Locking intramedullary osteosynthesis of lower extremity fractures in General Hospital Karlovac
Authors analyze the application of locking intramedullary implants (long and short Gamma 2 Stryker nail, Femoral locking S2 Stryker nail and Tibial locking S2 Stryker nail). Four and a half years follow up resulted with 183 GAMMA nails, 42 Femoral and 37 Tibial locking nails being implanted. Gamma nails were used to treat significantly older patients (average age 68.2 years) in comparison with patients treated with Tibial nails (average age 37.1 years) and Femoral nails (average age 38.1 years). We analyzed the length of hospital stay, technique of application (static or compressive), the relationship between open and closed reduction of the fracture, and morbidity. GAMMA nail had 12.5% morbidity while Femoral and Tibial nails had 16% which is similar to the literature data. The authors consider the short Gamma locking nail as the implant of choice for all unstable pertrochanteric fractures (loss of medial support) and the long GAMMA nail as an implant of choice for all subtrochanteric fractures. Femoral and tibial nails should be the implants of choice for all the diaphiseal and selected metaphiseal fractures. Biomechanical characteristics of these implants are superior to the plates, they produce less iatrogenic trauma, enable faster recovery and quicker return to everyday life.
Street DM: The evolution of intramedullary nailing. U: Browner B: Science and practice of intramedullary nailing. 2. izd. Baltimore: Williams &Wilkins; 1996: str.1-22.
Hoglund EJ: New intramedullary bone implant surgery. Gynecol Obstet 1917; 24; 243-9.
Rush LV, Rush HL: Technique for longitudinal pin fixation of certain fractures of ulna and of the femur. J Bone Joint Surg 1939; 21: 619-27.
Gallagher JC, Melton LJ, Riggs BL i sur: Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clin Orthop 1980: 150;163-71.
Mannius S, Mellstrom D, Oden A i sur: Incidence of hip fracture in Western Sweden 1974-1982. Comparison of rural and urban populations. Acta Orthop Scand 1987; 58: 38-42.
Hančević J, Antoljak T, Mikulić D, Žanić-Matanić D, Korać Ž. Lomovi i iščašenja. Zagreb: Slap;1998, str. 290-9.
Sernbo I, Johnell O: Background factors in patients with hip fractures – differences between cervical and trochanteric fractures. Compr Gerontol 1987; A1: 109-11.
Aitken JM: Relevance of osteoporosis in women with fractures of the femoral neck. Br Med J 1984; 288: 597-601.
Dias JJ, Robbins JA, Steingold RF i sur: Subcapital vs intertrochanteric fracture of the neck of the femur: are there two distinct subpopulations? J R Coll Surg Edinb 1987; 32: 303-5.
Cimmings SR, Nevitt MC: Non-sceletal determinants of fractures: the potential importance of the mechanics of falls. Osteoporosis Int 1994; Suppl 1: s67-70.
Halder SC: Gamma nail for peritrochanteric fractures. J Bone Joint Surg 1992; 74B: 340-4.
Hardy D, Descamps P, Krallis P i sur: Use of an intramedullary hipscrew compared with compression hip-screw with a plate for intertrochanteric femoral fractures: A prospective randomized study of one hunderd patients. J Bone Joint Surg 1998; 80A: 618-30.
Leung KS, So WS, Shen WY i sur: Gamma nails and dynamic hip screws for peritrochanteric fractures: A randomised prospective study in elderly patients. J Bone Joint Surg 1992; 74B: 345-51.
Bellabarba C, Herscovici D, Ricci, WM: Percutaneous treatment of peritrochanteric fractures using the Gamma Nail. J Orthop Trauma 2003; 17(8) Suppl:S38-50.
Kukla C, Heinz T, Gaebler C, Heinze G, Vecsei V: The standard Gamma Nail: A critical analysis of 1,000 cases. J Trauma 2001; 51(1): 77-83.
Cheng MT, Chiu FY, Chuang TY, Chen CM, Chen TH, Lee PC: Treatment of complex subtrochanteric fracture with the Long Gamma AP Locking Nail: A prospective evaluation of 64 cases. J Trauma 2005; 58(2):304-11.
Barquet A, Francescoli L, Rienzi D, Lopez L: Intertrochantericsubtrochanteric fractures: Treatment with the Long Gamma Nail. J Orthop Trauma 2000; 14(5):324-8.
Scalea TM et al: External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fracture: Damage control orthopedics. J Trauma 2000; 48: 613-23.
Pape HC et al: Changes in the management of femoral shaft fractures in polytrauma patients: From early total care to damage control orthopedic surgery. J Trauma 2002; 53: 542-62.
Harwood PJ et al: Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients. J Trauma 2005; 58: 446-54.
Korać Ž, Kelenc D, Mikulić D, Vuković D, Hančević J: Terminal Ballistics of Russian AK 74 Assault Rifle: Two Wounded Patients and Experimental Findings. Military Medicine 2001: 166(12); 1065-8.
