Intramedullary Nailing of the Lower Extremity: Biomechanics and Biology

Bong, Matthew R.; Kummer, Frederick J.; Koval, Kenneth J.; Egol, Kenneth A.

doi:10.5435/00124635-200702000-00004

Cited by 204 publications

(128 citation statements)

References 50 publications

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“…This probability of implant failure increases with longer patient survival and the presence of nonunion [6]. Intramedullary nails are designed to act as internal splints with load-sharing properties and are assumed to bear most of the load initially and then gradually transfer it to the bone as the fracture heals [3]. These devices were not designed to bear the entire load of the patient for the remainder of the patient's lifetime and are thus at a higher risk for failure in patients with large bone defects or fractures may never heal.…”

Section: Discussionmentioning

confidence: 99%

Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Harvey

Ahlmann

Allison

et al. 2012

Clinical Orthopaedics &Amp; Related Research

146

160

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Background The proximal femur is the most common site of surgery for bone metastases, and stabilization may be achieved through intramedullary fixation (IMN) or endoprosthetic reconstruction (EPR). Intramedullary devices are less expensive, less invasive, and may yield improved function over endoprostheses. However, it is unclear which, if either, has any advantages. Questions/purposes We determined whether function, complications, and survivorship differed between the two approaches. Methods We retrospectively reviewed 158 patients with 159 proximal femur metastatic lesions treated with surgical stabilization. Forty-six were stabilized with IMN and 113 were treated with EPR. The minimum followup was 0.25 months (mean, 16 months; median, 17 months; range, 0.25-86 months). Results The mean Musculoskeletal Tumor Society score was 24 of 30 (80%) after IMN and 21 of 30 (70%) after EPR. There were 12 complications (26%) in the IMN group, including 10 nonunions, six of which went on to mechanical failure. There were complications in 20 of 113 (18%) of the EPR group, which consisted of 10 dislocations (9%) and 10 infections (9%). There were no mechanical failures with EPR. Both implants remained functional for the limited lifespan of these patients in each group at all time intervals. EPRs were associated with increased implant longevity compared with IMNs (100% versus 85% 5-year survival, respectively) and a decreased rate of mechanical failure (0% versus 11%, respectively) when compared with the intramedullary devices. Conclusions Patients with metastatic disease to the proximal femur may live for long periods of time, and these patients may undergo stabilization with either IMN or EPR with comparable functional scores and the implant survivorship exceeding patient survivorship at all time intervals. Endoprostheses demonstrate a lower mechanical failure rate and a higher rate of implant survivorship without mechanical failure than IMN devices.

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Section: Discussionmentioning

confidence: 99%

Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Harvey

Ahlmann

Allison

et al. 2012

Clinical Orthopaedics &Amp; Related Research

146

160

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“…Over-reaming is the key to success of this technique. Although reaming can have an early deleterious effect on endosteal and cortical blood flow, canal reaming appears to have several positive effects on the fracture site, such as increasing extraosseous circulation, which is important for fracture healing [2]. Union at the fracture site was not affected in this series nor in another series of closed antegrade interlocked nailing of femoral shaft fractures in 200 patients where the canal was reamed 2 mm more than the diameter of the nail to prevent deformation of the nail [1].…”

Section: Discussionmentioning

confidence: 99%

Nail over nail technique for distal locking of femoral intramedullary nails

Rohilla

Singh

Magu

et al. 2008

International Orthopaedics (SICOT)

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The free hand technique remains the most popular method for distal locking; however, radiation exposure is a major concern. In an endeavour to overcome this concern, distal locking with the nail over nail technique is evaluated. Seventy patients with femoral diaphyseal fractures treated by intramedullary nailing were divided in two groups for distal locking: either using the free hand technique (group I) or with the nail over nail technique (group II). The average number of images taken to achieve nail insertion without locking, for distal locking, and for the complete procedure in group I was 25.8, 24.2, and 50.08, respectively, compared with 24.8, 4.1, and 28.9, respectively, in group II (statistically extremely significant decrease in radiation). The nail over nail technique appears to be a reliable solution for decreasing radiation exposure during closed femoral intramedullary nailing. However, over-reaming of 1.5 mm is the key to the success of the technique.

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“…That is, we proceeded to use the trochanteric incision to ream the medullary cavity, and knocked in a larger nail-size 13 diameter. This is a procedure recommended by none other than Kuntscher himself and confirmed by other authors in recent times (4,7). It would give us better axial stability, at the same time not interfering with the biological healing processes already in place.…”

Section: Discussionmentioning

confidence: 60%

Management of bilateral fracture femur with implant failure: a case report

Admani¹,

Mwangi²

2011

E Af Orth Jnl

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Successful treatment of a fracture by use of implants is a race between rate of fracture healing and metal fatigue of implant used. Implant failure is thus one of the most feared but often encountered complications in the practice of an orthopaedic surgeon. It becomes even more difficult for the surgeon when a patient has multiple fractures, increasing the indication for open reduction and accurate fixation, so that the patient may be mobilized as early as possible. The early mobility of the patient may then stress the implants in an unnatural manner predisposing the construct to failure. We hereby present the case of a patient who suffered fractures of both femurs, was operated on and suffered bilateral implant failure. Corrective surgery involved a repeat operation on either femur.

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Intramedullary Nailing of the Lower Extremity: Biomechanics and Biology

Cited by 204 publications

References 50 publications

Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur Metastases

Nail over nail technique for distal locking of femoral intramedullary nails

Management of bilateral fracture femur with implant failure: a case report

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