Intramedullary Fixation of Tibial, Femoral, and Humeral Fractures Using an Expandable Nail: Case Series and Systematic Review of the Existing Literature.

Intramedullary nail is the gold standard for treating long bones diaphysial fractures. Although the Fixion nail (Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel) is an alternative technique to this method which constitutes an expandable nail, which is used to gain surgical time due to the absence of locking screws. In our department, 28 patients with tibial, femoral and humeral shaft fractures were treated by the expandable nail system for 18 months. Operative time, radiation exposure and healing time were recorded. Follow-up was obtained for a minimum of 1 year with an average of 14 months. Furthermore, in this study, we demonstrated a systematic review of the existing literature regarding the outcomes of studies on the use of the Fixion nail. In our case series, we observed one pseudarthrosis of a femoral fracture treated with a retrograde nail and two infections in tibia's fractures. In two cases, during the nail insertion, we had a failure of the implant (deformation of the tip (apex) of the nail) and two cases with delayed unions. The average operating time was 30 min (range, 26-34 min) for the tibia, 45 (range, 35-50 min) for the femur, and 20 min (range, 15-25 min) for the humerus. The radiation exposure was 0.20-0.50 s. During the systematic review, 25 studies and 790 patients with fractures of the femur, tibia and humerus were included, that met the inclusion and exclusion criteria. The mean age was 37.8 years, the time for union was 26 weeks, and 33 nonunions were observed. This study demonstrates satisfactory healing and alignment for treating tibial, femoral and humeral shaft fractures using this device. The main advantages of the expandable nail are minimal exposure to radiation and shorter operating time due to the lack of transverse locking.