Early changes in nutrient artery blood flow following tibial nailing with and without reaming: A preliminary study
ABSTRACT To quantify the changes in nutrient artery blood flow following reamed and unreamed nailing of intact canine tibias.
In vivo animal study.
Eighteen dogs underwent nutrient artery blood flow measurements over a fourteen-day period. The intervention groups consisted of controls (Group I), nailing without reaming (Group II), and nailing with reaming (Group III).
Nutrient artery blood flow was measured through implantable ultrasonic blood flow probes placed around the nutrient artery of the tibia.
Nutrient artery blood flow averaged 1.94 milliliters per minute over the fourteen-day period in Group I (no reaming or nailing performed). Nutrient artery blood flow following nailing without reaming (Group II) decreased to 44 percent of baseline values immediately after the procedure. By postoperative day 1, flow had decreased to 23 percent of baseline; over the fourteen-day period, nutrient artery blood flow recovered toward baseline values. Immediately following nailing with reaming (Group III), nutrient artery blood flow measured zero milliliters per minute. Over the fourteen-day period, nutrient artery blood flow in this group averaged 39 percent of the baseline level (range 19 to 58 percent). Whereas nutrient artery blood flow recovered toward baseline values (99 percent of baseline) by fourteen days in Group II, nutrient artery blood flow measured only 26 percent of the baseline level on postoperative day fourteen in Group III.
The preliminary data suggest that nailing with reaming provides a double insult to the nutrient artery distribution.
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ABSTRACT: The healing outcome of long bone fractures is strongly influenced by the mechanical environment. High interfragmentary movement at the fracture site is detrimental to the fracture healing process. Long bone fractures stabilized with thin intramedullary nails commonly used for unreamed intramedullary nailing might be very flexible in shear direction and therefore critical for the fracture healing outcome. The aims of this study were to simulate the shear interfragmentary movement during gait for a human tibia treated with intramedullary nailing and to investigate if this movement could be lowered by implant design modifications. The shear movement was calculated with a 3D finite element model based on computer tomograph images of a cadaver bone-implant complex of a transverse tibia fracture treated with a Stryker T2 Standard Tibial Nail. This model was validated through in vitro test results under pure shear, axial, bending and torsional loading. High shear movements of approximately 4mm were calculated during gait. These shear movements could be reduced by approximately 30% either by implant modifications or the use of a 1mm thicker nail. Combining the implant modifications with a 1mm thicker nail, the shear movements could be reduced by 54%. The increase of the fixation stiffness by using an implant material with a high Young's modulus in combination with an angle-stable nail-screw fixation helps to reduce the shear movement during gait and possibly to lower the risk of a prolonged healing time with unreamed intramedullary nailing.Clinical biomechanics (Bristol, Avon) 10/2010; 26(2):147-51. DOI:10.1016/j.clinbiomech.2010.09.009 · 1.88 Impact Factor
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ABSTRACT: The management of open tibial shaft fractures remains challenging. Intramedullary nailing and external fixation are the most commonly used fixation techniques although the optimal fixation technique remains unresolved. In this article the outcomes of these two surgical techniques are compared. A comprehensive literature search was conducted through MEDLINE(®) using Ovid(®) and MeSH (Medical Subject Heading) terms for articles published in the English literature between 1999 and 2009. The outcome measures compared were time to fracture union, infection rates and complications. Forty-one studies were identified, of which only three met the inclusion criteria. The average time to union was variable. Delayed union and non-union appeared to be more prevalent in the external fixator group although this was not statistically significant. Both techniques were associated with secondary procedures as well as infection. The current literature indicates little evidence to suggest the superiority of one fixation technique over another for open tibial fractures.Annals of The Royal College of Surgeons of England 01/2012; 94(1):34-8. DOI:10.1308/003588412X13171221498668 · 1.22 Impact Factor
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ABSTRACT: Failure of internal fixation following treatment of a fracture or fracture nonunion presents a challenging clinical situation. In certain cases, Ilizarov external fixation may be the preferred method to treat bony injuries that have failed to unite following one or more attempts at internal fixation. This paper reviews the modes of failure following internal fixation, revision internal fixation as an option, and the application of the Ilizarov method following failure of internal fixation.Techniques in Orthopaedics 11/2002; 17(4):490-505. DOI:10.1097/00013611-200212000-00013