The Development Of Dynamic And Static Exchange Type Of Interlocking Intramedullary Nails And The Clinical Application Research Of It

Objective: To evaluate the effect in the treatment of tibial shaft fractures with a new Dynamic and static exchange type of interlocking intramedullary nail.Methods: From April 2009 to December 2012, 33 patients with tibial fracture were treated by this new dynamic and static exchange type tibial bone marrow nail. Among the 33 cases, 26 man and 7 women were in this study(ranging from 20 to 63 years old). The fractures happened at tibia and fibula in 23 cases and at tibial fractures in 10 cases. There were 6 cases of open fractures and 27 cases of closed fractures. There were 2 cases of tibia fracture, 8 cases in middle lower segment and 23 cases in middle segment. There were 10 cases of emergency operation and 23 patients undergoing elective operation. 5 locking screws were locked, and the distal common hole was removed in 3 mouths later, which can achieve motorization in the condition of ensuring fracture alignment. After 3 months, the implementation of static locking nail was taken out and all patients were with complete or partial weight-bearing to increase the longitudinal stress and fracture healing. If the dynamic locking nail was at the top of the sliding hole based on the X-ray after operation and the fracture was not healed, taken out of the dynamic locking nail was to achieve second motorization and promote fracture healing.Results: All cases were followed up. 33 cases of patients were available for the follow-up(ranging from 10 to 28 months). There were 21 cases with dynamic and 10 cases without dynamic. The dynamic time was from 12 to 28 weeks after operation. 3 cases were with second dynamic after 12 and 20 weeks postoperatively. The fracture healing time was from 6 to 12 months. The fixations were removed after operation ranged from 14 to 28 months. No infection, skin necrosis or fixation breakage occurred in the latest follow-up. No shortening of limbs, internal rotation and valgus deformity, osteomyelitis or bones ununion happened after motorization. All cases were evaluated by the standard of Johner-wruhs in treatment of tibial shaft fractures(32 in excellent function and 1 in good).Conclusion: The treatment of tibial shaft fractures using this type of dynamic and static exchange tibial intramedullary nail need early static fixation. After the fracture healing process obtains stablization relatively, early dynamic should be implemented to increase the effective stimulation of the fracture and promote fracture healing. This new type of dynamic and static interlocking intramedullary nail can avoid or overcome the defects and limits of common interlocking intramedullary nail effectively. It can also promote fracture healing. This new type of intramedullary interlocking nail is an ideal method for treatment of osteomyelitis, nonunion or fixation breakage.