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OS1-06 Intramedullary nailing of tibial fractures: results and complications
Osteosynthese International 2016 / Injury, Int. J. Care Injured 47S5 (2016) S1–S38
days requiring ventilator assistance. The average Injury Severity Score was 21, Fraser type IIB was significantly higher (ISS 30, p < 0.05) and Fraser type I the lowest (ISS 20). The average Fraser type I was significantly lower (32 years, p < 0.007) and Fraser type IIC having the highest age (45 years). The results of Fraser classification were: type I 41%, type IIA 30%, type IIB 12%, type IIC 17%. Intramedullary fixation was used as definitive treatment for 64.7% of femur fractures and 45.1% of tibia fractures. A single incision for the intramedullary nailing of both fractures was used in 17 patients, 12 at the same surgery. Complications included one perioperative death, one non-union and one malunion revision surgery. Significant complications occurred in the other floating knee patients including three amputation and five hospital deaths. Other significant complications occurred including acute compartment syndrome, nonunion, deep infection, and peri-implant fracture. Conclusions: Floating knee injuries, frequently associated with concomitant injuries and high energy trauma, represent a unique combination of fractures. In our study population Fraser type I patients were significantly younger than Type II patients and had a lower ISS. Fraser Type IIB injuries occurred in older patients and were associated with a significantly higher ISS. Because of the high energy associated with these fractures, external fixation was employed more frequently. At our institution, definitive intramedullary nailing through a single incision was useful treatment option for patients with Type 1 floating knee injuries. Our cohort of patients had multiple complications postoperatively including non-union, malunion, infections and peri-implant fractures. Floating knee injuries remain a life and limb threatening injury that is associated with multiple complications and a prolonged recovery. Damage control orthopaedics with external fixation is appropriate for initial management. OS1-06 Intramedullary nailing of tibial fractures: results and complications G. Tomoaia1, C. Bardas1, H. Benea1, M. Paiusan1, D. Oltean1, Z. Gabri1, R. Tomoaia1, C. Dan1. 1Orthopedics and Traumatology, UMF “Iuliu Hatieganu”, Cluj-Napoca, Romania Introduction: Tibial fractures are one of the most serious long bone fractures, due to their potential for malunion, nonunion and longterm dysfunction, as well as their propensity for open injury. Intramedullary nailing represents the gold standard treatment for displaced and closed fractures or some types of open diaphyseal fractures. Objectives: The aim of this retrospective clinical study was to analyze the functional outcome of patients with tibial shaft fractures, treated with conventional intramedullary nails. Materials and Methods: The study included 91 patients (62 males and 29 females) with tibial shaft fractures, hospitalized and surgically treated between January 2013 and December 2015 in the Orthopaedics and Traumatology Clinic of Cluj-Napoca, using intramedullary nailing as a definitive fixation treatment. The mean age of male patients was 38 (range 18–89 years) and for women 44 (range 26–90 years). Results: We have found 93 fractures in 91 patients that were treated with intramedullary nailing. Twenty-one percent of patients (6% females and 15% males) had a second intervention for dynamization of intramedullary nail, procedure that led to shortening of recovery time in this group in contrast with the rest of cases. Only 3 patients had surgery for complications related to intramedullary nailing. Conclusion: The study showed that intramedullary nailing represent a very good option for tibial fractures treatment, and the dynamization of the nail improves the healing and recovery of patients with this type of fracture.
