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  1. Fulltext Impact of Bone Cement Augmentation on the Fixation Strength of TFNA Blades and Screws
    Sermon A, Hofmann-Fliri L, Zderic I, Agarwal Y, Scherrer S, Weber A, et al.
    Medicina (Kaunas), 2021 Aug 28;57(9).
    PMID: 34577822 DOI: 10.3390/medicina57090899
    Background and Objectives: Hip fractures constitute the most debilitating complication of osteoporosis with steadily increasing incidences in the aging population. Their intramedullary nailing can be challenging because of poor anchorage in the osteoporotic femoral head. Cement augmentation of Proximal Femoral Nail Antirotation (PFNA) blades demonstrated promising results by enhancing cut-out resistance in proximal femoral fractures. The aim of this study was to assess the impact of augmentation on the fixation strength of TFN-ADVANCEDTM Proximal Femoral Nailing System (TFNA) blades and screws within the femoral head and compare its effect when they are implanted in centre or anteroposterior off-centre position. Materials and Methods: Eight groups were formed out of 96 polyurethane low-density foam specimens simulating isolated femoral heads with poor bone quality. The specimens in each group were implanted with either non-augmented or cement-augmented TFNA blades or screws in centre or anteroposterior off-centre positions, 7 mm anterior or posterior. Mechanical testing was performed under progressively increasing cyclic loading until failure, in setup simulating an unstable pertrochanteric fracture with a lack of posteromedial support and load sharing at the fracture gap. Varus-valgus and head rotation angles were monitored. A varus collapse of 5° or 10° head rotation was defined as a clinically relevant failure. Results: Failure load (N) for specimens with augmented TFNA head elements (screw/blade centre: 3799 ± 326/3228 ± 478; screw/blade off-centre: 2680 ± 182/2591 ± 244) was significantly higher compared with respective non-augmented specimens (screw/blade centre: 1593 ± 120/1489 ± 41; screw/blade off-centre: 515 ± 73/1018 ± 48), p < 0.001. For both non-augmented and augmented specimens failure load in the centre position was significantly higher compared with the respective off-centre positions, regardless of the head element type, p < 0.001. Augmented off-centre TFNA head elements had significantly higher failure load compared with non-augmented centrally placed implants, p < 0.001. Conclusions: Cement augmentation clearly enhances the fixation stability of TFNA blades and screws. Non-augmented blades outperformed screws in the anteroposterior off-centre position. Positioning of TFNA blades in the femoral head is more forgiving than TFNA screws in terms of failure load.
    Matched MeSH terms: Fracture Fixation, Intramedullary*
  2. WALANT technique for percutaneous pinning of distal radioulnar joint
    Azhar S, Abdullah S, Soh E
    J Hand Surg Eur Vol, 2023 Mar;48(3):279-281.
    PMID: 36691295 DOI: 10.1177/17531934221148115
    Matched MeSH terms: Fracture Fixation, Intramedullary*
  3. Fulltext Use of Unlocked Intramedullary Nailing in Winquist Type Iand II Femoral Isthmus Fracture
    Ling, H.T., Ng, W.M., Kwan, M.K., Fathi Aizuddeen, L.K., Tay, P.C.M.
    Malays Orthop J, 2008;2(1):17-22.
    MyJurnal
    Interlocked intramedullary nailing is accepted as the gold standard for femoral shaft fractures. However for Winquist type I and II femoral fractures at the isthmus region, unlocked intramedullary nailing (Küntscher nailing) is still a good option. We performed a retrospective study on 86 patients with a total of 88 femoral shaft fractures around the isthmus that presented at our institution between 1 January 1988 and 31 August 2003. All patients (84.1% Winquist type I and 15.9% Winquist Type II fractures) were treated with unlocked intramedullary nail. The average time to union was 16 weeks with 97.7% rate of union. There were two cases (2.3%) of infection and non-union each. Overall results were comparable to standard interlocking intramedullary nailing. We conclude that unlocked intramedullary nailing is a good treatment option for Winquist Type I and II femoral fracture around the isthmus with its good union rate and minimal complications.
    Matched MeSH terms: Fracture Fixation, Intramedullary
  4. Fulltext Unlocked Nailing vs. Interlocking Nailing for Winquist Type I and II Femoral Isthmus Fractures. Is there a Difference?
    Yu, C.K., Wong, H.Y., Vivek, A.S., To, BC Se
    Malays Orthop J, 2008;2(1):23-27.
    MyJurnal
    Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for noncomminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus unlocked intramedullary nailing in such fractures. Ninety-three cases of noncomminuted femoral isthmus fractures (Winquist I and II) treated with interlocking nailing and unlocked nailing from 1 June 2004 to 1 June 2005 were reviewed; radiological and clinical union rates, bony alignment, complication and knee function were investigated. There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with unlocked femoral nailing is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. We therefore conclude that unlocked nailing is still useful for the management of non-comminute isthmus fractures of the femur.
    Matched MeSH terms: Fracture Fixation, Intramedullary
  5. 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: Fracture Fixation, Intramedullary/methods*
  6. Fulltext Interlocking nails for treatment of femoral fractures
    Chin CH, Yeow C
    Med J Malaysia, 1993 Sep;48(3):336-40.
    PMID: 8183148
    A series of 23 fractures of the femur were treated using femoral interlocking nails. The average follow-up period was 14.8 months. There were 14 closed fractures and 9 compound fractures. Closed nailing was done for 8 patients and open nailing for 15 patients. All the fractures united. There were no superficial or deep infections. The most common complication was leg length discrepancy; shortening occurred in 5 patients whereas lengthening occurred in 2 patients. It is a technically demanding procedure but it is the method of choice in our Institution for stabilising complex fractures of the femoral shaft.
    Matched MeSH terms: Fracture Fixation, Intramedullary/methods*
  7. Fulltext Knee arthrodesis with interlocking nail after excision of giant cell tumour of the distal femur
    Yeow C, Chin CH, Ong PH
    Med J Malaysia, 1995 Dec;50(4):414-6.
    PMID: 8668066
    Giant cell tumour of bone occurring around the knee is fairly common and can be difficult to manage. We report a case of such tumour involving the distal femur which was successfully treated with complete excision followed by arthrodesis of the knee with a long interlocking intramedullary nail.
    Matched MeSH terms: Fracture Fixation, Intramedullary*
  8. Does obesity affect diaphyseal femoral fracture healing treated with intramedullary locking nail?
    Issace SJJ, Singh RSJS, Sisubalasingam N, Tokgöz MA, Jaiman A, Rampal S
    Jt Dis Relat Surg, 2023;34(1):9-15.
    PMID: 36700258 DOI: 10.52312/jdrs.2023.649
    OBJECTIVES: This study aims to evaluate the effect of obesity on radiological fracture union in diaphyseal femoral fractures (DFFs) treated with intramedullary nailing (IMN).

    PATIENTS AND METHODS: Between January 2017 and December 2018, a total of 120 patients (101 males, 19 females; mean age: 35.1±3.0 years; range, 18 to 72 years) treated with IMN for closed DFFs were retrospectively analyzed. Data including age, sex, location, weight, height, comorbidities such as diabetes mellitus, hypertension or kidney injury, date of injury, mechanism of injury, type of femoral fractures (AO classification), date of surgery, duration of surgery, IMN length and diameter used, date of radiological fracture union and complications of surgery such as nonunion, delayed union, and infections were recorded.

    RESULTS: Of the patients, 63 had obesity and 57 did not have obesity. There was a statistically significant difference in fracture configuration among patients with obesity; they sustained type B (p=0.001) and type C (p=0.024), the most severe fracture configuration. The nonunion rate was 45%. Obesity had a significant relationship with fracture nonunion with patients with obesity having the highest number of nonunion rates (n=40, 74.1%) compared to those without obesity (n=14, 25.9%) (p=0.001). Fracture union was observed within the first 180 days in 78.9% of patients without obesity, while it developed in the same time interval in only 38.1% of patients with obesity (p=0.001).

    CONCLUSION: Fracture union time for the patients with obesity was longer, regardless of the fracture configuration. Obesity strongly affects fracture union time in DFFs treated with an IMN. Obesity should be considered a relative risk in decision-making in the choice of fixation while treating midshaft femoral fractures.

    Matched MeSH terms: Fracture Fixation, Intramedullary*
  9. Fulltext Symptoms indicating imminent breakage of a femoral interlocking nail: a case report
    Pan K, Chan W
    Malays Orthop J, 2013 Nov;7(3):21-3.
    PMID: 25674303 MyJurnal DOI: 10.5704/MOJ.1311.003
    Fractures of the femoral shaft treated with interlocking nails will ultimately result in breakage of the nail if the bone does not unite. Further management requires removal of the broken nail which may be a difficult process for the distal segment. If we can identify the symptoms just before the nail breaks, an exchange nailing becomes much easier. We present a patient with fibromatosis who underwent repeated surgery as well as radiotherapy at the age of 16. Six years later, she had a pathological fracture of the upper third of the femur for which an interlocking nail was inserted. The femur did not unite and the nail subsequently broke. Over a period of 12 years, three nails broke and had to be replaced. Two to 3 months before each breakage, the patient experienced the same set of symptoms for each episode. Knowing that her fracture was not going to heal will now alert us to do an exchange nailing before the nail broke again. It is well known that where there is evidence of non-union, pre-emptive treatment is necessary before implant failure.

    KEY WORDS: Femur nonunion, interlocking nail, symptoms before breakage of nail.

    Matched MeSH terms: Fracture Fixation, Intramedullary
  10. Fulltext Operative internal fixation of isolated femoral diaphyseal fractures - is interlocking nail the best option?
    Zairul-Nizam, Z.F.
    International Medical Journal Malaysia, 2008;7(2):25-30.
    MyJurnal
    Femoral fractures are one of the commonest fractures encountered in orthopaedic practice. Over the years, treatment of this injury has evolved tremendously. The initial non-operative methods of reduction and stabilization have largely been replaced by operative fixation. There are currently three basic modes of internal fixation of femoral diaphyseal fractures in the adult age group: plate and screws, intramedullary Kuntscher nailing, and interlocking nailing. The objective of this study is to determine whether the so-called more ‘technologically advanced’ interlocking nailing results in better outcome compared to the more ‘traditional’ plate and screws, and Kuntscher nailing. It is found that, in terms of time to union and final function after an average of just under 2 years post-operative period, the group of patients who had interlocking nailing fared poorer. A review of relevant literature will then be presented.
    Matched MeSH terms: Fracture Fixation, Intramedullary
  11. The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children
    Santy JE, Kamal J, Abdul-Rashid AH, Ibrahim S
    Malays Orthop J, 2015 Jul;9(2):13-16.
    PMID: 28435603 MyJurnal DOI: 10.5704/MOJ.1507.006
    Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.
    Matched MeSH terms: Fracture Fixation, Intramedullary
  12. Missed Monteggia fracture dislocation in children
    Devnani AS
    Injury, 1997 Mar;28(2):131-3.
    PMID: 9205580
    Open reduction of the radial head and reconstruction of the annular ligament has been advocated for the Monteggia fracture dislocation in children who present more than a month after injury. Three patients with an anterior Monteggia lesion were treated by open reduction of the radial head which was held in place by a Kirschner wire passed from the humerus to the radius. No attempt was made either to repair or reconstruct the annular ligament. The patients were aged between 2 and 6 years, the delay between injury and reduction was between 6 and 8 weeks, and the length of follow up was 5 years for two patients and 1 year for the third. All three patients were free of pain, had no deformity and the radial head had not subluxated. All had nearly full flexion at the elbow. The forearm had full supination but restricted pronation.
    Matched MeSH terms: Fracture Fixation, Intramedullary/instrumentation; Fracture Fixation, Intramedullary/methods*
  13. Fulltext Closed Intramedullary Locking Nailing for Metacarpal Fractures: A Retrospective Study of Sixty-Six Fractures
    Ghazala C, Choudhry N, Rajeev A
    Malays Orthop J, 2018 Jul;12(2):7-14.
    PMID: 30112122 DOI: 10.5704/MOJ.1807.002
    Introduction: Metacarpal fractures are frequent injuries in the young male working population and the majority are treated non-operatively. There is a growing trend to surgically treat these fractures, with the aim of reducing the deformity and shortening the rehabilitation period. The aim of this retrospective case series is to report on our experience and clinical outcomes of using percutaneous flexible locking nails for the management of displaced metacarpal fractures. This study is a retrospective review of 66 fractures that were managed at our centre over a 7-year period. Materials and Methods: Records of 60 patients were retrospectively reviewed. Indications for surgery were a displaced metacarpal shaft or neck fracture with associated rotational deformity, or multiple metacarpal fractures. The fracture was reduced by closed manipulation, and a flexible pre-bent locked intramedullary nail (1.6mm diameter) was inserted through a percutaneous dorsal antegrade approach, facilitated by a specially designed pre-fabricated awl. The implant was removed at union. Patients were followed-up in clinic until the fracture had united. Results: The mean union time was seven weeks (range 2 to 22 weeks) and there were nine (14%) delayed unions (>3 months) and no non-unions. The nail had migrated in three cases (5%) and caused skin impingement in two cases (3%). There was one infected case (2%). Rotational clinical deformity was evident for two (3%) cases. Conclusion: The use of a minimally-invasive locked intramedullary nailing for unstable metacarpal fractures has a significantly low complication rate, with predictable union times and good functional outcomes.
    Matched MeSH terms: Fracture Fixation, Intramedullary
  14. Fulltext Femoral deformity correction and lengthening on nail with monorail external fixator : a case report
    Mohd Bakrynizam Abu Bakar Siddiq, Kamarul Izham Kamarudin, Kamarul Al Haq, Suresh Chopr
    International e-Journal of Science, Medicine & Education, 2018;12(2):26-29.
    MyJurnal
    Limb length discrepancy (LLD) is quite common.
    Lower limb shortening is one of the causes of limb
    length discrepancy. The common treatment that is
    used is the llizarov technique for bone lengthening.
    The new technique uses an intramedullary nail with
    a monoplanar external fixator. Using this technique,
    bone lengthening duration in patients can be reduced
    and knee joint mobility can be improved without
    jeopardizing bone regeneration. We report a case of a
    27-year-old gentleman who had right femur shortening
    from childhood and was referred to us for corrective
    deformity. He underwent bone lengthening on the nail
    which lenghthens and equalizes the leg while avoiding
    stiffness and reduces joint mobility which leads to good
    patient satisfaction outcome. The use of the external
    fixator with intramedullary nailing to lengthen the
    femur is one method that can reduce patient burden
    mentally and physically. However although it has many
    advantages we must watch out for the complications
    during the regular visits to ensure good outcome.
    Matched MeSH terms: Fracture Fixation, Intramedullary
  15. 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: Fracture Fixation, Intramedullary
  16. 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: Fracture Fixation, Intramedullary/methods*
  17. Fulltext Radiation exposure to the surgeon during femoral interlocking nailing under fluoroscopic imaging
    Muzaffar TST, Imran Y, Iskandar MA, Zakaria A
    Med J Malaysia, 2005 Jul;60 Suppl C:26-9.
    PMID: 16381279
    Femoral interlocking nailing requires fluoroscopic assistance for insertion of the nail and distal screws. In this study, scattered radiation to the eye and hand of the operating surgeon was measured during the procedure. Thermo-luminescent dosimeter (TLD) was used to quantify the dose received by the surgeon. The mean radiation exposure time during the procedure was 3.89 minutes. The mean scattered radiation doses to the hand and eye were 0.27 mSv and 0.09 mSv per procedure respectively. These very low doses have made a surgeon very unlikely to receive more than the recommended annual dose limit set by the National Council on Radiological Protection.
    Matched MeSH terms: Fracture Fixation, Intramedullary*
  18. 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: Fracture Fixation, Intramedullary/instrumentation*
  19. 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: Fracture Fixation, Intramedullary/instrumentation*
  20. A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur
    Deshmukh RG, Lou KK, Neo CB, Yew KS, Rozman I, George J
    Injury, 1998 Apr;29(3):207-10.
    PMID: 9709422
    Closed intramedullary nailing is a successful method of treating adult femoral shaft fractures. In comminuted or segmental fractures, this operation is associated with an incidence of rotational malalignment and malunion. After locked nailing, this can only be corrected by further operation. A simple method of judging and obtaining rotational alignment in such cases intra-operatively is described. A comparison of two groups of patients with such fractures, one using this technique and the other using conventional methods of judging alignment, revealed statistically significant improvement in rotational alignment (p = 0.016).
    Matched MeSH terms: Fracture Fixation, Intramedullary/methods*
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