Clinical and radiological midterm results from using the Fixion expandable intramedullary nail in transverse and short oblique fractures of femur and tibia

Development of an additively-manufactured functionally-graded expandable implant via the application of the adaptive response surface method: feasibility study on intramedullary humerus nail

The paper introduces the concept of the rational design of a deployable humeral intramedullary nail plug based on a honeycomb structure used for the surgical treatment of humeral shaft fractures. The concept serves for to restore the axial alignment of bone fragments and to maintain stability via bone-nail friction and locking screws. The design nail plug was gained by optimisation process the Latin Hypercube Sampling Design algorithm and Multi-Objective Genetic Algorithm. It was shown that we can use statistical shape function combined by 3 D printing for designing of a new rationally designed implants.

Expandable intramedullary nails in lower limb trauma: a systematic review of clinical and radiological outcomes

This study systematically reviews the evidence-base for the use of expandable nails in the treatment of acute diaphyseal fractures of the lower limb. Both electronic and hand searches were undertaken of the published and grey literature to 1 December 2011. A total of 154 citations were identified, of which 15 were deemed suitable and assessed with the Critical Appraisals Skills Programme tool. A total of 625 nailing procedures were performed in 620 patients: 279 femoral and 346 tibial nails. The expandable nail was found to be significantly quicker to insert than interlocked nails (p < 0.05), and the total incidence of non-union or other complication was 13 and 14 % for expandable femoral and tibial nails, respectively. Notable complications with the expandable nail included fracture propagation on nail inflation in 2.5 % and post-operative shortening in 3.3 %. Device failure secondary to problems with the expansion mechanism was seen in 2.9 %. The rate of non-union and infection following expandable nailing was 3.1 and 1.4 %, respectively. Despite promising initial results, there remains a paucity of good quality studies to support the use of expandable nails over interlocked nails for the treatment of acute diaphyseal fractures of the lower limb.

Expandable intramedullary nails for humeral fractures: a systematic review of clinical and radiological outcomes

The Fixion(™) system (Disc-O-Tech Medical Technologies, Herzeliya, Israel), which is currently the only expandable nailing system available for use in the humerus, has a number of purported advantages over the standard locked humeral nail, including a reduction in operating and fluoroscopy time since locking screws are not required. A systematic review was undertaken of all published (AMED, CINAHL, EMBASE and Medline via the Ovid platform) and unpublished or grey literature research databases from inception until 1st December 2010. Demographic data, clinical and radiological outcomes, and complications were extracted from each study by two independent investigators, and each study underwent independent critical appraisal using the CASP appraisal tool. Thirteen studies were deemed eligible for review, identified from a total of 154 citations. These included a total of 176 patients with 180 fractured humeri treated with expandable nails. Overall, 7.8% of humeral fractures treated with an expandable nail went on to non-union. Intra- and post-operative device failure rate was found to be 1.1 and 2.8%, respectively. These data compare favourably to published data on the outcome of locked humeral nails. However, there were numerous methodological flaws in the current evidence base; there were no comparative studies, treatment groups were heterogeneous, and there was no blinding of assessors or patients. Initial data indicate that the expandable humeral nail may be an acceptable form of treatment for humeral fracture or impending fracture, but high-quality comparative studies are needed to confirm these findings.

Treatment of acute tibial shaft fractures with an expandable nailing system: a systematic review of the literature

Locked Intramedullary Nailing is an established method of treatment for tibial shaft fractures. Locking of tibial nails is however not without its drawbacks. Locking is time consuming, and is associated with a noteworthy complication rate. The Fixion IM nailing system is an expandable nail designed to eliminate some of these drawbacks. We have performed a systematic review of the literature to determine the safety and efficacy of this system. Publications examining the use of the Fixion system were identified from the MEDLINE and the Cochrane databases. Forty-one citations were generated by the MEDLINE search. Of these, two quasi-randomised trials and eight case series satisfied our selection criteria and were reviewed. Overall the average reoperation rate for the Fixion nail was 10.2%. Shortening occurred in 3% of cases and fracture propagation was reported in 2% of cases. The Fixion cohort united at an average of 12.2 weeks and the average operative time was 54 minutes. The Fixion system eliminated complications and reoperations associated with the use of locking screws. Further studies in the form of randomised controlled trials are needed to evaluate the Fixion system against conventional locked nails.

Early results of retrograde expandable nail fixation of 29 distal femoral fractures

The authors retrospectively reviewed 27 consecutive patients with 29 fractures of the distal femur treated with the new retrograde expandable nail. One 10-mm diameter nail that expands to 16 mm was used with the possibility of locking in the condylar area only. Retrieved data included single versus multiple injuries, fracture type, operation time, reaming or nonreaming, hospitalization and healing times, and intra- and postoperative complications. The overall average operation time was 96 (range 40-320) minutes, but only 65 (range 40-120) minutes for isolated fractures. The overall mean hospitalization time was 16 (range 3-40) days, but only 7 (range 4-10) days for isolated fractures. Follow-up continued until fracture healing or for a minimum of 1 year (average 14 months, range 12-24 months). The average clinical union time was 83 (range 43-179) days, and the mean radiographic healing was 87 (range 43-179) days. One patient developed a nonunion that required exchange of the nail to the same device. Another patient underwent hardware removal during a procedure for a torn meniscus. These preliminary results demonstrate satisfactory healing and alignment for the treatment of distal femoral shaft fractures by means of this new device without jeopardizing the knee joint by nail protrusion.