Starr AJ, Bucholz RW: Fractures of the shaft of the femur. U: Rockwood and Greens: Fractures in adults. Lippincot Williams&Wilkins; 2001, str. 1683-730.
Winquist R, Hansen S, Clawson K: Closed intramedullary nailing of femoral fractures. J Bone Joint Surg Am 1984; 66: 529-39.
Brumback RJ, Uwagie-Ero S, Lakatos RP i sur: Intramedullary nailing of femoral shaft fractures: part II. Fracture-healing with static interlocking fixation. J Bone Joint Surg Am 1988; 70: 1453-62.
Albo A, Stromsoe K, Ekeland K: Locked intramedullary nailing of femoral shaft fractures. J Trauma 1991; 31: 49-59.
Wiss DA, Fleming CH, Matta JM I sur: Comminuted rotationally unstable fractures of the femur treated with an interlocking nail. Clin Orthop 1986; 212: 35-47.
Lucas S, Seligson D, Henry S: Intramedullary supracondylar nailing of femoral fractures: A preliminary report of the GSH supracondylar nail. Clin Orthop 1993; 296: 200-6.
Ricci WM, Devinney S, Haidukewych G, Herscovici D, Sanders R: Trochanteric nail insertion for the treatment of femoral shaft fractures. J Orthop Trauma 2008; 22 Suppl 3:S2-8.
Im GI, Shin SR: Treatment of femoral shaft fractures with a titanium intramedullary nail. Clin Orthop Res 2002; 401: 223-9.
Seifert J, Stengel D, Matthes G, Hinz P, Ekkernkamp A, Ostermann P: Retrograde fixation of distal femoral fractures: Results using a new nail system. J Orthop Trauma 2003; 17(7): 488-95.
Gellman RE, Paiement GD, Green HD, Coughlin RR: Treatment of supracondylar femoral fractures with a retrograde intramedullary nail. Clin Orthop Res 1996; 332: 90-7.
Court-Brown CM, McBirnie J: The epidemilogy of tibial fractures. J Bone Joint Surg 1995; 77B: 417-21.
Kay L, hansen BA, Raaschou HO: Fracture of the tibial shaft conservatively treated. Injury 1986; 17: 5-11.
Kyro A, Tunturi T, Soukka A: Conservative treatment of tibial fractures: Results in a series of 163 patients. Ann Chir Gynaecol 1991; 80: 294-300.
Sarmiento A, Sharpe FE, Ebramzadeh E i sur: Factors influencing the outcome of closed tibial fractures treated with functional bracing. Clin Orthop 1995; 315: 8-24.
Oni OOA, Hui A, Gregg PJ: The healing of closed tibial shaft fractures. J Bone Joint Surg 1988; 70B: 787-90.
Henley MB, Chapman JR, Agel J i sur: Treatment of type II, IIIa and IIIb open fractures of the tibial shaft: A prospective comparison of unreamed interlocking intramedullary nail and half-pin external fixators. J Orthop Trauma 1998; 12: 1-7.
Court-Brown CM, Hughes SPF: Huges external fixator in treatment of tibial fractures. J R Soc Med 1985; 78: 830-7.
Rommens P, Gielin J, Broos P i sur: Intrinsic problems with the external fixation device Hoffmann-Vidal-Adrey: A critical evaluation of 117 patients with tibial shaft fractures. J Trauma 1989; 29: 630-8.
Ruedi T, Webb JK, Allgoewer M: Experience with the dynamic compression plate (DCP) in 418 recent fractures of the tibial shaft. Injury 1976; 7: 252-7.
Clifford RP, Beauchamp CG, Kellam Jfi sur: Plate fixation of open fractures of the tibia. J Bone Joint Surg 1988; 70B: 644-8.
Court-Brown CM: Fractures of the tibia and fibula. U: Rockwood and Greens: Fractures in adults. Lippincot Williams&Wilkins; 2001, str.1939-2000.
Lang GJ, Cohen BE, Bosse MJ i sur: Proximal third tibial shaft fractures: should they be nailed? Clin Orthop 1995; 315: 64-74.
Blachur PA, O'Brien PJ, Meek RN i sur: Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft. J Bone Joint Surg 1997; 79A: 640-6.
Court-Brown CM, Will E, Christie J i sur: Reamed or unreamed nailing for closed tibial fractures. J Bone Joint Surg 1996; 78B: 801-4.
Court-Brown CM, Gustilo T, Shaw AD: Knee pain after intramedullary tibial nailing: Its incidence, ethiology, and outcome. J Orthop Trauma 1996; 11: 103-5.
Keating JF, Orfaly R, O'Brien PJ: Knee pain after tibial nailing. J Orthop Trauma 1996; 11: 10-13.
Lin J: Effectiveness of completely round nails with both-endsthreaded locking screws for tibial shaft fractures. J Trauma 2006; 61(4): 893-9.
Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF: A prospective randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma 2000; 14(3): 187-93.
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