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OBJECTIVE: To assess the fatigue and load-to-failure mechanical characteristics of an intramedullary nail with a threaded interference design (TID) in comparison to a commercially available veterinary angle-stable nail with a Morse taper bolt design (I-Loc) of an equivalent size. METHODS: 10 single interlocking screw/bolt constructs of TID and I-Loc implants were assembled using steel pipe segments and placed through 50,000 cycles of simulated, physiologic axial or torsional loading. Entry torque, postfatigue extraction torque, and 10th, 25,000th, and 50,000th cycle torsional toggle were assessed. Each construct was then loaded to failure in the same respective direction as fatigue testing. Four complete constructs of each design were then assessed using a synthetic bone analog with a 50-mm central defect via nondestructive torsional and axial loading followed by axial load to failure. RESULTS: All constructs were angle stable at all time points and withstood fatigue loading. Median insertional torque, extraction torque-to-insertion torque ratio, and torsional yield load were 33%, 33%, and 72.5% lower, respectively, for the TID interlocking screws. No differences in torsional peak load, torsional stiffness, axial yield load, axial stiffness, or axial peak load were identified. No differences in complete construct angle stability, torsional stiffness, axial peak load, axial stiffness, or axial yield load were identified. CLINICAL RELEVANCE: The TID had an inferior torsional yield load when compared to I-Loc implants but generated angle stability and sustained simulated physiologic fatigue loading. The TID may be a suitable mechanism for generating angle stability in interlocking nails. [ABSTRACT FROM AUTHOR]

Abstract Purpose The purpose of this systematic review is to examine the outcomes, complications, and potential advantages of using anatomical interlocking intramedullary nails (IMN) in the treatment of radius and ulnar shaft diaphyseal fractures in adults. Methods Medline, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched between January 2000 and January 2023. Studies meeting criteria were observational or randomized controlled trials evaluating outcomes in IMN for adult diaphyseal forearm fractures. Standardized data extraction was performed and a quality assessment tool was used to evaluate individual study methodology. Descriptive statistics for interventions, functional outcomes, and complications were reported. Meta-analysis was performed for patient-reported outcome measures and operative time. Results A total of 29 studies involving 1268 patients were included with 764 (60%) undergoing IMN, 21% open reduction and internal fixation (ORIF), and 9% hybrid fixation. There was no significant difference between groups in DASH and Grace–Eversmann scores. Operative time was significantly shorter in IMN compared with ORIF. The DASH scores were: 13.1 ± 6.04 for IMN, 10.17 ± 3.98 for ORIF, and 15.5 ± 0.63 in hybrids. Mean operative time was 65.3 ± 28.7 in ORIF and 50.8 ± 17.7 in IMN. Complication rates were 16.7% in the IMN group, 14.9% in ORIF, and 6.3% in hybrid constructs. There were 11 cases of extensor pollicis rupture in the IMN group. Average IMN pronation and supination were 78.3° ± 7.9° and 73° ± 5.0°, respectively. Average ORIF pronation and supination was 82.15° ± 1.9° and 79.7° ± 4.5°, respectively. Conclusions Similar functional outcomes and complication rates along with shorter operative times can be achieved with IMN compared with ORIF. The use of IMN is promising, however, higher quality evidence is required to assess appropriate indications, subtle differences in range of motion, implant-related complications, and cost-effectiveness. Trail Registration PROSPERO (International Prospective Register of Systematic Reviews) (ID: CRD42022362353). Level of evidence III.

OBJECTIVE To report indications, outcomes, and complications with a precontoured angle-stable interlocking nail (CAS-ILN). ANIMALS 90 client-owned animals. METHODS Dogs and cats treated with the CAS-ILN between 2020 and 2022 were retrospectively reviewed. Collected data included body weight, fracture configuration, percentage of medullary canal filled, limb alignment, complications, and follow-up. Favorable outcomes were defined when full functional restoration was observed. RESULTS Thirty-eight dogs and 52 cats were included. Median body weight was 4.3 kg (range, 1.5 to 6.7 kg) for cats and 25 kg (range, 6.8 to 54 kg) for dogs. A total of 54 femurs, 31 tibias, and 5 humeri were treated, including 65 comminuted fractures and 26 metaphyseal fractures. The median percentage of medullary canal occupied by the nail was 76.5% (range, 53% to 97.6%). Radiographic postoperative bone alignment was good in 85.5% (59/69) and satisfactory in 10 cases. The median duration of follow-up (57/90) was 476 days (range, 56 to 1,057 days). In the perioperative period (0 to 12 weeks), lameness had resolved or was mild in all (51/52) but 1 case. In the long-term postoperative period (> 12 months), 97.1% (34/35) of cases showed restoration of full function and 1 case had an unacceptable function. An overall complication rate of 11.5% (7/61) was reported including 1 catastrophic and 6 major complications. CLINICAL RELEVANCE Long-term functional outcomes following the CAS-ILN were favorable in 97.1% (34/35) of cases. Complication rates were comparable to previous studies. The CAS-ILN appears to be an alternative surgical option for most long-bone fracture repairs. [ABSTRACT FROM AUTHOR]

Background: Humeral shaft fracture makes up approximately 3% of all fracture types. Advantages of intramedullary nailing in management is considered a minor invasive surgical procedure that can effectively shorten the operative time and hospital stay and reduce the intraoperative blood loss. This study aimed to assess if better management of humeral shaft fracture by intramedullary nail fixation. Methods: This is a prospective clinical trial included 12 patients. All of them suffering from humeral shaft fracture with age ranged from 25 to 65 years. All patients were operated upon at Orthopedic Surgery Department, Zagazig University Hospitals. All patients were evaluated both clinically and radiologically. Assessment of shoulder movement was done by a constant score. Results: Time of union was distributed as 11.50±1.78 with minimum 10 and maximum 18 weeks. Regarding shoulder movement, majority of patients were excellent with 66.7 % then good 33.4 %. Regarding elbow movement, majority was excellent with 83.3 % then Good 16.7 %. Ten cases were excellent in movement and two cases were good according to shoulder constant score. Conclusion: Locked humeral nailing has proven to be a reliable therapeutic option for humeral diaphysis fractures, resulting in a satisfactory functional outcome and a high union rate. It also permitted early use of the limb, which is critical. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of femur shaft fracture in a developing country and develop prevention policies considering the findings. Methodology: This retrospective epidemiological study included all patients with a femur fracture who were admitted between January 2021 and April 2023 at the orthopedic and trauma surgery department of Lady Reading Hospital, Peshawar, Pakistan. The patient's medical records were retrospectively reviewed using electronic medical records in the Hospital information system (HIS). All patients with documented femur shaft fracture who were admitted and operated on with an interlocking nail during the study period, irrespective of age, were included. Results: A total of 347 patients were identified in HMIS and were included in this study. Mean age was 31.52 ± 15.475 SD (12-91). Male to female ratio was 295:52. According to AO classification, 27 patients had 32A1 injury, 45 patients had 32A2 injury, 74 patients had 32A3 injury, 16 patients had 32B1 injury, 44 patients had 32B2 injury, 22 patients had 32B3 injury, 18 patients had 32C1 injury, 15 patients had 32C2 injury and 27 patients had 32C3 injury. Different surgical options as well as the mode of fixation were used in the management of these fractures with missing data identification in 17% of patients. Conclusion: Traumatic femur fracture are not uncommon injuries in developing countries which occur due to road traffic accidents and firearm injuries in majority of the cases. [ABSTRACT FROM AUTHOR]

