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PF5 Clinical results of new intramedullary nails for the treatment of forearm diaphyseal fractures
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Osteosynthese International 2013 – Poster Sessions / Injury, Int. J. Care Injured 44S2 (2013) S37–S46
metaphyseal fracture. Treatment was made by locked anatomic tibial plate and MiPO technique on 17 patients (Group 1) and by closed intramedullary nailing on 18 patients (Group 2). According to the AO classification, the fractures were 43 A. Concomitant fibular fracture was determined in 11 patients of Group 1 and 9 patients of Group 2. The mean follow-up period was 11 months (6–17 months). The cases were evaluated clinically, radiographically and functionally with the American Foot and Ankle Score (AFAS). Results: There was full bone union in all cases. The mean union time was determined as 15.4 weeks (11–20 weeks) in Group 1 and as 17.4 weeks (12–22 weeks) in Group 2. The mean AFAS score was 79.4 (47–90) in Group 1 and 80.8 (65–90) in Group 2. The mean duration of surgery was 94.5 mins (59–139 mins) in Group 1 and 82.6 mins (59– 145 mins) in Group 2. Complications were determined as implant irritation in 2 patients in Group 1 and pain in the anterior knee in 3 patients in Group 2. Full ankle movement was achieved in all cases. Conclusion: The clinical and functional results of MiPO and intramedullar nailing fixation in the treatment of distal tibial metaphyseal fractures were determined to be similar. The mean operational time with intramedullar nailing was shorter and the mean time to union with MiPO was shorter. PF4 Expandable retrograde nail for femoral fracture above a total knee replacement 1 , Ö. Çetik1 , S. Durusoy1 . 1Department of Orthopedics and M. Turker ¨ Traumatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey Introduction: Periprosthetic fractures after total knee arthroplasty occur as a result of low energy trauma usually compounding some surgical pitfalls and patient related factors. Patient and technique related predisposing factors are osteopenia, osteolysis, malalignment, anterior femoral notching, poor flexion (stiff knee), corticosteroid use, rheumatoid arthritis, myasthenia gravis and cerebral palsy. Materials and Methods: The reported periprosthetic fracture incidence ranges from 0.3 to 2.5 percent. But unfortunately an increase of periprosthetic fracture incidence would be inevitable due to increased life expectancy and osteoporotic patient numbers. Treatment of periprosthetic fractures is a challenge for the surgeon because of decreased bone quality and complicating systemic diseases. The most prevalent type of periprosthetic fracture is the Rorabeck type 2. Recommended treatment options are plating, external fixation and retrograde intramedullary nailing (RiMN). There is still continuing debate which treatment option is optimal for these patients. There is no consensus on the technique to be used but logically it must be minimally invasive to decrease mortality and morbidity. Results: Stable osteosynthesis obtained by minimal invasive techniques assures more rapid fracture union. In treatment of femoral periprosthetic fractures classic locked RiMN is currently the most successful technique with lowest complication rates. But the applicability of this technique is confined to a limited number of periprosthetic femoral fractures. The main cause of this limitation is the small box size and design of some currently available prosthesis on the market, rendering insertion of classic RiMN. In the coronal plane the entry point of femoral nail shifts far posterior limiting the insertion of a larger diameter femoral nail. Conclusion: We suggest that in treatment of periprosthetic fractures with a narrow intercondylar box sized femoral component, expandable intramedullary nails (EiMN) may be a valuable option. But also, it must be beared in mind that expandable nails have some technical pitfalls and because of this it should not be regarded as the first choice. To our knowledge use of EiMN for a periprosthetic femoral fracture has not been reported before in englishlanguage
literature. Our patient signed a written consent that data concerning the case would be submitted for publication. PF5 Clinical results of new intramedullary nails for the treatment of forearm diaphyseal fractures A. Aydin1 , A. Kose ¨ 1 , M. Topal1 , N. Ezirmik1 , M. Kose ¨ 1 , M. Iptec1 . 1Department of Orthopaedics and Traumatology, Atat¨ urk University, Medical School Hospital, Erzurum, Turkey Introduction: In this study we aimed to evaluate the clinicial outcomes of new intramedullary nail for the treatment of radius and ulna diaphyseal fractures. Material and Methods: A prospective analysis of 34 patients (25 male, 9 female) who were treated with new intramedullary nails for forearm diaphyseal fractures was performed. The mean age was 35 (range 20–56). The patients were followed up monthly untill the fracture union occured. Mean follow-up period was 19 months (range 12–38). Radius and ulna fractures had been classified depending on the site of the fracture. Patients had been evaluated according to the Grace–Eversmann and DASH (Disabilities of the Arm, Shoulder and Hand) scores at the last follow up. Results: The mean time of fracture union was 11 weeks (range 8–20). 