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The interlocking nails have now become an established method of internal fixation. The introduction of better nail designs, innovations in the interlocking techniques and universal availability of image intensifiers have contributed a great deal to the evolution and widespread applications of this technique. It is truly said, that from difficulties arises the zeal to evolve, and from the zeal arises the new adaptations. My experience with the interlocking nails has been more than a decade long story of experiments with this art.
Diep The Hoa MD - HTO Interlocking Nailing Diep The Hoa MD - HTO Interlocking Nailing THIRD EDITION DD Tanna MS (Ortho) Honorary Consultant Jaslok Hospital Bhatia Hospital Saifee Hospital Mumbai, Maharashtra, India Consultant Orthopedic Surgeon Backbay View 3A Mama Parmamand Marg Mumbai, Maharashtra, India đ JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD Mumbai St Louis (USA) Panama City (Panama) London (UK) New Delhi Ahmedabad Bengaluru Chennai Hyderabad Kochi Kolkata Lucknow Nagpur Diep The Hoa MD - HTO Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357, Fax: +91-11-43574314 Registered Office B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021 +91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: jaypee@jaypeebrothers.com, Website: www.jaypeebrothers.com Offices in India Ahmedabad, Phone: Rel: +91-79-32988717, e-mail: ahmedabad@jaypeebrothers.com Bengaluru, Phone: Rel: +91-80-32714073, e-mail: bangalore@jaypeebrothers.com Chennai, Phone: Rel: +91-44-32972089, e-mail: chennai@jaypeebrothers.com Hyderabad, Phone: Rel:+91-40-32940929, e-mail: hyderabad@jaypeebrothers.com Kochi, Phone: +91-484-2395740, e-mail: kochi@jaypeebrothers.com Kolkata, Phone: +91-33-22276415, e-mail: kolkata@jaypeebrothers.com Lucknow, Phone: +91-522-3040554, e-mail: lucknow@jaypeebrothers.com Mumbai, Phone: Rel: +91-22-32926896, e-mail: mumbai@jaypeebrothers.com Nagpur, Phone: Rel: +91-712-3245220, e-mail: nagpur@jaypeebrothers.com Overseas Offices North America Office , USA, Ph: 001-636-6279734, e-mail: jaypee@jaypeebrothers.com, anjulav@jaypeebrothers.com Central America Office, Panama City, Panama, Ph: 001-507-317-0160, e-mail: cservice@jphmedical.com Website: www.jphmedical.com Europe Office, UK, Ph: +44 (0) 2031708910, e-mail: dholman@jpmedical.biz; rfurn@jpmedical.biz; pheilbrunn@jpmedical.biz Interlocking Nailing â 2010, DD Tanna All rights reserved No part of this publication interactive DVD ROM should be reproduced, stored in a retrieval system, or tra nsmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of th author and e the publisher This book has been published in good faith that the material provided by author is original Every effort is made to ensure acc uracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error (s) In case of any disp ute, all legal matters are to be settled under Delhi jurisdiction only First Edition: 2000 Second Edition: 2004 Third Edition: 2010 ISBN 978-81-8448-882-1 Typeset at JPBMP typesetting unit Printed at Diep The Hoa MD - HTO Dedicated to Dr KV Chaubal, a retired Professor of Orthopedics BYL Nair Hospital and TN Medical College Mumbai, Maharashtra, India I have worked with Dr Chaubal, as a Resident, as a Lecturer, as an Assistant Honorary and finally as his colleague at the BYL Nair Hospital I continued to associate with him at the Bhatia Hospital, till recently Now he has retired from orthopedics recently, and spends his time at home and family This book is dedicated to him not for the post he held in our institution It is the tribute to a person who has the most remarkable approach to teaching According to him, learning is not just gathering information and storing it He made tireless efforts to teach all his students to think independently He inspired and encouraged all of us to rise to our highest potential He broke the old tradition that the master should be obeyed blindly He strongly believes that learning is not at the feet of master, but by arguing and discussing with him In this way, the master and the disciple both learn This is the most important lesson to be learnt today, not only in orthopedics, but also in every field of life It is the matter of great privilege and honor for me to have been associated with Dr Chaubal during my entire career in orthopedics I am never tired of interacting with him even now after all these years Now he has retired from orthopedic practise I feel the vacuum in my interactions, as now I meet him very infrequently Diep