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Gareth Davies, Gerald Yeo, Mahendrakumar Meta, David Miller, Erik Hohmann, Kevin Tetsworth
OBJECTIVES: To compare the risk of major complications after either minimally invasive plate osteosynthesis (MIPO) or intramedullary nailing (IMN) of humeral shaft fractures. DESIGN: Retrospective, case-match controlled study. SETTING: A major metropolitan tertiary referral trauma center in Australia. PATIENTS: Thirty patients with fractures of the humeral shaft. INTERVENTION: Either MIPO or IMN were performed on 15 patients each with traumatic humeral shaft fractures...
November 2016: Journal of Orthopaedic Trauma
Stephen Matthew Quinnan
Obtaining optimal results in the treatment of extraarticular distal tibia fractures can be challenging. Plate and screw and intramedullary fixation have proven to be effective treatments, but are associated with significant complication rates when used for open fractures and patient with severe medical comorbidities. External fixation is a third alternative that is less often employed, but provides a very effective means of treatment. Circular external fixation offers great flexibility in obtaining anatomic alignment and stable fixation for even the most challenging distal tibia fractures...
November 2016: Journal of Orthopaedic Trauma
Richard S Yoon, Frank A Liporace
Intramedullary nail and plate combination techniques have been described mostly for use in the proximal tibia. However, the nail and plate combination technique can also be used in the distal tibia, to counteract the deforming forces that cause construct failure and nonunion. In this article, we review pertinent anatomy and biomechanics and offer case examples that highlight the indications and applications of the nail and plate combination technique for distal tibia fractures.
November 2016: Journal of Orthopaedic Trauma
John A Scolaro, Francis H Broghammer, Derek J Donegan
The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages...
November 2016: Journal of Orthopaedic Trauma
Michael Talerico, Jaimo Ahn
The objective of this article is to highlight the salient points of preoperative planning, intraoperative considerations for fracture reduction methods, and implant fixation when treating distal diaphyseal or diametaphyseal tibia fractures with an intramedullary nail. Through review of the necessary preoperative considerations, techniques available to hold and maintain a reduction, and lastly how to maximize the selected implant of intramedullary nail, we hope to assist the treating surgeon in simplifying these sometimes complex fractures into manageable injuries that can be treated successfully with an intramedullary implant...
November 2016: Journal of Orthopaedic Trauma
Heather A Vallier
Displaced distal tibia shaft fractures are effectively treated with standard plates and intramedullary nails. Plate fixation performed with meticulous soft tissue handling results in minimal risks of infection and poor wound healing. Standard plates have high rates of primary union, whereas locking plates may delay union because of increased stiffness. Tibial healing may also be delayed after plating of the fibula, although fibula reduction and fixation may aid accuracy of reduction of the tibia. Malalignment occurs more often with infrapatellar intramedullary nailing versus plates, and early results of suprapatellar nailing appear promising in minimizing intraoperative malalignment...
November 2016: Journal of Orthopaedic Trauma
J M Koshy, S Mohan, D Deodhar, M John, A Oberoi, A Pannu
BACKGROUND: Though cryptococcal meningitis (CM) is recognized as a disease of the immunocompromised, studies have implicated that it also affect immunocompetent patients. METHODOLOGY: This was a cross sectional study conducted in the Department of Medicine of a tertiary teaching institution in North India. All the patients diagnosed with CM on the basis of detection of cryptococcal antigen or the presence of capsulated budding yeast cells on India ink preparation, from April 2009 to March2015 were included in the study...
October 2016: Journal of the Association of Physicians of India
Phillip M Mitchell, Benjamin M Weisenthal, Cory A Collinge
OBJECTIVE: To evaluate the incidence of knee sepsis following suprapatellar nailing of open tibia fractures. DESIGN: Retrospective SETTING:: ACS Level 1 trauma centerPatients/Participants: We reviewed 139 open tibia fractures that underwent suprapatellar nailing as definitive treatment over a five-year period (January 1, 2011 to January 1, 2016). The majority of patients (90%, n=126) underwent intramedullary nailing at the time of their initial surgery. We defined knee sepsis as intra-articular infection requiring operative debridement, either open or arthroscopically, within one month's time...
October 1, 2016: Journal of Orthopaedic Trauma
David Sanders, Dianne Bryant, Christina Tieszer, Abdel Lawendy, Mark MacLeod, Steven Papp, Liew Allan, Viskontas Darius, Coles Chad, Gurr Kevin, Carey Tim, Gofton Wade, Bailey Chris, Bartley Debra, Andrew Trenholm, Stone Trevor, Leighton Ross, Julia Foxall, Mauri Zomar, Kelly Trask
OBJECTIVES: To compare outcomes in elderly patients with intertrochanteric hip fractures treated with either the sliding hip screw (SHS) or InterTAN intramedullary device (IT). DESIGN: Prospective, randomized, multi-centre clinical trial SETTING:: Five level 1 trauma centresPatients/Participants: 249 patients aged 55 years or older with AO/OTA 31A1 (43) and OA/OTA 31A2 (206) fractures were prospectively enrolled and followed for 12 months. INTERVENTION: Computer generated randomization to either IT (n=123) or SHS (n=126)...
September 30, 2016: Journal of Orthopaedic Trauma
Nasir Hussain, Corey Sermer, Parker J Prusick, Laura Banfield, Amit Atrey, Mohit Bhandari
The two commonly performed surgical techniques used to repair displaced midshaft clavicle fractures are plate fixation or intramedullary nailing; however, despite recent evidence, the optimal method to treat such fractures remains a continued topic of debate. A meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate long term function, complications, and operative duration in adult patients receiving intramedullary nailing in comparison to plating. Seven RCTs and three quasi-randomized trials were included...
