The Art of Intramedullary Nailing for Femoral Fracture

Preface
Contents
About the Author
Abbreviations
1: Brief History of Evolution of Femoral Nail
	1.1	 First-Generation Nail: Open Section Rod Type Nail
	1.2	 Second-Generation Nail: Interlocking Nail
	1.3	 Third-Generation Nail: Reconstruction Nail
	1.4	 Fourth-Generation Nail
	References
2: Fracture Healing Mechanism after IM Nailing
	2.1	 Formation of Hematoma
	2.2	 Intramembranous Ossification and Endochondral Ossification (Stage of Soft Callus: Unstable)
	2.3	 Intramembranous Ossification and Endochondral Ossification (Stage of Hard Callus: Stable)
	2.4	 Remodeling
	References
3: Indication and Contraindication of Femoral Nailing
	3.1	 Indication
		Femoral Shaft Fracture with Various Degrees of Comminution
		Segmental Fracture of the Femur
		Delayed Union or Nonunion of Femoral Shaft Fracture
		Pathologic Fracture
		Reconstruction of Segmental Defect
		Lengthening of Femur
	3.2	 Contraindication
	References
4: Antegrade Femoral Nailing for Femoral Shaft Fracture
	4.1	 Position of the Patient
	4.2	 Entry Point (for the Straight Femoral Nail)
	4.3	 Reduction Technique
	4.4	 Reaming of the Medullary Canal
	4.5	 Insertion of the Femoral Nail
	4.6	 Mode of Interlocking
	4.7	Summary
	References
5: Retrograde Nailing
	5.1	 Surgical Procedures
		Patient Positioning
		Surgical Approach for Entry Portal
		Fracture Reduction
		Reaming and Nail Insertion
		Optional Blocking Screw Fixation and Nail Reinsertion
		Interlocking and Wound Closure
		Postoperative Care
	5.2	 Use of Retrograde Nailing in Clinical Situations
		Femoral Shaft Fractures Associated with Ipsilateral Fractures Including Femoral Neck, Acetabulum, Pelvic Ring, or Tibia Shaft (Figs. 5.4 and 5.5)
		Infra-Isthmic Fractures of Femoral Shaft
		Intra-Articular Fractures of Distal Femur
		Periprosthetic Fractures of Distal Femur Following Total Knee Arthroplasty
	References
6: Ipsilateral Femoral Neck Fracture
	References
7: Bone Defect Due to Open Fracture and/or Infection After Osteosynthesis
	7.1	 Ordinary Interlocked IM Nailing if the Defect Size is not Significant
	7.2	 IM Nailing after Shortening of the Major Fragments (for Later Lengthening)
	7.3	 IM Nailing with Bone Defect Filled with Bone Cement (Masquelet Technique)
	7.4	 Internal Bone Transport Using a Monorail Type External Fixation System
	7.5	 Combination of the External Fixator and Plate Osteosynthesis
	References
8: Atypical Femoral Fracture (AFF)
	8.1	 Association with Bisphosphonate (BP)
	8.2	 Definition of AFF by the American Society of Bone and Mineral Research (ASBMR) Task Force Team
		Major Features
		Minor Features
	8.3	 Location of AFF
	8.4	 Early Detection of Incomplete AFF
	8.5	 Treatment of Preclinical Cortical Lesions
	8.6	 Risk Factors for Progression to Complete Fracture
	8.7	 Surgical Treatment for Impending AFF (Prophylactic Nailing)
	8.8	 Surgical Treatment (IM Nailing) for Complete AFF
		IM Nailing for Complete Subtrochanteric AFF
		IM Nailing for Complete AFF
	8.9	 Other Miscellaneous Causes of AFF or AFF-Like Fractures
	References
9: Subtrochanteric Fracture: Malalignment and Nonunion After IM Nailing
	9.1	 Tips for Correction of the External Rotation, Abduction, and Varus Deformity of the Proximal Fragment During IM Nailing
	9.2	 Exchange Nailing for Malaligned Subtrochanteric Fracture After IM Nailing
	9.3	 Osteosynthesis with a Fixed Angled Plate for Malaligned Subtrochanteric Fracture After IM Nailing
	9.4	 Removal of a Broken Nail in Nonunion of the Subtrochanteric Fracture
	9.5	 Nonunion of the Subtrochanteric Fracture After IM Nailing with the Appropriate Alignment
	References
10: Isthmic or Non-isthmic Femoral Nonunion After IM Nailing
	10.1	 Supra-Isthmal Nonunion
	10.2	 Isthmal Nonunion
	10.3	 Infra-Isthmal Nonunion
	References
11: Intramedullary Nailing in the Deformed Medullary Canal
	11.1	 Autosomal Dominant Type II (AD II) Osteopetrosis
	11.2	 Obstruction of the Medullary Canal Due to Osteoblastic Bone Metastasis
	11.3	 Deformity of the Medullary Canal Due to Malunion of the Femoral Shaft
	11.4	 Hypophosphatemic Rickets
	11.5	 Osteogenesis Imperfecta
	References
12: Limb Lengthening Using Intramedullary Lengthening Nail
	12.1	 Osteotomy (Lengthening) Site: Previous Fracture (Figs. 12.1 and 12.2) Vs. Intact (Figs. 12.3, 12.4, 12.5, 12.6 and 12.7)
	12.2	 Osteotomy (Lengthening) Site: Diaphysis (Figs. 12.8, 12.9 and 12.10) or Metaphysis (Figs. 12.11 and 12.12)
	12.3	Summary
		Osteotomy (Lengthening) Site: Apex of the Deformity or Intact Site
		Antegrade or Retrograde Nail
		Rate and Rhythm of Lengthening
	References
13: Various Problems Encountered During the Removal of the IM Nail
	13.1	 Failure of Attempted Removal of the Cephalomedullary Nail or Tibial Nail and its Solutions
	13.2	 Fracture of Femur or Tibia during Removal of a Nail
	13.3	 Femoral Neck Fracture after Removal of Cephalomedullary Nail
	References