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Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures

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Chinese Journal of Traumatology 2019年第5期22卷 270-273页

作者： Deepak Pinto K.Manjunatha Amarnath D.Savur Naufal Rizwan Ahmed Sharan Mally V.Ramya Department of Orthopaedics Kasturba Medical College MangaloreManipal Academy of Higher EducationIndia Department of Community Medicine Basaveshwara Medical CollegeChitradurgaIndia

Purpose:Open tibia fracture is prone to infection,consequently causing significant morbidity and increasing the hospital stay,occupational loss and onset of chronic osteomyelitis.Intramedullary nailing is one choice for treating tibia shaft fractures.To improve the delivery of antibiotics at the tissue-implant interface,many methods have been proposed as a part of prophylaxis against infection.This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking(IMIL)nail in the prevention of infection in Gustilo typeⅠandⅡopen tibia fractures and to compare the results with regular intramedullary nail.Methods:The study included 28 patients with open tibia fractures(Gustilo type 1 or type 2);of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing.Randomization was done by alternate allocation of the patients.Follow-up was done postoperatively(day 1),1 week,6 weeks,and 6 months for bone union,erythrocyte sedimentation rate(ESR),hemoglobin and C?reactive protein(CRP).Statistical significance was tested using unpaired t-test.A p value less than 0.05 was considered significant.Results:There were 4 cases of infection in controls(regular IMIL nail)and no infection among patients treated with gentamicin-coated nail during the follow up(Х^2=4.66,p=0.031).At 6 months postoperatively,CRP(p=0.031),ESR(p=0.046)and hemoglobin level(p=0.016)showed significant difference between two groups.The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up(p=0.016).Conclusion:Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo typeⅠandⅡopen tibia fractures.

关键词： Antibiotic impregnated nail Intramedullary nailing Open tibia fracture Infection

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Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

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World Journal of Orthopedics 2021年第8期12卷 575-583页

作者： Giulia Masci Osvaldo Palmacci Raffaele Vitiello Nadia Bonfiglio Maria Beatrice Bocchi Valerio Cipolloni Giulio Maccauro Enrico Pola Department of Orthopaedics and Traumatology Fondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy Policlinico di Napoli University Hospital Universitàdella Campania Luigi Vanvitelli School of MedicineNapoli 80100Italy

BACKGROUND Limb lengthening techniques play an increasingly important role in the pediatric orthopedic field.The principles of the osteogenesis distraction bonded traditionally with external fixators;however,the recent deployment of fully implantable systems has been able to overcome severities related to external fixators.The PRECICE®is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically driven.AIM To review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb lengthening.METHODS Only five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 femurs.The clinical and radiological outcomes of interest were:the main lengthening obtained,the distraction rate,the period of time to full weight bearing,the consolidation index,and the Association for the Study and Application of Methods of Ilizarov score.RESULTS In conclusion,data collected from the articles under investigation were comparable with the exception of the consolidation index.Unfortunately,the study population was too small and the patients’follow-up was too short to make definitive conclusions.CONCLUSION This review shows that the PRECICE nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons;however,careful preoperative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.

关键词： Limbs lengthening PRECICE nail Pediatric Dysmetria Deformities

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Squamous cell carcinoma of the nail bed: A case report

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World Journal of Clinical Cases 2019年第21期7卷 3590-3594页

作者： Peng-Fei Li Ning Zhu Hui Lu Department of Plastic and Aesthetic Center The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310000Zhejiang ProvinceChina Department of Ophthalmology The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310000Zhejiang ProvinceChina Department of Orthopedics The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310000Zhejiang ProvinceChina

