MyMedR

Fulltext Clinical experience with reamed locked nails for close and open comminuted tibial diaphyseal fractures: a review of 50 consecutive cases

Zainudin M, Razak M, Shukur SH

Med J Malaysia, 2000 Sep;55 Suppl C:59-67.

PMID: 11200046

We present the results of our experience in treating comminuted tibial shaft fractures with reamed interlocking intramedullary nail from September 1993 to December 1995. In this retrospective study, there were fifty patients with an average follow-up of 14.3 months (range six to twenty-eight months). Ninety-eight percent of the fractures were due to motor-vehicle accident with majority of the patients being motorcyclist (96%). Thirty-eight fractures were closed and twelve were open (Gustilo grade I--8; grade II--4); 44% of them had additional fractures or other injuries. According to Winquist-Hansen classification of diaphyseal fracture comminution, there were 24% type I; 18% type II; 26% type III and 32% type IV. The union rate was 98%. There were 6 infections, 2 superficial and 4 deep. All these infections arose from closed fractures, which was possibly due to the long operative time. No patients with open fractures, which underwent delayed nailing, had infection. One of the patient had severe deep infection which required early nail removal before union. Anterior knee pain following nailing occurred in 6% of the patients. The average hospital stay after operation was 3.4 days. Ninety-four percent of the patients had excellent to good functional outcome after nailing. The mean time to regain full range of movement of knee and ankle was 8.4 weeks. Patients were allowed full weight bearing in the average time of 10.7 weeks and the mean time to return to work was 24.7 weeks.

Matched MeSH terms: Bone Nails*

Fulltext X-linked hypophosphatemic rickets--a report of 2 cases and review of literature

Yong SM, Aik S

Med J Malaysia, 2000 Sep;55 Suppl C:101-4.

PMID: 11200035

We report two cases of x-linked dominant hypophosphatemic rickets involving a man and his daughter. The family tree consists of 44 members with 13 of them having short stature and bowing of the lower limbs. The study of this family tree strongly suggests an x-linked dominant inheritance.

Matched MeSH terms: Bone Nails

Fulltext Size of interlocking nails used in the treatment of diaphyseal femoral fractures

Tan WJ, Kwan MK, Deepak AS, Saw A, Peng BC, Jalalullah W

Med J Malaysia, 2006 Dec;61 Suppl B:18-22.

PMID: 17600988

Fracture of the femur is most commonly treated with interlocking nailing. We conducted this study to describe and analyze the size of femoral interlocking nails used in our local population. This is a retrospective study on reamed intramedullary interlocking nailing procedures performed between 1st July 1998 and 30th June 2003. Demographic data, the diameter and length of femoral nails used were obtained from patient's medical record. A total of 267 procedures were included. The most common diameter used was 10 mm (56.9%), followed by 11 mm (27.0%) and 12 mm (13.1%). Only 2.6% of the nails were less than 10 mm in diameter. The most common nail length was 38 cm (31.1%), followed by 36 cm (24.9%) and 40 cm (19.5%). The longest nail used was 46 cm while the shortest 32 cm. The most commonly used femoral nails were of 10 mm diameter with the length ranging from 36 to 40 cm, which is smaller than those reported in the English literature. Nails with diameter smaller than 10 mm were required in 2.6% of patients.

Matched MeSH terms: Bone Nails*

Fulltext Distraction osteogenesis over intramedullary nail: a report of two cases

Sulaiman AR, Munajat I, Liau KM, Salehuddin AY, Shukrimi A

Med J Malaysia, 2006 Dec;61 Suppl B:48-50.

PMID: 17600992

Distraction osteogeneis over intramedullary nail has a benefit of decreasing the time for external fixation thus reducing the rate of associated complications. However, risk of panosteomyelitis is still the major worry. We are reporting two patients who underwent the procedure. The first case was a 13-year-old girl requiring 6 cm of femoral lengthening and the second case was a 17-year-old girl who required 5 cm of tibial lengthening. The healing index was 19.5 days/cm and 14.8 days/cm respectively, compared favorably to 30 days/cm with traditional method of distraction osteogenesis. There were mild pin tract infections and joint stiffness which responded to non-operative treatment.

