The purpose of this article is to evaluate the humeral locking nail in the treatment of humeral shaft fractures. First disappointing experiences with reamed locking nails led at least to some controversy. A review of the literature on treatment of humeral fractures showed that he majority of (clinical) information was contained in retrospective reviews; only three prospective or randomized studies were identified. Furthermore the results are not consistent. The criticism based on experiences with first implants is not entirely justified. The humeral locking nail is a valid implant for the treatment of humeral fractures. Like every other implant however it comes with its own specific complications and there is a learning curve. The humeral locking nail therefore should be seen as a complementary technique to the existing implants with its own advantages and drawbacks.
Purpose: The occurence of complications after reamed and unreamed nailing of the tibia shaft should be analyzed to raise the awareness of quality and of occuring complications. In addition our own results should be compared to international studies in order to be able to recommend a better recommendation of treatment. Material and methods: In between January 1995 and December 2001 110 patients suffering from tibia shaft fractures (67 male, 43 female, average age 40.7 years) were treated with tibia nailing. In 94 cases (85.5 %) initially an unreamed nail, in 16 cases (14.5 %) a reamed nail was used. 55 cases (50.0 %) primarily with severe soft tissue damage were initially treated with external fixation. In these cases after an average of 10.9 days an intramedullary nailing followed. Primary additional procedures occured in 46 cases (41.8 %). In 2004 a follow-up examination based on the criteria of Merchant and Dietz (1989) was performed on 88 patients (80.0 %) with radiologically proved bony fracture consolidation. In order to prove if there is a statistically significant correlation between the applied nailing procedure and an occured complication a Pearson Chi-square test was used. Results: A complication occured in 21 cases (complication rate 19.1 %). The complication rate in the unreamed group was 20.2 % (19 cases), in the reamed group 12.5 % (2 cases). In 21 cases with a complication (19.1 %) secondary interventions were necessary and in all cases healing was achieved by bony consolidation. In our study the Pearson Chi-square test showed no significant correlation between the used nailing procedure and the occurence of a certain complication (p = 0.229). Conclusion: At primary reamed nailing the complication rate concerning fracture healing disturbances can be essentially reduced by correct setting of indication. In our study there is a tendency of higher pseudarthrosis rates after unreamed nailing. Reamed nailing should not be used in every case of tibia shaft fractures. Deciding between unreamed and reamed nailing requires constant consideration of advantages and disadvantages of each procedure and reconciliation with the individual character of each case.
Es existieren heute unterschiedliche Marknagelungssysteme, die sich in den Eintrittspunkten oder der Implantationstechnik unterscheiden. Trotz konkurrierender Verfahren wie z. B. der Plattenosteosynthese stellt die Marknagelung in vielen Fällen die beste Methode dar, um einfache Schaftfrakturen der langen Röhrenknochen zu versorgen. Bei distalen oder proximalen Frakturen muss die Indikation in Abhängigkeit vom Frakturtyp, dem Verletzungsmuster und den Vorerkrankungen des Patienten gestellt werden. Eine innere Frakturschienung besitzt die Vorteile eines geringeren Infektionsrisikos und höheren Komforts für den Patienten. Abhängig vom Frakturtyp muss der Operateur entscheiden, ob er durch eine Aufbohrung die mechanische Stabilität auf Kosten der Vaskularität erhöht oder einen ungebohrten Nagel zugunsten der Vaskularität implantiert. In den letzten zehn Jahren haben sich zunehmend auch retrograde Nagelsysteme etabliert. Dies hat für eine wesentliche Ausweitung des Indikationsspektrums gesorgt. Nach wie vor handelt es sich bei Marknagelungen jedoch um vergleichsweise aufwendige Verfahren, die an den Operateur hohe Ansprüche in Bezug auf die Präzision stellen, da zum einen der exakte Eintrittspunkt und zum anderen die Implantationstiefe entscheidend für den Erfolg der Operation sind. Daher bleibt die individuelle Fähigkeit des Operateurs der entscheidende Faktor bei der Wahl der jeweils geeigneten Osteosynthesemethode.
Introduction: Incidence of ankle fractures in the elderly population increased for the last years. Osteoporosis, compromised soft tissue conditions, vascular supply, and systemic diseases enhance the high demands on fracture management. Here, early results of ankle fracture fixation with transtibiocalcaneal arthrodesis in elderly patients are reported. Patient and methods: Five patients with an unstable ankle fracture were included into this prospective study. All of them underwent closed reduction and transtibiocalcaneal arthrodesis by intramedullary nailing (Hindfoot Fusion Nail, Trigen, smith & nephew). Cartilage of tibiotalar and subtalar joint was left intact. Postoperatively early mobilisation with full weight bearing in a Vacoped® boot was allowed. Results: The mean age of patients was 76 ± 11 years (range: 74-87). There were no intraoperative complications. One patient showed postoperatively a heel ulcer with subsequent superficial infection at a screw entry point, which requires screw removal. Postoperative radiographics before and after mobilisation revealed satisfactory reduction results and sufficient arthrodesis without secondary dislocation for all patients. Conclusion: Arthrodesis of unstable ankle fractures with transtibiocalcaneal intramedullary nailing allows immediate return to full weight bearing and has a low risk of complications. Therefore Hindfoot nail arthrodesis of ankle fractures might be appropriate particularly for patients with severe comorbidities, poor bone stock, and reduced tissue conditions.
Radial head fractures are common injuries which can be managed conservatively in the absence of instability or mechanical block at the elbow. We report a case of radial head and neck fracture which uniquely incorporates two rare complications: posterior interosseous nerve (PIN) palsy, and locking of the proximal radio-ulnar joint. The causative mechanisms are described with review of the relevant literature.
