Bone Nails

We read the article by Klute et al1 with interest; however, we
identified a number of issues with the article. The authors
compared the socket fit, activity level, and limb volume of 2
different prosthetic suspension systems, namely a vacuumassisted
suspension system (VASS) and a pin suspension.1
Because limited literature is available on the effect of vacuumassisted
suspension as a means of controlling residual limb
volume and pistoning,2 the article would have been more
clinically helpful if some ambiguities were clarified.
http://www.ncbi.nlm.nih.gov/pubmed/22541316

A new "light" maxillo-mandibular fixation system for treatment of mandibular fractures, based on use of special pins, is proposed. Fifteen patients with non-displaced mandibular fractures (angle, body and symphysis), have been treated at the Department of Maxillofacial Surgery, S. Paolo University Hospital, Milan. The system is based on pins formed by a no. 1 metal wire and a bead. The free end of the pin is threaded around a tooth and then wound three or four times around the bead to fix it in place and, at the same time, separate it from the gingiva. One pin is usually positioned on each quadrant. Once the pins are in place they are tied to each other using a loop no. 0 to complete the maxillo-mandibular fixation. Particular attention was paid to maintain a correct individual occlusion. The time of maxillo-mandibular block was 10-15 days. Results were good with complete healing of all fractures, restoration of individual occlusion, minimal periodontal lesions and a good ...

The treatment of humeral shaft fractures ranges from conservative modalities to operative fixation, including plate osteosynthesis and intramedullary fixation. Nonunion is a complication of conservative and operative interventions but is more often associated with elastic nailing. This article discusses elucidates the successful outcomes achieved with flexible nailing of humeral shaft fractures.

The percutaneous placement of lateral distal humeral pins risks injury to the radial nerve. We aimed to provide a reliable and safe parameter for the insertion of lateral distal humeral pins. A secondary aim of this study was to investigate the effect of pin/screw placement in the intended zone of fixation at the lateral distal humerus. We dissected 70 fresh cadaveric upper limbs and the radial nerve was identified and its course followed into the anterior compartment. The point where the radial nerve crosses humerus in mid lateral plane was identified and the distance between this point and lateral epicondyle was measured, as was the maximum trans-epicondylar distance, along with the olecranon fossa height. Statistical analysis was performed using the Pearson correlation coefficient. The average trans-epicondylar distance was measured at 62 ± 6 mm (range 52–78 mm), and the average lateral radial nerve height was 102 ± 10 mm (range 75–129 mm). The ratio of the lateral nerve height to the trans-epicondylar distance was an average of 1.7 ± 0.2 (range 1.4–2.0). The Pearson correlation coefficient between the lateral nerve height and the trans-epicondylar distance was r = 0.95. A relative dimension, the trans-epicondylar distance is both reliable and easily accessible to the operating surgeon. The absolute safe zone for pin entry into the lateral distal humerus is that area lying within the caudad 70% of a line, equivalent in length to the patient's own trans-epicondylar distance, when projected proximally from the lateral epicondyle. Clin. Anat. 22:684–688, 2009. © 2009 Wiley-Liss, Inc.

Objective— To investigate the effect of fracture configuration on the mechanical properties of standard interlocking nails (ILNs) and a novel angle-stable ILN (ILNn) in bending.Study Design— In vitro experimental study.Sample Population— Synthetic tibial gap fracture bone models.Methods— Bone models, featuring a 5 or 120 mm central defect, respectively, mimicking a simple diaphyseal and a comminuted fracture involving both metaphyses, were implanted with 6 or 8 mm screwed or bolted standard ILNs (ILN6s, ILN6b, ILN8s, ILN8b, respectively) or an ILNn. Specimens were tested in 4-point bending. Construct angular deformation (AD) and slack were statistically compared (P<.05).Results— With increasing gap size, standard ILN construct AD increased significantly by ∼27% in ILN8b and by up to 105% in ILN6s. Similarly, standard ILN construct slack significantly increased by ∼33% in ILN8b (from ∼4.2° to ∼5.6°) and by up to ∼130% in ILN6s (from ∼7° to ∼16°). Conversely, there was no difference in the ILNn construct AD (∼4°) regardless of gap size. ILNn AD was the lowest of all groups and occurred without slack.Conclusions— This study demonstrated that the angle-stable ILNn provided construct stability regardless of fracture configuration, whereas the intrinsic slack of standard ILNs could jeopardize construct stability in a fracture configuration involving the metaphyses.Clinical Relevance— Use of standard ILNs may be optimal in diaphyseal fractures where circumferential nail/cortical contact could augment repair stability. Conversely, the angle-stable ILNn may represent a reliable fracture stabilization method for diaphyseal fractures as well as fractures involving the metaphyseal regions.

Humeral shaft fractures account for about 1-3% of all fractures. These fractures are regarded as the domain of non-surgical management. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. In particular, a new generation of nails that general permit immediate mobilization have become available for improved management of longitudinal and multi-segmental fractures. Retrograde and antegrade nails have advantages and disadvantages and selection procedure is often based on the distal or proximal location of the fracture. Plates also offer an alternative for certain indications and have advantages at the proximal and distal shaft in particular. If there is primary lesion of the radial nerve, exploration is not very advisable, but in the absence of remission exploration can be conducted after several months with th...

Two of the fundamental requisites for guided bone regeneration (GBR) are space maintenance and primary soft-tissue closure. Allogeneic cortical bone pins measuring 2 mm in diameter in customized lengths can protect surrounding graft materials, support bioresorbable membrane barriers, and resist wound compression from the overlying soft tissues. In addition, a second-generation platelet concentrate, leukocyte- and platelet-rich fibrin (L-PRF), may be incorporated into the augmentation procedure to provide multiple growth factors, accelerate wound healing, and aid in the maintenance of primary closure over the grafted materials. Highlighting two case reports, this article features a GBR technique that uses bone pins in combination with L-PRF membranes to provide both horizontal and vertical ridge augmentation at severely compromised implant sites.