Background: Fractures of shaft of humerus are common, accounting 3% of all fractures. They have historically been managed conservatively with hanging casts or a functional brace. However, a lack of fracture reduction with these conservative measures resulted in malunion. Two surgical techniques under study include intramedullary nailing and limited contact dynamic compression plating. This study aims to analyze the functional outcome between the two surgical techniques. Materials and Methods: In this prospective randomized study, 38 patients were treated surgically for shaft of humerus fracture from August 2016 to August 2018 at a tertiary care center. Twenty patients underwent limited contact dynamic compression plate (LCDCP) plating and 18 underwent intramedullary nailing. All were assessed for radiological union, complications, and functional outcome at 6 weeks, 12 weeks, and 1 year using disabilities of arm, shoulder, and hand (DASH) questionnaire. Results: Thirty-eight patients completed the study of which 18 cases (47.5%) with fractures that were treated with interlocking nail and 20 cases that were treated with LCDCP plating. The mean duration to complete radiological healing was 15.06 weeks. The healing rate was relatively faster in the interlocking group as compared to the LCDCP group (P = 0.144). Complications such as shoulder impingement 8 (44.4%), shoulder pain 3 (16.7%), nonunion 1 (5.6%), and shoulder stiffness 1 (5.6%) were found to be more common in interlocking group as compared to LCDCP group, respectively. Whereas, complications such as superficial infection - 1(5%) and radial nerve deficits - 2(10%) were less common in the interlocking group compared to LCDCP group, respectively. The mean follow-up was 11.556 weeks, and the overall DASH score analysis showed better results in LCDCP group. Conclusion: In our study, LCDCP plating showed lower incidence of complications, particularly periarticular complications around the shoulder joint such as shoulder pain, stiffness, and impingement but carried a higher risk of radial nerve injury. Fracture union rates were found to be almost similar between both groups. DASH score analysis showed better functional outcome among the LCDCP plating group. The overall outcome of LCDCP plating over interlocking nailing was found to be better.

The C-Nail® system is a novel intramedullary fixation method for displaced intra-articular calcaneal fractures. The aim of this study was to evaluate the biomechanical performance of the C-Nail® system and compare it with conventional plate fixation for the treatment of displaced intra-articular calcaneal fractures using finite element analysis. The geometry of a Sanders type-IIB fracture was constructed using the computer-aided design software Ansys SpaceClaim. The C-Nail® system (Medin, Nové Mesto n. Morave, Czech Republic) and the calcaneal locking plate (Auxein Inc., 35 Doral, Florida) and screws were designed according to the manufacturer specifications. Vertical loading of 350 N and 700 N were applied to the subtalar joint surfaces to simulate partial weight bearing and full weight bearing. Construct stiffness, total deformation, and von Mises stress were assessed. The maximum stress on the C-Nail® system was lower compared with the plate (110 MPa vs. 360 MPa). At the bone level the stress was found to have higher values in the case of the plate compared to the C-Nail® system. The study suggests that the C-Nail® system can provide sufficient stability, making it a viable option for the treatment of displaced intra-articular calcaneal fractures. [ABSTRACT FROM AUTHOR]

Objective: To study the morphology of canine and feline femurs and tibias in lateral radiographic projections and assess their compatibility with either a straight or a curved full-length interlocking nail (ILN)., Methods: Lateral projection radiographs of 50 tibias and 50 femurs (10 cats and 40 dogs per bone) were used to measure the minimum and maximum radius of curvature of an ILN compatible with each bone. These radii were defined by cranial and caudal endosteal points at the proximal entry point of the nail, at the isthmus, and at the most distal point of the ILN insertion into the femoral or tibial metaphysis. These points were figured by 2 proximal circles, 2 diaphyseal circles at the isthmus, and 2 distal circles in distal metaphyses of the bones. The diameter of these circles corresponded to 75% of the medullary canal width at the isthmus of the bone., Results: An ILN with a radius between 750 and 806 mm fit 87% of all the bones reviewed. In dogs, an ILN within this radius range would fit 95% of the tibias, whereas a straight ILN would fit only 50%. For femurs, the curved ILN would fit 80% compared to 37.5% for a straight ILN. In cats, an ILN with a radius between 750 and 806 mm would fit 85% of the bones (femur, 100%; tibia, 70%), whereas a straight ILN would fit all tested bones., Conclusions: A full-length ILN with a radius of curvature between 750 and 806 mm would fit 87% of the studied bones, whereas only 55% of them could accept a straight ILN., Clinical Relevance: A full-length ILN with a 750-806-mm curvature radius may provide a suitable option for treating most femoral and tibial diaphyseal fractures.

Introduction: Critical-sized long bone defects represent a major therapeutic challenge and current treatment strategies are not without complication. Tissue engineering holds much promise for these debilitating injuries; however, these strategies often fail to successfully translate from rodent studies to the clinical setting. The dog represents a strong model for translational orthopedic studies, however such studies should be optimized in pursuit of the Principle of the 3R’s of animal research (replace, reduce, refine). The objective of this study was to refine a canine critical-sized femoral defect model using an angle-stable interlocking nail (AS-ILN) and reduce total animal numbers by performing imaging, biomechanics, and histology on the same cohort of dogs.Methods: Six skeletally mature hounds underwent a 4 cm mid-diaphyseal femoral ostectomy followed by stabilization with an AS-ILN. Dogs were assigned to autograft (n = 3) or negative control (n = 3) treatment groups. At 6, 12, and 18 weeks, healing was quantified by ordinal radiographic scoring and quantified CT. After euthanasia, femurs from the autograft group were mechanically evaluated using an established torsional loading protocol. Femurs were subsequently assessed histologically.Results: Surgery was performed without complication and the AS-ILN provided appropriate fixation for the duration of the study. Dogs assigned to the autograft group achieved radiographic union by 12 weeks, whereas the negative control group experienced non-union. At 18 weeks, median bone and soft tissue callus volume were 9,001 mm3 (range: 4,939–10,061) for the autograft group and 3,469 mm3 (range: 3,085–3,854) for the negative control group. Median torsional stiffness for the operated, autograft treatment group was 0.19 Nm/° (range: 0.19–1.67) and torque at failure was 12.0 Nm (range: 1.7–14.0). Histologically, callus formation and associated endochondral ossification were identified in the autograft treatment group, whereas fibrovascular tissue occupied the critical-sized defect in negative controls.Conclusion: In a canine critical-sized defect model, the AS-ILN and described outcome measures allowed refinement and reduction consistent with the Principle of the 3R’s of ethical animal research. This model is well-suited for future canine translational bone tissue engineering studies.