Matched MeSH terms: Bone Nails*

The tampered implant. Intra-medullary nailing of the femur for fracture of the shaft-unusual difficulty in extraction: case report

Subramanian N

Med J Malaysia, 1973 Dec;28(2):123-4.

PMID: 4276229

Matched MeSH terms: Bone Nails/adverse effects*

Fulltext The results of open reduction and pin fixation in displaced supracondylar fractures of the humerus in children

Srivastava S

Med J Malaysia, 2000 Sep;55 Suppl C:44-8.

PMID: 11200044

The treatment of displaced supracondylar fracture humerus (Gartland Type III) in children continues to be a challenging problem. We did a retrospective study of such fractures treated in Hospital Muar, over a 2 years period (from January 1998 to December 1999). A total of 42 cases with displaced supracondylar fractures, treated with open reduction and internal fixation were studied. All cases were operated using a posterior triceps splitting approach and crossed kirschner wires were used to stabilize the fracture site. An excellent outcome was seen in 34 patients (81%) and a good outcome in 7 patients (17%). The incidence of complications such as pin tract infection (14%), nerve injury (2%) was very low. None of the patients had vascular complications or myositis ossificans.

Matched MeSH terms: Bone Nails*

Fulltext A new species of wasp-mimicking clearwing moth from Peninsular Malaysia with DNA barcode and behavioural notes (Lepidoptera, Sesiidae)

Skowron Volponi MA, Volponi P

Zookeys, 2017.

PMID: 29133989 DOI: 10.3897/zookeys.692.13587

A new species of clearwing moth,Pyrophleps ellawiSkowron Volponi,sp. n., is described from Peninsular Malaysia. Information on the habitat, time and conditions of occurrence, flight and mud-puddling behaviour, functional morphology, and DNA barcode are also provided. Photographs and a supplementary video from the wild demonstrate the postures and behaviour of this species ofPyrophleps, whose remaining members were described only on the basis of pinned specimens. This is the first record of this genus in Peninsular Malaysia.

Matched MeSH terms: Bone Nails

A simple method for removal of a broken intramedullary nail

Sivananthan KS, Raveendran K, Kumar T, Sivananthan S

Injury, 2000 Jul;31(6):433-4.

PMID: 10831741

The removal of broken implanted intramedullary nails secondary to re-fracture or non-union is challenging. In 12 cases a simple and safe method has been used to remove broken implants.

Matched MeSH terms: Bone Nails*

Fulltext Comparison study between reamed and unreamed nailing of closed femoral fractures

Selvakumar K, Saw KY, Fathima M

Med J Malaysia, 2001 Dec;56 Suppl D:24-8.

PMID: 14569762

Intramedullary nailing is an accepted procedures for femoral fractures gives uniformly good results. Various methods of intramedullary fixation have been practiced in the past. Recently intramedullary fixation without reaming has come into vogue. Preservation of the endosteal blood supply, less blood loss and quicker union have been the alleged benefits of not reaming the medullary canal. This study is a prospective randomised study conducted to compare intramedullary nail fixation of closed femoral fractures with and without a reaming procedure to assess the validity of the above assumptions. One hundred and two consecutive cases of skeletally mature patients with closed fracture of femoral shaft were randomised into two groups, i.e. Reamed (52) and Unreamed (50). The average follow-up was 36 weeks (range 28-86 weeks). Average time taken for various stages of the operation and total operating time were longer in the reamed group (109.9 min vs 78.6 min) and the blood loss was also increased (320 mls vs. 190 mls). Bridging and callus formation were seen to occur earlier in the reamed group compared to the unreamed enabling the patients in the reamed group to return to normal functions earlier. Limb length discrepancy and rotational alignment measured clinically and with CT scan did not however show any significant difference between the two methods. Nails used in this study group were notably of a smaller diameter and of shorter length when compared to those used in the western population highlighting the difference in the femur in the Asian population. Complications were notably more in the unreamed group where these were screw breakage (3/50) delayed unions (9/50) and non-unions (4/50). In the reamed group however there were only delayed union (2/50) and all fractures eventually united without any implant failure. We conclude that closed, reamed, antegrade insertion of an intramedullary nail is the treatment of choice in femoral shaft fractures, especially those involving the distal 1/3. The unreamed procedure should be reserved for certain exceptions, such as in polytrauma, where a shorter operative time and less blood loss is desired.

