femur with a subtrochanteric fracture fixed with a slotted interlocking nail is about 2% as stiff as an intact femur in torsion and about 80% as stiff in bending. Using a closed-section, unslotted nail increases the torsional stiffness to 50% of the stiffness of an intact femur in torsion. Locking rods have been found to support 300% to 400% of a typical person's body weight in axial loading and to fail under load by bending, cracking along the axis of the proximal screw hole, or protruding with the screw through the greater trochanter.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Ten cadaveric femurs were reamed and an appropriate Grosse-Kempf intramedullary nail was placed in them. To measure the “toggle,” the bending of the distal femoral segment around the nail, a special jig was constructed. Serial measurements of the toggle were made for osteotomies at selected sites between the isthmus and the supracondylar region of the femur. The anteroposterior toggle was measured with the proximal supracondylar screw only, the distal screw only, and both screws. Two screws always resisted anteroposterior toggle better than one screw. If the distal femoral fragment is long, one screw can adequately stabilize the nail—bone construct; with short distal fragments, two screws are needed.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The indications for closed intramedullary fixation shaft fractures have been expanded with the advent of interlocked intramedullary nailing. For closed femoral fractures, the indications include most closed Winquist types III and IV fractures, acute fractures, long oblique fractures, and closed reconstructive defects or malrotations. Nail design is important in determining the proximal and distal extent of the fixation, and static or dynamic locking is dictated by the type of fracture. Locked intramedullary nailing of tibial fractures should be approached cautiously. Most reamed intramedullary fixation should be performed on a delayed elective basis.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Subtrochanteric fractures have been prone to nonunion and implant failure following internal fixation due in part to the high level of stress applied regularly to that area of the femur. A classification of these fractures based on current treatment options is offered. The use of intramedullary nails is encouraged for treatment of subtrochanteric fractures whenever possible. Recent studies have demonstrated improved results with the use of intramedullary nails when the fracture pattern will allow.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The Williams Y-nail is a modified interlocking Kiintscher Y-nail that is indicated for a wide variety of difficult proximal femoral fractures. In contrast to the classical Kiintscher Y-nailing procedure, the Williams Y-nailing technique requires intramedullary reaming and proximal set-screw locking. Distal interlocking is available and allows this device, unlike the original Kiintscher Y-nail, to be used in the management of type III and IV comminuted fractures. Although the technique is demanding, the clinical results have been favorable in patients with unstable subtrochanteric-intertrochanteric and ipsilateral trochanteric-diaphyseal fractures. The Williams Y-nail works well in complex proximal trochanteric fractures; however, because it has been associated with an increased risk of failure when used in the management of femoral neck fractures, its use for combined neck-shaft fractures is uncertain.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The AO/ASIF universal intramedullary nail is anatomically curved and has two transverse proximal locking holes for length and rotational (static) and rotational only (dynamic) locking. The same nail can be used for left or right femora, and a thinner wall allows for more flexibility. Since October of 1986, 72 nails have been used in our medical center for fractures that are unstable with respect to length or rotation, nonunions, and osteotomies. There have been two screw fractures and no nail fractures, infections, or nonunions. Because of its flexibility, greater versatility, and better distal targeting, this nail offers certain advantages over other interlocking nail systems.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Indications for Brooker-Wills locking nailing to treat femoral fractures have been expanded to include most fractures from the lesser trochanter proximally to a few centimeters above the condylar notch distally. The advantages of entirely proximal insertion are more distal fixation as its fins deploy at the tip of the nail, and the nail is an open section nail that generally does not need to be dynamized. As described in this article, the insertion technique is straightforward.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The use of the locked intramedullary nail in the tibia has broadened the indications for reamed tibial nailing. Fractures from just below the tibial tubercle to within 5 cm of the ankle joint are now able to be managed with the reamed interlocking tibial nail. This article is intended as a guide to the technique of closed reamed nailing of the tibia and the use of proximal and distal interlocking bolts.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Infection following interlocking nailing should be treated in stages. The infection is controlled with suction irrigation or gentamycin polymethyl methacrylate (PMMA) implants and systemic antibiotics. Medullary reaming removes endosteal sequestrae. If the nail is removed before the fracture is united, an external fixateur can be used to immobilize the fracture. The use of a loop drain for continuous suction irrigation and techniques for antibiotic PMMA implants are described. The goal is a healed fracture without recurrence of infection.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The surgical indications for and techniques of intramedullary nailing for nonunion of tibial fractures are presented in detail. The preoperative planning and intraoperative decision making are described. In a retrospective evaluation of 51 tibial nonunions treated with this method, union was found to occur in 49 of them. The average time to union was seven months after the operation.

ISSN:0885-9698    

出版商:OVID    

年代:1988

数据来源: OVID