The sciatic nerve and the posterior cutaneous nerve of the thigh appear to be safe during retrograde percutaneous screw fixation of a posterior column acetabular fracture through a central entry point in the ischial tuberosity. However, the inferior cluneal nerves that are responsible for the cutaneous sensitivity of the lower half of the gluteal region are at risk of injury.

The Synthes 4.5-mm plate can put the popliteal artery at risk with as little as 3-mm posterior liftoff in the intended straight lateral position or with 5-mm anterior plate translation with no posterior liftoff. Therefore, placement of the 4.5-mm plate in the proper position and confirmation of its position with a true lateral radiograph is paramount to avoid injury to the popliteal artery.

IntroductionThe definition of a non-union remains arbitrary. Traditionally, a finite period of time was allowed to elapse before a fracture was defined as delayed union or non-union [5,20]. Usually, the term nonunion is reserved for those fractures that have not healed after 9 months of treatment.This period of healing time differs from bone to bone, being 16 to 20 weeks for the femur, 12 to 17 weeks for the tibia and 16 to 20 weeks for the humerus. Fracture stability and bridging callus are signs of union [5,15,28].No single method of treatment is applicable to all situations [5,20,28]. Treatment is influenced by the location of the non-union, the integrity of the soft tissues, the presence or absence of infection, the angular and rotational alignment of the limb, the degree of instability at the non-union site, and the radiographic appearance [5,17,20].At our level I trauma center, we have been using an expandable nail (Fixion nail, Disc-O-Tech, Tel Aviv, Israel) for treatment of selected diaphyseal non-union fractures of the tibia, femur and humerus with good results. The expandable nail provides sufficient stabilization of the pseudarthrosis for satisfactory functional recovery [16,32].The objective of this retrospective case review is to evaluate the performance of the expandable nail in the treatment of a series of diaphyseal pseudarthrosis of the femur, tibia, and humerus. Patients and MethodsThe non-unions were classified by type as hypervascular or hypertrophic, avascular or atrophic, and defect non-unions [6, 25].Between July 2002 and December 2003 a series of 25 patients diagnosed with non-unions of the femur, tibia and humerus were treated using an expandable intramedullary nail (Fixion nail). Of these 25 patients, 13 had non-union femur fractures, 7 had non-union tibia fractures, and 5 patients had non-union humerus fractures. AbstractNon-union after diaphyseal fractures is an important and relevant clinical problem. Despite the availability of improved surgical techniques, antibiotics, and complex soft tissue coverage procedures, non-union occurs in many patients after diaphyseal fractures [10,20,23,36]. Twenty-four patients with the diagnosis of pseudarthrosis of femur, tibia, or humerus were operated on at the University of Louisville Hospital using an expandable intramedullary nail. The patients were followed until clinical and radiological union was achieved. Twenty-three of the twenty-four patients obtained satisfactory results with this method of fixation. This preliminary study demonstrates that an expandable intramedullary nail can be used successfully in the treatment of selected long bone pseudarthrosis.

Introduction:Postoperative radiographs are used to monitor fractures of the tibia and femur after intramedullary fixation. This study sought to examine how frequently these radiographs change management.Methods:This was a single-center chart review of patients over a 4-year period at a level I trauma center. Radiographs were defined as either performed for routine surveillance or performed with some clinical correlate on history and examination. Participants received intramedullary nailing for diaphyseal fractures of the femur or tibia. Patients required at least one postoperative radiograph. All patients were subject to our institution's follow-up protocol: visits at 2, 6, 12, and 24 weeks. Radiographs that changed management were those that led to alterations in follow-up, directed counseling, or contributed to the decision to proceed with revision surgery.Results:A total of 374 patients were found. Two hundred seventy-seven received at least one post-op radiograph. The median follow-up was 23 weeks. Six hundred seventeen total radiographs were reviewed. Nine radiographs contributed to a change in management (9/617 = 1.5%). No surveillance radiograph taken before 14 weeks resulted in changes in management.Discussion:Our results suggest that radiographs taken in the first 3 months post-op in asymptomatic patients treated with lower extremity intramedullary rods do not result in changes to clinical management.