BACKGROUND Squamous cell carcinoma(SCC)of the nail bed is a poorly reported malignant subungual tumor.Because it presents with nonspecific symptoms and signs,it is frequently misdiagnosed by dermatologists or surgeons.A delay in diagnosis and/or wrong treatment might increase the possibility of disease progression.Thus,new perspectives are needed to assist dermatologists and surgeons with diagnosing and treating SCC.This rare case presented with a 2-year delay in the diagnosis of SCC teaches a valuable lesson.CASE SUMMARY A 62-year-old female presented with a non-healing subungual growth in the nail bed of the right middle finger for 2 years.The lesion was first medicated with iodine by the patient herself without any relief.Twenty months later,a dermatologist diagnosed the lesion as paronychia and treated it with nail avulsions repeatedly with no obvious alleviation.A lesionectomy confirmed the lesion was SCC.An extended excision of the tumor with amputation of the distal interphalangeal joint was subsequently performed.A biopsy of sentinel lymph nodes was negative.Due to the result of preoperative positron emission tomography-computed tomography scanning,sweeping of axillary lymph nodes was considered dispensable and was skipped.At the 2-year follow-up,the patient showed a quick recovery and no sign of recurrence.CONCLUSION Our successful diagnosis and treatment of the case highlights the need for additional attention to long-standing non-healing lesions of the nail bed and the necessity for discreet evaluation and customization of surgical interventions.

关键词： Squamous cell carcinoma nail bed lesion Customized treatment Malignant subungual tumor Case report

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Subtrochanteric femur fracture treated by intramedullary fixation

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Chinese Journal of Traumatology 2015年第6期18卷 336-341页

作者： Zu-Bin Zhou Song Chen You-Shui Gao Yu-Qiang Sun Chang-O_ing Zhang Yao Jiang Medical College of Soochow University Shanghai 200233 China Department of Orthopaedic Surgery Shanghai Jiaotong University Affiliated Sixth People's Hospital Shanghai 200233 China

Purpose： To discuss surgical technique, operative efficacy and clinical outcome of intramedullary fixation in the treatment of subtrochanteric femur fractures. Methods： From February 2011 to February 2013, 76 cases of subtrochanteric femur fractures were treated by intramedullary fixation in our hospital, including 53 males and 23 females, with the age range of 37 -72 years （mean 53.5 years）. According to Seinsheimer classification, there were 2 cases of type I, 7 type Ⅱ, 15 type Ⅲ, 23 type IV and 29 type V. Firstly, all patients underwent closed reduction with the guidance of C-arm fluoroscopy in a traction table. Two cases of type I and 3 cases of type Ill fractures had ideal closed reduction followed by internal fixation. The others needed additional limited open reduction. Radiographic examination was used to evaluate callus formation and fracture healing in postoperative 1, 3, 6 and 12 months follow-up. Functional recovery was evaluated by Harris Hip Scoring （HHS） system. Results： Patients were followed up for 6-12 months. All fractures were healed except one patient with delayed union. The average bone union time was 4.5 months. According to HHS system, 65 cases were considered as excellent in functional recovery, 8 good, 2 fair and 1 poor. The proportion of the patients with excellent and good recovery was 96.05%. Conclusion： Intramedullary fixation is feasible for the treatment of subtrochanteric femur fracture. The accuracy of intraoperative reduction and surgical skill are important for the clinical outcome and the patients＇ prognosis.

关键词： Subtrochanteric femur fractures Intramedullary nail Surgical procedures, operative

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Using humeral nail for surgical reconstruction of femur in adolescents with osteogenesis imperfecta

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World Journal of Orthopedics 2017年第9期8卷 735-740页

作者： Paphon Sa-ngasoongsong Tanyawat Saisongcroh Chanika Angsanuntsukh Patarawan Woratanarat Pornchai Mulpruek Department of Orthopedics Faculty of Medicine Ramathibodi Hospital Mahidol University

Osteogenesis imperfecta(OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformities. While the treatment for these fractures was recommended as using intramedullary fixation for minimizing stress concentration, the selection of the best implant in the adolescent OI patients for the surgical reconstruction of femur was still problematic, due to anatomy distortion and implant availability. We are reporting the surgical modification by using a humeral nail for femoral fixation in three adolescent OI patients with favorable outcomes.

