Analysis of Centromedullary Nailing with Implant Failure

Abstract

Centromedullary nailing is the most preferred surgical technique for the treatment of lower limb fractures and sometimes also on the upper extremity. It is a minimal invasive surgical intervention used mainly for long bones fractures that permits treatment without opening the fracture site thus preserving the local vascularization. With the improved knowledge and understanding of the fracture pattern and of the implantation technique good stability and rapid bone healing is obtained.We present a study on 8 patients with long bones fractures (femur, tibia, humerus) that were surgically treated with intramedullary nailing which failed due to non-union. Implant failure usually occured at 6 to 10 months after surgery. In our group of patients the primary causes of non-union was improper fracture reduction, infection and faulty surgical technique. The implant usually failed several months after loading when the nail was not sharing but bearing all the weight. In this cases the metallic implant usually fails due to fatigue in its weakest point. Loss of reduction, inadequate fixation, a need to change implant and breakage of nails were considered as implant failure.Inappropriate usage of intramedullary nailing technique will lead to nonunion or delayed union and after loading the affected limb the metallic implant will bear all the mechanical forces. This will lead to implant failure and a new difficult surgery for the patients.Revision surgery should address both the biological part and the mechanical part of bone union .

Metallosis - Literature Review and Particular Cases Presentation

“…We have to take into account that the size of metallic debris is under 50 nm comparing to PE debris size regularly under 0,1 μm [11]. It has been proven that size and shape of metallic debris change with severity of wear [12][13][14][15]. The small size of the metallic debris increases tremendously the host-particles interface and consequently enhances host inflammatory response.…”

Short Term Behaviour of Fixed-Loop Cortical Suspension System Used for Surgical Treatment of <i>Hallux valgus</i>

“…An important issue are the design of the orthopedic implants because are used different processing techniques of the metallic biomaterials in order to obtain various types of orthopedic implants like screws, plates, wires, pins, that could affect the metallic materials microstructure, mechanical properties and implant surface [16,18,19]. The processing techniques of metallic biomaterials and the excesive biomechanical loading are the main causes for metallic implant failure, as is mentioned in various studies [20][21][22][23]. Even various studies describe now the potential of biodegradable metals and metallic glass for orthopedic implants, we consider that the classical metallic biomaterials like titatinium and his alloys are still the best option available for trauma implants [24][25][26][27][28][29].…”

Fractographic Evaluation of the Metallic Materials for Medical Applications

“…Various papers evaluate the failure causes of different orthopaedic implants but it was observed that most of them didn't follow a specific protocol for implant or material analysis because they use different microscopically techniques for these analyses [25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”