Effects of intramedullary nail removal after tibial fracture repair: A prospective study

Abstract

Introduction: Tibial fractures are the most common long bone fracture. The standard of care for the treatment of diaphyseal tibial fractures is an intramedullary nail (IMN). Implant removal is one of the most common procedures in bone and joint surgery, and criteria for implant removal are typically left to the treating surgeon. We conducted a prospective study to investigate effects of intramedullary nail removal after tibial fracture union. Methods: Sixty patients at our hospital were enrolled in a prospective study and divided into moderate/severe knee pain (visual analog scale (VAS) -4) and mild/no knee pain (VAS < 4) groups after interlocking intramedullary nailing. Variables studied included the distance from the tip of the nail to the tibial plateau and the front of the tibia on a normalized lateral X-ray, the VAS score of knee and ankle pain, the range of motion of the knee and ankle, and Johner-Wruhs criteria before, 6 weeks after operation, and at the last follow-up. Results: Fifty-seven patients were followed for a mean of 8.4 (2-17) months. In patients with moderate or severe knee pain intramedullary nail removal led to significant pain reductions (p < 0.05). A significantly shorter distance from the tip of the nail to the tibial plateau (<10 mm) and the anterior border of tibia (<6 mm) was found in the 24 patients with moderate or severe knee pain. Conclusion: For patients complaining knee pain after interlocking intramedullary nailing of tibial fractures, especially with a short distance from the tip of the nail tail to the tibial plateau(<10 mm) and the anterior border of the tibia (<6 mm) removal of the intramedullary nails relieved the pain significantly.

Reduced Cell Adhesion on LightPLAS-Coated Implant Surfaces in a Three-Dimensional Bioreactor System

“…This is one reason why studies focus on the improvement of osseointegration, in contrast to this study [52][53][54]. However, many studies describe complications during intramedullary nail removal or the need for special instruments [55][56][57]. Therefore, in recent decades, some studies have also focused on reducing osseointegration, like Levanus et al, who showed a decreased osteocalcin and collagen 1 expression after cultivation on Ti300 substrates, a titanium surface with 300 nm pores [58].…”

Laser Ablated Periodic Nanostructures on Titanium and Steel Implants Influence Adhesion and Osteogenic Differentiation of Mesenchymal Stem Cells

“…Especially for metal implants in load-bearing regions, increased bone formation and accelerated tissue integration seem reasonable. Nevertheless, several studies describe complications during nail removal through nail failure, jamming in the fracture callus during removal, or difficulties and need for special instruments [46][47][48]. Most studies of modified surfaces focused on increased cell adhesion/osseointegration [39,[42][43][44][45] or decreased bacteria adhesion/prevention of biofilm formation [49][50][51].…”