October 20, 2016: Scientific Reports
Joey Chan Yiing Beh, Ehab Shaban Mahmoud Hamouda
Post-traumatic osseous cystic lesions are a rare complication in children. An aetiology of intramedullary fat seepage through the damaged bone cortex and its entrapment within the subperiosteum has been proposed. These lesions run a benign course and usually resolve spontaneously. The presence of fatty marrow gives it a distinct appearance which aids in its diagnosis and differentiation from other bone lesions. This case demonstrates a fat-fluid level within the subperiosteal cystic lesion in Magnetic Resonance Imaging (MRI) and this is a typical feature of post-traumatic cystic lesion in a child...
July 2016: Journal of Radiology Case Reports
G Zhao, H N Liu, N Li, L He, X B Wu
Objective: To evaluate the mid-term clinical efficacy of plate and intramedullary nail for humeral shaft fracture. Methods: In this retrospective study a total of 122 patients with humeral shaft fracture were divided into 2 groups according to surgery type from May 2010 to July 2012. There were 63 patients in plate group and 59 patients in intramedullary nail group. The factors related to the operation for each group were compared respectively. The clinical outcome was evaluated by the Neer scores, Myao scores and EuroQol 5 dimensions scores (EQ-5D)...
October 11, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Seth H Richman, Marcelo Bogliolo Piancastelli Siqueira, Kirk A McCullough, Mark J Berkowitz
BACKGROUND: K-wire fixation has been the most common method of fixation for hammertoe deformity. However intramedullary devices are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink). METHODS: A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013...
October 18, 2016: Foot & Ankle International
Beigang Fu
OBJECTIVES: The aim of this study was to evaluate clinical results of a new design titanium elastic nail (TEN) for displaced midshaft clavicular fractures. PATIENTS AND METHODS: Between February 2012 and December 2013, a total 36 patients with displaced midshaft clavicular fractures were treated with intramedullary nailing stabilization with our new design TEN. Blood loss, mean times of operation, postoperative complications, hospital stays and time to bone union was recorded...
October 15, 2016: Acta Orthopaedica et Traumatologica Turcica
Dat T Vo, George F Cravens, Robert E Germann
BACKGROUND: Intramedullary abscess is a rare neurosurgical condition that usually arises in the setting of penetrating trauma to the spinal cord, infected congenital dural sinuses, or tuberculosis. CASE PRESENTATION: We describe a case of a 35-year-old African American male who presented with sepsis and a clinical picture of meningitis. The patient continued to have declining neurological status with decreasing sensation and worsening motor strength in all four extremities...
October 19, 2016: Journal of Medical Case Reports
Utku Kandemir, Safa Herfat, Mary Herzog, Paul Viscogliosi, Murat Pekmezci
OBJECTIVES: The goal of this study is to compare the fatigue strength of a locking intramedullary nail (LN) construct to a double locking plate (DLP) construct in comminuted proximal extra-articular tibia fractures. METHODS: Eight pairs of fresh frozen cadaveric tibias with low bone mineral density (Age: 80 ± 7 (SD) years, T-score: -2.3 ± 1.2) were used. One tibia from each pair was fixed with LN while the contralateral side was fixed with DLP for complex extra-articular multifragmentary, metaphyseal fractures (simulating OTA41-A3...
October 7, 2016: Journal of Orthopaedic Trauma
Rohan A Ramasubbu, Benjamin M Ramasubbu
BACKGROUND: Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children...
September 2016: Indian Journal of Orthopaedics
L H Dünnweber, R Rödl, G Gosheger, F M Schiedel
Although clear advances have been made during the last 5 years, practical difficulties persist for patients and surgeons in procedures for intramedullary lengthening of long bones. In particular, precise adjustment of the desired amount of lengthening and technically reliable checking of the length actually achieved are problematic. An intramedullary nail with a new type of drive that exploits the shape memory effect has been constructed. The drive technology and the behavior of the intramedullary nail in situ were evaluated in a cadaver experiment...
October 10, 2016: Medical Engineering & Physics
W Michael Pullen, Nicholas J Erdle, Colin Crickard, Christopher S Smith
Intramedullary tibial fixation is a commonly used and highly successfully treatment in acute fractures, nonunion settings, and correctional procedures. In the setting of a nonunion, removal of a failed implant can add to operative time and surgeon frustration while further compromising bone in an area already at risk for failure. Here we present a technique, using readily accessible equipment, for removing a distal solid tibial nail fragment in a manner that preserves bone.
September 2016: American Journal of Orthopedics
Dan Wang, Jianbo Yu
In this study, C3H/HeNCrlVr mice are implanted with sarcoma NCTC 2472 cells into the intramedullary space of the femur to induce ongoing bone cancer-related pain behaviors. During the progress of the bone cancer pain, the down-regulation in spinal REST (Neuron-restrictive silencer factor, NRSF/REST) with concomitant up-regulation in spinal NR2B (2B subunit of N-methyl-D-aspartate receptor, NR2B) protein expression are observed at days 5, 7, 10 and 14 post-inoculation. Immunofluorescence assay shows that almost all of REST and NR2B-positive signals encompass NeuN (neuron-specific nuclear protein, a neuronal marker)-positive signals in spinal cord of sham and tumor-bearing mice...
July 30, 2016: Oncotarget
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