Conversion of External Fixation to Intramedullary Nailing for Fractures of the Shaft of the Femur in Multiply Injured Patients*

Nowotarski, Peter J.; Turen, Clifford H.; Brumback, Robert J.; Scarboro, J. Mark

doi:10.2106/00004623-200006000-00004

Cited by 262 publications

(114 citation statements)

References 17 publications

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“…Brewster et al reported a 1.4 % rate of pin tract infection and a 5.5 % rate of deep infection in the group lengthening over a nail in a literature review [19]. Rates of infection have ranged between 1.7 % and 21 % and bony union rates were high when an intramedullary nail is inserted after initial use of external fixation for high-energy and open tibial fractures [20][21][22]. However, all the tibiae in our study were healthy and well-vascularized.…”

Section: Discussionmentioning

confidence: 99%

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

Lan

Zhang

Tang

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to explore the clinical effect of the novel method combined longitudinal S-osteotomy and Lengthen And Then Nail (LATN) technique for leg lengthening and compare with the classic Ilizarov method. Methods This retrospective study was performed from March 2008 to April 2012. A total of 176 leg lengthenings (88 consecutive patients) were performed at our institution. The mean duration of follow-up was 2.2 years (range, one to four years). In group A, 78 tibial lengthenings were performed with longitudinal S-osteotomy and LATN technique. In group B, 98 tibial lengthenings were performed with the classic method. The final gain in length, mean surgical time for bilateral tibial osteotomy, the external fixation index and the radiographic consolidation index were calculated and compared. The complications encountered during operation and follow-up were documented. Results There was no significant difference in the final gain in length between the two groups. Mean surgical time in group A (130.05±6.60 min) was significantly longer than that in group B (91.4±6.61 min; P<0.05). External fixation index in group A (21.02±3.16 days/cm) was significantly lower than that in group B (76.19±8.32 days/cm; P<0.05). Consolidation index was significantly lower (more rapid healing) in group A (43.38±5.35 days/cm) than that in group B (76.19±8.32-days/cm; P<0.05). There was a significant difference in pintract problems and axial deviation between the two groups. Conclusion The novel method combined longitudinal Scorticotomy and LATN technique safely reduces the consolidation time, rate of pin-tract problems and axial deviation during leg lengthening, compared with the classic Ilizarov method.

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Section: Discussionmentioning

confidence: 99%

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

Lan

Zhang

Tang

et al. 2013

International Orthopaedics (SICOT)

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“…16 Therefore, in most cases, an early elective conversion to an intramedullary stabilizing technique takes place, 17 although in retrospective studies, an infection rate up to 13.3% was reported. 18,19 The ability to safely nail the femur as an initial procedure would avoid many of these problems.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Schult

Küchle²,

Hofmann³

et al. 2006

Journal Orthopaedic Research

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Although reamed intramedullary nailing has been one of the greatest advances in modern fracture care, the concomitant increase in medullary cavity pressure leads to intravasation of bone marrow content into the blood stream, an effect that can evoke serious systemic reactions. A newly developed rinsing-suction-reamer (RSR) was able to substantially reduce the pressure and bone marrow intravasation content during experimental femoral nailing. We investigated the pathophysiological effects using the RSR, testing the hypothesis that by reducing marrow fat embolization, RSR would also reduce the activation of coagulation compared with the universial AOReamer (AOR) and comparable to external fixation. Twenty-two pigs were treated with either simulated external fixation or reamed femoral nailing using AOR or RSR. During surgery, the intramedullary pressure was measured and intravasation of medullary material was quantified. After surgery, the pigs were kept anaesthetised and monitored for 6 h. At defined intervals, serological, hematological, and hemodynamic parameters were evaluated. The RSR was significantly superior when compared to AOR with regard to the generation of intramedullary pressure and fat embolization; however, with external fixation the values were even lower. The evaluation of other parameters revealed no clear differences between the two reamers and the external fixator. The pig model showed that RSR led to a significant reduction of the intramedullary increase in pressure and fat intravasation compared to AOR. Although the reduction of fat embolism by RSR is not associated with pathophysiological changes, RSR can have advantages for the treatment of femoral fractures.

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“…In approximately 5% of fractures of the long bones in the leg, the patient is 'physiologically unstable' after initial resuscitation because of coagulopathy, haemodynamic instability, raised intracranial pressure, vascular damage or injury to a solid organ. 87,88 The treatment of these life-threatening conditions takes priority over the orthopaedic injuries in the early stages, and the use of external fixation is advocated, dictated by the requirement for rapid temporary stabilisation of the fracture. If these patients survive, they are also at a much higher risk of ARDS within the first week after injury and it is important Summary of the previous English-language studies which have compared the effects of early operative stabilisation of the fracture (usually within 24 hours) with late or non-operative treatment on the incidence of post-traumatic respiratory complications.…”

Section: 84-86mentioning

confidence: 99%

“…Many of these patients also have evidence of SIRS and concerns have been raised about the safety of early reamed nailing because the procedure may act as a secondary 'hit', which may trigger the development of ARDS. 9,19,20,89 Modifications to the basic protocol of early reamed nailing have been examined including the use of temporary external fixation until the inflammatory response has settled or resuscitation is complete, 88,91 the employment of different methods of fixation such as unreamed nails 78,92,93 or compression plates, 94,95 or of techniques designed to reduce fat embolisation during reamed nailing including venting, 96 lavage of the medullary canal 86 or an altered design of reamer.…”

Section: 84-86mentioning

confidence: 99%

Current Concepts of Respiratory Insufficiency Syndromes After Fracture

Robinson

2001

The Journal of Bone and Joint Surgery. British volume

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Conversion of External Fixation to Intramedullary Nailing for Fractures of the Shaft of the Femur in Multiply Injured Patients*

Cited by 262 publications

References 17 publications

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

S-osteotomy with lengthening and then nailing compared with traditional Ilizarov method

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Current Concepts of Respiratory Insufficiency Syndromes After Fracture

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