The Hoa MD - HTO Preface to the Third Edition When I was asked to 3rd edition of my book, initially I felt, there is not much changed in interlocking in last years so what is the purpose of 3rd edition But when I started modifying 2nd edition, I realized how locking plate has become a big replacement for interlocking nail, and in many situations it has replaced the nailing procedure Keeping this in mind, I have introduced the Chapter on Locking Plates I have also described wherever it is alternative treatment to nailing to me I felt treating surgeon will have a ready-reference of locking plate also in the given fracture Many new case studies and new bold changes of concept have been included I also requested Dr B Shiv Shankar, Sholapur to write on his nail extraction device which he has successfully introduced I also requested Dr Sunil Kulkarni, Miraj to write on antibiotic coated nail for infected surgery and how to make these nails I felt these two new introductions will help readers to have complete knowledge of the art I am very thankful to Dr B Shiv Shankar and Dr Sunil Kulkarni for their ready acceptance to write in this book I thank my associate Dr Gauresh Palekar for his help and Dr Anand Thakur to lend me plenty of hand-drawings from his book DD Tanna ddtanna@gmail.com Diep The Hoa MD - HTO Preface to the Second Edition The interlocking nails have now become an established method of internal fixation The introduction of better nail designs, innovations in the interlocking techniques and universal availability of image intensifiers have contributed a great deal to the evolution and widespread applications of this technique It is truly said, that from difficulties arises the zeal to evolve, and from the zeal arises the new adaptations My experience with the interlocking nails has been more than a decade long story of experiments with this art I remember those years of late eighties, when interlocking nails had almost become a norm in the Western world I used to hear about them in every meeting and conference I attended abroad However, its application was not possible back home, due to lack of availability of the interlocking nails and the image intensifiers I began to use interlocking nails somewhere in around 1992 My carpenter made the first interlocking nail I used (Figs and 2) He made two holes proximally and distally in an ordinary Knail used in femur Later on, I started using custom made nails manufactured specially for me by a company without any other instruments (Figs to 6) I used to ask them to make two nails of identical size and with identical placement of holes (Fig 7) We used Fig 1: Holes were made in old K-nail femur to carry out the procedure with X-rays, as the image intensifier had not become available at that time The success with these experiments inspired me to develop the concept of interlocking nails without the use of image intensifier With the help of the Instrument Company, I developed a nail, which has some standardization and can be used by every surgeon Today, with increasing Fig 2: First patient with compound comminuted tibia operated with such nail Fig 3: Early nail Diep The Hoa MD - HTO x Interlocking Nailing Fig 4: Early instruments (Introducer along with holding handles) Fig 5: Early instruments Fig 6: Early instruments for nail removal (Extractor was needed) Fig 7: Second identical nail was the instrument for distal jig experience, the accuracy of interlocking with radiographs is 100 percent I published an article in JBJS in 1994 on interlocking without C-arm I have been organizing the workshops on interlocking nails since 1994 all over India, so that more and more surgeons can practice this art within their limited set-up However, it is not possible to reach out to a wider audience by conferences and workshops This book is an effort to reach out to every possible surgeon, who wants to learn this art This book is the crux of all that I have been talking about and practicing since so many years It is not the review of literature but contains most what is published and is currently practised art of interlocking I have emphasized what I strongly believe in and what I practice, in interlocking nailing In this book, I have tried to cover all the aspects related to interlocking nailing I have covered each and every step of the nailing and the interlocking procedure I have discussed, about the different techniques of interlocking The possible difficulties that one may come across and the practical solutions are also discussed I have also discussed at