Advertisement

Diaphyseal Fractures

  • John D. AdamsJr.Email author
  • Shea B. Ray
Chapter
  • 84 Downloads

Abstract

The gold standard for treatment of long bone diaphyseal fractures is intramedullary nail fixation, leading to secondary bone healing. The biomechanical environment created by the construct can dictate whether or not the fracture goes on to unite. Biological factors such as fracture pattern, concomitant injuries, extent of the associated soft tissue injury, and patient comorbidities are not modifiable by the surgeon; however, the mechanical environment is. Modifiable factors include nail diameter, nail working length, number and position of interlocking bolts, and the use of a reamed or unreamed technique. In this chapter, several cases that illustrate the optimization of these modifiable factors are discussed, as well as cases where some changes had to be made in order to achieve fracture union. Surgeons have the responsibility to optimize the fracture biomechanical environment. This includes considering both modifiable and nonmodifiable factors and utilizing implants in a way that provides enough stability to induce healing.

Keywords

Biomechanics Intramedullary nail Nonunion Delayed union Strain Stabilization Secondary bone healing Exchange nailing Dynamization Reaming 

References

  1. 1.
    Samiezadeh S, Avval PT, Fawaz Z, Bougherara H. Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: a finite element study. Clin Biomech. 2014;29(7):803–10.CrossRefGoogle Scholar
  2. 2.
    Hierholzer C, Friederichs J, Glowalla C, Woltmann A, Bühren V, von Rüden C. Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion. Int Orthop. 2017;41(8):1647–53.CrossRefGoogle Scholar
  3. 3.
    Ricci WM, Gallagher B, Haidukewych GJ. Intramedullary nailing of femoral shaft fractures: current concepts. J Am Acad Orthop Surg. 2009;17(5):296–305.CrossRefGoogle Scholar
  4. 4.
    Shih KS, Hsu CC, Hsu TP. A biomechanical investigation of the effects of static fixation and dynamization after interlocking femoral nailing: a finite element study. J Trauma Acute Care Surg. 2012;72(2):E46–53.CrossRefGoogle Scholar
  5. 5.
    Wähnert D, Gehweiler D. Complications of intramedullary nailing—evolution of treatment. Injury. 2017;48(2017):S59–63.CrossRefGoogle Scholar
  6. 6.
    Rosa N, Marta M, Vaz M, Tavares SM, Simoes R, Magalhães FD, Marques AT. Recent developments on intramedullary nailing: a biomechanical perspective. Ann N Y Acad Sci. 2017;1408(1):20–31.CrossRefGoogle Scholar
  7. 7.
    Kyle RF. Biomechanics of intramedullary fracture fixation. Orthopedics. 1985;8(11):1356–9.CrossRefGoogle Scholar
  8. 8.
    Perren SM. Fracture healing: fracture healing understood as the result of a fascinating cascade of physical and biological interactions. Part I. an attempt to integrate observations from 30 years AO research. Acta Chir Orthop Traumatol Cechoslov. 2014;81(6):355–64.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Prisma Health, Department of Orthopedic Surgery, School of Medicine GreenvilleUniversity of South CarolinaGreenvilleUSA

Personalised recommendations