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BASIC CONCEPTS
Dr.S.V.Hari krishnan
PGT , M.S .(Ortho)
Learning Objectives
Introduction
Evolution
Classification
Biomechanics
Applications
Special Circumstances
Recent Advances
Introduction
Fracture stabilized by one of two systems
Compression
Splinting
Centromedullary Antegrade
K nail Retrograde
Cephalomedullary
Gamma nail
Russell taylor nail
PFN
Condylocephalic nail
Ender nail
Centromedullary Nails
First generation
Floating hip, floating knee, floating elbow. Open fractures up to grade IIIA
IM Nail Plate
D D
Bending moment for plate
greater due to force being applied
over larger distance.
Comparision
• Nail cross section round
• Resisting loads equally in all
directions.
+ - compressive loads borne
by bony cortex
- - compressive loads
transferred to interlocking
screws (“four-point bending
of screws ”)
Ideal Intramedullary Nail
Strong and stable - maintain alignment and position
Principle :
Resistance to axial and torsional forces depends on
screw – bone interface
Length of bone maintained even in bone defect.
Number of interlocks :
Fracture location
Amount of fracture comminution
Fit of nail within canal.
Corrects mal-alignment.
Centers IM nail.
Indications :
Communited
Spiral
Pathological fractures
Fractures with bone loss
Atropic non union
Dynamic locking
Screws inserted only at one end (short fragment)
Indications
Fractures with good bone contact
Non unions
Indications
Established nonnunion
Pseudoarthrosis
Secondary Dynamisation
Removing interlocking screw from longer fragment
/ moving proximal interlocking screw from static to
dynamic slot in nail
High chance of embolization of bone marrow fat to lungs but this phenomenon is limited &
transient
Skin scars
increased risk of infection after use of external fixation pins longer than 2
weeks followed by reamed intramedullary nailing.
Cement nail elute high concentration of antibiotic in local sites for up to 36 weeks.
Antibiotic impregnated cement nail
Nailing in damage control orthopaedics (DCO)/early total care (ETC)
Indications :
Patient request(after union)
Pain, swelling secondary to backing out of implant.
Infected nailing
Femoral nail removed after 24-36 months , tibial nail 18-24 months
Failure
When fracture healing is delayed or nonunion occurs.