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Re: Fixion nails
Alexander Chelnokov 12 Март 2006, 18:31
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EK> mainly AO type 1 and 2 fractures; it may not provide
EK> enough stability in type 3 fractures and fractures
EK> distal to the isthmus.
Looks very reasonable.
EK> I may list the advantages chronically as follows:
EK> Minimal incision can be used in femur fractures.
What specific is in this for Fixion nails? Skin incision in interlocking nailing can be limited to nail diameter - it depends on the insertion handle design not a nail itself.
EK> preoperative radiographs carefully because
EK> a missed fissure can turn out to be a spiral fracture when nail is
EK> inflated. Axially unstable fractures are not suitable for fixion
EK> nails because it cannot provide enough stability, it can separate
EK> fracture fragments when inflated, may result in limb shortening.
THX, it is what i mainly was interested to confirm.
EK> theory because we do not yet have evidence based
EK> trials of these nails.
Many of your statements about the nails looks self-evident so RCT hardly ever are necessary to confirm that the missed fissure can expand
with inflating or that subisthmal fractures are less sable for this sort of nails.
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Re: Fixion nails
Erden Kilic 12 Март 2006, 18:35
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You are right. Diameter of unreamed locking nails is less than diameter of the isthmus. But these nails have a high incidence of delayed union, non-union and secondary procedures for union.
I meant that fixion's deflated diameter which is at least 2-3 mm less than the diameter of the bone, helps its insertion. In classic Kьnstcher or reamed locking nails, nail is inserted by force through the medullary canal and with some resistance. With fixion nails you can easily insert without reaming; actually it is the
same in unreamed nails.
I emphasized to use minimal incision through the fracture site in femoral fractures to help reduction and insertion of nail when surgeon does not have fluoroscopy. In fact the inventory you need to achieve operation is reasonably reduced, three nails, one you need, one longer and one shorter to be used in case, and the small insertion set.
Fractures proximal and distal to isthmus can be
managed by these nails, as it increases the contact area. Fractures very close to joints can be fixed with locking types of fixion nails.
I believe that important issues about these nails are: reduced operation time by easy insertion, optional reaming and no distal locking, reduced inventory, no floroscopy so no radiation to patient and to us.
I also want to add that biomechanics of these nails allow axial compression like Kьntscher nails. It resolves the stability problems of Kьnstcher nails and expands its indications. But indications of these fixion nails stand still between Kьntscher and locking nails.
Best regards.
Erden KILIC, MD
Konya Military Hospital
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