S3
OS1-08 The treatment of the leg fractures using internal medullar nail implants. Retrospective study D. Calin1, D. Grecu1, A. Grecu1, C. Prica1, M. Sarbu1, W. Shaban1. 1 Orthopedics-Traumatology, Emergency Hospital Craiova, Craiova, Romania Purpose: The present paper represents the experience of our clinics regarding the treatment of leg fractures using internal medullar nails – Kuntscher nails and locking nails. Materials and Methods: We reviewed 178 patients in our clinics during 01/01/2014–31/01/2016 treated by bone synthesis with locked nails and Kuntscher’s nails. We used 123 Kuntscher’s nails and 55 locked nails. We used the Kuntscher′s nail in simple fractures in 1/3 middle legs. In the 1/3 inferior leg fractures (>5 cm from to the ankle) and 1/3 upper leg fractures (>5 cm from the knee) we used locked nails. In the multi fragmentary fractures we used static locked nails, that were dinamised at 8 weeks after surgery. In Kuntscher’s we also used external plaster immobilization for 8–9 weeks, with 4 weeks of above knee cast followed by other 4 weeks of plaster immobilization below knee cast. For locked nails, 4 days after the surgery, the patients started the rehabilitation. They were allowed to walk, without walking on the injured foot. After 10 weeks they were allowed to walk on the injured foot, with partially weight bearing −5 kilos. For Kuntscher’s nails, 4 days after the surgery, the patients started the rehabilitation. They were allowed to walk, without walking on the injured foot. After 12 weeks they were allowed to walk on the injured foot, partially weight bearing −5 kilos maximum. The patients had an X-ray examination (F+P). The average anticlotting therapy for the locking nails was for 30 days and in the Kuntscher nails 80–85 days. Results: The rehabilitation was shorter on the locked nails treated patients, with a lower complication rate, especially vascular complication. After 10 weeks they were allowed to walk on the injured foot, partially weight bearing −5 kilos. The Kuntscher’s nail bone synthesis has a higher rate of vascular complications that can make the recovery heavier or even stop the fully rehabilitation of the patients. The complete recovery with walking completely on the foot was in 17–22 weeks for locked nails compared to 20–24 weeks for Kuntscher’s nails. Complications: DVT, late post thrombotic syndrome, chronic edema were observed more frequently in the Kuntscher nail patients. Conclusions: Even treatment with K nail is cheaper, total cost, due to longer recovery period is higher.
Session II: Nail vs. plate vs. prosthesis: femur OS2-09 The clinical results of the Dynamic Locking Blade Plate in the fixation of undisplaced and displaced femoral neck fractures A. van Walsum1, W. Roerdink2, J. Vroemen3, H. Janzing4, T. Winkelhorst5. 1Trauma Surgery, MST, Enschede, Netherlands, 2 Trauma Surgery, Deventer Ziekenhuis, Deventer, Netherlands, 3 Trauma Surgery, Amphia Ziekenhuis, Breda, Netherlands, 4Trauma Surgery, VieCuri Medical Centre, Venlo, Netherlands, 5 Trauma Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
days requiring ventilator assistance. The average Injury Severity Score was 21, Fraser type IIB was significantly higher (ISS 30, p < 0.05) and Fraser type I the lowest (ISS 20). The average Fraser type I was significantly lower (32 years, p < 0.007) and Fraser type IIC having the highest age (45 years). The results of Fraser classification were: type I 41%, type IIA 30%, type IIB 12%, type IIC 17%. Intramedullary fixation was used as definitive treatment for 64.7% of femur fractures and 45.1% of tibia fractures. A single incision for the intramedullary nailing of both fractures was used in 17 patients, 12 at the same surgery. Complications included one perioperative death, one non-union and one malunion revision surgery. Significant complications occurred in the other floating knee patients including three amputation and five hospital deaths. Other significant complications occurred including acute compartment syndrome, nonunion, deep infection, and peri-implant fracture. Conclusions: Floating knee injuries, frequently associated with concomitant injuries and high energy trauma, represent a unique combination of fractures. In our study population Fraser type I patients were significantly younger than Type II patients and had a lower ISS. Fraser Type IIB injuries occurred in older patients and were associated with a significantly higher ISS. Because of the high energy associated with these fractures, external fixation was employed more frequently. At our institution, definitive intramedullary nailing through a single incision was useful treatment option for patients with Type 1 floating knee injuries. Our cohort of patients had multiple complications postoperatively including non-union, malunion, infections and peri-implant fractures. Floating knee injuries remain a life and limb threatening injury that is associated with multiple complications and a prolonged recovery. Damage control orthopaedics with external fixation is appropriate for initial management. OS1-06 Intramedullary nailing of tibial fractures: results and complications G. Tomoaia1, C. Bardas1, H. Benea1, M. Paiusan1, D. Oltean1, Z. Gabri1, R. Tomoaia1, C. Dan1. 1Orthopedics and Traumatology, UMF “Iuliu Hatieganu”, Cluj-Napoca, Romania Introduction: Tibial fractures are one of the most serious long bone fractures, due to their potential for malunion, nonunion and longterm dysfunction, as well as their propensity for open injury. Intramedullary nailing represents the gold standard treatment for displaced and closed fractures or some types of open diaphyseal fractures. Objectives: The aim of this retrospective clinical study was to analyze the functional outcome of patients with tibial shaft fractures, treated with conventional intramedullary nails. Materials and Methods: The study included 91 patients (62 males and 29 females) with tibial shaft fractures, hospitalized and surgically treated between January 2013 and December 2015 in the Orthopaedics and Traumatology Clinic of Cluj-Napoca, using intramedullary nailing as a definitive fixation treatment. The mean age of male patients was 38 (range 18–89 years) and for women 44 (range 26–90 years). Results: We have found 93 fractures in 91 patients that were treated with intramedullary nailing. Twenty-one percent of patients (6% females and 15% males) had a second intervention for dynamization of intramedullary nail, procedure that led to shortening of recovery time in this group in contrast with the rest of cases. Only 3 patients had surgery for complications related to intramedullary nailing. Conclusion: The study showed that intramedullary nailing represent a very good option for tibial fractures treatment, and the dynamization of the nail improves the healing and recovery of patients with this type of fracture.