8 (23.5%) of 34 fractures were in the distal 1/3rd, 19 (55.8%) were in the middle 1/3rd, 7 (20.5%) were in the proximal 1/3rd. 28 patients were evaluated as excellent, 5 patients as good and 1 patient as fair result according to Grace–Eversmann score. Mean DASH score was 37.14 (range 30–80). No postoperative complications had been noted. Conclusion: Treatment of adult forearm diaphyseal fracture with the new intramedullary nails have promising results. Postoperative immobilisation is not required so early rehabilitation can be performed. Complication rate is very low. More extensive researchs with greater number of patients are required. Keywords: New intramedullary nail, intramedullary nail, forearm fractures. PF6 Treatment of radius and ulna pseudoarthrroses with the new intramedullary nails A. Aydin1 , A. Kose ¨ 1 , M. Topal1 , N. Ezirmik1 , M. Kose ¨ 1 , M. Iptec1 . 1Department of Orthopaedics and Traumatology, Atat¨ urk University, Medical School Hospital, Erzurum, Turkey Introduction: In this study we have evaluated the clinical outcomces of radius and ulna pseudoarthroses treated with the new intramedullary nail. Materials and Methods: This study included 9 patients whom had been operated for Radius and ulna pseudoarthroses. Mean age of the patients was 39 (range 26–54). 3 of 9 patients had pseudoarthrosis of radius, 2 had pseudoarthrosis of ulna and 4 had pseudoarthroses of both radius and ulna. The mean time after the inital operation was 14 months (range 7–24). Intramedullary nailing was performed on 7 patients whereas intramedullary nailing together with autologous tricortical bone grafting was performed on 2 of the patients with radius fractures, 2 of the patients with ulna fractures and on 2 of the patients with radius and ulna fractures. Patients had been followed up monthly after the operation untill the fracture union occured. The mean time of follow up was 20 months (12–28). Results: The mean time of fracture union was 13 months (range 9–24). The mean time of fracture union in patients with radial pseudoarthroses was 10 months, in patients with ulna pseudoarthroses it was 13 months and in patients with ulna and radius pseudoarthroses it was 11 months. Autologous bone marrow injection was done to the fracture site of a patient with radius and ulna pseudoarthroses who had delayed union after the intramedullary nailing and the patient is still being followed up.
Osteosynthese International 2013 – Poster Sessions / Injury, Int. J. Care Injured 44S2 (2013) S37–S46
metaphyseal fracture. Treatment was made by locked anatomic tibial plate and MiPO technique on 17 patients (Group 1) and by closed intramedullary nailing on 18 patients (Group 2). According to the AO classification, the fractures were 43 A. Concomitant fibular fracture was determined in 11 patients of Group 1 and 9 patients of Group 2. The mean follow-up period was 11 months (6–17 months). The cases were evaluated clinically, radiographically and functionally with the American Foot and Ankle Score (AFAS). Results: There was full bone union in all cases. The mean union time was determined as 15.4 weeks (11–20 weeks) in Group 1 and as 17.4 weeks (12–22 weeks) in Group 2. The mean AFAS score was 79.4 (47–90) in Group 1 and 80.8 (65–90) in Group 2. The mean duration of surgery was 94.5 mins (59–139 mins) in Group 1 and 82.6 mins (59– 145 mins) in Group 2. Complications were determined as implant irritation in 2 patients in Group 1 and pain in the anterior knee in 3 patients in Group 2. Full ankle movement was achieved in all cases. Conclusion: The clinical and functional results of MiPO and intramedullar nailing fixation in the treatment of distal tibial metaphyseal fractures were determined to be similar. The mean operational time with intramedullar nailing was shorter and the mean time to union with MiPO was shorter. PF4 Expandable retrograde nail for femoral fracture above a total knee replacement 1 , Ö. Çetik1 , S. Durusoy1 . 1Department of Orthopedics and M. Turker ¨ Traumatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey Introduction: Periprosthetic fractures after total knee arthroplasty occur as a result of low energy trauma usually compounding some surgical pitfalls and patient related factors. Patient and technique related predisposing factors are osteopenia, osteolysis, malalignment, anterior femoral notching, poor flexion (stiff knee), corticosteroid use, rheumatoid arthritis, myasthenia gravis and cerebral palsy. Materials and Methods: The reported periprosthetic fracture incidence ranges from 0.3 to 2.5 percent. But unfortunately an increase of periprosthetic fracture incidence would be inevitable due to increased life expectancy and osteoporotic patient numbers. Treatment of periprosthetic fractures is a challenge for the surgeon because of decreased bone quality and complicating systemic diseases. The