Orthopaedic review
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Multicenter Study Clinical Trial
The treatment of open and/or unstable tibial fractures with an unreamed double-locked tibial nail.
A multicenter, prospective study was conducted to assess the efficacy of an unreamed, double-locked tibial nail for the acute management of open and/or unstable tibial fractures. Seventy-seven acute unstable and/or open tibial fractures in 74 patients were treated from December 1986 to February 1989. Forty fractures were closed and 37 were open; 25% occurred in polytraumatized patients and 39% of the patients had additional fractures. ⋯ Difficulty was encountered with proximal screw insertion in one third of the cases. Considering the high energy of these injuries, the treatment of open and/or unstable tibial fractures with an unreamed, double-locked tibial nail can offer the surgeon a high rate of union (97%) with minimal complications. The low infection rate found in this series indicates that this nail may be of particular benefit in the treatment of closed and select open tibial fractures.
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Fifty patients with intertrochanteric and subtrochanteric fractures of the femur were treated with closed reduction and internal fixation with Vector intramedullary nail (Biomet Inc, Warsaw, Indiana) and lag-screw fixation. Sixty-five percent of intertrochanteric fractures were unstable, with subtrochanteric extension in 12 cases. Lag-screw fixation preceded closed, unreamed nailing. ⋯ The Vector nail has recently been introduced as an alternative form of fixation for complex proximal femur fractures. In the present study, consistently good results were obtained, despite the stability or location of the fracture. We especially recommend using the Vector nail for managing complex, unstable intertrochanteric and subtrochanteric fractures.