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Re: Fixion nails
послал Erden Kilic 11 Март 2006, 20:19
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Mr. Chelnokov and group members,
I have graduated three months ago as an orthopedic
surgeon from Gülhane Military Medical Academy in
Turkey and my thesis was about the fixion nail in long bone fractures. So I would like to share my opinions about the fixion nail.
Fixion nails biomechanically behave as classic Küntscher nails because its stability depends on friction force between the bone and the nail surface.
Fixion nails have a contact surface much more than the classic Küntscher nail where its contact is just around the isthmus. Therefore it has better axial loading capabilities. Also inflation under pressure somewhat improves the axial stability. Rotational stability is achieved by for longitudinal bars.
Inflation of the nail forces and collapses the cancellous bone and embeds the bars in to the cancellous bone, preventing rotation.
Its main indication is long bone diaphyseal fractures, mainly AO type 1 and 2 fractures; it may not provide enough stability in type 3 fractures and fractures distal to the isthmus. Proximal fractures can be treated with proximal interlocking fixion nails and distal fractures with retrograde locking supracondylar nails.
I may list the advantages chronically as follows:
Deflated nail when inserting, optional reaming, bullet shaped tip, manipulation with its insertion handle favors closed nailing. Humeral and tibial closed nailing can be possible even without fluoroscopy.
Minimal incision can be used in femur fractures.
Operation time is really shortened because distal
locking is not required and reaming is optional. Full endosteal contact increases its stability, therefore early rehabilitation is possible. Its biomechanics allowing axial loading favors callus maturation.
Special considerations when using these nails can be expressed as follows. It is important to examine preoperative radiographs carefully because a missed fissure can turn out to be a spiral fracture when nail is inflated. Axially unstable fractures are not suitable for fixion nails because it cannot provide enough stability, it can separate fracture fragments when inflated, may result in limb shortening. So locking nails or ECF are still possible solutions for these fractures. When treating proximal and distal fractures fixion nails should be used cautiously because its stability decreases as fracture line comes closer to joints.
It is really an expensive implant which renders its use. Its expense and advantages for the patient and the surgeon should be weighed to decide the treatment. But it is not a candidate to replace locking nails.
Rather it has expanded the indications of Künstcher nails.
Those were my personal opinions which are mostly in theory because we do not yet have evidence based trials of these nails. Studies are mostly case series as our study, and it formed our basic experience about the fixion nail.
I would welcome any specific question about the nail.
Erden KILIC
Konya Military Hospital,
Konya, Turkey
(City of Mevlana, great philosophier of Anatolia, UN has accepted 2007 as "Mevlana" year.)
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