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Preoperative Planning

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Intramedullary Nailing

Abstract

A thorough understanding of the fracture’s morphology, patient condition, the indications and the limitations of the available implants and an honest insight of the skills and limitations of the surgeons are of paramount importance for a successful nailing procedure. The availability of different nail types and designs can have a major impact on the decision whether to use an intramedullary nail for a certain fracture. The choice of patient’s position prior to nailing can be crucial to the success of the procedure and should be an integral part of the plan. The correct entry portal, an appropriate nail diameter and adequate locking options are essential for correct fracture alignment and stabilization.

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References

  1. Casstevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012;20:675–83.

    Article  PubMed  Google Scholar 

  2. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011;25:736–41.

    Article  PubMed  Google Scholar 

  3. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005;87:1213–21.

    Article  PubMed  Google Scholar 

  4. Nork SE, Barei DP, Schildhauer TA, et al. Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma. 2006;20:523–8.

    Article  PubMed  Google Scholar 

  5. Hessmann MH, Nijs S, Mittlmeier T, et al. Internal fixation of fractures of the proximal humerus with the MultiLoc nail. Oper Orthop Traumatol. 2012;24:418–31.

    Article  CAS  PubMed  Google Scholar 

  6. Seifert J, Stengel D, Matthes G, Hinz P, Ekkernkamp A, Ostermann PA. Retrograde fixation of distal femoral fractures: results using a new nail system. J Orthop Trauma. 2003;17:488–95.

    Article  PubMed  Google Scholar 

  7. Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone Joint Surg Am. 1985;67:709–20.

    CAS  PubMed  Google Scholar 

  8. Nahm NJ, Vallier HA. Timing of definitive treatment of femoral shaft fractures in patients with multiple injuries: a systematic review of randomized and nonrandomized trials. J Trauma Acute Care Surg. 2012;73:1046–63.

    Article  PubMed  Google Scholar 

  9. Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998;12:1–7.

    Article  CAS  PubMed  Google Scholar 

  10. Fang X, Jiang L, Wang Y, Zhao L. Treatment of Gustilo grade III tibial fractures with unreamed intramedullary nailing versus external fixator: a meta-analysis. Med Sci Monit. 2012;18:RA49–56.

    PubMed Central  PubMed  Google Scholar 

  11. Okike K, Bhattacharyya T. Trends in the management of open fractures. A critical analysis. J Bone Joint Surg Am. 2006;88:2739–48.

    Article  PubMed  Google Scholar 

  12. Bhattacharyya T, Vrahas MS, Morrison SM, et al. The value of the dedicated orthopaedic trauma operating room. J Trauma. 2006;60:1336–40; discussion 40–1.

    Article  PubMed  Google Scholar 

  13. Winquist RA, Hansen Jr ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984;66:529–39.

    CAS  PubMed  Google Scholar 

  14. Park J, Kim SG, Yoon HK, Yang KH. The treatment of nonisthmal femoral shaft nonunions with in nail exchange versus augmentation plating. J Orthop Trauma. 2010;24:89–94.

    Article  PubMed  Google Scholar 

  15. Jaarsma RL, Pakvis DF, Verdonschot N, Biert J, van Kampen A. Rotational malalignment after intramedullary nailing of femoral fractures. J Orthop Trauma. 2004;18:403–9.

    Article  CAS  PubMed  Google Scholar 

  16. Jaarsma RL, Verdonschot N, van der Venne R, van Kampen A. Avoiding rotational malalignment after fractures of the femur by using the profile of the lesser trochanter: an in vitro study. Arch Orthop Trauma Surg. 2005;125:184–7.

    Article  CAS  PubMed  Google Scholar 

  17. Tornetta 3rd P, Ritz G, Kantor A. Femoral torsion after interlocked nailing of unstable femoral fractures. J Trauma. 1995;38:213–9.

    Article  PubMed  Google Scholar 

  18. Keast-Butler O, Lutz MJ, Angelini M, et al. Computer navigation in the reduction and fixation of femoral shaft fractures: a randomized control study. Injury. 2012;43:749–56.

    Article  PubMed  Google Scholar 

  19. Weil YA, Gardner MJ, Helfet DL, Pearle AD. Computer navigation allows for accurate reduction of femoral fractures. Clin Orthop Relat Res. 2007;460:185–91.

