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A10 Fixator assisted nailing in radial and ulnar shaft fractures
Oral presentations / Injury, Int. J. Care Injured 42 (2011) S3, S1–S24
criteria included severe soft tissue injury, comorbidities such that the infection rate following a large skin incision was unacceptable, patients with a degree of comminution such that the articular surface was not amenable to reconstruction. These patients underwent staged treatment with external fixation initially and conversion to retrograde calcaneo talo tibial nailing as a second procedure. Results: A total of 6 patients fell into our inclusion criteria. The mean age was 56 years old at the time of the injury. There were no infections noted. One patient had healed at one year and underwent removal of the implant and one patient had prominent calcaneal screw that had to be removed. Conclusion: The decision to use a retrograde tibiotalocalcaneal nail has proven itself useful in decreasing pain as well as reducing the number of operative procedures and in helping patients return to their pre-injury levels sooner. Additional benefits have included leaving the soft tissue envelope intact, decreasing incidence of deep seated infection, which has proven useful when high energy, open, severely comminuted and contaminated polytrauma individuals present. A9 Angle stable plate or angle stable locked nail fixation in distal radius fractures. An experimental examination and Phase I clinical study W. Friedl1 , M. Rinner2 , M. Simnacher2 , C. Mathieu2 . 1 Klinikum Aschaffenburg, 2 Smith & Nephew Schweiz, Germany Aims: Distal radius fractures are typical and frequent fracture of elderly woman with reduced bone density. Thus implant fixation is more difficult. Dorsal and radial comminution are frequent in these patients and so reduction and angle stable osteosynthesis needed. The angle stable plate, often also multidirectional is today the most common stabilisation device. Because of the introduction of bulky and bended implants as the Micronail or Targon DR wich require difficult opening of the bone with awles we decided to test the XS radius nail witch is a 4.5 mm or 3.5 mm straight nail and witch is introduced after guide wire placement and over drilling with a canulated drill of the same diameter. It is locked parallel to the joint in 3 different directions with angular stability with threaded wires. Methods: 16 radius sawbones were osteotomised corresponding to a A3 Fracture and stabilised with a angle stable plate (8) and XS nail (8). 1000 alternating load cycles from 20–200N were performed and the deformation was registered. Also a FE analysis with the MSC Patran/Marc softwere were performed. Due to the results we developed a anatomically adapted XS radius nail. The results of the first 100 patients are presented. The clinical results of the first 100 patients treated with the XS Radius nail were prospectively analysed. Results: Both devices show good biomechanical results. Both types of osteosynthesis showed good stability. The deformation of the XS group however was 20% lower. Also the calculated deformation in the FE study was 20% lower. The deformation amplitude was also lower for the XS Nail with 0.31mm compared tu 0.42mm in the plate group. The differences however were not significant. In the first 100 patients one partial loss pf reduction and two threaded wire breakage were observed. Conclusiones: The XS nail has the advantage of mainly intraosseus position, simple operation technique with introduction over a guide wire from the proc. Styloideus radii and over drilling with a canulated drill of the same size as the nail. The exposure of the N rad.superf. must be performed.
