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Tanna’s Interlocking Nailing
DD Tanna, Sushrut Babhulkar
CHAPTER 1:
Introduction to Interlocking Nailing
EVOLUTION
BIOMECHANICS
BIOLOGY
FRACTURE HEALING FOLLOWING INTRAMEDULLARY NAILING
CHAPTER 2:
Interlocking Tibia Nail
DESIGN OF TIBIA NAILS
INDICATIONS FOR INTERLOCKING NAILING
PREOPERATIVE ASSESSMENT FOR INTERLOCKING NAIL
Site of Fracture
Bone
Size of the Medullary Canal
Bone Quality
CLOSED NAILING OF THE TIBIA
PROCEDURE
Position of the Patient
Fracture Reduction
Surgery on Ordinary Table
Procedure for Both Positions
Point of Entry
Suprapatellar Incision (Figs 2.16A to D)
Problems of Point of Entry
Reduction
Insertion of Guidewire
Reaming
Insertion of Nail
Assessment of Nail Length
DISTAL LOCKING
Steps
Free Hand Technique
C-arm Mounted Jig: Gross Lafforgue Device (Fig. 2.28)
With Laser
Orthofix
Navigation System
Distal Locking if the C-arm Conks out during Surgery
Distal Locking without C-arm
TRAPS TO BE AVOIDED DURING INTERLOCKING TIBIA NAIL
CHAPTER 3:
Lower One-third Fracture of the Tibia
DISTAL THIRD TIBIAL FRACTURES
ANATOMY
Which Fractures can be Nailed?
Tibial Nail Designs
Number of Screws
Direction of Screws
Reduction of Fracture
Reduction
Reduction Tricks
CHAPTER 4:
Upper One-third and One-fourth Tibia
ANATOMY OF PROXIMAL TIBIA
INTRAMEDULLARY NAILING (FIG. 4.2)
PREPARATION
POSITIONING AND ENTRY POINT (FIGS 4.3 AND 4.4)
AUTHORS’ PREFERRED METHOD
REDUCTION
POLLER SCREWS (FIGS 4.7 TO 4.9)
NAIL LOCKING
CASES (FIGS 4.10 TO 4.17)
CHAPTER 5:
Locked Nails of the Femur
CLOSED NAILING OF THE FEMUR
PROCEDURE
Position
Supine Position
Lateral Position
Reduction in Supine Position
Incision
Point of Entry
Introduction of Guidewire
Correction of Rotation During Reduction
Insertion of Nail
Lower One-third Femur
Insertion of the Interlocking Screws
Distal Locking of the Femur
Proximal Locking of Femur
Good Interlocking Nail in Mid Shaft Femur
CHAPTER 6:
Tips on Tibia and Femur
OBSERVATIONS AND TIPS IN THE USE OF THE INTERLOCKING NAILING PROCEDURE IN THE TIBIA AND FEMUR
CHAPTER 7:
Open Fractures
INFECTION
CHAPTER 8:
Reaming
REAMING IN A NONUNION OR A MALUNION
CONTROVERSY OVER REAMED AND UNREAMED NAILS
Effect of Reaming on Circulation
Reaming and Embolism
Role of Reaming in Osteoinduction
Role of Reaming in Stability
REAMING IN OSTEOPETROSIS OR MARBLE BONE DISEASE
NEW DEVELOPMENTS IN REAMING
CHAPTER 9:
Nonunion Aseptic
INTRODUCTION
MANAGEMENT OF NONINFECTED TIBIA NONUNIONS
NONUNION PROXIMAL TIBIA
METAPHYSEAL AND DIAPHYSEAL NONUNION
Diaphyseal Nonunion
NONUNION DISTAL TIBIA
INFECTED NONUNION
CONGENITAL PSEUDARTHROSIS OF THE TIBIA
CONCLUSION
CHAPTER 10:
Complications Associated with Procedure of Nailing and Locking, and Implant Removal
BROKEN DRILL BIT
BROKEN SCREW
BENDING OF NAIL
NAIL BREAKAGE
Removal by Open Method
Removal by Closed Method
CHAPTER 11:
Complications of Internal Fixation by Proximal Femoral Nail
CONTRAINDICATIONS
METHOD OF PROXIMAL FEMORAL NAIL SURGERY
Position of the Patient
Reduction of Fracture
Incision
Entry Point (Fig. 11.4)
Assemble the Instruments on Jig (Figs 11.5A and B)
Insertion of the Nail
Insertion of the Guidewire in the Neck (Figs 11.7A and B)
Insertion of the Screws (Figs 11.8A and B)
Drill Hole for Distal Locking (Figs 11.9A and B)
Closer of the Wound
Postoperative Regime
COMPLICATIONS
Medical Complications
Surgical Complications
Technical Intraoperative Complications
Breakage of Drill Bits
Suboptimal Entry Point of Nail
Poor Position of Fixation or Malposition of the Hip Screw
PFNs had the Wrong Screw Length
Distal Interlocking Problem
Malrotation of the Femoral Shaft
Femoral Shaft Fracture
Technical and Mechanical Complications of the PFN System Published in the Literature
Early Postoperative Complications
Hematoma, Superficial Wound Infection and Deep Infection
Cut-out of the Screws
Lateral Migration Hip Screw(s)
Medial Protrusion Hip Screw (Slide Failure)
Shaft Fracture
Z-Effect and Reverse Z-Effect
Progressive Varus and Shortening
