Objective To investigate an effect of the Fixion expandable intramedullary nail on treatment of the closed fracture of the tibial shaft, and to compare the Fixion nail with the traditional locked intramendullary nail.Methods From September 1, 2005 to August 31, 2006, 79 patients (53 men, 26 women; aged 17-57 years, 37 years on average) with the closed fracture of the tibial shaft were treated with the Fixion expandable intramedullary nail, and the effect of the nail was evaluated. According to the AO classification, the patients were typed as Type 42A or Type 42B. And the patients were divided into the following two groups: the expandable intramedullary nail group (n=31) and the traditional locked intramedullary nail group (n=48). Of the 31 patents in the first group, 24 were of Type 42A and 7 were of Type 42B; of the 48 patients in the second group, 37 were of Type 42A and 11 were of Type 42B. All the patients were followed up after operation. Observation was made on the time of the bony callus development and the time of the clinical healing of the bone,and on whether there was the bone malunion, late healing, disunion or infection. The limb function was also evaluated.Results The follow-up of all the 79 patients for 4-15 months averaged 10.3 months revealed that in the expandable intramedullary nail group, the average operating time was 35 minutes (range, 20-60 minutes), with no requirement of blood transfusion. The X-ray examination showed that the bony callus developed as early as 4 weeks after operation. The clinical healing time of the bone was 3-8 months, averaged 5 months. All the patients in this group had the healing by first intention. Evaluatedby the Johner-Wruhs method, an excellent result was found in 28 patients, goodin 3 patients, and poor in none of the patients, with an excellent/good rate of100%. In the traditional locked intramedullary nail group, the average operating time was 75 minutes (range, 45-110 minutes), with no requirement of blood transfusion. The X-ray examination showed that the bony callus developed as early as 4.5 weeks after operation. The clinical healing time was 3-12 months, averaged 5.8 months. In this group, 46 patients had the healing by first intention and 2 patients had the healing by second intention. Evaluated by the JohnerWruhs method,an excellent result was found in 35 patients, good in 11 patients, and fair in 2 patients, with an excellent/good rate of 95.8%.Conclusion The expandable intramedullary nail treatment has advantages of less invasion, simpler manipulation, earlier weightbearing of the bone, quicker healing ofthe bone fracture, and fewer complications. This kind of treatment is worth popularizing in the medical practice if the indication is strictly controlled.
Objective To compare the effectiveness of two minimally invasive methods: minimally invasive plating osteosynthesis (MIPO) and expandable intramedullary nail ing technique in treatment of middle third humeral shaft fractures. Methods The cl inical data were retrospectively analyzed and compared from 33 cases with middle third humeral shaft fractures between May 2004 and December 2008. All the patients were divided into 2 groups: 14 patients were treated with MIPOtechnique (group A) and 19 with expandable intramedullary nail ing technique (group B). In group A, there were 10 males and 4 females with an average age of 35 years (range, 21-51 years). The disease cause was traffic accident in 5 cases, tumbl ing in 6 cases, machine related trauma in 2 cases, crushed by a heavy object in 1 case. Six fractures were classified as AO type A, 6 as type B, and 2 as type C. The time from injury to operation was 3 to 11 days with an average of 5.9 days. In group B, there were 12 males and 7 females with an average age of 40 years (range, 19-68 years). The disease cause was traffic accident in 7 cases, tumbl ing in 8 cases, fall ing from height in 3 cases, crush injury in 1 case. Ten fractures were classified as AO type A, 8 as type B, and 1 as type C. The time from injury to operation was 2 to 6 days with an average of 4.2 days. There was no significant difference in general data between 2 groups (P gt; 0.05). Results The operation time was (104.6 ± 25.8) minutes in group A and (85.0 ± 35.7) minutes in group B, showing no significant difference (P gt; 0.05). Incision healed by first intention without iatrogenic radial nerve palsy in 2 groups. The patientswere followed up 21.4 months on average (range, 12-37 months) in group A and 20.5 months on average (range, 22-35 months) in group B. The X-ray films showed bony heal ing in all patients. The fracture union time was (16.4 ± 6.1) weeks in group A and (15.0 ± 2.5) weeks in group B, showing no significant difference (P gt; 0.05). The University of Cal ifornia Los Angeles (UCLA) End- Result scores were 34.1 ± 1.1 in group A and 31.8 ± 2.6 in group B and the Mayo Elbow Performance scores were 100 in group A and 97.6 ± 3.9 in group B; all showing significant differences (P lt; 0.05). Conclusion Good cl inical outcomes could be obtained when middle third humeral shaft fractures are treated by either MIPO or expandable intramedullary nail ing techniques. However, MIPO technique could offer better shoulder and elbow functional results.