length about my method of interlocking I hope the reader finds this book a very helpful guide and answers many of the unanswered questions In this 2nd edition, I have put in lot of new experiences There are additions of chapters on what we did not teach you in workshops and Photo Gallery. There is intended repetition in the book in order to make rapid reading most fruitful DD Tanna Diep The Hoa MD - HTO Preface to the First Edition The interlocking nails have now become an established method of internal fixation The introduction of better nail designs, innovations in the interlocking techniques and the availability of image intensifiers have contributed a great deal to the evolution and widespread applications of this technique As is said truly that from difficulties arise the zeal to evolve and from the zeal arises the discovery My experience with the interlocking nails has been a decade long story of experiments with this art I remember those early years of nineties, when interlocking nails had almost become a norm in the Western world I used to hear about them in every meeting and conference I attended abroad However, its application was not possible in India due to lack of availability of the interlocking nails and the image intensifiers I began to use interlocking nails somewhere in around 1992 The first interlocking nail I used was made by my carpenter He made two holes proximally and distally in an ordinary K-nail used in femur Later on, I started using custom-made nails manufactured specially for me by a company I used to ask them to make two nails of identical size and with identical placement of holes We used to carry out the procedure with radiographs, as the image intensifier had not become available at that time The success with these experiments inspired me to develop the concept of interlocking nails without the use of image intensifier With the help of the instrument company, I developed a nail, which has some standardization and can be used by every surgeon Today, with increasing experience, the accuracy of interlocking with radiographs is 100 percent I have been organizing the workshops on interlocking nails since 1994 all over India, so that more and more surgeons can practise this art within their limited set-up However, it is not possible to reach out to a wider audience merely by conferences and workshops This book is an effort to reach out to every possible surgeon, who wants to learn this art This book is the crux of all that I have been talking about and practising since so many years It is not the review of literature I have emphasized what I strongly believe in and what I practise, in interlocking nailing In this book, I have tried to cover all the aspects related to interlocking nailing I have covered each and every step of the nailing and the interlocking procedure I have discussed about the different techniques of interlocking The possible difficulties that one may come across and the practical solutions are also discussed I have also discussed at length about my method of interlocking In the last chapter, I have covered the recent developments like Recon nail, Polarus nail, Gamma nail There is a brief mention of the various other applications of the interlocking nails also I hope the reader will find this book a very helpful guide and get answers of many unanswered questions DD Tanna Diep The Hoa MD - HTO Contents Introduction to Interlocking Nailing Interlocking Tibia Nail 3 Lower One-third Fracture of the Tibia 17 Upper One-third and One-fourth Fractures 26 Locked Nails of the Femur 32 Tips on Tibia and Femur 40 Open Fractures 44 Reaming 49 Nonunion 55 10 Complications Associated with Procedure of Nailing and Locking and Implant Removal 60 11 Fracture Neck Femur with Shaft Femur 75 12 Dynamization 78 13 Fractures of Proximal Femur 83 14 Supracondylar Nail 95 15 Fracture Humerus Interlocking Nail 108 16 Extended Use of Interlocking Nails 125 17 New Developments and Perspectives 133 18 What We did not Teach in Workshops? 