MyMedR

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

Fulltext The treatment of femoral neck fractures by percutaneous pinning

Manukaran MN, Abdul Hamid AK

Med J Malaysia, 1990 Dec;45(4):288-92.

PMID: 2152048

Sixty two patients with displaced femoral neck fractures treated by percutaneous pinning are reviewed. There were 37 females and 25 males with an average age of 63.7 years. There were 36 Garden grade III and 26 grade IV fractures. Twenty three patients had other medical conditions. Fourteen patients were operated under local anaesthesia. Superficial wound infection was found in three cases with no deep infection. Union occurred in 41 patients by eight months. Of the 21 non-unions 15 remained painless. The pins migrated outwards in seven cases but caused no clinical problem. Avascular necrosis was seen in 11 patients by 18 months. Avascular necrosis and non-union occurred together in six patients. Secondary hemiarthroplasty was performed in only ten patients. Routine hemiarthroplasty for femoral neck fractures is not always indicated. Femoral head preservation should be attempted before prosthetic replacement. The pinning surgery is simple, fast and can be performed under local anaesthesia. Hemiarthroplasty should be reserved for failed cases only.

Matched MeSH terms: Bone Nails*

Letter to the editor regarding "Important tips and numbers on using the cortical step and diameter difference sign in assessing femoral rotation - Should we abandon the technique?"

Hwang PX, Wang CK

Injury, 2023 Nov;54(11):111038.

PMID: 37741171 DOI: 10.1016/j.injury.2023.111038

We have read the paper "Important tips and numbers on using the cortical step and diameter difference sign in assessing femoral rotation - Should we abandon the technique?" [1] with great interest. Restoring femoral rotation during intramedullary nailing can pose challenges to many experienced surgeons. Femur rotational side-to-side asymmetry which is greater than 10 ° will cause functional deficit. We propose a surgical technique which allows surgeons to evaluate and reduce the malrotated femur intraoperatively. This technique also improves the ergonomics of the surgery and can be used simultaneously with other femoral rotation evaluation techniques. LEVEL OF EVIDENCE: V.

Matched MeSH terms: Bone Nails

Fulltext Early outcome of reamed interlocking nail for non-union of tibia

Faisham WI, Sulaiman AR, Sallehuddin AY, Zuhmi W

Med J Malaysia, 2006 Aug;61(3):339-42.

PMID: 17240586 MyJurnal

Aseptic non-union is a major problem following complicated fracture tibia, which carries significant morbidity and prolonged course of treatment. Plate fixation and autogenous bone grafting has been established as a method of treatment. However the risk of infection, implant failure and donor site morbidity are high. We reviewed twelve consecutive cases of established non-union tibia treated by closed reamed interlocking nail in our centre. All patients had clinical and radiological union at three months. Three patients were complicated with infection and one required removal of implant and re-reaming to eradicate infection. Reamed interlocking nailing is an alternative treatment for selected non-union of fracture tibia with promising results.

Matched MeSH terms: Bone Nails*

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*

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*

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*

An intramedullary cement spacer in total hip arthroplasty

Deshmukh RG, Thevarajan K, Kok CS, Sivapathasundaram N, George SV

J Arthroplasty, 1998 Feb;13(2):197-9.

PMID: 9526214

Revision arthroplasty of the hip is often complicated by infection, bone loss, and perioperative fracture of the femur. A simple, inexpensive spacer that keeps tissue planes intact and prevents soft tissue contracture during the interoperative period of a 2-stage revision is described. This can provide intramedullary support to a fractured or weak femur and enable local antibiotic delivery, as well as permit limited mobilization of the patient. It can be easily fabricated during surgery using universally available materials and can be tailored for specific requirements. Such a spacer was used in 5 cases. The experience is presented, and the technique and pitfalls are discussed.

Matched MeSH terms: Bone Nails

Fulltext Modified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease

Faisham, W.I., Muslim, D.A.J., Bhavaraju, V.M.K., Nawaz, A.H., Zulmi, W.

Malays Orthop J, 2009;3(1):36-41.

MyJurnal

Extensive peri-acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti-protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86).

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

Fulltext Biomechanical Analysis of Crossed Pinning Construct in Supracondylar Fracture of Humerus: Does the Point of Crossing Matter?

Hanim A, Wafiuddin M, Azfar MA, Awang MS, Nik Abdul Adel NA

Cureus, 2021 Mar 22;13(3):e14043.

