Abstract
Interlocking nails are commonly performed using an image intensifier. These are expensive and are not readily available in most resource-poor countries of the world. The aim of this study was to achieve interlocking nailing without the use of an image intensifier. This is a prospective descriptive analysis of 40 consecutive cases seen with shaft fractures of the humerus, femur, and tibia. Fracture fixation was done using Surgical Implant Generation Network (SIGN) nails. Forty limbs in 34 patients were studied. There were 12 females and 22 males, giving a ratio of 1:2. The mean age (years) was 35.75±13.16 and the range was 17–70 years. The studied bones were: humerus 10%, femur 65%, and tibia 25%. The fracture lines were: transverse 40%, oblique 15%, and communited 45%. Fracture grades were: closed 90%, grade I, 5%, grade II, 2.5%, and grade IIIA, 2.5%. Surgical approaches were: antegrade 62.5% and retrograde 37.5%. Indications for fixation were: recent fracture 92.5%, non-union 5%, and malunion 3%. Methods of reductions were: open 85% and closed 15%. The mean follow-up period (years) was 1.50±0.78. The union time averaged 3 months. Complication was mainly screw loosening due to severe osteoporoses in one case. It is, therefore, concluded that, with the aid of external jigs and slot finders, interlocking can be achieved without an image intensifier.
Résumé
Les clous verrouillés sont d’utilisation commode mais demande une imagerie dans leur utilisation. Cette imagerie est chère et ne peut être réalisée de façon valable dans les pays pauvres. Le but de cette étude est de montrer que le verrouillage des clous peut se faire sans l’utilisation d’une imagerie. Il s’agit d’une étude prospective de 40 cas de fracture de la diaphyse humérale, fémorale ou tibiale, la fixation de ces fractures étant réalisée par un clou de type SIGN. 40 membres chez 34 patients ont été étudiés, 12 femmes, 22 hommes (ratio de 12). L’âge moyen a été de 35,75±13,16 s’échelonnant de 17 à 70 ans. Les fractures affectaient l’humérus dans 10% des cas, le fémur dans 65% des cas et le tibia dans 25% des cas. La fracture était transverse dans 40% des cas, oblique dans 15% et communitive dans 45% des cas. Il s’agissait d’une fracture fermée dans 9 cas sur 10. Lorsqu’elle était ouverte, de grade I dans 5%, de grade II dans 2,5% et de grade IIIA dans 2,5%. L’approche chirurgicale a été antérieure dans 62,5% des cas et postérieure dans 37,5% des cas. Il s’agissait d’enclouage pour fixer une fracture fraîche dans 92,5% des cas, après pseudarthrose dans 5% des cas et cal vicieux dans 3% des cas. La réduction a été réalisée par voie sanglante dans 85% des cas, à foyer fermé dans 5% des cas. Le suivi moyen a été de 1,50±0,78, la consolidation a été obtenue en moyenne en 3 mois. Une seule complication avec mobilisation d’une vis après une ostéoporose sévère a été observée dans un seul cas. Nous pouvons conclure qu’il est possible, grâce à la méthode que nous décrivons de verrouiller un clou sans imagerie.
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Acknowledgment
SIGN (Surgical Implant Generation Network), founded by Dr. Lewis G. Zirkle, was created in 1999 as a humanitarian, non-profit corporation in Washington, USA, with a goal to provide improved health care and proper orthopedic treatment of fracture at little or no cost to people in need throughout the world. All implants and instrumentations (FDA-approved) were provided free of cost by SIGN, USA, to our institutions in Nigeria.
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Ikem, I.C., Ogunlusi, J.D. & Ine, H.R. Achieving interlocking nails without using an image intensifier. International Orthopaedics (SICO 31, 487–490 (2007). https://doi.org/10.1007/s00264-006-0219-3
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DOI: https://doi.org/10.1007/s00264-006-0219-3