135 19 Locking Plates 144 Photo Gallery 157 Suggested Reading 191 Index 197 Diep The Hoa MD - HTO Photo Gallery 185 CASE 18 Fig 120: Nail with butterfly closed nailing Fig 121: Upper screw broke Fracture trying to collapse for healing Fig 122: Absorption of the piece and instability Upper screw broke, ultimately nail broke Fig 123: Locking plate healed Diep The Hoa MD - HTO 186 Interlocking Nailing CASE 19 Fig 124: Rod bent so corrective surgery Fig 125: Rod broke so plate Fig 126: Plate broke so rod Fig 127: Too weak implant Fig 128: Fracture united without deformity Diep The Hoa MD - HTO Photo Gallery 187 MISCELLANEOUS A B Figs 129A and B: (A) Comminuted segmental fracture proximal femur wks old untreated, (B) Open reduction and Recon nailing, Cerclage wiring and interfragmentary screw across the fracture and bone grafting Fig 130: Three months postoperative showing evidence of healing A Fig 131: Short nail distally, not try to get length by pushing it down White U is original point of entry Nail was pushed down instead of going in expected direction of black line it travels down on anterior cortex as seen in X-ray A B C B C Figs 132A to C: (A) Preoperatvie no butterfly piece, (B) Point of entry on trochanter so, butterfly occurred as nail hits inner cortex as per line in (A), (C) fracture united D E Figs 133A to E: (A and B) Comminuted segmental fracture tibia treated with interlock nailing and interfragmentary screw fixation anatomically united (C to E) Diep The Hoa MD - HTO 188 Interlocking Nailing Fig 134: Nonunion fracture junction of upper and middle third humerus with a plate replaced by proximal humeral interlock nail and bone grafting Fig 135: Oblique fracture treated with lag screw and interlock nail, united fracture Diep The Hoa MD - HTO Photo Gallery A Fig 136: Shaft femur treated by plate Note the bending of the plate at the site of screw hole, screw too close to the fracture site and varus angulation at the fracture site A B 189 C Figs 137A to C: (A) Three months post 1st surgery, (B) Replaced by interlock nailing and ft, (C) Two years post 2nd surgery not united B Figs 138A and B: (A) On removal of nail realized it was broken (B) Broken distal portion of femur nail being removed by a special instrument with a hook entering broken nail Fig 139: Hook pushed till end of nail and gently nail removed by closed method Fig 140: Removal of the broken portion of nail with the hook inside it Fig 141: Bone growth distal to the distal end of nail does not allow negotiation by a guidewire Diep The Hoa MD - HTO 190 Interlocking Nailing A B Figs 142A and B: (A) Guidewire does not go down, (B) Reamer on plain guidewire used to break this bone so that longer nail can be passed Fig 143: Evidence of delay in healing at site of fracture, but desperate attempts at callus formation Now years no healing yet Fig 144: Three years still no perfect healing Six months last operation Patient walking no pain, stable healing fracture Diep The Hoa MD - HTO Suggested Reading Aktekin CN, Oztỹrk AM, Altay M, Toprak A, Ozkurt B, Tabak AY Flexible intramedullary nailing of children Ulus Travma Acil Cerrahi Derg 2007;13(2):115-21 Ali MA, Hussain SA, Khan MS Evaluation of results of interlocking nails in femur fractures due to high velocity gunshot injuries J Ayub Med Coll Abbottabad 2008;20(1):16-19 Anglen J, Banovetz J Compartment syndrome in the well leg resulting from fracture-table positioning Clin Orthop 1994; 301:239-42 Anglen JO, Blue JM A comparison of reamed and unreamed nailing of the tibia J Trauma 1995;39(2):351-55 Anup K, Mehra MM Retrograde femoral interlocking nail in complex fractures J Orthop Surg (Hong Kong) 2002;10(1): 17-21 Arpacioglu MO, Akmaz I, Mahirogullari M, Kiral A, Rodop O Treatment of femoral shaft fractures by interlocking intramedullary nailing in adults Acta Orthop Traumatol Turc 2003;37(3):203-12 Arpacioglu MO, Pehlivan O, Akmaz I, Kiral A, Oguz Y Interlocking intramedullary nailing of humeral shaft fractures in adults Acta Orthop Traumatol Turc 2003;37(1):19-25 Arslan H, Kapukaya A, Kesemenli CC, Necmioglu S, Subasi M, Coban V The floating knee in adults: Twenty-four cases of ipsilateral fractures of the femur and the tibia Acta Orthop Traumatol Turc 2003;37(2):107-12 Baumgaertel F, Dahlen C, Stiletto R, Gotzen L Technique of using the AO-femoral distractor for femoral intramedullary nailing J Orthop Trauma 1994;8(4):315-21 10 Beaty JH (Ed) Orthopaedic Knowledge Update Rosemont, IL American Academy of Orthopaedic Surgeons 1999;39: 493-504 11 Beaty JH, Austin SM, Warner WC, Canale ST, Nichols L Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: Preliminary results and complications J Pediatr Orthop 1994;14(2):178-83 12 Bekmezci T, Baca E, Kaynak H, Kocabs R, Tonbul M, Yalaman O Early results of treatment with expandable intramedullary nails in femur shaft fractures Acta Orthop Traumatol Turc 2006;40(1):1-5 13 Bekmezci T, Baca E, Kocabas R, Kaynak H, Tonbul M Early results of treatment with expandable intramedullary nails in tibia shaft fractures Acta Orthop Traumatol Turc 2005;39(5):421-24 14 Berton