Clinical and Radiographic Results with the Fixion® Intramedullary Nail: An Inflatable Self-Locking System for Long Bone Fractures

Abstract

The authors present in this article a new inflatable self-locking intramedullary nailing system for treatment of long bone fractures. The features of this system and the advantages of the technique are shown: fixation along the entire length of the nail, lack of proximal or distal interlocking screws, optional reaming, reduced exposure of the surgeon to x-rays and reduced operating room time. The clinical and radiographic results are reported: out of 82 implants in closed fractures classified according to A. O. method, 58 were available up to date for follow-up. We observed in all 58 cases (100 %) fracture consolidation, with absence of non-unions, infections or rotational malalignments. Only 4 (6.9 %) cases of complication are reported, consisting in opening of the fracture after inflation of the nail: a good stability of the nail, however, assured a complete callus formation. The authors conclude that this intramedullary nail is an innovative, effective, simple and minimally invasive procedure for treating long bone shaft fractures.

Key words

Intramedullary nail - expandable - self-locking - unreamed

References

• 1 Anglen J O, Blue J M. A comparison of reamed and unreamed nailing of the tibia.  J Trauma. 1995;  39 351-355
• 2 Bonatus T, Olson S A, Lee S, Chapmann M W. Non reamed locking intramedullary nailing for open fractures of the tibia.  Clin Orthop Rel Res. 1997;  339 58-64
• 3 Browner D B, Jupiter J B, Levine A M, Trafton P G. Skeletal Trauma. W. B. Saunders Company, Philadelphia 1995
• 4 Court-Brown C M, McQueen M M, Quaba A A, Christie J. Locked intramedullary nailing of open tibial fractures.  J Bone Joint Surg [Br]. 1991;  73 959-964
• 5 Court-Brown C M, Will E, Christie J, McQueen M M. Reamed or unreamed nailing for closed tibial fractures. A prospective study in Tscherne C1 fractures.  J Bone Joint Surg [Br]. 1996;  78 580-583
• 6 Curtis M J, Brown P R, Dick J D, Jinnah R H. Contaminated fractures of the tibia: a comparison of treatment modalities in an animal model.  J Orthop Res. 1995;  13 286-295
• 7 Dankwardt-Lilliestrom G, Lorenzi L. et al . Intra cortical circulation after intramedullary reaming with reduction of pressure in the medullary cavity. A microangiographic study on the rabbit tibia.  J Bone Joint Surg [Am]. 1970;  52 1390-1394
• 8 Duwelius P J, Schmidt A H, Rubinstein R A, Green J M. Nonreamed interlocked intramedullary tibial nailing. One community experience.  Clin Orthop Rel Res. 1995;  315 104-113
• 9 Finkemeier C, Kyle R F, Schmidt A H, Templeman D C, Varecka T F. Prospective, surgeon randomized, study comparing reamed versus unreamed intramedullary nailing for the treatment of unstable closed and open diaphyseal fractures AAOS 1998 annual meeting. Scientific Programme: Paper No. 212, 1998
• 10 Gregory P, Sanders R. The treatment of closed, unstable tibial shaft fractures with unreamed interlocking nails.  Clin Orthop Rel Res. 1995;  315 48-55
• 11 Grundnes O, Reikeras O. Acute effects of intramedullary reaming on bone blood flow in rats.  Acta Orthop Scan. 1993;  64 203-206
• 12 Heim D, Regazzoni P, Tsakiris D A, Aebi T, Schlegel U, Marbet G A, Perren S M. Intramedullary nailing and pulmonary embolism: Does unreamed nailing prevent embolization? An in vitro study in rabbits.  J Trauma. 1995;  38 899-906
• 13 Kempf I, Pidhorz L. Enclouage des fractures de la diaphyse fémorale. In: Encycl Méd Chir Techniques Chirurgicales Orthopédie-Traumatologie, Editions Scientifiques et Médicales Elsevier SAS, Paris 2000; 44-705
• 14 Koval K J, Clapper M F, Brumback R J, Ellison P S , Poka A, Bathon G H, Burgess A R. Complications of reamed intramedullary nailing of the tibia.  J Orthop Trauma. 1991;  5 184-189
• 15 Krettek C, Schandelmaier P, Tscherne H. Non reamed interlocking nailing of closed tibial fractures with severe soft tissue injury.  Clin Orthop Related Res. 1995;  315 34-47
• 16 Melcher G A, Ryf C, Leutenegger A, Ruedi T. Tibial fractures treated with the AO unreamed tibial nail.  Injury. 1993;  24 407-410
• 17 Müller M E, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of the Long Bones. Springer, Berlin, Heidelberg, New York, Tokyo 1990
• 18 Schemitsch E H, Kowalski M J, Swiontkowski M F, Senft D. Cortical bone blood flow in reamed and unreamed locked intra medullary nailing: a fractured tibia model in sheep.  J Orthop Trauma. 1994;  8 373-382
• 19 Singer R W, Kellam J F. Open tibial diaphysial fractures. Results of unreamed locked intramedullary nailing.  Clin Orthop Rel Res. 1995;  315 114-118
• 20 Wiss D A, Stetson W B. Unstable fractures of tibia treated with a reamed intramedullary interlocking nail.  Clin Orthop Rel Res. 1995;  315 56-63
• 21 Wozasek G E, Simon P, Redl H, Schlag G. Intramedullary pressure changes and fat intravasation during intramedullary nailing: an experimental study in sheep.  J Trauma. 1994;  36 202-207