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Desaturating Patient with Long Bone Fractures
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Devendra Kumar Chouhan, Narendra Chouhan
In the case of established FES and patients requiring ICU care, a damage control procedure should be done to ensure fracture stabilization. The rationale of long bone fracture stabilization is to reduce fat globule shower into the system. The preferred approach is to apply external fixation or intramedullary nailing following Pepe's criteria.
Animal Models of Bone Fracture or Osteotomy
Published in Yuehuei H. An, Richard J. Friedman, Animal Models in Orthopaedic Research, 2020
Yuehuei H. An, Richard J. Friedman, Robert A. Draughn
Intramedullary nailing is a successful procedure which allows some motion and loading at the bone ends (a less rigid fixation) and is usually associated with external callus formation. Intramedullary reaming causes circulatory disturbances in the inner 2/3 of the cortex, but it does not impede the formation of external callus and the damaged parts will be revascularized.
Osteoporotic long bone fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Sascha Halvachizadeh, Hans-Christoph Pape
The surgical stabilization of long bone fractures with intramedullary nailing remains a well-established strategy. The short fragment should be locked with two to three locking screws. The compression mechanism can be used for fractures that support at least 50% of the circumference. Indications for compression nail use include use for the therapy of pseudoarthrosis and arthrodesis. Dynamization of the anterograde compression nail should always be performed through the removal of the proximal locking screw in the static holes.
Complications common in motorized intramedullary bone transport for non-infected segmental defects: a retrospective review of 15 patients
Published in Acta Orthopaedica, 2021
Mindaugas Mikužis, Ole Rahbek, Knud Christensen, Søren Kold
Our current approach for treating segmental defects differs between the femur and the tibia. All femoral cases are treated by nails to avoid final treatment with external fixators. In cases of clinical infection or compromised soft tissues, extensive debridement is followed by temporal external fixation converted to an intramedullary nail within 2 weeks. Acute shortening is well tolerated on the femur, and segmental defects up to 4–6 cm are treated with a staged protocol. Acute shortening, autologous bone grafting, and standard intramedullary nailing allow for crucial early functional rehabilitation. When union has been obtained, the LLD is corrected at a second stage by standard intramedullary lengthening nail. Larger femoral defects of more than 4–6 cm are treated by femoral bone transport nails.
Reoperations in intramedullary fixation of pertrochanteric hip fractures
Published in Journal of Medical Economics, 2019
Abhishek S. Chitnis, Mollie Vanderkarr, Jill Ruppenkamp, Jason Lerner, Chantal E. Holy, Charisse Sparks
Fixation with extramedullary devices, intramedullary nailing, and arthroplasty are among the surgical options for fixation of pertrochanteric fractures. Intramedullary nailing for hip fractures has become more popular in recent years8–10. A narrative review by Mavrogenis et al.11 suggested that potential advantages of intramedullary nailing for hip fracture fixation might include a more efficient load transfer due to the proximity of the implant to the medial calcar, less implant strain and shorter lever arm because of its closer positioning to the mechanical axis of the femur, less soft tissue disruption and periosteal stripping of the femoral cortex, shorter operative time and hospital stay, fewer blood transfusions, better post-operative walking ability, and lower rates of leg-length discrepancy. Mavrogenesis et al.11 suggested that compromise of the posteromedial cortex and/or the lateral cortex, a subtrochanteric extension of the fracture, and a reversed obliquity fracture pattern represent signs of fracture instability, which may warrant the use of intramedullary nailing11.
Lower extremity fractures in patients with spinal cord injury characteristics, outcome and risk factors for non-unions
Published in The Journal of Spinal Cord Medicine, 2018
Lukas Grassner, Barbara Klein, Doris Maier, Volker Bühren, Matthias Vogel
The management of fractures in patients with SCI requires special consideration due to the mentioned sublesional osteoporosis and dysfunction of the spinal cord with all related consequences. The development of intramedullary-nailing systems, however, improved surgical treatment options. This study provides demographic characteristics, distribution patterns, outcome analysis and complication rates of lower extremity fractures in patients with SCI managed in our institution, with a special emphasis on bone healing. In general non-unions are thought to be multifactorial and several risk factors have been identified for this complication in patients without SCI.11 However, in the SCI population, pseudarthrosis probably has been underestimated, since the clinical significance of this complication has been questioned. However, we believe that also in patients with SCI the compromised mechanical stability and increased risk for infections and other complications caused by pseudarthrosis must not be neglected especially ambulatory patients but also in non-walkers. Therefore, non-unions in patients with SCI deserve special attention among physicians.