Matched MeSH terms: Bone Nails/adverse effects*

Rates of pin site infection during distraction osteogenesis based on monthly observations: a pilot study

Saw A, Chua YP, Hossain G, Sengupta S

J Orthop Surg (Hong Kong), 2012 Aug;20(2):181-4.

PMID: 22933675

To assess the monthly rates of infection of individual pin sites in 7 patients during distraction osteogenesis.

Matched MeSH terms: Bone Nails/adverse effects*

Fulltext A simple practical protocol for care of metal-skin interface of external fixation

Saw A, Chan CK, Penafort R, Sengupta S

Med J Malaysia, 2006 Feb;61 Suppl A:62-5.

PMID: 17042233

Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.

Matched MeSH terms: Bone Nails/microbiology

Fulltext Halovest treatment in traumatic cervical spine injury

Razak M, Basir T, Hyzan Y, Johari Z

Med J Malaysia, 1998 Sep;53 Suppl A:1-5.

PMID: 10968176

This is a cross-sectional study on the use of halovest appliance in the Orthopaedic and Traumatology Department, Kuala Lumpur Hospital from June 1993 to September 1996. Fifty-three patients with cervical spine injuries were treated by halovest stabilization. Majority of cases was caused by motor-vehicle accident; others were fall from height at construction sites, fall at home, hit by falling object and assault. The injuries were Jefferson fracture of C1, odontoid fractures, hangman fractures, open spinous process fracture and fracture body of C2, and fracture, and fracture-dislocation of the lower cervical spines. Majority of patients had hospital stay less than 30 days. The use of the halovest ranges from 4 to 16 weeks and the healing rate was 96%. Two patients of lower cervical spine injury had redislocation and one of them was operated. There was one case of non-union of type II odontoid fracture and treated by posterior fusion. Other complications encountered during halovest treatment were minor. They were pin-site infection, pin-loosening, clamp loosening and neck pain or neck stiffness. This method of treatment enables patient to ambulate early and reduces hospital stay. We found that halovest is easy to apply, safe and tolerable to most of the patients.

Matched MeSH terms: Bone Nails/adverse effects

TENS for surgical stabilisation of acetabular fracture in the skeletally immature: A novel technique

Razak KAA, Ghani KHA, Musa AA

Injury, 2021 Jan;52(1):90-94.

PMID: 33168201 DOI: 10.1016/j.injury.2020.11.004

BACKGROUND: Acetabular fractures in childhood are rare and the literature is scarce to describe a standard protocol in surgical management of these injuries. As the patient is still growing, it warrants a detailed assessment with a sound surgical plan if operative intervention is deemed necessary to prevent late complications. Throughout literature, most fixation rely on using pins, screws, plates or combination of the three which require large surgical exposure and risk of secondary physeal injury, hence we come up with a method of using the Titanium Elastic Nail System (TENS) to overcome this issue. We describe a novel technique in managing acetabular fractures in this group of patients using the TENS.

METHOD: An 8 year old girl with a diagnosis of right anterior column posterior hemitransverse acetabular fracture was fixed with 3 TENS for supra-acetabular, anterior column and posterior column fragments. Surgery was performed in a minimally invasive manner. No drilling was performed during the surgery and implant insertion is done manually.

RESULTS: Advantages of this procedure include minimally invasive surgery with smaller wounds, minimal intraoperative bleeding and theoretically reduces the risk of premature fusion of the triradiate cartilage. Patient is allowed early rehabilitation with this method.

CONCLUSION: This novel method provides an alternative to traditional usage of wires, pins, plates and screws as is described in most literature. However, it requires the surgeon to appreciate that the safe corridors for the implant are much narrower than adults. We recommend this technique for fractures that are deemed suitable for intramedullary fixation and further research in the future will be needed.