R, Moed MD, J Tracy, Watson MD Retrograde nailing of the femoral shaft J Am Acad Orthop Surg 1999;7:209-16 15 Bessler W, Eich G, Stuckmann G, Zollikofer C Kissing osteochondromata leading to synostoses Eur Radiol 1997;7(4): 480-85 16 Blachut PA, OBrien PJ, Meek RN, Broekhuyse HM Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft A prospective, randomized study J Bone Joint Surg Am 1997;79(5):640-46 17 Blum J, Rommens PM, Janzing H The unreamed humeral nailA biological osteosynthesis of the upper arm Acta Chir Belg 1997;97(4):184-89 18 Bombaci H, Gỹneri B, Gửrgeỗ M, Kafadar A A comparison between locked intramedullary nailing and plate-screw fixation in the treatment of tibial diaphysis fractures Acta Orthop Traumatol Turc 2004;38(2):104-09 19 Bonatus T, Olson SA, Lee S, Chapman MW Nonreamed locking intramedullary nailing for open fractures of the tibia Clin Orthop 1997;339:58-64 20 Bonnevialle P, Cauhepe C, Alqoh F, Bellumore Y, Rongiốres M, Mansat M Risks and results after simultaneous intramedullary nailing in bilateral femoral fractures: A retrospective study of 40 cases Rev Chir Orthop Reparatrice Appar Mot 2000;86(6):598-607 21 Bonnevialle P, Mansat P, Cariven P, Bonnevialle N, Ayel J, Mansat M Single-plane external fixation of fresh fractures of the femur: Critical analysis of 53 cases Rev Chir Orthop Reparatrice Appar Mot 2005;91(5):446-56 22 Borel JC, Dujardin F, Thomine JM, Biga N Closed locked nailing of complex femoral fractures in adults Apropos of 68 cases Rev Chir Orthop Reparatrice Appar Mot 1993;79(7):553-64 23 Bostrom MP, Lyden JP, Ernberg JJ, Missri AA, Berberian WS A biomechanical evaluation of the long stem intramedullary hip screw J Orthop Trauma 1995;9(1):45-52 24 Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR Intramedullary nailing of femoral shaft fractures Part II: Fracture-healing with static interlocking fixation J Bone Joint Surg Am 1988;70(10):1453-62 25 Brumback RJ, Virkus WW Intramedullary nailing of the femur: Reamed versus nonreamed J Am Acad Orthop Surg 2000; 8(2):83-90 26 Brumback RJ The rationales of interlocking nailing of the femur, tibia, and humerus Clin Orthop 1996;324:292-320 27 Burỗ H, Dursun M, Orhun H, Gỹrkan V, Bayhan I Treatment of adult tibial diaphysis fractures with reamed and locked intramedullary nailing Acta Orthop Traumatol Turc 2009;43(1):7-13 Diep The Hoa MD - HTO 192 Interlocking Nailing 28 Butler MS, Brumback RJ, Ellison TS, Poka A, Bathon GH, Burgess AR Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur J Bone Joint Surg Am 1991;73(10):1492-502 29 Chan PS, Luchetti WT, Campbell JT, Vresilovic EJ Supracondylar femur fracture above a mature knee fusion treated with a long locked intramedullary rod Am J Orthop 1997;26(9):630-32 30 Chang IL, Lee TS, Ku MC Treatment of femoral fracture with nonunion Kao Hsiung I Hsueh Ko Hsueh Tsa Chih 1994; 10(10): 543-49 31 Chiu FY, Lo WH, Chen CM, Chen TH, Huang CK Treatment of unstable tibial fractures with interlocking nail versus Ender nail: A prospective evaluation Chung Hua I Hsueh Tsa Chih Taipei 1996;57(2):124-33 32 Chiu FY, Lo WH, Chen CM, Chen TH, Huang CK Unstable closed tibial shaft fractures: A prospective evaluation of surgical treatment J Trauma 1996;40(6):987-91 33 Cilli F, Mahirogullari M, Pehlivan O, Keklikỗi K, Kuskucu M, Kiral A, Avsar S Treatment of femoral shaft fractures with expandable intramedullary nail Ulus Travma Acil Cerrahi Derg 2009;15(4):383-89 34 DeCasas R, Lazaro FJ, Garcia Rayo MR, Arias J Arteriovenous fistula after interlocking nailing of the femur: A case report J Trauma 1995;38(2):303-04 35 Durakbasa O, Haklar U, Tuygun H, Tỹrkmen M Intramedullary nailing of adult femoral fractures Acta Orthop Traumatol Turc 2002;36(4):316-21 36 Duwelius PJ, Schmidt AH, Rubinstein RA, Green JM Nonreamed interlocked intramedullary tibial nailing One communitys experience Clin Orthop 1995;315:104-13 37 Eingartner C, Volkmann R, Putz M, Weller S Uncemented revision stem for biological osteosynthesis in periprosthetic femoral fractures Int Orthop 1997;21(1):25-29 38 Ertỹrer E, Oztỹrk I, Dirik Y, Uzun M, Aksoy B Radiographic and functional results of osteosynthesis with locked unreamed intramedullary nailing of femoral shaft fractures in adults Acta Orthop Traumatol Turc 2005;39(5):381-86 39 Fadero PE, Alabi S, Adebule GT, Odunubi OO, Yinusa W, Eyesan SU, Obianyor OD Locked intramedullary nailing for the treatment of femoral shaft fractures: Experience and result in 19 cases Niger J Med 2008;17(2):168-72 40 Fairbank AC, Thomas D, Cunningham B, Curtis M, Jinnah RH