Thigh Pain
Late Postoperative Complications
Delayed Union and Nonunion
Malunion
Breakage of Nail
Breakage of Screws
Osteolysis at the Tip of Trochanter and Trochanteric Bursa Formation
Heterotropic and Ectopic Calcification
Peri-nailar Fracture
Avascular Necrosis of Femoral Head
Osteitis at Site of the Distal Locking Screws and Thigh Pain
Abductor Lurch
Prevention of Complications
CHAPTER 12:
Ipsilateral Femoral Neck Fracture and Shaft Femur Fracture
MECHANISM OF INJURY
Management
Illustrations
Postoperative Protocol
Complications
CONCLUSION
CHAPTER 13:
Subtrochanteric Fractures
CLASSIFICATION
Biomechanical Factors
Intramedullary Devices
PROCEDURE
Reduction of the Fracture
Reaming and Nailing
95° Degree AO Angle Blade Plate
Dynamic Condylar Screw Plate
DISCUSSION
Mechanical Complications
Loss of Proximal Fixation
Fracture Shaft Femur
Nonunion–Delayed Union
Malunion
PAINFUL HARDWARE
CONCLUSION
CHAPTER 14:
Fractures of Proximal Femur
PROCEDURE
PROBLEMS AND THEIR SOLUTIONS
Resistance to Nail Insertion
Proximal Migration of Nail while Drilling the Neck
Distal Repositioning
SUBTROCHANTERIC FRACTURE
PROXIMAL SUBTROCHANTERIC FRACTURE
CHAPTER 15:
Supracondylar Nail
SURGICAL TECHNIQUE
Preoperative Planning
Assessment of Nail Length and Size
Patient Positioning
Surgical Procedure
POSTOPERATIVE CARE
PLANNING THE SURGERY IN INTRA-ARTICULAR AND SUPRACONDYLAR FRACTURES
Retrograde Femur Nail
Locking Plate
Distal Femur Plate
CHAPTER 16:
Fracture Humerus Interlocking Nail
INTRODUCTION
PROCEDURES
Patient Positioning
Incision Planning
Conventional Nailing
Nail Length Selection
Assessment of Nail Length (Figs 16.36 to 16.38)
Guidewire Method
Radiographic Ruler Method
Reaming
Nail Insertion
Postoperative Care
Retrograde Nailing of Humerus
CLINICAL CASE 1 (FIGS 16.31 TO 16.33)
CLINICAL CASE 2 (FIG. 16.34)
CLINICAL CASE 3 (FIGS 16.39 AND 16.40)
CLINICAL CASE 4 (FIGS 16.52 TO 16.55)
POLARIS NAIL FOR PROXIMAL HUMERUS FRACTURE
Introduction to Locking Plates
Concept and Design Features
Radiology
Decision to Operate
Reduction Maneuvers
Positioning
Approach
Lateral Approach (Fig.16.76)
CLINICAL CASE 5 (FIGS 16.85 AND 16.87)
CHAPTER 17:
Extended Use of Interlocking Nails
FUSION OF KNEE JOINT
PROCEDURE (FIGS 17.1 TO 17.8)
SEGMENT TRANSPORT AND LIMB LENGTHENING ON THE INTERLOCKING NAIL
INTERLOCKING OF THE TOTAL HIP JOINT
CHAPTER 18:
Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints
INDICATIONS FOR RETROGRADE NAILING
Newer Nail Designs (Fig. 18.2)
Preoperative Planning
Surgical Technique
Preparation of Joints
Finding Nail Insertion Point
Nailing Technique
Clinical Case 1 (Fig. 18.6)
CALCANEAL SCREWS
PROXIMAL TIBIAL SCREWS
POSTOPERATIVE CARE
DISCUSSION
Clinical Case 2 (Figs 18.7A to C)
Avascular Necrosis of Talus
Clinical Case 3 (Figs 18.8A to C)
Clinical Case 4 (Figs 18.9A to D)
Osteoarticular Tuberculous
Complications of Pantalar Arthrodesis
Nonunion
Stress Fracture
Implant Failure
Malunion
Difficulty in Ascending Steps
Neighboring Joint Arthrosis
Infection
Diabetes and Retrograde Nailing
CHAPTER 19:
New Developments and Perspectives
TELESCOPING LOCKING NAILS
CHAPTER 20:
What We did not Teach in Workshops?
TIBIA
FEMUR
FOREARM INTERLOCKING NAIL
HUMERUS FRACTURE SHAFT
HUMERUS FRACTURE NECK
NAIL LENGTH
MALPOSITIONED UN-UNITED OR UNITED DISTAL FRACTURE OF TIBIA
CHAPTER 21:
Locking Plates
INTRODUCTION
Biomechanics
SPECIAL CONSIDERATIONS FOR USE OF LOCKING PLATE
Principles of Use
Compression Plate (Principle of Absolute Stability)
Technique of Using in Two Part Fractures
Key Points
Biological/Bridge Plating (Principle of Relative Stability) Use of LCP as an Internal Fixator
Preconditions for Bridge Plating
Indications
Biomechanical Basis
CHAPTER 22:
Clinical Cases
CASE 1
CASE 2
CASE 3
CASE 4
CASE 5
CASE 6
CASE 7
CASE 8
CASE 9
CASE 10
CASE 11
CASE 12
CASE 13
CASE 14
CASE 15
CASE 16
CASE 17
CASE 18
CASE 19
CASE 20
CASE 21
CASE 22
CASE 23
MISCELLANEOUS
INDEX
TOC
Index
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