S3
A10 Fixator assisted nailing in radial and ulnar shaft fractures A.N. Chelnokov, A.Yu. Lazarev. Ural Scientific Institute of Traumatology and Orthopaedics named after V.D. Chaklin, Ekaterinburg, Russia Purpose and Aim: Closed nailing has become the “gold standard” in shaft fractures of long bones but not in the forearm where plating is conventional technique. Limited use of forearm nailing is caused by difficulties of closed restoration of anatomy. Main problems are rotational alignment of the radius and resoration of radial bow to prevent functional deficit. Aim of our study was development of surgical technique of closed fixator-assisted forearm nailing. Material and Methods: We treated 144 patients with forearm fractures (120) and nonunions (24). There were lesions of both bones in 57, ulna – 54, radius – 33. For fixator assisted nailing we used a device consisted of a half-ring proximally and a ring distally. The distal part of the forearm was fixed in neutral rotaton regardless of the fracture level. For rotational control of the proximal fragment of the radius a joystick K-wire was used. The ulna was nailed first by a straight nail, then the radius was nailed with a pre-bent nail. Results: Patients demonstrated fast functional recovery. Full range of motions occurred in 1 month after the surgery in 78% of patients, and in 2 month in 97%. DASH functional score improved from 21 in 1 month to 3 in 2 month. Nonunion of the ulna occurred in 5 cases (3.4%), of the radius in 1 case (0.7%). Exchange reamed nailing was performed in ulna and plating with bone grafting in the radius nonunion. Conclusion: The technique provides good alignment of both bones which results with quick and full functional recovery and high union rate. Closed nailing can be treatment of choice in any forearm shaft fractures. Negative perception of forearm nailing is caused mostly by inadequacy of conventional reduction and nailing techniques rather than implant designs. A11 Intramedullary fixation of proximal ulna fractures – a comparative biomechanical study T.E. Nowak, K.J. Burkhart, D. Klitscher, L.P. Mueller, P.M. Rommens. Department of Trauma Surgery, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany Aims: The aim of this study was to evaluate the biomechanical stability of two new designed fracture fixation devices for the treatment of olecranon fractures in dynamic continuous loading in comparison to tension band wiring. Materials and Methods: Simulated oblique olecranon fractures were created in sixteen pairs of fresh-frozen cadaver ulnae and were stabilized using either a pre-contoured locking compression plate or an intramedullary locking nail in comparison to tension band wiring. The specimens were then subjected to continuous dynamic loading (from 25 to 200 N) with a continuous angle alteration between 0° and 90° of flexion to perform a matched pairs comparison. Significant differences in the distance between the markers surrounding the fracture gap was determined after 4 and 300 loading cycles using the Wilcoxon test. Results: After 300 cycles the displacement in the fracture fixation model was significantly higher in the tension band wiring group than in the intramedullary nailing group. The intramedullary nail resulted in significantly less displacement in comparison to locked plating in the fracture gap at 0° extension (P = 0.036), 45° flexion (P = 0.035) and 90° flexion (P = 0.017) after 300 cycles of continuous loading. Conclusion: The tested nailing system showed significant advantages in loosening and stability in comparison to tension band wiring. Locked plating and intramedullary nailing showed less displacement of the fragments after dynamic continuous loading to simulate light physiotherapeutic training in cadaver upper
criteria included severe soft tissue injury, comorbidities such that the infection rate following a large skin incision was unacceptable, patients with a degree of comminution such that the articular surface was not amenable to reconstruction. These patients underwent staged treatment with external fixation initially and conversion to retrograde calcaneo talo tibial nailing as a second procedure. Results: A total of 6 patients fell into our inclusion criteria. The mean age was 56 years old at the time of the injury. There were no infections noted. One patient had healed at one year and underwent removal of the implant and one patient had prominent calcaneal screw that had to be removed. Conclusion: The decision to use a retrograde tibiotalocalcaneal nail has proven itself useful in decreasing pain as well as reducing the number of operative procedures and in helping patients return to their pre-injury levels sooner. Additional benefits have included leaving the soft tissue envelope intact, decreasing incidence of deep seated infection, which has proven useful when high energy, open, severely comminuted and contaminated polytrauma individuals present. A9 Angle stable plate or angle stable locked nail fixation in distal radius fractures. An experimental examination and Phase I clinical study W. Friedl1 , M. Rinner2 , M. Simnacher2 , C. Mathieu2 . 1 Klinikum Aschaffenburg, 2 Smith & Nephew Schweiz, Germany Aims: Distal radius fractures are typical and frequent fracture of elderly woman with reduced bone density. Thus implant fixation is more difficult. Dorsal and radial comminution are frequent in these patients and so reduction and angle stable osteosynthesis needed. The angle stable plate, often also multidirectional is today the most common stabilisation device. Because of the introduction of bulky and bended implants as the Micronail or Targon DR wich require difficult opening of the bone with awles we decided to test the XS radius nail witch is a 4.5 mm or 3.5 mm straight nail and witch is introduced after guide wire placement and over drilling with a canulated drill of the same diameter. It is locked parallel to the joint in 3 different directions with angular stability with threaded wires. Methods: 16 radius sawbones were osteotomised corresponding to a A3 Fracture and stabilised with a angle stable plate (8) and XS nail (8). 1000 alternating load cycles from 20–200N were performed and the deformation was registered. Also a FE analysis with the MSC Patran/Marc softwere were performed. Due to the results we developed a anatomically adapted XS radius nail. The results of the first 100 patients are presented. The clinical results of the first 100 patients treated with the XS Radius nail were prospectively analysed. Results: Both devices show good biomechanical results. Both types of osteosynthesis showed good stability. The deformation of the XS group however was 20% lower. Also the calculated deformation in the FE study was 20% lower. The deformation amplitude was also lower for the XS Nail with 0.31mm compared tu 0.42mm in the plate group. The differences however were not significant. In the first 100 patients one partial loss pf reduction and two threaded wire breakage were observed. Conclusiones: The XS nail has the advantage of mainly intraosseus position, simple operation technique with introduction over a guide wire from the proc. Styloideus radii and over drilling with a canulated drill of the same size as the nail. The exposure of the N rad.superf. must be performed.