The goal of this study is to evaluate surgical treatment outcomes of fracture shaft humerus by using intramedullary interlocking nail. Fifteen patients (ages ranged from 51 to 70 with an average age of 64.20 ± 6.338 years, (10 males and 5 females) with shaft humeral fractures from Beni-Suef University and General hospitals during the period from December 2012 to June 2014. The selected participants were treated with intramedullary interlocking nail. Patients were followed up for a mean of 9 (range 6–12) months. The mean length of hospital stay was 3 (range 1–5) days. All the fractures united radiographically after a mean of 14 (range, 12–20) weeks. Conclusion: That the majority of humeral shaft fractures can be treated safely and effectively by non-operative methods. However, for the subset of patients requiring surgical treatment, intramedullary nailing provides predictable means of achieving fracture stabilization and ultimate healing. Poor outcome in intramedullary interlocking nailing is attributable to rotator cuff tear and shoulder impingement and lack of expertise of surgeon.

Purpose: Morbid obesity is a rising worldwide health problem. Tibial shaft nonunion with retained intramedullary nail (IMN) in the morbidly obese is a challenging orthopaedic problem. Prolonged immobilization carries a significant risk of complications. This study aimed to investigate whether decortication and cancellous bone grafting with the application of a circular external fixator (CEF) over the preexisting IMN can achieve fracture union and avoid serious complications.Methods: We retrospectively reviewed 27 consecutive morbidly obese patients treated for tibial diaphysis aseptic nonunion after failed IMN. All cases were treated with osteoperiosteal decortication, cancellous bone grafting, and fixation with CEF over the IMN. Peri-operative multidisciplinary patient evaluation included internal medicine, cardiology, chest, vascular surgery, and anesthesia consultations. The union rate, bone results, functional results, and complications were recorded.Results: The mean age of the patients was 37.9 years. The mean BMI was 45.8. Sixteen cases (59.3%) were treated for hypertrophic nonunion, while 11 cases (40.7%) were treated for atrophic nonunion. Seven cases (25.9%) had open initial injury, 14 cases (51.9%) had associated comorbidities, and seven cases (25.9%) were smokers. Twenty-six cases united. The mean time to union was 5.2 months. Bone results and functional results were good to excellent in 96.3% of the cases. We recorded 25 complications in 21 patients. However, most of the complications were minor.Conclusion: Decortication and cancellous bone grafting with the application of CEF over the preexisting nail is a safe and reliable treatment method for aseptic tibial shaft nonunion with retained IMN in morbidly obese patients. [ABSTRACT FROM AUTHOR]

A 1-year-old intact female dog was presented for a comminuted proximal diaphyseal right tibial fracture that extended toward the proximal lateral metaphyseal region. Initial stabilisation with an intramedullary nail resulted in unsatisfactory external torsion and valgus malalignment. Revision was performed using a temporary two-ring circular external fixator to facilitate multiplanar improvements in tibial alignment and to maintain that alignment during repositioning and stabilisation of the intramedullary nail. The fracture subsequently healed without further intervention and lameness was not observed when the dog was evaluated 16 months following surgery. [ABSTRACT FROM AUTHOR]

Nowadays, magnetic targeting systems are developed for clinical/surgical applications, such as treatment of carotid artery aneurysm, endo-bronchoscopic diagnosis for lung-cancer tumors, colonoscopic diagnosis for colon-cancer tumors, and intramedullary interlocking-nail surgery. Based on clinical requirements, the targeting systems specific for above endo-bronchoscopic diagnosis and nail surgery are urgently needed and thus rapidly developed. Moreover, because the systems have similar magnetic configurations and use similar magnetic targeting principles, the systems can be reviewed together. Endo-bronchoscopic diagnosis is a new clinical-proved method for doctors to diagnose lung-cancer tumors/lesions. However, in the diagnosis, targeting the endo-bronchoscope to tumors/lesions must be repeated many times and thereby is inconsistent. Thus, diagnosis-yield decreases and diagnosis-duration increases. To address this issue, researchers developed novel magnetic targeting systems to more accurately and rapidly target the endo-bronchoscope, i.e., increase yield and save time. The systems are categorized to magnetic-sensors based and magnetic-materials based targeting systems. Representative systems are reviewed (design, targeting principles, test methods, results, and features are highlighted) in this paper. Intramedullary interlocking-nail surgery is a standard clinical-method for fractured-bones. In the surgery, 2D X-ray imaging system is a conventional most-used method to target distal screw-hole of the nail for fractured-bones fixing. However, patients are over-exposed under X-ray radiation. To solve this problem, researchers presented innovative magnetic targeting systems to target the screw-hole without any X-ray radiation. Same as above-section, the systems are divided to magnetic-sensors based and magnetic-materials based targeting systems. Representative systems and corresponding design, targeting principles, test methods, results, and features are reviewed in this paper. [ABSTRACT FROM AUTHOR]

Road traffic accidents are responsible for most lower limb compound fractures. Such fractures have to be treated immediately with utmost care and precision. Patients are sometimes inadequately treated with traditional practices which causes further disability to the patient and makes it more difficult for the orthopedic surgeon. This case report highlights the meticulous planning and management of a distal tibia-fibula-infected nonunion which was initially mal-treated by an unqualified practitioner following trauma on multiple occasions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rakhunde et al.)

Background. Growing number of patients with pelvic fractures is associated with evolution of high-speed transport, high-rise construction and industrial production. The optimal surgical procedure for pubic rami fractures must ensure a stable fixation and simultaneously minimize the risk of postoperative complications. Our aim was to evaluate the efficiency of a new technique for pubic bones fixation by a titanium nail in patients with pelvic fractures.Material and Methods. The authors present the experience on treatment of 18 patients who underwent 25 surgeries for internal fixation of pubic rami fractures by a designed solid titanium nail. Mean age of patients was 40.16±10.35 years. Proposed surgical method provides for mandatory use of image intensifier during all stages of the procedure. With patient in a supine position the authors performed internal fixation of pubic bones by a retrograde nail inserted using a navigating handle through a skin incision of1 cm in the area of symphysis. After complete insertion into the bone the nail was interlocked proximally by two3.5 mm cortex screws through an additional skin incision of1.0 cm using a navigating handle and guiding sleeves. All pelvic ring fractures were classified according to AO/OTA classification and pubic fractures by Nakatani classification. Functional outcome was evaluated by Majeed score.Results. Bilateral fractures were diagnosed in 7 (38.8%) patients (floating pubic symphysis). 13 (72.2%) patients featured polytrauma with average ISS score of 25.1±7.8. 2 (11,1%) patients were diagnosed with open pelvic fractures, 3 (16.6%) patients had a concomitant acetabular fracture. The authors performed epicystostomy in two (11.1%) patients and laparotomy bringing out the drainages in 5 (27,8%) patients. Mean follow up was 7.8±6.2 months. Stable fixation was obtained in all patients. By the moment of the present publication x-ray healing of pubic bones was observed in 16 (64%) cases, in remaining 9 (36%) cases the follow up period was less than mean healing period (2 months). In 11 (68.8%) patients the functional outcome averaged 91±3.9 by Majeed score 6 months postoperatively, in 8 (50%) patients – 93.8±2.9 by Majeed score 12 months postoperatively and more. No complications like skin necrosis, secondary fragments displacement or infection were not observed.Conclusion. Preliminary results demonstrated the absence of wound infection and reliable fragments fixation. This technique can be applied in patients with stomas and drainages upon the anterior abdominal wall which extends the indication range for surgical treatment of anterior pelvic ring. High fixation properties of proposed nailing create conditions for early mobilization of the patients and for conducting the exercise therapy.