most prevalent type of periprosthetic fracture is the Rorabeck type 2. Recommended treatment options are plating, external fixation and retrograde intramedullary nailing (RiMN). There is still continuing debate which treatment option is optimal for these patients. There is no consensus on the technique to be used but logically it must be minimally invasive to decrease mortality and morbidity. Results: Stable osteosynthesis obtained by minimal invasive techniques assures more rapid fracture union. In treatment of femoral periprosthetic fractures classic locked RiMN is currently the most successful technique with lowest complication rates. But the applicability of this technique is confined to a limited number of periprosthetic femoral fractures. The main cause of this limitation is the small box size and design of some currently available prosthesis on the market, rendering insertion of classic RiMN. In the coronal plane the entry point of femoral nail shifts far posterior limiting the insertion of a larger diameter femoral nail. Conclusion: We suggest that in treatment of periprosthetic fractures with a narrow intercondylar box sized femoral component, expandable intramedullary nails (EiMN) may be a valuable option. But also, it must be beared in mind that expandable nails have some technical pitfalls and because of this it should not be regarded as the first choice. To our knowledge use of EiMN for a periprosthetic femoral fracture has not been reported before in englishlanguage
literature. Our patient signed a written consent that data concerning the case would be submitted for publication. PF5 Clinical results of new intramedullary nails for the treatment of forearm diaphyseal fractures A. Aydin1 , A. Kose ¨ 1 , M. Topal1 , N. Ezirmik1 , M. Kose ¨ 1 , M. Iptec1 . 1Department of Orthopaedics and Traumatology, Atat¨ urk University, Medical School Hospital, Erzurum, Turkey Introduction: In this study we aimed to evaluate the clinicial outcomes of new intramedullary nail for the treatment of radius and ulna diaphyseal fractures. Material and Methods: A prospective analysis of 34 patients (25 male, 9 female) who were treated with new intramedullary nails for forearm diaphyseal fractures was performed. The mean age was 35 (range 20–56). The patients were followed up monthly untill the fracture union occured. Mean follow-up period was 19 months (range 12–38). Radius and ulna fractures had been classified depending on the site of the fracture. Patients had been evaluated according to the Grace–Eversmann and DASH (Disabilities of the Arm, Shoulder and Hand) scores at the last follow up. Results: The mean time of fracture union was 11 weeks (range 8–20). 8 (23.5%) of 34 fractures were in the distal 1/3rd, 19 (55.8%) were in the middle 1/3rd, 7 (20.5%) were in the proximal 1/3rd. 28 patients were evaluated as excellent, 5 patients as good and 1 patient as fair result according to Grace–Eversmann score. Mean DASH score was 37.14 (range 30–80). No postoperative complications had been noted. Conclusion: Treatment of adult forearm diaphyseal fracture with the new intramedullary nails have promising results. Postoperative immobilisation is not required so early rehabilitation can be performed. Complication rate is very low. More extensive researchs with greater number of patients are required. Keywords: New intramedullary nail, intramedullary nail, forearm fractures. PF6 Treatment of radius and ulna pseudoarthrroses with the new intramedullary nails A. Aydin1 , A. Kose ¨ 1 , M. Topal1 , N. Ezirmik1 , M. Kose ¨ 1 , M. Iptec1 . 1Department of Orthopaedics and Traumatology, Atat¨ urk University, Medical School Hospital, Erzurum, Turkey Introduction: In this study we have evaluated the clinical outcomces of radius and ulna pseudoarthroses treated with the new intramedullary nail. Materials and Methods: This study included 9 patients whom had been operated for Radius and ulna pseudoarthroses. Mean age of the patients was 39 (range 26–54). 3 of 9 patients had pseudoarthrosis of radius, 2 had pseudoarthrosis of ulna and 4 had pseudoarthroses of both radius and ulna. The mean time after the inital operation was 14 months (range 7–24). Intramedullary nailing was performed on 7 patients whereas intramedullary nailing together with autologous tricortical bone grafting was performed on 2 of the patients with radius fractures, 2 of the patients with ulna fractures and on 2 of the patients with radius and ulna fractures. Patients had been followed up monthly after the operation untill the fracture union occured. The mean time of follow up was 20 months (12–28). Results: The mean time of fracture union was 13 months (range 9–24). The mean time of fracture union in patients with radial pseudoarthroses was 10 months, in patients with ulna pseudoarthroses it was 13 months and in patients with ulna and radius pseudoarthroses it was 11 months. Autologous bone marrow injection was done to the fracture site of a patient with radius and ulna pseudoarthroses who had delayed union after the intramedullary nailing and the patient is still being followed up.