S3
A10 Fixator assisted nailing in radial and ulnar shaft fractures A.N. Chelnokov, A.Yu. Lazarev. Ural Scientific Institute of Traumatology and Orthopaedics named after V.D. Chaklin, Ekaterinburg, Russia Purpose and Aim: Closed nailing has become the “gold standard” in shaft fractures of long bones but not in the forearm where plating is conventional technique. Limited use of forearm nailing is caused by difficulties of closed restoration of anatomy. Main problems are rotational alignment of the radius and resoration of radial bow to prevent functional deficit. Aim of our study was development of surgical technique of closed fixator-assisted forearm nailing. Material and Methods: We treated 144 patients with forearm fractures (120) and nonunions (24). There were lesions of both bones in 57, ulna – 54, radius – 33. For fixator assisted nailing we used a device consisted of a half-ring proximally and a ring distally. The distal part of the forearm was fixed in neutral rotaton regardless of the fracture level. For rotational control of the proximal fragment of the radius a joystick K-wire was used. The ulna was nailed first by a straight nail, then the radius was nailed with a pre-bent nail. Results: Patients demonstrated fast functional recovery. Full range of motions occurred in 1 month after the surgery in 78% of patients, and in 2 month in 97%. DASH functional score improved from 21 in 1 month to 3 in 2 month. Nonunion of the ulna occurred in 5 cases (3.4%), of the radius in 1 case (0.7%). Exchange reamed nailing was performed in ulna and plating with bone grafting in the radius nonunion. Conclusion: The technique provides good alignment of both bones which results with quick and full functional recovery and high union rate. Closed nailing can be treatment of choice in any forearm shaft fractures. Negative perception of forearm nailing is caused mostly by inadequacy of conventional reduction and nailing techniques rather than implant designs. A11 Intramedullary fixation of proximal ulna fractures – a comparative biomechanical study T.E. Nowak, K.J. Burkhart, D. Klitscher, L.P. Mueller, P.M. Rommens. Department of Trauma Surgery, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany Aims: The aim of this study was to evaluate the biomechanical stability of two new designed fracture fixation devices for the treatment of olecranon fractures in dynamic continuous loading in comparison to tension band wiring. Materials and Methods: Simulated oblique olecranon fractures were created in sixteen pairs of fresh-frozen cadaver ulnae and were stabilized using either a pre-contoured locking compression plate or an intramedullary locking nail in comparison to tension band wiring. The specimens were then subjected to continuous dynamic loading (from 25 to 200 N) with a continuous angle alteration between 0° and 90° of flexion to perform a matched pairs comparison. Significant differences in the distance between the markers surrounding the fracture gap was determined after 4 and 300 loading cycles using the Wilcoxon test. Results: After 300 cycles the displacement in the fracture fixation model was significantly higher in the tension band wiring group than in the intramedullary nailing group. The intramedullary nail resulted in significantly less displacement in comparison to locked plating in the fracture gap at 0° extension (P = 0.036), 45° flexion (P = 0.035) and 90° flexion (P = 0.017) after 300 cycles of continuous loading. Conclusion: The tested nailing system showed significant advantages in loosening and stability in comparison to tension band wiring. Locked plating and intramedullary nailing showed less displacement of the fragments after dynamic continuous loading to simulate light physiotherapeutic training in cadaver upper