The Fixion expansion nail in the surgical treatment of diaphyseal fractures of the humerus and tibia. Our experience.

The authors present their experience in the application of a Fixion expansion intramedullary nail for the treatment of diaphyseal fractures of the humerus and tibia, in a total of 40 surgeries. The features of the nail are: stability and flexibility of the instrumentation, speed of surgery, minimal exposure to radiation. The results obtained up to now are encouraging; there are no significant problems either during or after surgery, and mean consolidation time is 3 months for fractures of the humerus, and 4 months for those of the tibia. The Fixion nail is a versatile type of instrumentation that is easy to use.

Long-term results of surgery for the treatment of sustentacular fractures of the calcaneus.

The authors reviewed 55 sustentacular fractures of the calcaneus treated between 1979 and 1988. Our therapeutic objective was that of reconstructing the subtalar joint. This purpose was always achieved in a short amount of time; nonetheless, there were some cases of secondary unreduction in time (13% poor results in 4.5 years). Essex-Lopresti closed surgery was used to treat fractures with limited damage of the joint surface; open osteosynthesis with associated grafting was used to treat fractures with more than one fragment.

Grosse Kempf locked intramedullary nailing in the treatment of diaphyseal fractures of the lower limb. A case review.

After a review of the cases (57 between 1981 and 1988) the authors present the results of treatment of diaphyseal fractures of the lower limb by Grosse Kempf locked intramedullary nailing. The advantages and the effectiveness of the method are emphasized; the method has obtained brilliant results in complex and "boundary" fractures of the femur and tibia; furthermore, some suggestions are made with regard to surgery.

Intramedullary osteosynthesis 3. Küntscher nailing in the humerus.

With regard for the principles that govern the correct application of intramedullary osteosynthesis in the long bones of the lower limb, the authors also support its use in the humerus. After an exhaustive survey of the specific problems at this site, a critical review of 130 cases observed over the last 15 years is reported. Extremely favourable results emerged in the treatment of the humerus with this means of synthesis, thanks to its surgical, mechanical and biological advantages.

Intramedullary osteosynthesis. 4. Küntscher nailing in the ulna.

Intramedullary osteosynthesis with Küntscher nailing is an appropriate and extremely effective operation in the treatment of diaphyseal fractures of the ulna. Like the other long bones of the limbs (femur, humerus, tibia), in the ulna, as well, the advantages of the method, particularly when performed in closed surgery, are undeniable, so much so that this bone has a shape which is particularly favourable to nailing. The authors present and discuss their personal series of cases reporting results which are excellent. Thus, once again, the great reliability of this simple means of synthesis, in use for more than 20 years, is emphasised, and the subject is completed with a series of previous technical suggestions on how to obtain the best results.

Intramedullary osteosynthesis. 1. Küntscher nailing in the femur.

Based on more than 20 years experience, the authors support the effectiveness of intramedullary nailing in the treatment of diaphyseal fractures of the femur. They review the history and advantages of this method and discuss the biomechanical principles on which it is based. Recent advances in technique have made it possible to secure proximal and distal anchorage in cancellous bone. This allows the method to be extended to more proximal and distal fractures than in the traditional method which is applicable only to the middle third. It also facilitates progressive axial compression, early loading and early mobilisation of the limb, thus creating the optimum biological conditions for consolidation and joint function. The closed method also reduces blood loss and the risk of infection. The techniques adopted to deal with more complex situations are described. These include moderately comminuted oblique and spiral fractures and certain bifocal fractures. Finally, the results of treating 450 cases are reviewed, with a longterm analysis of 198 patients.

Intramedullary osteosynthesis. 2. Küntscher nailing in fractures of the tibia.

The purpose of this study is to discuss diaphyseal fractures of the tibia treated by intramedullary Küntscher nailing. This is based on 368 cases treated over the last 20 years. Closed intramedullary osteosynthesis favours the healing process, resulting in the early formation of callus which is of good quality and abundant. A careful review of the cases showed a 93.7% incidence of good results.

Osteosynthesis of fractures of the femoral neck by nail-plate, screws and valgus osteotomy.

The authors describe the method used for the treatment of subcapital fractures of the femoral neck in younger subjects. This method associates intertrochanteric osteotomy with osteosynthesis using one or two spongy bone screws and a nail plate. The series includes 26 patients followed up both clinically and radiographically. The results were very good, with 100% union and only 4 cases of ischaemic necrosis (15%).