    PubMed  Google Scholar 

  20. Bedi A, Toan Le T. Subtrochanteric femur fractures. Orthop Clin North Am. 2004;35:473–83.

    Article  PubMed  Google Scholar 

  21. Liporace FA, Stadler CM, Yoon RS. Problems, tricks, and pearls in intramedullary nailing of proximal third tibial fractures. J Orthop Trauma. 2013;27:56–62.

    Article  PubMed  Google Scholar 

  22. Afsari A, Liporace F, Lindvall E, Infante Jr A, Sagi HC, Haidukewych GJ. Clamp-assisted reduction of high subtrochanteric fractures of the femur. J Bone Joint Surg Am. 2009;91:1913–8.

    Article  PubMed  Google Scholar 

  23. Koval KJ, Oh CK, Egol KA. Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur? Bull NYU Hosp Jt Dis. 2008;66:102–6.

    PubMed  Google Scholar 

  24. Hou Z, Zhang Q, Zhang Y, Li S, Pan J, Wu H. A occult and regular combination injury: the posterior malleolar fracture associated with spiral tibial shaft fracture. J Trauma. 2009;66:1385–90.

    Article  PubMed  Google Scholar 

  25. Tornetta 3rd P, Kain MS, Creevy WR. Diagnosis of femoral neck fractures in patients with a femoral shaft fracture. Improvement with a standard protocol. J Bone Joint Surg Am. 2007;89:39–43.

    Article  PubMed  Google Scholar 

  26. Pilson HT, Reddix Jr RN, Mutty CE, Webb LX. The long lost art of preoperative planning – resurrected? Orthopedics. 2008;31.

    Google Scholar 

  27. Conn KS, Clarke MT, Hallett JP. A simple guide to determine the magnification of radiographs and to improve the accuracy of preoperative templating. J Bone Joint Surg Br. 2002;84:269–72.

    Article  CAS  PubMed  Google Scholar 

  28. Mosheiff R, Peyser A, Friedman A, Liebergall M. “Krammer splint technique” for immediate measuring of intramedullary nails. Am J Orthop (Belle Mead NJ). 1997;26:375.

    CAS  Google Scholar 

  29. Gustilo RB, Gruninger RP, Davis T. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics. 1987;10:1781–8.

    CAS  PubMed  Google Scholar 

  30. Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;(243):36–40.

    Google Scholar 

  31. Wiss DA, Brien WW. Subtrochanteric fractures of the femur. Results of treatment by interlocking nailing. Clin Orthop Relat Res. 1992;(283):231–6.

    Google Scholar 

  32. Gary JL, Taksali S, Reinert CM, Starr AJ. Ipsilateral femoral shaft and neck fractures: are cephalomedullary nails appropriate? J Surg Orthop Adv. 2011;20:122–5.

    PubMed  Google Scholar 

  33. Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R. Ipsilateral fractures of the femur and tibia: treatment with retrograde femoral nailing and unreamed tibial nailing. J Orthop Trauma. 1996;10:309–16.

    Article  CAS  PubMed  Google Scholar 

  34. Tucker MC, Schwappach JR, Leighton RK, Coupe K, Ricci WM. Results of femoral intramedullary nailing in patients who are obese versus those who are not obese: a prospective multicenter comparison study. J Orthop Trauma. 2007;21:523–9.

    Article  PubMed  Google Scholar 

  35. Ma CH, Tu YK, Yu SW, Yen CY, Yeh JH, Wu CH. Reverse LISS plates for unstable proximal femoral fractures. Injury. 2012;41:827–33.

    Article  Google Scholar 

  36. Migaud H, Cortet B, Assaker R, Fontaine C, Kulik JF, Duquennoy A. Value of a synthetic osseous model obtained by stereo-lithography for preoperative planning. Correction of a complex femoral deformity caused by fibrous dysplasia. Rev Chir Orthop Reparatrice Appar Mot. 1997;83:156–9.

    CAS  PubMed  Google Scholar 

  37. Attal R, Hansen M, Kirjavainen M, et al. A multicentre case series of tibia fractures treated with the Expert Tibia Nail (ETN). Arch Orthop Trauma Surg. 2012;132:975–84.

    Article  PubMed  Google Scholar 

  38. Brumback RJ, Ellison TS, Molligan H, Molligan DJ, Mahaffey S, Schmidhauser C. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am. 1992;74:1450–5.

    CAS  PubMed  Google Scholar 

  39. Anglen J, Banovetz J. Compartment syndrome in the well leg resulting from fracture-table positioning. Clin Orthop Relat Res. 1994;(301):239–42.

