Journal of Musculoskeletal Trauma

Results and Problems of open Intramedullary Nailing of Femoral Shaft Fracture: Chung Nam Kang, Jong Oh Kim, Dong Wook Kim, Young Do Koh, Jae Doo You, Kyoung Soo Kim; J Korean Soc Fract 1999;12(1):28-34. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.28

Abstract PDF: The intramedullary nailing is one of the most available methods in treatment of femoral shaft fracture. The closed intramedullary nailing is known to be the best method of treatment of femur shaft fracture, but it is not always available in cases of deficit of equipment, severe associated injury, and some fracture pattern. The open intramedullary nailing has advantage of easily obtaining anatomical reduction but it increases the risk of infection, the incidence of delayed union and additional operations inevitably. We reviewed 33 cases of open intramedullary nailing in femur shaft fracture from September 1994 to September 1997. The results were as follows : 1. The average union time was 27.3 weeks. 2. Location of fractures was middle one-thirds in most cases, and Winquist-Hansen classification type II was the most common. 3. The complication included 8 delayed unions, 3 nonunions, 2 infections, shortening of more than two centimeters in 3 patients. 4. In 4 cases, we did open intramedullary nailing with bone graft initially, but all of them has complication as delayed union and nonunion. We can use open intramedullary nailing method in some femur shaft fractures, but there are many problems and complications. So we must consider it carefully before using this method.

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Delayed Intramedullary Nailing after Failed External fixation for Open Tibial Fractures: Jin Hong Ko, Bum Gu Lee, Do Hyun Moon, Hong Gi Park, Cheol Won Park; J Korean Soc Fract 1997;10(3):694-701. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.694

Abstract PDF: Recently, extemal fxation and unreamed intramedullary nailing are largely used for operative treatment for open long bone fractures. Extemal fixation, especially in cases of unstable fractures, blamed for complications, for example, malunion, delayed union, loss of reduction, refracture, pin tract infection. In addition, there are some problems such as long hospital stay and delayed returning to work. Some surgeons tried to treat such problems by secondary intramedullary nailing, but they came to different retults. The purpose of the current study is to evaluate our experience with secondary intramedullary nailing after failed external fixation of 4 cases of open Grade II, 8 cases of open Grade III a, and 4 cases of open Grade III b tibial fractures. The results are as follows ; 1. The external fixation had been maintained for 123 days in average. 2. The mean interval between removal of the external fixation and intramedullary nailing was 16 days except 5 immediate operation. 3. Reamed intramedullary nailing with static interlocking were done in all 16 cases. 4. In 12 cases of 16, bone union was obtained without complications, and the mean union time after intramedullary nailing was 21.7 weeks radiollogically. 5. Deep infections developed in 2 cases, which had in fracture site, and local infections in 2 cases, which had been in previous pin site of external fixator. In conclusion, delayed intramedullary nailing was a method for treatment of problematic external fixation, such as delayed union, nonunion, loss of fixation, and pin site infection, for open fractures of the tibia.

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Treatment of Tibial Shaft Fractures Using Interlocking Intramedullary Comparison of Reamed and Unlearned Methods: Woo Nam Moon; J Korean Soc Fract 1997;10(3):562-568. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.562

Abstract PDF: Sixty-four closed or Gustilo type I open fractures of the tibial shaft were treated with interlocking intramedullary nailing with(n=38) or without(n=26) reaming and were followed for an average of 13 months. The time to bony union ranged from twelve to twenty-five weeks with an average of 16.4 weeks in reamed method and from thirteen to twenty-seven weeks with an average of 15.9 weeks in unlearned method. The complications of reamed method were seen in 4 cases(11%) (two stiffness of ankle joint, one malunion and one distal screw breakage) whereas complications of unlearned method were seen in 7 cases(27%) (one stiffness of ankle joint, two malunions and four distal screw breakages). There was no significant difference in the union time of reamed and unlearned interlocking intramedullary nailing. But complications of fracture healing were less frequently seen on reamed interlocking intramedullary nailing.

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Treatment of Tibial Shaft Fracture Using Intramedullary Nail: Dae Young Han, Kyu Hyun Yang, Young Chul Cho, Myung Koo Kim, Seong Jin Park; J Korean Soc Fract 1995;8(3):566-571. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.566

Abstract PDF: In the treatment of tibial shaft fracture with intramedullary nail. reaming effectively lengthens the isthmus of the tibia and there by extends the number of fractures amenable to this technique. Reming process, however, destroys the endosteal blood supply, may impair bony union and provecate infection in open fracture. Eighty-eight cases of tibial shaft fractures treated with reamed nail(56 cases) and unlearned nail(32 cases) from January 1991 to August 1994 at Yonsei Medical Center were analyzed. Average follow-up period was 7.3 months.
Results
were as follows 1. In closed fractures, there was no difference in union time between reamed and unlearned group, and low energy injury group had shorter union time than high energy injury group. 2. In open fractures, unlearned group had shorter union time than reamed group. 3. Unlearned group had less complications such as infection and delayed union, and had more cases of interlocking screw breakage(3 cases) which did not dusturb the bony union. In conclusion, unlearned tibial nailing was useful method to treat not only open fracture but also closed fracture.

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