56 Cases of Lower Limb Bone Fracture Diagnosis and Treatment Efficacy Analysis
The midpoint of the tibial tuberosity, the method of inserting the nail and locking it with the femur is basically the same, but note that the bone entry and screw holes should be large enough, with a 45-degree downward tilt angle for thorough reaming of the canal to ensure smooth insertion without resistance. Postoperatively, elevate the limb, and during the first two days, actively exercise the limb's function. For difficult fractures of the distal femur and proximal tibia, combine CPM (Continuous Passive Motion) after two days post-surgery for passive knee and ankle exercises. The group of 56 patients was followed up for more than 0.5-2 years; all bones healed, with no postoperative infection, breakage, or fracture. Two cases of distal 1/3 tibial fractures showed a backward angular deformity at the distal fracture site, without knee joint or ankle joint dysfunction.
Discussion: Complex fractures of the femur and tibia can involve combined injuries across various sections and stages of fractures. Traditional surgical approaches are often difficult to achieve firm fixation effects, prone to delayed union or non-healing, extensive surgical trauma, and periosteal stripping. Poorly fixed fractures frequently lead to complications. In recent years, interlocking intramedullary nailing has been applied to simplify complex fracture surgeries, shorten operation time, reduce surgical trauma and blood loss, enhance firm fixation, accelerate healing, decrease complications, thereby reducing patient pain. Particularly, domestic interlocking nails, being cost-effective, make treatment more accessible for patients. Interlocking intramedullary nails fixate in the marrow, located along the central axis of the tibia, where bending stress is almost zero. When bearing load, uniform pressure on the fracture stimulates callus growth, and through both ends, the lock nail plays a role not only in maintaining limb length but also preventing rotation.
When choosing the interlocking nail model, note the distinction between left and right interlocking nails to avoid selecting the wrong one. The length of the femoral nail should be measured as 2 cm from the contralateral subtrochanteric region to the patella, while for the tibia, measure from the contralateral tibial tubercle to the medial malleolus plus 2 cm. Thickness selection should consider the finest bone marrow cavity diameter on X-ray films, excluding a 10%-15% magnification rate, then select a nail with a diameter 2 mm larger than this standard. Among three alternate locking nails, choose one that is neither too long nor too short, ideally passing through the contralateral cortex by 2 mm [1]. To avoid errors due to unskilled femoral screw insertion, retrograde plum nail perforation of cortical bone at the fracture site is recommended. Ream the canal progressively from small to large, ensuring the final nail diameter is 1 mm larger than the inserted nail. The nail should converge well with the handle, avoiding forceful screwing, curved nails, or reversed direction. Emphasize that resistance into the nail cannot fully insert straight limb measurement lines of force to ensure no external rotation deformity of the limb, then gently twist the remote sight and fixed depth device.
To use interlocking intramedullary nails effectively, attention should be paid to the following aspects:
(1) Select an appropriate reamed medullary pin. For femoral shaft fractures, usually choose an intramedullary nail with a diameter not less than 10mm, and the final reamed canal file diameter should be 2 mm larger than the intramedullary nail. Pay attention to controlling the direction of the canal file, especially maintaining the longitudinal axis parallel with the femoral shaft in proximal reaming to ensure the medullary nail is centrally positioned in the medullary cavity.
(2) When inserting the marrow nail, maintain the anterior arch of the medullary nail in the same direction as the femoral anterior arch to avoid substantial rotation caused by medullary nail deformation. Maintaining the same direction of the anterior arch generally allows for successful insertion with gentle hammering.
(3) Positioning rod drilling is the key to good vision throughout the operation. Install the back of the distal femur pad level, positioning casing, cut the skin and subcutaneous soft tissue down to the periosteum, use a vascular clamp to push through the drill sleeve hole to the medullary nail surface, and use an X-ray machine to determine lever fixation after successful drilling, exploring deep tapping locking remotely.
(4) For sections of femur, tibia fractures, and comminuted fractures, bone grafts must be taken from the iliac bone, tying available wire or silk thread around the bone block to matchstick-like grafting.
(5) Promote the combination of open reduction and closed reduction with limited small incisions. For simple transverse and short oblique fractures, especially of the tibia, advocate closed reduction because the tibia is relatively superficial and easier for manipulative reduction. During nail insertion, flex the hip 45 degrees and the knee 90 degrees.
(6) For open fractures, perform early and complete debridement, early use of antibiotics, completely remove necrotic tissue injury FI with a large amount of normal saline, hydrogen peroxide, and repeated washing, soaking the wound.