Because of the complexity of proximal humeral fractures, the treatment of proximal humeral fractures has always been a challenge for clinicians. The MultiLoc intramedullary nail is a new type of internal fixation device which has been gradually used in the treatment of proximal humeral fractures in recent years. At present, it is mainly used in the Neer two- and three-part fractures, especially surgical neck fractures. Its flexible design can provide personalized and multi-plane fixation for fracture patients, “screw-in-screw” and medial supporting screw can effectively reduce the axial displacement and varus angle of humeral head, and minimally invasive surgical incision can reduce the injury of rotator cuff. This review focuses on the research status and related evidence of the design, operation, prognosis, and postoperative complications of MultiLoc intramedullary nail, in order to provide a theoretical basis for the application of MultiLoc intramedullary nail in fracture treatment, and enhance clinicians’ understanding of MultiLoc intramedullary nail as a new type of internal fixation device.
ObjectiveTo design an auto-compressive and anti-circumrotate intramedullary nail( ACACIN) and to evaluate the preliminary clinical efficacy on fixing adult femur fracture. Methods From January 1998 to June 2001, 23 patientswith femur fracture were stabilized with auto-compressive and anti-circumrotateintramedullary nail. 2-4 elastic blocks were installed into the proximal and distal different distance of quincunx nail to defend circumrotate and axis compress. Results Fracture healing were obtained in all 23 patients treated with auto-compresseiveand anti-circumrotate intramedullary nail, the time of fracture healing was 6-13 weeks in 21 cases and 15-22 weeks in 2 cases of old fracture. There was no complication related to infection, nail break, abnormal union and joint ankylosis. The results were excellent in 19 cases, good in 3 cases, and moderate in 1 case according Kolmert’s criterion for function ; the effective rate was 95.7%. Conclusion Auto-compressive and anti-circumrotate intramedullary nail has a suitable radian for adult femur, can afford stable fixation, anti-circumrotate andaxis compress.
【Abstract】 Objective To explore the biomechanical properties of a new intramedullary controlled dynamicnail ing (ICDN). Methods Ten pairs of specimens of adult femurs, with the age of 18 to 55 years, were divided into twogroups (groups A1 and B2, n=10). The length of the specimens was (438 ± 10) mm , and the external diameter was (26.4 ± 1.5) mm. The specimens of the two groups were osteotomized transversely after the biomechanical test. ICDNs and GK nails were randomly implanted into the femurs, respectively (groups A2 and B2). Torsional, bending and axial compressive tests were made in each group, and the effect of dynamic compression between the fracture fragments was tested. Results The resistance to compression of groups A1, B1, A2 and B2 were (0.19 ± 0.18) × 106, (0.22 ± 0.12) × 106, (1.67 ± 0.68) × 106 and (0.86 ± 0.32) × 106 N/mm, respectively. There was statistically significant difference between groups A2 and B2 (P lt; 0.01). The bending stiffnesses of coronal section of groups A1, B1, A2 and B2 were (0.94 ± 0.25) × 103, (1.10 ± 0.21) × 103, (0.70 ± 0.22) × 103, (0.64 ± 0.21) × 103 N/mm, respectively. The bending stiffness of sagittal plane of groups A1, B1, A2 and B2 were (1.06 ± 0.26) × 103, (0.96 ± 0.25) × 103, (0.67 ± 0.25) × 103, (0.61 ± 0.18) × 103 N/mm, respectively. There were no statistically significant differences between groups A1 and B1 or between groups A2 and B2 (P gt; 0.05). When the torque was 5 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.00 ± 2.54), (4.76 ± 1.93), (0.50 ± 0.63), (0.35 ± 0.31) Nm/°, respectively. When the torque was8 Nm, the torsional stiffness of groups A1, B1, A2 and B2 were (4.30 ± 3.27), (3.94 ± 2.01), (0.42 ± 0.52), (0.36 ± 0.18) Nm/°, respectively. There were statistically significant differences between groups A1 and A2 or between groups B1 and B2 (P lt; 0.05), and no statistically significant difference between between groups A2 and B2 (P gt; 0.05). The average maximal pressure generated between the fracture fragments which were fixed with ICDN was 21.6 N, and the pressure between the fracture fragments which were fixed with GK nail ing could not be tested. Conclusion The design of ICDN conforms to the special anatomical structure of the femur. ICDN could provide a completely different structure, a different fixation principal and a more balancedfixation than GK nail. ICDN incorporates the flexible and rigid fixation, which is l ikely to be the trend of the fracture fixation.