Stability of reamed and unreamed intramedullary tibial nails: A biomechanical study Injury 1995;26(7):483-85 41 Fox IM, Shapero C, Kennedy A Tibiotalocalcaneal arthrodesis with intramedullary interlocking nail fixation Clin Podiatr Med Surg 2000;17(1):19-31 42 Frost HM Perspectives: A proposed general model of the mechanostat (suggestions from a new skeletal-biologic paradigm) Anat Rec 1996;244(2):139-47 43 Gagala J, Kolodziej R, Blacha J, Blicharski T Intramedullary locked nailing in the treatment of proximal femoral fractures Chir Narzadow Ruchu Ortop Pol 2006;71(3):211-5 44 Giampapa VC, Di Bernardo BE Neck recontouring with suture suspension and liposuction: An alternative for the early rhytidectomy candidate Aesthetic Plast Surg 1995;19(3):217-23 45 Giddins GE An aid to interlocking screw insertion Injury 1994;25(7):481-82 46 Gordon JE, Khanna N, Luhmann SJ, Dobbs MB, Ortman MR, Schoenecker PL Intramedullary nailing of femoral fractures in children through the lateral aspect of the greater trochanter using a modified rigid humeral intramedullary nail: Preliminary results of a new technique in 15 children J Orthop Trauma 2004;18(7):416-22; discussion 423-24 47 Gottsauner Wolf F, Egger EL, Markel MD, Schultz FM, Chao EY Fixation of canine tendons to metal Acta Orthop Scand 1994;65(2):179-84 48 Gregory P, DiCicco J, Karpik K, DiPasquale T, Herscovici D, Sanders R Ipsilateral fractures of the femur and tibia: Treatment with retrograde femoral nailing and unreamed tibial nailing J Orthop Trauma 1996;10(5):309-16 49 Gregory P, Sanders R The treatment of closed, unstable tibial shaft fractures with unreamed interlocking nails Clin Orthop 1995; 315: 48-55 50 Gregory P, Sullivan JA, Herndon WA Adolescent femoral shaft fractures: Rigid versus flexible nails Orthopedics 1995;18(7):645-49 51 Grover J, Wiss DA A prospective study of fractures of the femoral shaft treated with a static, intramedullary, interlocking nail comparing one versus two distal screws Orthop Clin North Am 1995;26(1):139-46 52 Guerra JJ, Della Valle CJ, Corcoran TA, Torg JS, Duda JR Arthroscopically assisted placement of a supracondylar intramedullary nail: Operative technique Arthroscopy 1995;11(2): 239-44 53 Haas N, Schutz M, Sudkamp N, Hoffmann R The new unreamed AO nails for the tibia and the femur Acta Orthop Belg 1995;61(Suppl 1): 204-06 54 Harrington KD Orthopaedic management of extremity and pelvic lesions Clin Orthop 1995; 312: 136-47 55 Harrington KD Orthopedic surgical management of skeletal complications of malignancy Cancer 1997; 80(8 Suppl): 1614-27 56 Hellemondt FJ, Haeff MJ Removal of a broken solid intramedullary interlocking nail A technical note Acta Orthop Scand 1996; 67(5): 512 Diep The Hoa MD - HTO Suggested Reading 193 57 Helmy N, Jando VT, Lu T, Chan H, OBrien PJ Muscle function and functional outcome following standard antegrade reamed intramedullary nailing of isolated femoral shaft fractures J Orthop Trauma 2008;22(1):10-15 58 Hems TE, Bhullar TP Interlocking nailing of humeral shaft fractures: The Oxford experience 1991 to 1994 Injury 1996; 27(7): 485-89 59 Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft A prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators J Orthop Trauma 1998;12(1):1-7 60 Heybeli M, Muratli HH, Celebi L, Gỹlỗek S, Biỗimoglu A The results of intramedullary fixation with titanium elastic nails in children with femoral fractures Acta Orthop Traumatol Turc 2004;38(3):178-87 61 Hửntzsch D, Weller S, Engels C, Kaiserauer S Change in the procedure from external fixator to intramedullary nailing osteosynthesis of the femur and tibia Aktuelle Traumatol 1993;23(1):21-35 62 Huang CK, Chen WM, Chen TH, Lo WH Segmental tibial fractures treated with interlocking nails: A retrospective study of 33 cases Acta Orthop Scand 1997;68(6):563-66 63 Huang P, Tang P, Yao Q Comparison of LCP and locked intramedullary nailing fixation in treatment of tibial diaphysis fractures Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007;21(11):1167-70 64 Huang P, Tang PF, Yao Q, Liang YT, Tao S, Zhang Q, Guo YZ, Liang XD, Wang Y, Zhongguo Gu Shang A comparisive study between intramedullary interlocking nail and plate-screw fixation in the treatment of tibial shaft fractures 2008;21(4):261-63 65 Hutson JJ, Zych GA, Cole JD, Johnson KD, Ostermann P, Milne EL, Latta L Mechanical failures of intramedullary tibial nails applied without reaming Clin Orthop 1995;315:129-37 66 Hyodo A, Kotschi H, Kambic H, Muschler G Bone transport using intramedullary fixation and a single flexible traction cable