A case of an adolescent female patient who suffered from first grade open multi-fragment fracture of the tibia (AO42-C2) with a large hypermobile intermediate fragment is presented in this case report. Intramedullary nailing of the tibia remains the treatment of choice despite a high risk of malformation and anterior knee pain especially in multi-fragment fractures. Here the suprapatellar appro...

PURPOSE To evaluate outcome of intramedullary nailing supplemented with Poller screws for proximal tibial fractures using small diameter nails. METHODS 50 men and 20 women (75 fractures) aged 18 to 65 (mean, 33) years underwent intramedullary nailing supplemented with Poller screws for acutely displaced fractures (n=60) or for delayed union (n=10) or mal-union (n=5) of the proximal metadiaphy...

Anterior midtibial stress fractures are an uncommon but difficult entity for the sports medicine physician. When a transverse radiolucent line is visible in the anterior tibial cortex ("the dreaded black line"), the problem takes on the characteristics of a nonunion and rarely responds to conservative treatment. We recommend taking a more aggressive approach with the use of electrical stimulati...

Broken screws after interlocking nailing of long bones are commonly seen in Orthopaedic practice. Removal of such screws can be difficult particularly the distal part which is often held within the bone. We describe a simple technique of using Steinman pin to aid removal of broken screws in a case of non-union fracture tibia with broken interlocking nail and screws. Steinman pin being easily av...

PURPOSE To evaluate treatment outcomes after intramedullary nailing using Ender nails for diaphyseal forearm fractures. METHODS 11 male and 9 female patients aged 6 to 15 (mean, 12) years underwent intramedullary nailing using Ender nails plus cast immobilisation for fractures of both the radius and ulna after conservative treatment had failed. RESULTS After a mean follow-up of 24 (range, 1...

BACKGROUND There are many ways to treat aseptic non-union of femoral shaft fractures with reported varied success rate. Amongst all these, Exchange nailing is the simplest and most successful technique for treating aseptic non union of femoral shaft fractures. We have carried out a prospective study in the Department of Trauma & Orthopaedics, Ayub Medical College Abbottabad to analyse the role ...

BACKGROUND The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population. METHODS A retrospective review of surgical databases at three ...

BACKGROUND Endoprosthetic reconstruction is widely applied for pathological fractures of the proximal humerus; however, functional impairment is usually unsatisfactory. The aims of the current study are to evaluate the reliability of interlocking intramedullary (IM) nailing with cement augmentation as a fixation method in proximal humeral lesions and to assess functional outcomes. METHODS We ...

BACKGROUND Metastatic disease to the shoulder girdle is a challenging problem because of the potential for pain, pathologic fracture and loss of function of that limb. Management of the bone disease centers around palliation, prevention of further complications and the preservation of residual function. A variety of surgical options exist for managing metastatic disease to the shoulder girdle a...

This article describes FRACAS, a computer-integrated orthopedic system for assisting surgeons in performing closed medullary nailing of long bone fractures. FRACAS's goal is to reduce the surgeon's cumulative exposure to radiation and surgical complications associated with alignment and positioning errors of bone fragments, nail insertion, and distal screw locking. It replaces uncorrelated, sta...