PMID: 33898129 DOI: 10.7759/cureus.14043

Introduction This appears to be the first biomechanical study that compares the stability of various locations of the crossing points in crossed pinning Kirschner wiring (K-wire) construct in treating pediatric supracondylar humerus fracture (SCHF). Additionally, this study compared the biomechanical stability between crossed pinning K-wire construct and the three-lateral divergent K-wire construct. Methods For the study purpose, 30 synthetic humerus bones were osteotomised at mid-olecranon fossa, anatomically reduced, and pinned using two 1.6-millimeter K-wires in five different constructs. A total of six samples were prepared for each construct and tested for extension, flexion, valgus, varus, internal rotation, and external rotation forces. Results As for crossed pinning K-wire construct, the center crossing point emerged as the stiffest construct in both linear and rotational forces, in comparison to the lateral crossing point, superior crossing, and medial crossing point Conclusion Based on this analysis, it is highly recommended that, if the crossed pinning construct is selected to treat supracondylar humerus fracture, the surgeon should aim for center crossing point as it is the most stable construct. Nevertheless, if lateral and superior crossing points are obtained during the initial attempt of fixation, the fixation may be accepted without revising the K-wire as the stability of these two constructs are comparable and portrayed no significant difference when compared to that of the center crossing point. Additionally, it is essential to avoid the medial crossing point as it is significantly less stable in terms of rotational force when compared to the center crossing point.

Matched MeSH terms: Bone Nails

Fulltext Scanning Electron Microscopy Study of Retrieved Implants Suggests a Ratcheting Mechanism Behind Medial Migration in Cephalomedullary Nailing of Hip Fractures

Law GW, Koh J, Yew A, Howe TS

Malays Orthop J, 2020 Mar;14(1):7-17.

PMID: 32296476 DOI: 10.5704/MOJ.2003.002

Introduction: Medial migration is the paradoxical migration of the femoral neck element (FNE) superomedially against gravity with respect to the intramedullary component of the cephalomedullary device, increasingly seen in the management of pertrochanteric hip fractures with the intramedullary nail. We postulate that the peculiar anti-gravity movement of the FNE in the medial migration phenomenon stems from a ratcheting mechanism at the intramedullary nail-FNE interface, which should inadvertently produce unique wear patterns on the FNE that can be seen with high-powered microscopy. By examining the wear patterns on retrieved implants from patients with medial migration, our study aims to draw clinical correlations to the ratcheting mechanism hypothesis.

Material and Methods: Four FNEs were retrieved from revision surgeries of four patients with prior intramedullary nail fixation of their pertrochanteric hip fractures complicated by femoral head perforation. The FNEs were divided into two groups based on whether or not there was radiographic evidence of medial migration prior to the revisions. Wear patterns on the FNEs were then assessed using both scanning electron microscopy and light microscopy.

Results: Repetitive, linearly-arranged, regularly-spaced, unique transverse scratch marks were found only in the group with medial migration, corresponding to the specific segment of the FNE that passed through the intramedullary component of the PFNA during medial migration. These scratch marks were absent in the group without medial migration.

Conclusion: Our findings are in support of a ratcheting mechanism behind the medial migration phenomenon with repetitive toggling at the intramedullary nail-FNE interface and progressive propagation of the FNE against gravity.

Matched MeSH terms: Bone Nails

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 Is the femoral neck geometry adequate for placement of the proximal femoral nail in the Malaysian population? A review of 100 cases

Chiu CK, Chan CY, Singh VA

Med J Malaysia, 2009 Mar;64(1):22-6.

PMID: 19852315

Issues that had been encountered during proximal femoral fracture fixation using proximal femoral nail include (i) the adequacy of the femoral neck width in the local population and (ii) the potential difficulty encountered during fixation in certain prefixed angles as determined by the implant. This was a retrospective, descriptive study evaluating the anterior-posterior pelvic radiographs of 100 consecutive patients, from January to August 2007, managed at University Malaya Medical Centre, Kuala Lumpur. The femoral neck width in the population studied was adequate for placement of femoral neck screw and anti-rotation pin or hip pin using the proximal femoral nail implant. (mean = 34.0 +/- 3.7 mm, min = 24.6 mm). There was no significant difference between the working area using an implant angled at 130 degrees or 135 degrees (P = 0.91). Both femoral neck width and neck shaft angle of the Malaysian population studied were not a factor influencing the placement of femoral neck lag screws and anti-rotation pin.

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*

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

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*

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 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*

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