Purpose: To compare the radiological and clinical outcomes of interlocking nail (ILN) and locking plate fixation (LCP) for humeral shaft fractures. Methods: A total of 63 patients with displaced humeral shaft fractures between October 2014 and January 2017 were evaluated prospectively. They were divided randomly into two as LCP fixation (group 1) and interlocking nail (ILN) (group 2). Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons (ASES), the University of California at Los Angeles (UCLA) shoulder scores, and Short Form-36 (SF-36) questionnaires, and pain was assessed with visual analogue scale (VAS). Results: After fracture callus was radiologically observed, DASH, ASES, and UCLA scores as well as SF-36 questionnaires and VAS results were noted to have no significant difference between the two groups (p = 0.109, p = 0.082, p = 0.146, p = 0.322, and p = 0.175, respectively). At the last follow-up (post-operative 24 months), the UCLA score was significantly better in group 1 (p = 0.034), whereas VAS result was significantly worse in group 2 (p = 0.017). DASH, ASES scores, and SF-36 questionnaires had no difference (p = 0.193, p = 0.088, p = 0.289). Other parameters revealed no significant differences. Fracture consolidation was observed at a mean of four months in both groups (3 to 7 months in group 1 and 3 to 8 months in group 2) (p = 0.189). Four patients in group 1 and five patients in group 2 underwent surgery for nonunion (p = 0.725). Post-operative radial nerve palsy was seen in one patient in group 2. Two patients in group 1 with superficial infection were treated with antibiotics, and they recovered. Conclusions: Regarding our results, the LCP group had significantly better shoulder function than the ILN group, whereas the ILN group had significantly less pain, with similar complication rates. Therefore, both procedures are favourable surgical options for patients with humeral shaft fractures. [ABSTRACT FROM AUTHOR]

Since the removal of a metallic interlocking nail system leaves a blank cavity inside a healed bone, bioactive and biodegradation materials have been used instead to induce bone formation and eliminate complications of the material removal procedure. The previous study presented the possibility of an interlocking nail fabrication from polylactic acid (PLA), polycaprolactone (PCL), and hydroxyapatite (HA) using 3D printing, namely fused filament fabrication (FFF), for canine diaphyseal fractures. Therefore, a finite element analysis (FEA) was used to predict the maximum principal stress of this 3D-printed composite interlocking nail to stabilize a canine femoral fracture, and the biomechanical performance was evaluated for the treatment of canine femoral shaft fractures using both traditional and new fixation techniques. Three-dimensional FEA models were created, and the composite interlocking nail was tested for implant strength and stability. Three types of canine femoral shaft fracture (proximal shaft fracture, middle shaft fracture, and distal shaft fracture) fixed by traditional and new fixation techniques, consisting of two, four, and six locking screws, were analyzed with a multilevel factorial design technique. The maximum principal stresses of the composite interlocking nail were compared with each fixation technique. According to the multilevel factorial design, gap type, fracture gap, and fixation techniques are factors that affect the maximum principal stress of the composite interlocking nail for two and four locking screws. For six locking screws, all factors, including gap type, fracture gap, nail length, and fixation techniques, significantly affect the maximum principal stress. The use of a 3D-printed composite interlocking nail system with new fixation techniques demonstrated lower maximum principal stresses than the interlocking nail system that used a traditional fixation technique. The results of this study could help orthopedic veterinary surgeons to understand the biomechanical performances of traditional and new fixation techniques. Furthermore, surgeons may use the numerical results of this analysis to choose a fixation technique based on a patient's condition. [ABSTRACT FROM AUTHOR]

Background: Tibial shaft fractures are usually treated by interlocking nails or plates. The ideal implant choice depends on many variables. Aim: To assess the mechanical behavior of interlocking nails and plates in the treatment of closed comminuted midshaft fractures of the tibia using finite element analysis. Material and methods: This is a prospective study of 50 patients with a mean age of 28.4 years with closed comminuted fractures of the midshaft of the tibia. Data evaluation was done by Finite element analysis (FEA). Fixation was revised in two cases. Results: After load application, there were significant differences in both bending (P = 0.041) and strain percent (P = 0.017), reflecting that interlocking nails were superior to plates. There were also significant differences between titanium and stainless-steel materials in bending (p = 0.041) and strain percent (p = 0.017) after applying load, indicating that titanium was superior to stainless steel. Conclusion: Interlocking nails are superior to plates in treating midshaft tibial fractures. The use of blocking screws may be needed in interlocking nails depending on the pattern and extension of the fracture.

INTRODUCTION: Osteosynthesis of the femur using an interlocking nail is the gold standard for treating diaphyseal fractures of the femur. There are two established entry points for the antegrade interlocking nails which is the piriformis fossa or the greater trochanter. It has been reported that varus malalignment was frequently seen in proximal femur fracture which were treated with interlocking nail utilizing the greater trochanter entry point. The study was done to find out if the problem was of significance. MATERIALS AND METHODS: This was a retrospective study which included 179 patients with femur fractures which were treated from January 2013 till September 2015 in one Hospital. They were treated with interlocking nail either by utilizing the piriformis fossa (PF) or the greater trochanter (GT) entry points. Post-operative radiographs of the femur were used to measure the varus deformity. RESULTS: Out of 179 patients, there were 5 patients who were reported to have unacceptable varus malalignment (2.79%). These 5 patients were out of the 88 (5.68%) patients utilizing the greater trochanter as the entry point. The same 5 patients were out 90 patients that were diagnosed with proximal femur shaft fractures (5.55%). Analysis with logistic regression was statistically not significant. CONCLUSION: There was higher rate of varus malalignment seen in proximal femur shaft fractures treated with interlocking nails utilizing the greater trochanter entry point. The incidence of varus malalignment was not significant statistically.