Clin Orthop 1996;325:256-68 67 Iannacone WM, Bennett FS, DeLong WG J, Born CT, Dalsey RM Initial experience with the treatment of supracondylar femoral fractures using the supracondylar intramedullary nail: A preliminary report J Orthop Trauma 1994;8(4):322-27 68 Ikpeme JO Intramedullary interlocking nailing for humeral fractures: Experiences with the Russell Taylor humeral nail Injury 1994;25(7):447-55 69 Itoman M, Sekiguchi M, Yokoyama K, Minamisawa I Closed intramedullary osteotomy for rotational deformity after long bone fractures Int Ortho 1996;20(6):346-49 70 Jabczenski FF, Crawford M Retrograde intramedullary nailing of supracondylar femur fractures above total knee arthroplasty A preliminary report of four cases J Arthroplasty 1995;10(1):95-101 71 Jiang X, Li X, Wang M, Gu X, Zhang B, Sun L, Zhang L, Liu Y, Liu D, Rong G Measurement of fracture malrotation after interlocking intramedullary nailing of femoral shaft fracture Zhonghua Wai Ke Za Zhi 2002;40(1):55-58 72 Johnson KD, Johnston DW, Parker B Comminuted femoral-shaft fractures: Treatment by roller traction, cerclage wires and an intramedullary nail, or an interlocking intramedullary nail J Bone Joint Surg Am 1984;66(8):1222-35 73 Joshi D, Ahmed A, Krishna L, Lal Y Unreamed interlocking nailing in open fractures of tibia J Orthop Surg (Hong Kong) 2004;12(2):216-21 74 Kakkar R, Kumar S, Singh AK Cephalomedullary nailing for proximal femoral fractures Int Orthop 2005;29(1):21-4 Epub 2005 Jan 13 75 Kalenderer O, Agus H, Sanli C Open reduction and intramedullary fixation through minimal incision with Ender nails in femoral fractures of children aged from to 16 years Acta Orthop Traumatol Turc 2002;36(4):303-09 76 Keating JF, OBrien PI, Blachut PA, Meek RN, Broekhuyse HM Reamed interlocking intramedullary nailing of open fractures of the tibia Clin Orthop 1997;338:182-91 77 Keating JF, Orfaly R, OBrien PJ Knee pain after tibial nailing J Orthop Trauma 1997;11(1):10-13 78 Kelley SS, Bonar S, Hussamy OD, Morrison JA A simple technique for insertion of distal screws into interlocking nails J Orthop Trauma 1995;9(3):227-30 79 Kelley SS, Morrison JA, Templeman DC Techniques for the removal of broken small-diameter tibial nails: A report of two cases J Orthop Trauma 1995;9(6):523-25 80 Kempf and Leung Practice of Intramedullary Locked Nails, Springer 2002 81 Kneifel T, Buckley R A comparison of one versus two distal locking screws in tibial fractures treated with unreamed tibial nails: A prospective randomized clinical trial injury 1996;27(4):271-73 82 Koval KJ (Ed) Orthopaedic Knowledge Update Rosemont, IL American Academy of Orthopaedic Surgeons 2002; 453-64 83 Kraemer WJ, Hearn TC, Powell JN, 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implants using interlocking bipolar cut short GK nail and Enders nail Arch Orthop Trauma Surg 1997;116(4):229-32 175 Zuckerman JD, Veith RG, Johnson KD, Bach AW, Hansen ST, Solvik S Treatment of unstable femoral shaft fractures with closed interlocking intramedullary nailing J Orthop Trauma 1987;1(3):209-18 Diep The Hoa MD - HTO Index A Anterior approach 124 Antibiotic impregnated nail 58 advantages 58 how to prepare? 58 postoperative 58 tips 58 when to remove 59 Approach 121 anterior 124 fusion of knee joint 125 lateral 121 procedure 125 Assessment of nail length 10, 11 distal locking 12 guidewire method 111 radiographic ruler method 111 B Bending of nail 63 Biological/bridge plating 150 Biology Biomechanical basis 152 Biomechanics 1, 144 Bone quality Broken drill bit 61 Broken screw 63 C C-arm mounted jig: Gross Lafforgue device 13 Closed nailing of femur 33 tibia Complications associated with procedure of nailing and locking, and implant removal 60 bending of nail 63 broken drill bit 61 broken screw 63 design of tibia nails fracture healing following intramedullary nailing nail breakage 63 Compression plate 147 biological/bridge plating 150 biomechanical basis 152 indications 151 preconditions for bridge plating 150 technique of using in two part fractures 149 use of LCP as an internal fixator 150 Concept and design 119 Considerations for use of locking plate 146 Controversy over reamed and unreamed nails 53 Conventional nailing 109 Correction of rotation during reduction 36 D Decision to operate 120 Distal femur plate 101 Distal locking if C-arm conks out during surgery 14 distal locking without C-arm 14 traps to be avoided during interlocking tibia nail 16 Distal locking of femur 38 Distal locking without C-arm 14 Distal repositioning 87 proximal subtrochanteric fracture 87 