By A. Grosse, I. Kempf, K.S. Leung, H.J.T.M. Haarman, H. Seidel, G.J.T.M. Taglang
This publication specializes in the interior fixation of lengthy bones by utilizing intramedullary locked nails in a closed process. Intramedullary fixation fulfils the organic standards for fracture therapeutic and minimises surgical trauma. Locked nails supply a beneficial mechanical atmosphere for fracture stabilisation and post-operative rehabilitation. It illustrates the use and relevance of this method in orthopaedic and trauma surgical procedure together with reconstructive surgical procedure, masking the elemental medical rules of reaming and locking in addition to easy and complicated surgical suggestions. Prevention of problems and hardship administration are mentioned intimately. a global board of editors and authors stand for services within the diversified subspecialties of the subject. complete details is hence supplied permitting the reader to reliably use the innovations described.
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Extra resources for Practice of Intramedullary Locked Nails: Advanced Techniques and Special Applications Recommended by “Association Internationale pour l’OstéosynthÈse Dynamique” (AIOD)
Once an adequate debridement has been performed, the fracture can be nailed. The technique of nailing Gustilo type I, II, and IIIA open fractures is exactly the same as the technique employed for closed fractures. Fracture reduction is usually straightforward and the reduced fracture can be held with a bone clamp. In Gustilo type IIIB fractures the situation is somewhat different. In these fractures there will often be significant bone loss and therefore in some Gustilo type IIIB fractures the surgeon may experience difficulty in assessing bone length.
Nail Insertion The nail is inserted after checking its length (determined by the difference method between 2 guidewires of identical length ± one in the shaft and the other outside of the bone). The nail is introduced over a nailing guidewire; a Teflon tube is used to exchange the reaming guidewire. The diameter is usually 11 mm, except in very narrow tibiae where 10-mm and even 9-mm nails can be used. In proximal fractures, there is a risk of damaging the posterior cortex and/or displacing the fracture.
However, the other area of contention is the effect reaming has on the vascularity of the bone. This debate concerns the tibia more than other bones and it is suggested by proponents of unreamed nailing that reaming damages the intramedullary vasculature in a tibia whose nutrient artery is already damaged by the effects of the open fracture. The resulting avascularity is said to increase the incidence of infection and nonunion as well as raise the intracompartmental pressure in the soft tissues, thereby inducing compartment syndrome.