Interlocking nails are widely used implants in the management of long-bone diaphyseal fractures. Interlocking nailing is an easy, predictable, and standard method owing to the presence of ancillary instruments and image intensifier. Proximal jigs help in guiding and inserting nail as well as its proximal locking. Intraoperative breakage of proximal jig may be an uncommon problem that is underreported in the literature. The creative use of variable unrelated instruments may prove instrumental to manage the complication and result in safe surgery. We describe one such uncommon intraoperative failure of proximal jig during femoral interlocking procedure and our experience in getting past the hurdle by an innovative solution.

Since the removal of a metallic interlocking nail system leaves a blank cavity inside a healed bone, bioactive and biodegradation materials have been used instead to induce bone formation and eliminate complications of the material removal procedure. The previous study presented the possibility of an interlocking nail fabrication from polylactic acid (PLA), polycaprolactone (PCL), and hydroxyapatite (HA) using 3D printing, namely fused filament fabrication (FFF), for canine diaphyseal fractures. Therefore, a finite element analysis (FEA) was used to predict the maximum principal stress of this 3D-printed composite interlocking nail to stabilize a canine femoral fracture, and the biomechanical performance was evaluated for the treatment of canine femoral shaft fractures using both traditional and new fixation techniques. Three-dimensional FEA models were created, and the composite interlocking nail was tested for implant strength and stability. Three types of canine femoral shaft fracture (proximal shaft fracture, middle shaft fracture, and distal shaft fracture) fixed by traditional and new fixation techniques, consisting of two, four, and six locking screws, were analyzed with a multilevel factorial design technique. The maximum principal stresses of the composite interlocking nail were compared with each fixation technique. According to the multilevel factorial design, gap type, fracture gap, and fixation techniques are factors that affect the maximum principal stress of the composite interlocking nail for two and four locking screws. For six locking screws, all factors, including gap type, fracture gap, nail length, and fixation techniques, significantly affect the maximum principal stress. The use of a 3D-printed composite interlocking nail system with new fixation techniques demonstrated lower maximum principal stresses than the interlocking nail system that used a traditional fixation technique. The results of this study could help orthopedic veterinary surgeons to understand the biomechanical performances of traditional and new fixation techniques. Furthermore, surgeons may use the numerical results of this analysis to choose a fixation technique based on a patient’s condition.

The present study was conducted on 6 clinical cases of long bone (femur, humerous and tibia) fractures in dogs. The cases with closed fracture of long bones were included in this study for open reduction and internal fixation using intramedullary interlocking nailing (ILN). After stabilization with interlocking nail, Demineralized Bone Matrix (DBM) was applied at the fracture site. Pre and post-operative (2nd and 4th week) Haemato-biochemical parameters viz. haemoglobin (Hb), total erythrocyte count (TEC), total leukocyte counts (TLC) and differential leukocyte count (DLC) and serum calcium, phosphorus and alkaline phosphatase enzyme activity were analyzed. The mean value of haemoglobin was lower than the reference value. The mean values of TEC,TLC and DLC were within normal reference range at all examination periods. Mean value of Ca and P was within normal range at all period of examination. The average value of ALKP was higher than the normal range at both preoperative and postoperative period of evaluation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate and compare the radiological and functional outcome of interlocking nail femur in dynamized with static mode. STUDY DESIGN: Prospective Randomized trial. PLACE AND DURATION: Orthopaedic and Traumatology Department Lady Reading Hospital from 3rd February 2014 to 10th January 2018. METHODOLOGY: Transverse and oblique fractures shaft of femur meeting the inclusion criteria were randomly divided into two equal groups. Group I was treated with reamed antegrade interlocking nail in dynamized mode while group II in static mode. Both groups were followed for two years. Radiologically union time, delayed union,non union and implant failure was assessed and compare in both groups. Functional evaluation was assessed with Thorensen's criteria as excellent, good, fair and poor. P value was considered significant if < 0.05. RESULTS: Both group I and II had 50 patients each. Mean age of group I and II was 36.1±SD 11.41 and 37.4±SD11.24 years respectively. Dynamic nails were associated with early fracture healing(15th week) than static nailing(22nd week).Excellent functional results were achieved in 84% patients in group I and 22% patients in group II.( P value < 0.05) Delayed union was noted in 8% patients in group I and 26% in group II(P value < 0.05) while non union in 2% patient in group I and 16% patients in group II( P value < 0.05) CONCLUSION: Dynamic interlocking nail femur for oblique and transverse shaft fractures results in excellent radiological and functional outcome in majority of patients than static interlocking nails. [ABSTRACT FROM AUTHOR]

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Distal locking is a challenging subtask of intramedullary nailing fracture fixation due to the nail deformation that makes the proximally mounted targeting systems ineffective. A patient specific finite element model was developed, based on the QCT data of a cadaveric femur, to predict the position of the distal hole of the nail postoperatively. The mechanical interactions of femur and nail (of two sizes) during nail insertion was simulated using ABAQUS in two steps of dynamic pushing and static equilibrium, for the intact and distally fractured bone. Experiments were also performed on the same specimen to validate the simulation results. A good agreement was found between the model predictions and the experimental observations. There was a three-point contact pattern between the nail and medullary canal, only on the proximal fragment of the fractured bone. The nail deflection was much larger in the sagittal plane and increased for the larger diameter nail, as well as for more distally fractured or intact femur. The altered position of the distal hole was predicted by the model with an acceptable error (mean: 0.95; max: 1.5 mm, in different tests) to be used as the compensatory information for fine tuning of proximally mounted targeting systems. [ABSTRACT FROM AUTHOR]

Background: Antegrade reamed interlocked intramedullary nailing is the treatment of choice forfemoral diaphyseal fractures. More recently, retrograde intramedullary nailing of the femur has been seen as a viable alternative to the antegrade nail. Methods: This was a prospective comparative study. Consecutive patients were placed alternately into a study group (retrograde nailing) and a control group (antegrade nailing) in a ratio of 2:1 i.e two retrograde nailing for every antegrade nailing. Forty one fractures had interlocking intramedullary fixation via the retrograde approach (study group), while the control group consisted of twenty fractures that had fixation via the antegrade approach. All were followed up for a minimum period of nine months (range of nine to twenty-four months). Results: The mean duration of surgery in the retrograde group was 157.07minutes and 137.40 minutes in the antegrade group (p=0.093). The mean duration to fracture union was 16.98±4.71 weeks in the retrograde group and 15.80±5.43 weeks in the antegrade group (p = 0.388). There was no incidence of non-union in the two groups. Conclusion: Retrograde approach compares favourably with antegrade approach for intramedullary interlocking nail fixation of diaphyseal femoral fracture in adults with respect to time of fracture healing.

