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We treated 167 diaphyseal tibial fractures without reaming and with intramedullary fixation, using an unlocked Küntscher nail. The patients were followed for a minimum of 2 years. The mean time to union was 16 weeks. There were no serious complications, but 1 case of nonunion, 1 case of deep infection and 2 cases of clinically relevant malalignment. Migration of the nail was observed in 11 cases. We conclude that this treatment is simple and gives satisfactory results in diaphyseal fractures after low- or mid-energy trauma.

Twenty consecutive patients with displaced fractures of the olecranon were operated on using the tension-band wiring technique with a nonsliding pin. The patients were followed until clinical and radiographic healing or removal of the implant. Healing was uneventful in 19 patients after a median of 6 weeks. Redislocation occurred in 1 patient with a severely comminuted fracture. The design of the nonsliding pin eliminates outward pin migration, as well as migration into the medullary canal.

Jewett and McLaughlin hip nail plates were mechanically tested, and the mode of failure of both types of implants are described and discussed in this communication. Mechanical problems at the nail plate junction in the present design of the McLaughlin implant seem to make it unsuitable for internal fixation of unstable trochanteric fractures, but Jewett nail plates with angles of 125 degrees or 135 degrees can be recommended for this purpose.

Mechanical testing of McLaughlin hip nail-plates manufactured from 316 LVM stainless steel was performed. The mode of failure is described and the results are compared with previous tests of McLaughlin implants manufactured from Cobalt-Chromium-Molybdenum alloy. As there was no significant difference between these two products as regards the basic mechanical problem of failure of the nail-plate junction, it is recommended that the design be changed to make the implant suitable for internal fixation of unstable trochanteric fractures.

For 14 consecutive months, all 152 femoral neck fracture patients greater than or equal to 50 years of age admitted to the Lund University Hospital were operated on with two hook-pins if born on an uneven date and a four-flanged nail if born on an even date. A clinical 2-year follow-up revealed a 35 per cent mortality. Among survivors, radiographic healing complications were seen in undisplaced fractures in 1/13 pinned and 5/14 nailed (p greater than 0.05) and in displaced fractures in 12/36 pinned and 23/32 nailed (p less than 0.01). This outcome correlated well with the early postoperative scintimetry. Reoperation within 2 years had been performed for seven pinned and 19 nailed fractures. In hook-pinning, thus, less than one patient out of 12 needed a reoperation with THR within 2 years. This figure is interpreted as strongly favouring hook-pinning before arthroplasty as the primary procedure in femoral neck fracture.

In a series of 127 consecutive patients with trochanteric femoral fractures treated with Ender nailing, bone quality and technical failures were analysed. Of the fractures, 35 per cent were stable and 65 per cent unstable according to the definitions of Evans. There were no implant failures. Technical failures occurred in 16 cases. These could be referred to unsuitable location of the nails in the femoral head and/or to an insufficient fixation of the nails in the medullary cavity, especially in patients with poor bone quality and unstable fractures. Technical failures should therefore be preventable. When a correct surgical technique is used with a sufficient number of nails in femurs with low bone quality and a wide medullary canal, the method seems to be a simple and safe treatment for most pertrochanteric fractures, with elimination of many of the problems often associated with this injury.

Stable trochanteric fractures were produced in 12 pairs of human cadaver femora, which were fixed by either a 135 degree Jewett nail plate, a 135 degree NoLok sliding screw/plate, or a 140 degree Hansson pin/plate. The bone-implant preparations were then subjected to 20,000 load cycles simulating full weight bearing, measuring the elastic and permanent fracture displacement. In each case, elastic displacement occurred during loading. For the Jewett-stabilized fractures, a steady increased elastic displacement, as well as permanent displacement, was seen throughout the test, causing 2/8 failures when the implant penetrated the femoral head. In the NoLok- and Hansson-stabilized fractures, there were no failures, both giving better overall stability than the Jewett device with sufficient fracture stability throughout the test.