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Letters to the Editor to:

Current Concepts Review:
Mark R. Brinker and Daniel P. O'Connor
Exchange Nailing of Ununited Fractures
J Bone Joint Surg Am 2007; 89: 177-188 [Abstract] [Full text] [PDF]
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[Read Letter to the Editor] Use of Ilizarov Frame with Exchange Nailing
Subir L. Bali   (18 January 2007)

Use of Ilizarov Frame with Exchange Nailing 18 January 2007
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Subir L. Bali,
Research Fellow
University of Roehampton, London SW15 5PU, U.K.

Send letter to journal:
Re: Use of Ilizarov Frame with Exchange Nailing

subirbali{at}doctors.org.uk Subir L. Bali

To The Editor:

I read with interest the article on exchange nailing of ununited fractures(1). Although the authors performed a comprehensive review, I would like to point out that there is an important operative technique that they did not discuss.

The use of a circular fixator to compress a long bone nonunion with an intramedullary nail in situ has previously been described by the same authors(2) and requires the exchange of an intramedullary nail with one of smaller diameter in addition to the application of an Ilizarov fixator to allow slow compression at the nonunion site. This technique relies on different mechanical and biological effects than exchange nailing per se with a smaller nail being placed unreamed and providing stability by resisting only bending and shearing forces. Indeed, this technique has also been utilised with retention of a failed exchange nail(3) and provided excellent results in these recalcitrant nonunion cases.

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .

References:

1. Brinker MR, O’Connor DP. Exchange Nailing of Ununited Fractures. J Bone Joint Surg Am. 2007; 89:177-188

2. Brinker MR, O’Connor DP. Ilizarov Compression Over a Nail for Aseptic Femoral Nonunions That Have Failed Exchange Nailing: A Report of Five Cases. J Orthop Trauma. 2003; 17:668-676

3. Menon DK, Dougall TW, Pool RD, Simonis RB. Augmentative Ilizarov External Fixation After Failure Of Diaphyseal Union With Intramedullary Nailing. J Orthop Trauma. 2002; 16:491-497