Long bone fractures are commonly in surgery routine and several bone imobilization techniques are currently available. Technological progress has enabled to use low cost materials in surgical procedures. Thus, the aim of this study was to evaluate the applicability of polyamide 12 rods, solid and hollow in swine femurs, comparing them through flexion strength. This study had as second aim to fix the locking errors, commom place in interlocking nails, once polyamide 12 allows perforation in any direction by orthopaedic screw. Six groups were used: G1 - eight whole swine femurs; G2 - eight whole swine femurs with drilled medullary canal; G3 - two solid polyamide 12 rods; G4 - two hollow polyamide 12 rods; G5 - eight osteotomized drilled swine femurs with a solid polyamide 12 rod implanted in the medullary canal and locked by four 316L stainless steel screws and G6 - similar to G5 but using hollow rods instead of solid ones. No significant differences were observed for the modulus of rupture between solid and hollow rods, demonstrating that both rods had similar performances. These results led to the speculation that the addition of other polymers to the hollow rods could increase their strength and thus the bone-implant system. Furthermore, the comparison between G1, G5 and G6 could be analyzed using the finite element method in future. New polymeric materials may be developed based on the data from this study, strengthening the bone-implant system and making possible screws to be placed in any direction, nullifying the detrimental forces on the fracture site. [ABSTRACT FROM AUTHOR]

O desenvolvimento de novos aparatos usando materiais disponíveis e de baixo custo pode ser uma alternativa viável para o tratamento cirúrgico de fraturas em ossos longos de bovinos. O objetivo deste estudo foi avaliar a resistência mecânica de fêmures de bovinos jovens com fratura diafiseal, imobilizados com hastes intramedulares bloqueadas, compostas por diferentes polímeros. Para tanto, testes físicos de compressão e flexão, por meio de uma máquina universal de ensaios foram realizados em quatro grupos distintos de seis fêmures obtidos de bovinos jovens. Em um dos grupos, os ossos foram mantidos íntegros (grupo controle), enquanto que os outros os ossos, foram fraturados e imobilizados com uma haste intramedular bloqueada, composta por polipropileno, poliacetal ou poliamida (uma para cada grupo). Independente do polímero utilizado, nenhuma das hastes estudadas ofereceu aos fêmures fraturados resistência comparável ao osso íntegro, quando consideradas em conjunto as forças de flexão e compressão. A concordância desses achados com resultados in vivo previamente publicados, demonstra que a metodologia utilizada para testes ex vivo pode ser útil na seleção de materiais mais resistentes para confecção de novos modelos.The development of new devices using available and low cost materials may be an useful alternative for the treatment of long bone fractures in large animals. The aim of this study was to evaluate the mechanical strength of young bovine femur with diaphyseal fracture fixed with different polymeric intramedullary nails. Bending and compression tests using a universal machine were carried out in 4 distinct groups of 6 femurs from young calves. In one of the groups bones were intact while in the other three fractured bones were fixed using an intramedullary nail made of polypropylene, polyacetal or polyamide (one for each group). Considering bending and compression tests together, none of the used polymers offered strength to the fractured bones similar to the intact ones. The agreement of this findings with those from previous published in vivo results indicates that the employed ex vivo methods for mechanical assays may be useful in the search of stronger materials to be used in development of new devices.

We are reporting a case of post-traumatic chronic osteomyelitis of the tibia with an open wound exposing an intra medullar nail implant for 13 years. The patient presented with fresh ipsilateral tibia plateau fracture. He was treated by removal of the implant, debridement and local placement of Gentamicin-impregnated PMMA beads according to guidelines of the two-stage Belfast technique . After five months of wound treatment, the exposed bone was covered by healthy granulation tissue and the patient was able to fully bear weight.

Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for non- comminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus unlocked intramedullary nailing in such fractures. Ninety-three cases of non- comminuted femoral isthmus fractures (Winquist I and II) treated with interlocking nailing and unlocked nailing from 1 June 2004 to 1 June 2005 were reviewed; radiological and clinical union rates, bony alignment, complication and knee function were investigated. There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with unlocked femoral nailing is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. We therefore conclude that unlocked nailing is still useful for the management of non-comminuted isthmus fractures of the femur.

As hastes bloqueadas além de permitirem estabilização rígida de fraturas, possuem vantagens biomecânicas quando comparadas a outras técnicas de imobilização, por atuar ao longo do eixo mecânico central do osso, além de preservar os conceitos de padrões biológicos de osteossíntese . O uso limitado de hastes bloqueadas em gatos se atribui ao fato da cavidade intramedular ser pequena, limitando o tamanho e diâmetro dos pinos. Relatam-se casos de 10 felinos que apresentavam fraturas fechadas simples ou múltiplas da diáfise femoral. Os animais pesavam entre 3,5 e 5 kg, o que permitiu a utilização de hastes de 4,0mm e 4,7mm de diâmetro. Para inserção da haste, adotou-se a via retrógrada ou a normógrada e foram realizados bloqueios com quatro parafusos de titânio de 2,0 mm de diâmetro. Complicações intra-operatórias não ocorreram, entretanto um animal sofreu fratura de colo femoral e fratura transversa distal ao implante, três dias após o ato cirúrgico, devido a novo trauma. Os animais foram submetidos a exames radiográficos até quatro meses após a intervenção, evidenciando-se formação de calo ósseo secundário e consolidação óssea em período de 61-89 dias. Clinicamente, ocorreu esporadicamente alteração na marcha por leve claudicação de apoio definida por escala de claudicação, entretanto os animais iniciaram o apoio adequado entre três e oito dias após o ato operatório. Complicações pósoperatórias ocorreram referentes ao animal que sofreu novo trauma, entretanto notou-se consolidação do foco primário tratado pelo implante com 61 dias e consolidação da nova fratura num período total de 150 dias do início do tratamento conservativo por penso esparadrapado e tala. Conclui-se que o uso de haste bloqueada em felinos foi adequado uma vez que houve consolidação óssea em todos os casos, com retorno precoce da função do membro, permitindo a deambulação.Interlocking nails allow rigid fracture stabilization and present biomechanical advantages when compared to other immobilization techniques. It acts along the central mechanical axis of the bone and preserves biological concept standards for osteosynthesis. The use of interlocking nail in cats is limited because the intramedullary space is relatively small for the available nail sizes. We reported 10 cases of cats that had simple or multiple closed fractures of the femoral diaphysis. The animals weighed 3.5 to 5 kg , which allowed using nails of 4.0mm and 4.7mm in diameter. For the nail insertion, retrograde and normograde routs were used, and four 2mm titanium screws were used to lock all the perforations. No trans-surgical complication occurred, however, due to a new trauma, one of the animals suffered femoral neck fracture and transversal distal fracture to the nail, three days after surgery. Radiographies were made up to four months after surgery, and in most cases secondary bone formation was seen, showing bone consolidation in 61-89 days, excluding the animal who suffered new trauma, who presented bone healing in 150 days. Clinically, occasional lameness occurred; however, except for the animal that had new trauma, all animals initiated adequate limb support in 3 to 8 days after surgery. In conclusion, the use of 4.0mm and 4.7mm interlocking nails in felines was adequate, with bone healing in all cases, and also return of good limb function after surgery.