S3
OS1-08 The treatment of the leg fractures using internal medullar nail implants. Retrospective study D. Calin1, D. Grecu1, A. Grecu1, C. Prica1, M. Sarbu1, W. Shaban1. 1 Orthopedics-Traumatology, Emergency Hospital Craiova, Craiova, Romania Purpose: The present paper represents the experience of our clinics regarding the treatment of leg fractures using internal medullar nails – Kuntscher nails and locking nails. Materials and Methods: We reviewed 178 patients in our clinics during 01/01/2014–31/01/2016 treated by bone synthesis with locked nails and Kuntscher’s nails. We used 123 Kuntscher’s nails and 55 locked nails. We used the Kuntscher′s nail in simple fractures in 1/3 middle legs. In the 1/3 inferior leg fractures (>5 cm from to the ankle) and 1/3 upper leg fractures (>5 cm from the knee) we used locked nails. In the multi fragmentary fractures we used static locked nails, that were dinamised at 8 weeks after surgery. In Kuntscher’s we also used external plaster immobilization for 8–9 weeks, with 4 weeks of above knee cast followed by other 4 weeks of plaster immobilization below knee cast. For locked nails, 4 days after the surgery, the patients started the rehabilitation. They were allowed to walk, without walking on the injured foot. After 10 weeks they were allowed to walk on the injured foot, with partially weight bearing −5 kilos. For Kuntscher’s nails, 4 days after the surgery, the patients started the rehabilitation. They were allowed to walk, without walking on the injured foot. After 12 weeks they were allowed to walk on the injured foot, partially weight bearing −5 kilos maximum. The patients had an X-ray examination (F+P). The average anticlotting therapy for the locking nails was for 30 days and in the Kuntscher nails 80–85 days. Results: The rehabilitation was shorter on the locked nails treated patients, with a lower complication rate, especially vascular complication. After 10 weeks they were allowed to walk on the injured foot, partially weight bearing −5 kilos. The Kuntscher’s nail bone synthesis has a higher rate of vascular complications that can make the recovery heavier or even stop the fully rehabilitation of the patients. The complete recovery with walking completely on the foot was in 17–22 weeks for locked nails compared to 20–24 weeks for Kuntscher’s nails. Complications: DVT, late post thrombotic syndrome, chronic edema were observed more frequently in the Kuntscher nail patients. Conclusions: Even treatment with K nail is cheaper, total cost, due to longer recovery period is higher.
Session II: Nail vs. plate vs. prosthesis: femur OS2-09 The clinical results of the Dynamic Locking Blade Plate in the fixation of undisplaced and displaced femoral neck fractures A. van Walsum1, W. Roerdink2, J. Vroemen3, H. Janzing4, T. Winkelhorst5. 1Trauma Surgery, MST, Enschede, Netherlands, 2 Trauma Surgery, Deventer Ziekenhuis, Deventer, Netherlands, 3 Trauma Surgery, Amphia Ziekenhuis, Breda, Netherlands, 4Trauma Surgery, VieCuri Medical Centre, Venlo, Netherlands, 5 Trauma Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands