Long-term results of olecranon fractures treated using the XS nail® system.

PURPOSE: Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces. Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition, as well as neutralizing the strain inhibiting fracture healing. The XS nail® (Intercus GmbH, Bad Blankenberg, Germany), an intramedullary implant exerting compression across the entire fracture surface, unlike plates, leaves a minimal extra-cortical profile, and can be secured with threaded locking wires, thereby retaining the anatomical reduction without displacement or steps within the articular surface, which was often found in tension band wiring. After encouraging initial results, the long-term outcome was assessed. METHODS: This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®. Patients over the age of 18 years eligible for the study must have undergone surgery for isolated, recent (less than 14 days) traumatic olecranon fractures, without concomitant injuries to the ipsilateral elbow and forearm. Further exclusion criteria were pseudarthrosis, re-fractures and osteotomy for distal humerus surgery, as well as polytraumatized patients unable to aid in their own recovery. Data were retrospectively gathered by standardised questionnaire and patient records, as well as surgery and anesthesiology reports. Data analysis was performed using Microsoft Office Excel® 2016. RESULTS: There were 32 patients, 13 males (mean age 49.0 years) and 19 females (mean age 68.9 years) with 11 Schatzkers type D, 7 each type A and C, 5 type B and 2 type E at an average of 55.2 months, all showing complete consolidation. Of them, 6 patients had a loss of range of motion with more than 10° in the sagittal plane, and only 1 patient exceeded 10° reduction of supination. Twenty-five patients reported being pain-free under all circumstances, and all but 2 patients (93.75%) had returned to their previous activity level. The average disabilities of the arm, shoulder and hand score was 21.15 (range 0-88.3), and the overall Mayo elbow performance index was 91.87, without complications, such as wound infection, neurovascular impairment or premature hardware removal. CONCLUSION: Using the XS nail® system, all fracture types can be successfully treated and the rate of complications was lower than that treated by standard methods published in current literature. An excellent functional outcome, high range of motion as well as good retention of reduction without soft tissue irritation makes this a very suitable implant for fractures subject to tension.

Long-term results after over 17 years - Intramedullary gliding nail as treatment for traumatic femoral neck fractures.

BACKGROUND: For the treatment of femoral neck fracture there are many different implants present on the market. Postoperative complications still exist. PATIENTS AND METHODS: The aim of this retrospective study was to evaluate the Gliding Nail in patients with medial femoral neck fractures and their long-term complications. RESULTS: In a collective of 113 patients we had all together 21 major complications in 2018.12/113 minor complications in 2008 and all together 13/78 in 2018 has been detected. CONCLUSIONS: The Gliding Nail as an intramedullary implant shows a high load-bearing capacity with a high rotational stability and a low cut-out rate.

Treatment of Traumatic Femoral Neck Fractures with an Intramedullary Nail in Osteoporotic Bones.

PURPOSE: Sufficient anchoring of intramedullary osteosynthesis in the femoral head in a femoral neck fracture is a challenge with increasing age of the patients and decreasing bone quality. For older patients with inferior bone quality, it has not been investigated whether the application of an intramedullary force carrier, as a minimally invasive and rapid intervention, can provide a considerable benefit and reduce the postoperative complication and lethality rate. This retrospective study aimed to investigate the stability and functionality after the acute treatment of a femoral neck fracture in osteoporotic bone using an intramedullary force carrier even with higher grade fracture types. MATERIAL AND METHODS: The retrospective analysis was based on a collective of 82 patients over 60 years of age with a femoral neck fracture treated with a gliding nail in our centre between 1999 and 2006. RESULTS: The average time to follow-up was 69.05 months (median 71.0; minimum 27.0-maximum 108.0). Female patients made up more than two-thirds of the patient collective at 63 of the 82 patients (76.83%). The average age of the patients was 77.76 years (median 78.00; range 60.00-93.00).In 66 patients (80.49%), the implantation showed good results and no complications or further treatments. 24/82 patients of our collective had died in our re-evaluation. In no case, a pseudarthrosis or severe impaction with neck shortening occurred (loss of offset).11/82 patients had femoral head necrosis which led to total hip replacement in 8 cases, a hemiarthroplasty in 2 cases and in 1 case a remaining Girdlestone situation because of a deep infection. Another five patients also had to undergo a total hip replacement because of a central perforation of the blade in one case, breakout of the blade after another fall in another two cases and a lateral dislocation of the blade in two cases. CONCLUSION: The use of an intramedullary force carrier in the osteoporotic bone can mean distinct advantages for the selected patient as a minimally invasive and rapid surgical method compared to extensive surgery, even in the case of severe injuries. However, the advantages and disadvantages for the patient should be considered critically.

Complications and imaging artifacts related to MRI in patients with intramedullary osteosynthesis after proximal femur fracture.

BACKGROUND: Fractures of the proximal femur is one of the most frequent human injuries, and most of the patients are treated with osteosynthesis, such as intramedullary nails. These patients often require magnetic resonance imaging (MRI) scans in their further lives due to various reasons. This raises the question of whether complications with implanted osteosynthesis material such as implant loosening, burning, dislocation, or other complications are to be expected or whether an MRI examination is even suitable with regard to imaging artifacts. METHODS: The aim of this retrospective study was to investigate the rate and type of complications after MRI examinations in patients with inserted intramedullary osteosynthesis device. Furthermore, artifacts in MRI caused by this device were assessed. RESULTS: MRI scans of the head (20 of 62), spine (20 of 62), pelvis (10 of 62), and lower extremity (6/62) were performed. Three of the 62 patients received an MRI of the abdomen, and 2 of the 62 patients received an MRI of the thorax and the upper extremity. Of the 62 patients, noneexperienced complications during the immediate examination. Similarly, none of the patients showed early complications within the first 2 weeks after MRI. In our long-term follow-up examination, no long-term complication after MRI was observed in the recorded 15 patients. Artifacts were found in 14 patients: in MRI scans of the pelvis (10/10), of the abdomen (2/3), and of the lower extremity (2/6). CONCLUSION: There were no complications during the MRI scan, in the first 2 weeks after MRI, or in the recorded long-term results. MRI with an enclosed intramedullary nail provided good image quality unless the immediate implant site was imaged. MRI diagnosis is thus possible in patients with an inserted intramedullary nail. The inserted intramedullary nail should therefore not be an exclusion criterion when sectional imaging with MRI is required.

Radial Palsy Caused by Ganglion of the Elbow.

Ganglion of the humeroradial joint is a relatively rare condition, which may cause local compressive neuropathy. It is usually diagnosed in adults. Sonography of peripheral nerves can be of high value in finding the exact localization of the nerve lesion. We present a case of a healthy 55-year-old woman with radial palsy caused by an elbow ganglion which was resolved following a surgical procedure.

Intramedullary locking compression nail for the treatment of an olecranon fracture.

OBJECTIVE: Reconstruction of the anatomy of the olecranon, while protecting the soft tissue, by an internal stabilization method that is stable under exertion. INDICATIONS: All olecranon fractures. CONTRAINDICATIONS: Very small (< 5 mm) proximal fragments at the point of nail entry. Bony avulsions of the triceps tendon. SURGICAL TECHNIQUE: In the case of displaced olecranon fractures, exposure of the ulnar nerve, open reduction, fracture retention with reduction forceps, introduction of a 1.6 or 2.0 mm thick central guide wire into the medullary cavity in a slightly radial direction, overdrilling with a 3.5- or 4.5-mm cannulated drill bit, introduction of the nail to the aiming arm, and locking with 2.0-mm threaded wires. If the fracture pattern is transverse or slightly oblique, axial compression can be achieved by insertion of a compression screw into the nail. Fragments from the posterior margin or medial/lateral comminuted zones can be fixed more securely to the system via fiber cerclage wires around the threaded wires. After checking by X-ray, shortening of the threaded wires with the bolt cutters. POSTOPERATIVE MANAGEMENT: Stable under exertion, splint-free postoperative management for 6 weeks, followed by full load bearing. RESULTS: From May 1999 to December 2002, 80 olecranon fractures were treated using the XS nail. 73 patients (91.3%) were followed up after an average of 15 months. 49 (67.1%) had a multifragmentary or comminuted fracture, and 24 (32.9%) a simple transverse fracture. According to the Murphy Score, results were excellent in 47 cases (64.4%), good in 21 (28.8%), satisfactory in three (4.1%), and poor in two (2.7%).

[Intramedullary locked fixation and compression nail (IP-XS-Nail): treatment of ankle joint fractures].

OBJECTIVE: Reconstruction of the anatomy of the ankle joint while protecting the soft tissue, and osteosynthesis to maintain stability for function and weight bearing. INDICATIONS: Distal fractures of the fibula, bimalleolar fractures, and isolated fractures of the medial malleolus. CONTRAINDICATIONS: Very small (< 5 mm) distal fragments (if fixation of the fragments is not possible using a small XXS nail) and very narrow (< 2.5 mm) medullary cavity (conversion to plate fixation). SURGICAL TECHNIQUE: With displaced fibula fractures, open reduction should be performed with fracture retention using wide-armed reduction forceps, insertion of a central guide wire into the medullary cavity, use of a cannulated drill bit, introduction of the nail using an aiming arm and locked fixation with threaded wire. After checking the position using X-ray, the wire should be shortened using the bolt cutters. POSTOPERATIVE MANAGEMENT (Depending on the Weber classification): Full weight bearing for all isolated distal fractures of the fibula (Weber types A and B) and isolated fractures of the medial malleolus. For distal fractures of the fibula (Weber types A and B) with additional fracture of the medial malleolus or involvement of the medial ligament partial weight bearing of 20 kp for 4 weeks, followed by full weight bearing. For all Weber C fractures and/or additional Volkmann fracture only 10 kp of partial weight bearing with a rocker-sole orthosis should be allowed for 6 weeks followed by full weight bearing. No weight bearing for 6 weeks until the screws are removed is only recommended, if positioning screws have been used for Weber C fractures. RESULTS: In the period from 05/2000 to 01/2002, 194 ankle fractures were treated with the IP-XS-Nail((R)). Follow-up examinations were conducted on 162 patients with an average age of 51.2 years after an average of 15 months. 62 Weber B fractures (38.3%) and 45 Weber C fractures (27.7%) were evaluated. There were bimalleolar fractures in 55 cases (34.0%). According to the Olerud Score (clinical and radiologic score), 95 patients (58.6%) had an excellent, 54 (33.3%) a good, nine (5.5%) a moderate, and four (2.4%) an unsatisfactory result.