Pin Locked Kuntscher Intrameduallry Nailing (PLKIN): An Innovative Construct for the fixation of Femoral Shaft Fractures.
Keywords:Kuntscher nail, Intramedullary nail, Interlocking nail.
Objective: To determine the functional and radiological outcome of our newly designed an innovative Pin Locked Kuntscher Intrameduallry Nailing (PLKIN) construct for Femoral Shaft Fractures.
Methods: This descriptive study was conducted in Millat Orthopedic and Trauma Surgery Hospital Sargodha- from 23rd February 2019 to 23rd May 2022.All patients with femoral shaft fractures fulfilling the inclusion criteria were treated with our indigenously designed innovative PLKIN construct. The final radiological outcome of PLKIN was determined at two years of follow up by assessing fracture healing. The functional outcome was assessed with Thorensen’s criteria and graded as excellent, good fair and poor outcome.
Results: We treated 19 patients with PLKIN construct. The mean age was 36.74±3.11 years. Male patients were 13(68.42% ) and females were 6( 31.57%).Right sided femoral fracture was present in 11( 57.89%) patients and left in 8(42.10% ) patients. At two years follow up union was achieved in all 19 patients without additional surgeries. Excellent functional outcome was noted in 14(73.68%) patients and good in 5( 26.31%) patients.
Conclusion: Our newly designed innovative Pin Locked Kuntscher Intrameduallry Nailing (PLKIN) construct is an effective device for the treatment of selective femoral shaft fractures as shown by excellent functional and radiological outcome in majority of our patients. We therefore recommend PLKIN construct a suitable alternative to conventional Kuntscher intramedullary nails and interlocking nails for treating femoral shaft fractures.
Fakhry SM, Rutledge R, Dahners LE, Kessler D. Incidence, management, and outcome of femoral shaft fracture: a statewide population-based analysis of 2805 adult patients in a rural state. J Trauma. 1994;37(2):255-260.
Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984 ;66(4):529-539.
Treatment of femoral shaft fractures by interlocking intramedullary nailing in adults]. Acta Orthop Traumatol Turc. 2003;37(3):203-212.
Rosa N, Marta M, Vaz M, Tavares SMO, Simoes R, Magalhaes FD, Marques AT. Intramedullary nailing biomechanics: Evolution and challenges. Proc Inst Mech Eng H. 2019;233(3):295-308.
Anup K, Mehra MM. Retrograde femoral interlocking nail in complex fractures. J Orthop Surg (Hong Kong). 2002 ;10(1):17-21.
Georgiadis GM, Minster GJ, Moed BR. Effects of dynamization after interlocking tibial nailing: an experimental study in dogs. J Orthop Trauma. 1990;4(3):323-330.
Christie J, Court-Brown C, Kinninmonth AW, Howie CR. Intramedullary locking nails in the management of femoral shaft fractures. J Bone Joint Surg Br. 1988;70(2):206-210.
Im GI, Shin SR. Treatment of femoral shaft fractures with a titanium intramedullary nail. Clin Orthop Relat Res. 2002;(401):223-229.
Wu LD, Wu QH, Yan SG, Pan ZJ. Treatment of ipsilateral hip and femoral shaft fractures with reconstructive intramedullary interlocking nail. Chin J Traumatol. 2004 ;7(1):7-12.
Brumback RJ. The rationales of interlocking nailing of the femur, tibia, and humerus. Clin Orthop Relat Res. 1996;(324):292-320.
Lee TC, Taylor,D. Bone remodelling: Should we cry wolff? Ir J Med Sci. 1999;168:102–105.
Tencer AF, Johnson KD, Johnston DW, Gill K. A biomechanical comparison of various methods of stabilization of subtrochanteric fractures of the femur. J Orthop Res. 1984;2(3):297-305.
Dueland RT, Berglund L, Vanderby R Jr, Chao EY. Structural properties of interlocking nails, canine femora, and femur-interlocking nail constructs. Vet Surg. 1996 ;25(5):386-396.
Wu CC, Shih CH. Biomechanical analysis of the mechanism of interlocking nail failure. Arch Orthop Trauma Surg. 1992;111(5):268-272.
Chiu FY, Lo WH, Chen CM, Chen TH, Huang CK. Treatment of unstable tibial fractures with interlocking nail versus Ender nail: a prospective evaluation. Zhonghua Yi Xue Za Zhi (Taipei). 1996 ;57(2):124-133.
Wang YQ, Hu YC, Xu ZM, Zhao YW, Wu JM. An intramedullary nail with multifunctional interlocking for all types of fracture in both femurs. Orthop Surg. 2009;1(2):121-126.
Thoresen BO, Alho A, Ekeland A, Stromsoe K, Folleras G, Haukebo A. Interlocking intramedullary nailing in femoral shaft fractures: a report of forty-eight cases. J Bone Joint Surg Am. 1985;67:1313–1320.
Wolinsky PR, McCarty E, Shyr Y, Johnson KD. Reamed intra- medullary nailing of the femur: 551 cases. J Trauma. 1999;46: 392–399.
Cheung G, Zalzal P, Bhandari M, Spelt JK, Papini M: Finite element analysis of a femoral retrograde intramedullary nail subject to gait loading. Med Eng Phys.2004;26:93-108.
Bong MR, Kummer FJ, Koval KJ, Egol KA:Intramedullary nailing of the lower extremity: J Am Acad Orthop Surg 2007;15:97-106.
Bucholz RW, Ross SE, Lawrence KL: Fatigue fracture of the interlocking nail in the treatment of fractures of the distal part of the femoral shaft.J Bone Joint Surg Am 1987;69:1391- 1399.