Objective To study the effect of internal fixation with absorbable intramedullary nail on the treatment of phalange fractures in replantation of severed finger. Methods From September 2001 to October 2003, 28 cases with industrial severed finger (21 males and 7 females, with the age of 18-35 years) were replanted within 1-6 hours. The severed locations were index fingers in 11 cases, middle fingers in 8 cases, ring fingers in 6 cases, little fingers in 3 cases. All cases of phalange fractures were fixed by absorbable intramedullary nails of poly-DL-lactic acid(PDLLA) that combined with chitosan. Out of the 28 cases, 15 cases were with proximal phalange, 11 cases were with middle phalange, 2 cases were with distal phalange. The bone marrow cavity of the phalanges were dilated, then the intramedullary nail was inserted with suitable diameter and length to fix the fracture. Postoperatively resin bandage was applied for 3-4 weeks.Results All the 28 patients survived the performance and postoperative follow-up ranged from 3 to 10 months(4 months in average). Rejection was observed in one case 3 weeks after operation, bone unions were obtained in other cases. According to the Chinese Medical Association’s evaluation standard for replantation of amputated finger, 18 fingers resulted in excellence, 9 fingers in good function and 1 with unsatisfactory function. The excellent and good rate was 96.4%. Conclusion Internal fixation with absorbable intramedullary nail of PDLLA combined with chitosan proves to be effective in the replantation of severed finger.
ObjectiveTo review the cause, treatment, and prevention of complications of retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis and enhance the recognition on the complications of tibiotalocalcaneal arthrodesis. MethodsThe recent literature concerning intramedullary nail fixation for tibiotalocalcaneal arthrodesis was consulted and reviewed. ResultsThere are intraoperative and postoperative complications of intramedullary nail fixation for tibiotalocalcaneal arthrodesis, and the causes, treatment, and prevention of complications are various. ConclusionProgress of retrograde intramedullary nail fixation increases the successful rate of tibiotalocalcaneal arthrodesis. However, there is still a high complication rate, so strict preoperative assessment and skilled surgical technique are necessary to prevent complications.
【Abstract】 Objective To discuss the techniques and advantages of closed reduction and intramedullary nail ing intreating femoral shaft fracture without cannulated femoral reamer. Methods From January 2006 to June 2007, 24 cases offemoral shaft fracture were treated with closed reduction and intramedullary nail ing. Among them, there were 14 males and 10 females, with the average age of 38.3 years (ranging from 18 years to 63 years), with 7 left legs and 17 right legs. The average course of the disease was 7.6 days (ranging from 3 days to 20 days). According to the AO typing, there were 5 cases of type A, 6 of type B, 7 of type C1, 2 of type C2 and 4 of type C3. Closed reduction was achieved with manipulation and reaming of femoral canal was instructed by fluoroscopy. Results The operation time lasted from 100 minutes to 170 minutes, with the average time of 128.3 minutes. One patient was given a transfusion of 400 mL, and others were not. Twenty cases were followed up with the average time of 13.1 months (ranging from 6 months to 24 months). A mild to large amount of bony callus was showed on X-ray films 6 to 12 weeks postoperatively. Walking without crutches began at the average week of 22.2 (ranging from 15 to 30) postoperatively. Range of motion of the knee was 0° to 145.5°. No infection or break of the internal fixator occurred. Myositis ossificans with pain and insufficient flexion of hip (120°) happened in 1 case and the pain disappeared after non-steroid anti-inflammatory drugs were taken. Nonsymptomatic myositis ossificans occurred in 2 cases and no treatment was needed. Conclusion Closed reductionand intramedullary nail ing can help to protect the blood supply of fracture fragments and provide central fixation. The operation process will be more compl icated if cannulated femoral reamer is not available.
ObjectiveTo explore the effectiveness of three different operative methods in the treatment of closed fracture of the tibial shaft. MethodsBetween January 2012 and May 2014, 94 patients with closed fracture of the tibial shaft were treated, and the clinical data were retrospectively analyzed. Fracture was fixed with locking plate (external fixation) in 25 cases (group A), with intramedullary nail in 34 cases (group B), and with minimally invasive locking plate in 35 cases (group C). There was no significant difference in gender, age, reasons of injury, fracture types, and time from injury to operation among groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency during operation, fracture union time, and complications were recorded. The effectiveness was evaluated according to Johner-Wruhs criteria. ResultsThe operation time and fluoroscopy frequency during operation in groups A and C were significantly less than those in group B (P<0.05), but there was no significant difference between groups A and C (P>0.05). The intraoperative blood loss in groups A and C was significantly less than that in group B (P<0.05), and the blood loss in group A was significantly less than that in group C (P<0.05). All patients were followed up 15.61 months on average (range, 12-41 months). There was no significant difference in fracture union time among 3 groups (F=1.712, P=0.186). The excellent and good rates of groups A, B, and C were 92.00%, 88.24%, and 91.43% respectively according to Johner-Wruhs criteria at 12 months after operation, showing no significant difference (χ2=0.301, P=0.860). At 12 months after operation, the complication incidences of groups A (12.00%, 3/25), and C (15.55%, 5/35) were significantly lower than that of group B (44.12%, 15/34) (P<0.017), but no significant difference was found between groups A and C (P>0.017). ConclusionUsing locking plate as external fixation and minimally invasive locking plate internal fixation are better than intramedullary nail fixation in treating closed fracture of tibial shaft because of less injury and lower complication incidence, and locking plate as external fixation is better than minimally invasive locking plate internal fixation because of less injury.