Background: Open fractures of tibia have posed great difficulty in managing both the soft tissue and the skeletal components of the injured limb. Gustilo Anderson III B open tibial fractures are more difficult to manage than I, II, and III A fractures. Stable skeletal fixation with immediate soft tissue cover has been the key to the successful outcome in treating open tibial fractures, in particular, Gustilo Anderson III B types. If the length of the open wound is larger and if the exposed surface of tibial fracture and tibial shaft is greater, then the management becomes still more difficult. Materials and Methods: Thirty six Gustilo Anderson III B open tibial fractures managed between June 2002 and December 2013 with "fix and shift" technique were retrospectively reviewed. All the 36 patients managed by this technique had open wounds measuring >5 cm (post debridement). Under fix and shift technique, stable fixation involved primary external fixator application or primary intramedullary nailing of the tibial fracture and immediate soft tissue cover involved septocutaneous shift, i.e., shifting of fasciocutaneous segments based on septocutaneous perforators. Results: Primary fracture union rate was 50% and reoperation rate (bone stimulating procedures) was 50%. Overall fracture union rate was 100%. The rate of malunion was 14% and deep infection was 16%. Failure of septocutaneous shift was 2.7%. There was no incidence of amputation. Conclusion: Management of Gustilo Anderson III B open tibial fractures with "fix and shift" technique has resulted in better outcome in terms of skeletal factors (primary fracture union, overall union, and time for union and malunion) and soft tissue factors (wound healing, flap failure, access to secondary procedures, and esthetic appearance) when compared to standard methods adopted earlier. Hence, "fix and shift" could be recommended as one of the treatment modalities for open III B tibial fractures. [ABSTRACT FROM AUTHOR]

Background: Open reduction and internal fixation with a plate is deemed to represent the gold standard of surgical treatment for displaced intra-articular calcaneal fractures. Standard plate fixation is usually placed through an extended lateral approach with high risk for wound complications. Minimally invasive techniques might avoid wound complications but provide limited construct stability. Therefore, 2 different types of locking nails were developed to allow for minimally invasive technique with sufficient stability. The aim of this study was to quantify primary stability of minimally invasive calcaneal interlocking nail systems in comparison to a variable-angle interlocking plate. Material and Methods: After quantitative CT analysis, a standardized Sanders type IIB fracture model was created in 21 fresh-frozen cadavers. For osteosynthesis, 2 different interlocking nail systems (C-Nail; Medin, Nov. Město n. Moravě, Czech Republic; Calcanail; FH Orthopedics SAS; Heimsbrunn, France) as well as a polyaxial interlocking plate (Rimbus; Intercus GmbH; Rudolstadt, Germany) were used. Biomechanical testing consisted of a dynamic load sequence (preload 20 N, 1000 N up to 2500 N, stepwise increase of 100 N every 100 cycles, 0.5 mm/s) and a load to failure sequence (max. load 5000 N, 0.5 mm/s). Interfragmentary movement was detected via a 3-D optical measurement system. Boehler angle was measured after osteosynthesis and after failure occurred. Results: No significant difference regarding load to failure, stiffness, Boehler angle, or interfragmentary motion was found between the different fixation systems. A significant difference was found with the dynamic failure testing sequence where 87.5% of the Calcanail implants failed in contrast to 14% of the C-Nail group (P < .01) and 66% of the Rimbus plate. The highest load to failure was observed for the C-Nail. Boehler angle showed physiologic range with all implants before and after the biomechanical tests. Conclusion: Both minimally invasive interlocking nail systems displayed a high primary stability that was not inferior to an interlocking plate. Clinical relevance: Based on our results, both interlocking nails appear to represent a viable option for treating displaced intra-articular calcaneal fractures. [ABSTRACT FROM AUTHOR]

Fractures of the femoral shaft treated with interlocking nails will ultimately result in breakage of the nail if the bone does not unite. Further management requires removal of the broken nail which may be a difficult process for the distal segment. If we can identify the symptoms just before the nail breaks, an exchange nailing becomes much easier. We present a patient with fibromatosis who underwent repeated surgery as well as radiotherapy at the age of 16. Six years later, she had a pathological fracture of the upper third of the femur for which an interlocking nail was inserted. The femur did not unite and the nail subsequently broke. Over a period of 12 years, three nails broke and had to be replaced. Two to 3 months before each breakage, the patient experienced the same set of symptoms for each episode. Knowing that her fracture was not going to heal will now alert us to do an exchange nailing before the nail broke again. It is well known that where there is evidence of non-union, pre-emptive treatment is necessary before implant failure.

Copyright of Revista Iberoamericana de Ingeniería Mecánica is the property of Editorial UNED and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

At present, intramedullary interlocking nails are widely used for bone-fracture fixation in orthopedic surgeries. Surgeons often use X-ray imaging to find the actual location of the distal screw-holes of the nail after the nail is inserted into the medullary canal of a bone for fixation. Thus, the patients and medical team are inevitably exposed to radioactivity. In this paper, we report a radiation-free electromagnetic/magnetic-coupled targeting system to locate the distal screw-holes of the nail used in interlocking-nail surgery. The targeting system consists of a c-shaped electromagnet with a pick-up coil, a highly permeable curved silicon-steel strip embedded on the nail, a guiding mechanism, and electronic measuring instruments. An alternative current is applied to the electromagnet to generate a uniform magnetic field/flux in the electromagnet's air gap. When the nail inserted into the medullary canal of a bone is scanned through or rotated in the air gap of the electromagnet, the magnetic flux in the air gap is influenced by the silicon-steel strip embedded on the nail. The variation of the magnetic flux induces a voltage response in the pick-up coil due to electromagnetic induction. The pattern of the voltage response is analyzed to establish a criterion for screw-hole targeting. The results obtained using this criterion reveal that the maximum targeting error of the location and orientation targeting for a screw-hole with a diameter of 5 mm is <;2 mm and 10°, respectively. Thus, the system/approach is sufficiently simple and accurate to be used by surgeons in clinical surgery. [ABSTRACT FROM PUBLISHER]

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Background: To evaluate the results of fixation of fracture neck of femur associated with fracture shaft of femur, by reconstruction nail or lag screws with conventional nail system. Methods: In this descriptive study, 22 patients, with ipsilateral femoral neck and shaft fracture were included. Reconstruction nails were used in 16 cases and cancellous lag screws in 06 cases, where femur had been already fixed with k nail and interlocking nail. Results: Majority (90.9%) were male. Complex fracture of femoral shaft and neck was seen in 72.72%. In majority ( 81.81%) %) type II Gorden Fracture took place.Patients were mobilized on crutches on second day of surgery and were not allowed weight bearing till union of neck of femur. No case of avascular necrosis or non union of neck fracture was noted. Conclusion: Reduction of neck fracture is the key factor for good outcome. Patients with complex fractures requires minimally invasive techniques. There should be lesser soft tissue dissection to prevent complications. Where reconstruction nail is not possible two to three lag screws with good reduction of neck of femur has satisfactory results.