subtrochanteric fracture 87 Dynamization 78 E Effect of reaming on circulation 53 new developments in reaming 54 reaming and embolism 53 reaming in osteopetrosis or marble bone disease 54 role of reaming in osteoinduction 53 role of reaming in stability 53 treatment of non-infected nonunion 55 Entry site preparation 110 Extended use of interlocking nails 125 interlocking of total hip joint 132 segment transport and limb lengthening 131 F Femur 138 Forearm interlocking nail 141 Fracture healing following intramedullary nailing humerus interlocking nail 108 procedures 109 neck femur shaft femur 75 reduction of proximal femur 83 problems and their solutions 87 procedure 86 Free hand technique 12 Fusion of knee joint 125 G Guidewire method 111 H How to execute? 19 locking plate for proximal fractures 29 traps for proximal tibia fractures 31 traps to be avoided in lower one-third fractures 25 Diep The Hoa MD - HTO 198 Interlocking Nailing Humerus fracture neck 141 fracture shaft 141 I Incision 34 planning 109 conventional nailing 109 Infection 47 Insertion of guidewire 10 interlocking screws 38 nail 10, 37 interlocking screws 38 distal locking of femur 38 observations and tips 40 proximal locking of femur 39 Interlocking nailing of total hip joint 132 tibia nail indications for interlocking nailing preoperative assessment for interlocking nail Introduction to interlocking nailing biology biomechanics evolution Introduction to locking plates 118 L Laser 14 Lateral approach 121 Lateral position 33 Locked nails of femur 32 closed nailing of femur 33 procedure 33 Locking plate 101, 144 for proximal fractures 29 special considerations for use of locking plate 146 Lower one-third femur 38 Lower one-third fracture of tibia 17 polar screws 19 M Malpositioned un-united or united distal fracture of tibia 143 N Nail breakage 63 Nail insertion 111 Nail length and size 96, 142 Nail length selection 111 Navigation system 14 New developments and perspectives 133 tibia 135 New developments in reaming 54 Nonunion 55 treatment of long standing infected nonunion 56 O Observations and tips in use of interlocking nailing procedure 40 Open fractures 44 infection 47 Orthofix 14 P Patient positioning 97,109 Planning surgery in intra-articular and supracondylar fractures 99 Point of entry 34 correction of rotation during reduction 36 introduction of guidewire 35 Points to ponder 82 Polar screws 19 Polaris nail for proximal humerus fracture 115 Position 33 lateral position 33 supine position 33 Position of patient Positioning 121 Postoperative care 99 Preconditions for bridge plating 150 Preoperative assessment for interlocking nail Preoperative planning 96 assessment of nail length and size 96 Principles of use 147 Problems and their solutions 87 Problems of point of entry Procedure for both positions point of entry problems of point of entry Proximal locking of femur 39 Proximal migration of nail while drilling neck 87 Proximal subtrochanteric fracture 87 R Radiographic ruler method 111 Radiology 119 Reaming 10,49,111 controversy over reamed and unreamed nails 53 reaming in a nonunion or a malunion 51 Reaming and embolism 53 Reaming in a nonunion or a malunion 51 Reaming in osteopetrosis or marble bone disease 54 Reduction 10, 110 insertion of guidewire 10 insertion of nail 10 reaming 10 in supine position 34 maneuvers 120 Removal by closed method 64 open method 63 Resistance to nail insertion 87 Retrograde femur nail 100 nailing of humerus 112 polaris nail for proximal humerus fracture 115 Diep The Hoa MD - HTO Index Role of reaming in osteoinduction 53 reaming in stability 53 S Segment transport and limb lengthening on interlocking nail 131 Site of fracture bone bone quality closed nailing of tibia procedure size of medullary canal Size of medullary canal Steps 12 C-arm mounted jig: Gross Lafforgue device 13 free hand technique 12 navigation system 14 orthofix 14 with laser 14 Subtrochanteric fracture 87 Supine position 33 Supracondylar nail 95 surgical technique 96 Surgery on ordinary table Surgical procedure 97 planning 99 postoperative care 99 technique 96 T Technique of using in two part fractures 149 Telescoping locking nails (TLN) 133 199 Tibia 135 nails Tips on tibia and femur 40 interlocking tibia nail 16 lower one-third fractures 25 proximal tibia fractures 31 Treatment of long standing infected nonunion 56 non-infected nonunion 55 W Workshops? 135 femur 138 forearm interlocking nail 141 humerus fracture shaft 141 humerus fracture neck 141 nail length 142 malpositioned un-united or united distal fracture 143