关键词： Osteogenesis imperfecta Adolescent Humeral nail Femoral fracture Femoral bowing deformity

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Effects of Angular Fillers on Thermal Runaway of Lithium-Ion Battery

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Journal of Materials Science & Technology 2016年第11期32卷 1117-1121页

作者： Meng Wang Anh V.Le Yang Shi Daniel J.Noelle Hyojung Yoon Minghao Zhang Y.Shirley Meng Yu Qiao Department of Structural Engineering University of California-San Diego Program of Materials Science and Engineering University of California-San Diego Department of Nanoengineering University of California-San Diego

By adding 1 wt% damage homogenizer（DH）, i.e. carbon black microparticles, into the electrodes of lithiumion batteries, thermal runaway can be mitigated as the battery cells are subjected to impact loadings. In a drop tower test, the generated heat of the modified cells is reduced by nearly 40%, compared with the reference cells. This phenomenon may be attributed to the weakening effect of the carbon black fillers.The shape of the filler grains does not have a pronounced influence on the temperature profile.

关键词： Lithium-ion battery Thermal runaway Micro-particulate nail Impact

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Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

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World Journal of Orthopedics 2017年第5期8卷 379-384页

作者： Matthew Lacey Joseph Lamplot Kempland C Walley Joseph P De Angelis Arun J Ramappa Department of Orthopaedic Surgery Harvard Medical School Beth Israel Deaconess Medical Center

AIM To describe an approach to anterior cruciate ligament(ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary(IM) femoral nail.METHODS Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware(locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL's anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft's outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip stitched, quadrupled and shaped to match th

关键词： Anteromedial drilling Intramedullary femoral nail Anterior cruciate ligament reconstruction Retained hardware

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A comparative study of the therapeutic effect between long and short intramedullary nails in the treatment of intertrochanteric femur fractures in the elderly

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Chinese Journal of Traumatology 2015年第6期18卷 332-335页

作者： Xue-Feng Guo Ke-Ming Zhang Hong-Bo Fu Wen Cao Qiang Dong Department of Traumatic Orthopaedics Tianjin Hospital Tianjin 300211 China Department of CF and MRI The General Hospital of Jilin Chemical Group Corporation Jihua City 132021 Jilin Province China Department of Orthopaedics People's Hospital of Wucheng County Dezhou City 253300 Shandong Provice China

Purpose： To compare the clinical effects of long vs. short intramedullary nails in the treatment of intertrochanteric fractures in old patients more than 65 years old. Methods： A retrospective analysis of 178 cases of intertrochanteric fractures of the femur （AO type AI and A2） in the elderly was conducted from January 2008 to December 2013. There were 85 males （47.8%） and 93 females （52.2%） with the age of 65-89 （70.2 ±10.8） years. The patients were treated by closed reduction and long or short intramedullary nail （Gamma 3） fixation. The length of short nail was 180 mm and that for long nail was 320-360 ram. The general data of patients, operation time, intraoperative blood loss, length of hospital stay, preoperative hemoglobin level, blood transfusion rate, postoperative periprosthetic fractures, infections, complications, etc were carefully recorded. Results： There were 76 cases （42.7%） in the long intramedullary nail group and 102 cases （57.3%） in the short nail group. All the cases were followed up for 12-48 （21.3 ± 6.8） months, during which there were 21 deaths （11.8%）, mean （13.8 ± 6.9） months after operation. The intraoperative blood loss was （90.7±50.6） ml in short nail group, greatly less than that in long nail group （127.8 _＋ 85.9） ml （p 0.004）. The short nail group also had a significantly shorter operation time （43.5 min ± 12.3 min vs. 58.5 rain ± 20.3 min, p = 0.002） and lower rate of postoperative transfusion （42.3% vs. 56.7%, p =0.041 ）. But the length of hospital stay showed no big differences. After operation, in each group there was 1 case of periprosthetic fracture with a total incidence of 1.1%, 1.3%; in long nail group and 0.9% in short nail group. At the end of the follow-up, all patients achieved bony union. The average healing time of the long nail group was （6.5 ±3.1 ） months, and the short nail group was （6.8 ± 3.7） months, revealing no sig- nificant differences （p = 0.09）. Postoperative complications showed no great differences either. Conclusion： Both the intramedullary long and short