    Google Scholar 

  40. Stephen DJ, Kreder HJ, Schemitsch EH, Conlan LB, Wild L, McKee MD. Femoral intramedullary nailing: comparison of fracture-table and manual traction. a prospective, randomized study. J Bone Joint Surg Am. 2002;84-A:1514–21.

    PubMed  Google Scholar 

  41. Bishop JA, Rodriguez EK. Closed intramedullary nailing of the femur in the lateral decubitus position. J Trauma. 2010;68:231–5.

    Article  PubMed  Google Scholar 

  42. Dora C, Leunig M, Beck M, Rothenfluh D, Ganz R. Entry point soft tissue damage in antegrade femoral nailing: a cadaver study. J Orthop Trauma. 2001;15:488–93.

    Article  CAS  PubMed  Google Scholar 

  43. Ansari Moein CM, Verhofstad MH, Bleys RL, van der Werken C. Soft tissue injury related to choice of entry point in antegrade femoral nailing: piriform fossa or greater trochanter tip. Injury. 2005;36:1337–42.

    Article  CAS  PubMed  Google Scholar 

  44. Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Anterior knee pain following the lateral parapatellar approach for tibial nailing. Arch Orthop Trauma Surg. 2009;129:773–7.

    Article  PubMed  Google Scholar 

  45. Toivanen JA, Vaisto O, Kannus P, Latvala K, Honkonen SE, Jarvinen MJ. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am. 2002;84-A:580–5.

    PubMed  Google Scholar 

  46. Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma. 2000;14:162–6.

    Article  CAS  PubMed  Google Scholar 

  47. Streubel PN, Wong AH, Ricci WM, Gardner MJ. Is there a standard trochanteric entry site for nailing of subtrochanteric femur fractures? J Orthop Trauma. 2011;25:202–7.

    Article  PubMed  Google Scholar 

  48. Hiesterman TG, Shafiq BX, Cole PA. Intramedullary nailing of extra-articular proximal tibia fractures. J Am Acad Orthop Surg. 2011;19:690–700.

    PubMed  Google Scholar 

  49. McFerran MA, Johnson KD. Intramedullary nailing of acute femoral shaft fractures without a fracture table: technique of using a femoral distractor. J Orthop Trauma. 1992;6:271–8.

    Article  CAS  PubMed  Google Scholar 

  50. Baumgaertel F, Dahlen C, Stiletto R, Gotzen L. Technique of using the AO-femoral distractor for femoral intramedullary nailing. J Orthop Trauma. 1994;8:315–21.

    Article  CAS  PubMed  Google Scholar 

  51. Moed BR, Watson JT. Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique. J Orthop Trauma. 1994;8:195–202.

    Article  CAS  PubMed  Google Scholar 

  52. Forman JM, Urruela AM, Egol KA. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures. Acta Orthop Belg. 2011;77:802–8.

    PubMed  Google Scholar 

  53. Krettek C, Miclau T, Schandelmaier P, Stephan C, Mohlmann U, Tscherne H. The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma. 1999;13:550–3.

    Article  CAS  PubMed  Google Scholar 

  54. Shahulhameed A, Roberts CS, Ojike NI. Technique for precise placement of poller screws with intramedullary nailing of metaphyseal fractures of the femur and the tibia. Injury. 2011;42:136–9.

    Article  PubMed  Google Scholar 

  55. Ricci WM, O’Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma. 2001;15:264–70.

    Article  CAS  PubMed  Google Scholar 

  56. Winquist RA. Locked femoral nailing. J Am Acad Orthop Surg. 1993;1:95–105.

    PubMed  Google Scholar 

  57. El Attal R, Hansen M, Rosenberger R, Smekal V, Rommens PM, Blauth M. Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail. Oper Orthop Traumatol. 2011;23:397–410.

    Article  PubMed  Google Scholar 

  58. Hontzsch D, Blauth M, Attal R. Angle-stable fixation of intramedullary nails using the Angular Stable Locking System(R) (ASLS). Oper Orthop Traumatol. 2011;23:387–96.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Yoram A. Weil MD .

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Weil, Y.A., Mosheiff, R. (2015). Preoperative Planning. In: Rommens, P., Hessmann, M. (eds) Intramedullary Nailing. Springer, London. https://doi.org/10.1007/978-1-4471-6612-2_5

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  • DOI: https://doi.org/10.1007/978-1-4471-6612-2_5

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