Matched MeSH terms: Bone Nails

Fulltext The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital

Rasit AH, Mohammad AW, Pan KL

Med J Malaysia, 2006 Feb;61 Suppl A:79-82.

PMID: 17042236

Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.

Matched MeSH terms: Bone Nails/adverse effects; Bone Nails/utilization

Locked intramedullary nailing for complex non-union of the tibia

Pan KL, Shukur MH, Ghani MA

Injury, 1994 Dec;25(10):655-7.

PMID: 7829188

Ten patients with complex non-union of the tibia were treated by locked intramedullary nailing. These patients had scarred skin as a result of initial severe open fractures, multiple debridement or fasciotomies with external fixators and skin grafts applied. Seven of the patients also had previous osteomyelitis or pin track infections. Fully pain-free walking was achieved in all patients and radiological union in nine patients without the need for a bone graft. Four patients developed infection after nailing, of which three resolved with treatment.

Matched MeSH terms: Bone Nails*

Fulltext A simple method for removal of the distal segment of a broken femoral intramedullary nail: a case report

Pan K, Reuben P

Malays Orthop J, 2012 Nov;6(3):66-8.

PMID: 25279064 MyJurnal DOI: 10.5704/MOJ.1207.011

We report a method for removing the distal segment of a broken locked intramedullary nail secondary to nonunion of the femur following radiotherapy for fibromatosis. A Kirschner wire with one tip fashioned into a hook was used to remove the distal segment without opening with the nonunion site. Details of the procedure are described.

Matched MeSH terms: Bone Nails

A simple and inexpensive external fixator

Noor MA

Injury, 1988 Nov;19(6):377-8.

PMID: 3267638

A simple and inexpensive external fixator has been designed. It is constructed of galvanized iron pipe and mild steel bolts and nuts. It can easily be manufactured in a hospital workshop with a minimum of tools.

Matched MeSH terms: Bone Nails

Partially degradable friction-welded pure iron-stainless steel 316L bone pin

Nasution AK, Murni NS, Sing NB, Idris MH, Hermawan H

J Biomed Mater Res B Appl Biomater, 2015 Jan;103(1):31-8.

PMID: 24757071 DOI: 10.1002/jbm.b.33174

This article describes the development of a partially degradable metal bone pin, proposed to minimize the occurrence of bone refracture by avoiding the creation of holes in the bone after pin removal procedure. The pin was made by friction welding and composed of two parts: the degradable part that remains in the bone and the nondegradable part that will be removed as usual. Rods of stainless steel 316L (nondegradable) and pure iron (degradable) were friction welded at the optimum parameters: forging pressure = 33.2 kPa, friction time = 25 s, burn-off length = 15 mm, and heat input = 4.58 J/s. The optimum tensile strength and elongation was registered at 666 MPa and 13%, respectively. A spiral defect formation was identified as the cause for the ductile fracture of the weld joint. A 40-µm wide intermetallic zone was identified along the fusion line having a distinct composition of Cr, Ni, and Mo. The corrosion rate of the pin gradually decreased from the undeformed zone of pure iron to the undeformed zone of stainless steel 316L. All metallurgical zones of the pin showed no toxic effect toward normal human osteoblast cells, confirming the ppb level of released Cr and Ni detected in the cell media were tolerable.

Matched MeSH terms: Bone Nails*

The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture

Mohamed Haflah NH, Ng MH, Mohd Yunus MH, Naicker AS, Htwe O, Fahmi M, et al.

Int J Low Extrem Wounds, 2017 Sep;16(3):212-216.

PMID: 28862056 DOI: 10.1177/1534734617724974

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

Matched MeSH terms: Bone Nails

Simple method for retrieval of distal segment of the broken interlocking intramedullary nail

Marwan M, Ibrahim M

Injury, 1999 Jun;30(5):333-5.

PMID: 10505126

A simple technique for removal of the distal fragment of the broken intramedullary interlocking nail is described. It was successfully used in three patients with a broken nail due to nonunion. The technique requires only cerclage wire, which is available in any operating room, avoiding the difficulties obtaining the custom made hook and of excessive exposure to radiation.

Matched MeSH terms: Bone Nails*

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