关键词： Intertrochanteric fracture lntramedullary long nail Intramedullary short nail Periprosthetic

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Methods to shorten the duration of an external fixator in the management of tibial infections

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World Journal of Orthopedics 2011年第9期2卷 85-92页

作者： Khaled M Emara Khaled Abd Al Ghafar Mohamed Ahmed Al Kersh Orthopaedic Surgery Ain Shams University HospitalsCairo 0020Egypt Lecturer in Orthopaedic Surgery Ain Shams UniversityCairo 0020Egypt Assistant Lecturer of Orthopaedic Surgery Ain Shams UniversityCairo 0020Egypt

Massive segmental bone loss due to chronic osteomyelitis represents a considerable challenge to orthopedic surgeons and is a limb threatening condition.The only option available in such a clinical situation is segment transport using the Ilizarov technique of distraction osteogenesis;yet the most common problem in cases of bone transport with the Ilizarov technique in massive bone loss,is the long duration of the fixator.In addition to autologous bone grafting,several mechanical,biologic,and external physical treatment modalities may be employed to promote bone formation and maturation during segment transport in osteomyelitis patients.Mechanical approaches include compressive loading of the distraction regenerate,increased frequency of small increments of distraction,and compression-distraction.Intramedullary nailing and hemicorticotomy can reduce the time in external fixation;however,these techniques are associated with technical difficulties and complications.Exogenous application of low-intensity pulsed ultrasound or pulsed electromagnetic fields may shorten the duration of external fixation.Other promising modalities include diphosphonates,physician-directed use(off-label use)of bone morphogenetic proteins,and local injection of bone marrow aspirate and platelet gel at the osteotomy site.Well-designed clinical studies are needed to establish safe and effective guidelines for various modalities to enhance new bone formation during distraction osteogenesis after segment transfer.

关键词： Ilizarov Bone infection Intramedullary nail Hemicorticotomy Tibiofibular synostosis Fibular transport

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Effect of lengthening along the anatomical axis of the femur and its clinical impact

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World Journal of Orthopedics 2017年第5期8卷 431-435页

作者： Khaled M Emara Ahmed Nageeb Mahmoud Ahmed K Emara Mariam K Emara Limb Reconstruction and Deformity Correction Unit Orthopaedic Surgery Department Ain Shams University Hospitals

AIM To review and study the effect of lengthening along the anatomical axis of long bones and its relation to the mechanical axis deviation.METHODS We try in this review to calculate and discuss the exact clinical impact of lengthening along the anatomical axis of the femur on affecting the limb alignment. Also we used a trigonometric formula to predict the change of the femoral distal anatomical mechanical angle(AMA) after lengthening along the anatomical axis. RESULTS Lengthening along the anatomical axis of the femur by 10% of its original length results in reduction in the distal femoral AMA by 0.57 degrees. There is no objective experimental scientific data to prove that the Mechanical axis is passing via the center of the hip to the center of the knee. There is wide variation in normal anatomical axis for different populations. In deformity correction, surgeons try to reproduce the normal usual bone shape to regain normal function, which is mainly anatomical axis. CONCLUSION Lengthening of the femur along its anatomical axis results in mild reduction of the distal femoral AMA. This may partially compensate for the expected mechanical axis lateralisation and hence justify its minimal clinical impact.

关键词： Bone lengthening Deformity Femoral lengthening External fixation Intramedullary nail Axis deviation

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