The Old Begets the New: Trochanteric Nail Insertion for Femoral Shaft Fractures, Revisited
Purpose : Intramedullary (IM) nailing of femoral shaft fractures through a trochanteric starting point with the patient in a lateral decubitus position was popularized in the 1940s by G. Kuntscher. Large diameter nails (without locks) were used to obtain an interference...

OTA 2002 - Session 2 Session II - Post-Traumatic Reconstruction Fri., 10/11/02 Post Traumatic Reconstruction, Paper #10, 3:06 PM *Arthroscopically Assisted Removal of Retrograde Femoral Nails: Description of Technique and Intraarticular Findings at Long-Term Follow-Up Christopher T. Born, MD, FACS (a-Smith + Nephew, Synthes, USA, Howmedica; b-Zimmer; e-Stryker Howmedica Osteonics); Paul...

Extensive Menu on this subject - topics -
Work Up: anesthesia, medical considerations, and timing of surgery - X-rays for Femoral Neck...

TRODUCTION: There are limited data on hardware removal after femoral fracture healing. We determined the incidence of intramedullary nail (IMN) removal after midshaft femoral fractures. We also studied demographic factors influencing IMN removal. METHODS: The senior author reviewed all adult femoral fractures with IMN placement in the trauma practice between...

Case presentation We report the case of an 80-year-old Caucasian woman with a subtrochanteric fracture originally treated using a trochanteric gamma nail which failed, resulting in a nonunion and fracture of its proximal end. The nonunion was revised with the removal of the broken trochanteric gamma nail, application of a condylar...

Removal of intramedullary nails often is relegated to younger surgeons but may be difficult and challenging. We describe difficulties with removal of an incarcerated expandable femoral nail and a new technique for retrograde mobilization of an intramedullary nail through a small infrapatellar incision. No special device was necessary for successful...

METHODS: Between October 1996 and December 2002, 286 femoral fractures, 211 tibial fractures, and 47 humeral fractures were repaired using variously designed interlocking nails. Fracture pattern, level and site, nail size and type, weight bearing after nailing, and union status were reviewed after a mean follow-up of 22 months. RESULTS:...

PURPOSE: To study clinical and mechanical factors that predispose to failure of interlocking nails. METHODS: Between October 1996 and December 2002, 286 femoral fractures, 211 tibial fractures, and 47 humeral fractures were repaired using variously designed interlocking nails. Fracture pattern, level and site, nail size and type, weight bearing after...

AO Foundation Case Discussion September 2003 Male patient 35 years old who had a motorcycle accident with a closed left femoral fracture. No other injuries. 1. Fracture Male patient 35 years old who had a motorcycle accident with a closed left femoral fracture. No other injuries. Discussion Classification: Is this a...

OTA paper 1998: This study examines the effects of retrograde femoral nail insertion on the biomechanics of the patello-femoral joint.

OTA paper 2004: The purpose of this study was to compare results of femoral shaft fracture treatment with use of a nail designed specifically for trochanteric entry, Trigen TAN, to results with use of an identical nail without a trochanteric bend inserted through the piriformis fossa, Trigen FAN.

OTA abstract 2002
This technique allows for the evaluation and treatment of potentially painful intraarticular pathologic conditions after femur fracture and subsequent retrograde nailing. In our series, 88% of patients were found to have some identifiable pathologic condition most likely related to the index injury and not to the nail or...

Conclusion Favourable fixation of unstable complex femoral fractures in the elderly population can be achieved with the Russell-Taylor reconstruction nail. However, use of this device in this frail population was associated with a high implant complication and mortality rate that undoubtedly reflected the severity of the injury sustained, co-morbidity within the...

Wheeless Textbook of Orthopaedics Discussion: - known risk factors include notching of the femur, osteoporosis, and excessive polyethylene wear (w/ subsequent osteolytic defect) - Radiographs: - often oblique radiographs are needs as well as AP and Lateral views, due to the rotation of the distal fragment; ...

OTA paper 1998 Randomized Clinical Trial: The objective of this clinical trial was to determine if the type of intramedullary nail fixation (IMN) in acute femoral shaft fractures affects pulmonary function.

Abstract: Clinical Orthopaedics & Related Research. (423):222-226, June 2004. Gosling, Thomas MD; Hufner, Tobias MD; Hankemeier, Stefan MD; Zelle, Boris A MD; Muller-Heine, Assia MD; Krettek, Christian FRACS

OTA poster/paper 1998 The etiology of the radiographic findings of osteolysis and periosteal reaction is not specifically known, but the presence of corrosion products at the taper junctions suggests particulate debris as a factor. There was an association between the radiographic abnormalities (osteolysis and periosteal reaction) and thigh pain and elevated...

Discussion:
- IM may be most reliable technique for achieving union;
- w/ TKR infection, IM fusion needs to be performed in a staged fasion with removal of components and control of infection before fusion is attempted;
- contra indications:
 - active infection:
   - presence of active infection because of risk of infection spreading...

We have used total hip replacement combined with cemented intramedullary nailing to treat a selected group of nine patients with pathological fractures of the proximal femur and impending fractures of the shaft due to metastases. One patient died from cardiopulmonary failure on the third postoperative day, but the others were able to walk within the first...