BACKGROUND AND OBJECTIVE: Tibia fracture is one of the most common long bone fractures in body and primary treatment of open fracture always worries surgeons. The aim of this study was to evaluate the treatment of open tibia fractures by flexible medullary NAILING.METHODS: This descriptive-analytical study was performed on 44 patients suffering from open tibial fractures treated with flexible medullary nails in Shahid Beheshti and Yahyanejad hospitals from 1998-2001. In this study with limited incision, fixation of open fractures (gustilo type I to type IIIA) was done by 2-3 nails (3mm or 3.5mm). Demographic information associated with variables such as infection, for 1.5 years followed up in patients and data was analyzed by ANOVA test.FINDINGS: Mean age of patients was 29.8 years and 37(84.1%) patients were male. The average time of union was 6.1 months. There were 2(4.5%) patients with deep infection and 7(15.9%) with superfacial infection. Delayed union was seen in 4(9.1%) patients and malunion was seen in 1(2.3%) patient and there was not non-union.CONCLUSION: Results of this study showed that flexible medullary NAILING is a reliable method for treatment of open tibia fractures.

Background: According to high incidence of femoral shaft fracture in children and active persons and contraversial results in literature about the best method of treatment especially spica casting and TEN NAILING, this study was done in Imam hossein hospital in 1381-1383.Materials and Methods: This randomized clinical trial study was performed on 40 cases of femoral shaft fracture. Patients were 6-10 years children, without open wound, multiple fracture, head trauma and sever comminution. Children were divided into two groups: one group (cases) treated with TEN NAILING and the other group (control) treated by Spica Casting.Theraputic effects of two methods based on change in Anterior/Posterior angulation Varus/Valgus angulation, Shortening/Overgrowth. Malrotation and LLD in 10-26 month follow up were compared.Results: In the control group Anterior / Posterior angulation in third visit was 9.4±5.8 and in cases was 1.4±2.2 (P<0.000). In control group Varus/Valgus angulation in third visit was 5.6±3.4 and in cases was 1.59±2.3 (p<0.000). Rate of Shortening/Overgrowth in follow up period was 2.85±1.75 in control group and 2.5±1.8 in cases (p<0.009). Malrotation was same in both group. Rate of acceptable LLD in second visit was better in cases and was the same in third visit.Conclusion: It seems that TEN NAILING method is more effective than Spica casting in treatment of femoral shaft fracture in children. More studies with greater number of cases and longer follow up period is needed to confirm this results.

The history of the new NAILING method dates back to Gerhard Kü ntscher, who introduced this concept in Germany in 1940. He believed in two general principles: Stable fixation and fixation of fractures without opening the fracture site. In the beginning, primary nails with various weaknesses were only used in fractures of femur. Over time, effective changes were made in the design and insertion of bone nails. This article aimed to review the evolution of the design of nails and simple but significantly important principles of inserting nails in long bones. In any case, lack of adherence to these simple principles by surgeons leads to lack of desirable fixation.

Introduction: Interlocking has been widely accepted for treatment of femoral shaft fracture. However, complications still exist. Numerous investigations have been carried out on earlier phase of fracture healing with interlocking nail.Purpose: In this research, a three dimensional model of bone with antegrade interlocking nail in post fracture healing phase during gait cycle is studied. Additionally, published results of others, obtained under different boundary condition, are discussed. Stress distribution pattern in femur with dynamised nail and static nail are investigated.Results: Three dimensional model of the third generation composite femur was considered in which simple stainless steel Gross Kempf femoral nail was inserted in the medullary canal. Simulation was performed with the assistance of Abaqus analysis finite element codes. Two different loading patterns were used in simulations: Simple loading pattern, and Full muscle loading.Discussion: Results were verified through simple analytical beam column model. Good agreement between analytical and numerical results was found. Results proved the importance of exact boundary conditions for interlocked femoral nail testing and simulation. Fifty percent increase in bone stress level after removal of proximal screw was observed.

Background: Treating open fracture of the femur is problematic. In this study the results of undreamed intramedullary (IM) NAILING in this kind of fracture is reviewed.Methods: In a prospective study, 41 patients (40 males, 1 female) with open femur fractures were treated, using the above method, in two hospitals in Meshhad from 2004 to 2006. Fifteen cases could not be followed. The remaining 26 patients, with 28 years mean age (16-45 years) were comprised of 6 type A, 9 B, and 11 type C fractures- according to AO classification. There were 2 type II, and 24 IIIA, Gustillo/Anderson open fractures, with a mean injury severity score (ISS) of 10.96. The cases were followed from 18 to 36 months, and the union rate, infection rate, and limb function were assessed.Results: Twenty three patients reached union in 156 days on average (84-250 days). Infection occurred in 2 patients. At the end of the follow-up period, the range of motion of the knee was 120 degrees. Shortening of 3 centimeters was observed in one case.Conclusions: Unreamed intramedullary titanium NAILING is effective in treatment of type II and IIIA open femoral fractures.