Abstract: Background: Neglected trauma is a common problem faced by Orthopaedic surgeons practicing in developing countries. Nothing much in English literature is available regarding the practical difficulties and guidelines for treating neglected trauma of long bones. Methods: In our institution from November 2003 to October 2009 we treated 25 cases of neglected fracture of shaft of femur. Patients underwent either of three types of management protocols depending upon the preoperative manual traction radiographs. The fracture was fixed with open interlocking nail. Primary bone grafting and bone shortening procedures were not performed in any of the patient. Results: The fractures united in all patients at an average duration of 17 weeks. Two patients had limb length discrepancy. Conclusion: Careful preoperative evaluation is mandatory for good results. Preoperative skeletal traction and two stage surgical procedure may be required to avoid limb length discrepancy and neurovascular complication. [Copyright &y& Elsevier]

Abstract: Introduction: Dynamisation is a simple method for treating femoral shaft fractures (FSFs) in patients with delayed healing after intramedullary nailing. However, only around half of patients with a slow-healing FSF have been successfully treated with this strategy. Although it is thought that dynamisation with a screw preserved in the dynamic locking hole improves treatment outcome in these patients, to date, no studies have demonstrated empirical evidence supporting this technique. In this study, we investigated the effects of dynamisation with and without rotation and length control as well as timing of dynamisation on treatment outcomes in FSF patients with delayed healing. Patients and methods: Thirty-nine consecutive acute FSF patients with static locking intramedullary nails who subsequently underwent dynamisation were recruited between January 2000 and June 2011. The indication for dynamisation was the presence of gap caused by bone absorption or over-traction at the fracture site when the locking screws were placed. Age, gender, dynamisation method, fracture classification, duration from nail insertion to dynamisation (i.e., timing of dynamisation) and dynamisation outcome were included in the statistical analysis. Results: Patients whose nail was dynamised with a screw preserved in the dynamic locking hole had a significantly higher successful bone union rate (14/15 vs. 14/24, p =0.028) compared with those with all screws removed from one end of the nail. The patients treated in 10–24 weeks had a significantly increased chance of bone union than those treated after 24 weeks (p =0.027). A significantly higher bone union rate (p =0.036) was observed in 10–24 weeks (83.3%) than after 24 weeks (33.3%) in the group of dynamisation with all screws removed from one end of the nail. No statistical difference in bone union success rate was found between patients at 10–24 weeks and after 24 weeks in the group of dynamisation with a screw preserved in the dynamic locking hole. There were no significant differences in outcome based on other variables. Conclusion: (1) Dynamisation with a screw preserved in the dynamic locking hole was associated with a higher success rate in bone union than all screws removed from one end of the nail for patients with delayed healing FSFs. (2) Early dynamisation (10–24 weeks) had a better outcome than late dynamisation (>24 weeks). Late dynamisation with all screws removed from one end of the nails resulted in a poor success rate. Alternative treatment should be considered if the latter approach is to be adopted. [Copyright &y& Elsevier]

Previous animal models have been developed to study intramedullary nailing for challenging segmental defects in the tibia. In large animals, interlocked nail fixation created a stable environment suitable to study new bone growth technologies placed in the defect. To our knowledge, there are no comparable interlocked tibial defect models for the rabbit in which new technologies could be evaluated. Such a model would be helpful since the rabbit is a popular initial model for orthopedic research studies owing to its wide availability and low cost. While numerous studies have nailed the rabbit tibia, all were non-locked implants that allowed some degree of instability between the fracture fragments. In addition, the non-locked nails were constructed of stainless steel, whereas human nails are increasingly made from titanium alloy. In the current study, an interlocked titanium nail was developed for the rabbit tibia. It was implanted in cadaver tibiae and subjected to fatigue cycling in combined compression and bending at physiologic levels to 21,061 cycles. This duration is estimated to represent 12 weeks of gait by the animal. Before and after fatigue cycling, monotonic testing was performed in compression and bending at physiologic levels. The intact contralateral limbs served as controls. All limbs completed the cycling; the instrumented limbs exhibited interfragmentary cyclic strain amplitudes during fatigue (616 ± 139 microstrain), which was significantly greater than the control limbs (136 ± 35 microstrain). Monotonic strain amplitudes for the test limbs in bending and compression were 4839 ± 1028 and 542 ± 122 microstrain, respectively; corresponding values for the control bones were 407 ± 118 and 95 ± 38 microstrain, respectively. These data are similar to those presented in prior studies in larger bone models. The current study presents one method for interlocked nail fixation for this complex tibial shaft fracture in a small animal. [ABSTRACT FROM AUTHOR]

The article presents a case study of a one-year-old black swan with a closed midshaft, a left tibiotarsal fracture. Robert-Jones bandage and enrofloxacin was used to immobilize the bird's limb. It was pretreated with ketamine and midazolam and was given anaesthesia induced by propofol. The swan was intubated through a 3.5-milimeter endotracheal cuffless tube. It discusses the efficiency of the interlocking nail in the tibiotarsal fracture treatment of the bird.

Objectives: To determine the fracture healing (callus formation) with the use of interlocking intramedullary nailing in type II open diaphyseal fractures of tibia. Methodology: Forty patients with open type II tibial diaphyseal fracture of tibia were included in this case series study conducted in Orthopaedic Unit-1 of Civil Hospital Karachi from August 15, 2008 to August 14, 2009. All patients underwent fracture stabilization by reamed locking intramedullary nail within three days of injury. The main outcome measure was fracture healing (i.e. adequate callus formation) on X-ray at twenty four weeks. The SPSS version 13 was used to analyze data for descriptive statistics. Results: Majority of the patients (42.5%) were between 18-30 years of age group with mean ± SD age was 36.50 (12.89) years. Males were affected more than females with male to female ratio being 4:1. Adequate callus formation was achieved in 35 (87.5%) patients radiographically at the end of six-months. Conclusion: Intramedullary interlocking nail can be safe and effective in management of open type II diaphyseal fracture of tibia as it is associated with satisfactory healing. [ABSTRACT FROM AUTHOR]

Objective: To report clinical outcome after use of an interlocking nail (ILN) for stabilization of diaphyseal fractures in dogs and cats. Study design: Prospective study. Animals: Six client-owned dogs and cats. Methods: Interlocking nails (4 or 5mm diameter for 3 cats and 6 or 8 mm for 3 dogs) were used in femoral diaphyseal fractures treatments. Data about the patient (species, breed, weight, age), characteristics of the fracture, details of the surgery and perioperative complications were recorded. We evaluated functional outcome and fracture healing at 30 and 60 days after surgery. Results: Femoral fractures in 3 dogs and 3cats were repaired. Two of the fractures were comminuted. Clinical outcome was excellent in all cases. The six cases were x-ray evaluated at 60 days after surgery and healed without complication. Conclusion: The high success rate associated with a functional outcome suggests that ILN can be used to stabilize diaphyseal fractures in dogs and cats. [ABSTRACT FROM AUTHOR]