Objective To explore the application of intramedullary nail fixation combined with auxiliary plate and bone cement in the palliative treatment of pathologic fracture of extremities caused by metastatic tumors. Methods Clinical data of 11 cases with pathologic fracture of extremities caused by metastatic tumors between April 2015 and October 2016 were retrospectively analyzed. All the patients were treated by intramedullary nail fixation combined with auxiliary plate and bone cement. There were 6 males and 5 females with an age of 54-72 years (mean, 62.9 years). The disease duration was 1.0-1.5 months. Of the 11 patients, 4 metastatic tumors were diagnosed at humerus, 6 at femur, and 1 at tibia, respectively. And the tumor infiltration length ranged from 3.3 to 5.6 cm (mean, 4.6 cm), the depth could reach the bilayer of limb bones. All the patients had suffered the limbs pain and incapability of physical movement. The preoperative visual analogue scale (VAS) score was 6.36±1.03, and the Karnofsky Performance Status (KPS) score was 42.73±10.09. The operation time, intraoperative blood loss, and postoperative complications were recorded. The VAS score, KPS score, and Musculoskeletal Tumor Society (MSTS) score were used to evaluate the effectiveness at 3 months after operation. Results The operation time was 1.1-1.8 hours (mean, 1.5 hours), the intraoperative blood loss was 102.5-211.3 mL (mean, 135.6 mL). Postoperative limb incisions healed well without infection, necrosis, and delayed healing or other complications. All the patients were followed up 7-10 months (mean, 8.2 months). At 3 months after operation, the functions of limbs recovered. The VAS score decreased to 0.82±0.75 and the KPS score increased to 85.45±5.22, both showing significant difference when compared with preoperative ones (t=35.218, P=0.000; t=–18.470, P=0.000); and the MSTS score was 23.91±2.47. At last follow-up, the anteroposterior and lateral X-ray films showed that all the limbs healing well and no breakage of intramedullary nail and steel plate, or loosening in bone cement, limb shortening, malalignment, or other complications occurred. Conclusion In treating metastatic tumors of extremities, the combination of intramedullary nail fixation with auxiliary plate and bone cement will contribute to an invariable length and fixed location for limbs, resulting in biomechanical stability for skeleton. Under this premise, the tumor lesions can be eliminated and pathological pains be relieved, so as to improve patients’ life quality.
Objective To determine the efficacy and safety of external fixation versus intramedulllary nailing in the treatment of adult tibial shaft fracture. Methods We searched the specialized trials register of The Cochrane Collaboration’s Bone, Joint and Muscule Trauma Group, The Cochrane Library (CENTRAL), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006) and PUBMED (1966 to March 2006). We also handsearched some Chinese orthopedic journals. Randomized controlled trials (RCTs) and quasi-randomized trials (quasi-RCTs) comparing external fixation versus intramedullary nailing for tibial shaft fractures in adults were included. The quality of these trials was critically assessed. We used the Cochrane Collaboration’s RevMan 4.2.8 for data analyses. Result Three RCTs and two quasi-RCTs involving a total of 279 patients were included. The results of meta-analyses showed that external fixation for tibial shaft fractures in adults may increase the infection rate [RR 2.45, 95%CI (1.31,4.61), P=0.005], and the malunion rate [RR 2.85, 95%CI (1.20,6.79), P=0.02] but may reduce the duration of hospitalization [RR –5.50, 95%CI (–6.99,–4.01)]. The nonunion rate, delayed healing rate, and healing time, were comparable between external fixation and intramedulllary nailing. Conclusion The trials available for this systematic review are too few and small for reliable estimates of the relative effects of external fixation and intramedulllary nailing. Further studies are needed to determine these effects , especially for patients who have GustiloШ C fractures.
ObjectiveTo summarize the research progress in the lower limb lengthening by intramedullary nail. MethodsThe domestic and foreign related literature about the lower limb lengthening by intramedullary nail was reviewed, summarized, and analyzed. ResultsThe intramedullary nail lengthening systems can be divided into 3 types:distraction by mechanical strength, by motorized electronic power, or by motorized magnetic force. The new technology has obvious advantages in complication incidence, limb function, bone healing rate, comfortable and cosmetic degree of the patients, and hospitalization days compared with the external fixation, but it also has the disadvantages including lengthening failure of system breakdown, intramedullary infection, injuries of vessel and nerve, limited distraction length, and expensive price of the apparatus. And the method also has several contraindications:narrow medulla, multiple curves of medulla, osteomyelitis, skin infection, and unclosed epiphyseal plate. ConclusionThe lower limb lengthening by intramedullary nail is a major improvement of Ilizarov technology. Although the method has been used in limited cases, the preliminary clinical results are excellent, and it can be regarded as a new trend of the limb lengthening, bone reconstruction, and deformity correction.