{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T15:48:26Z","timestamp":1754149706763,"version":"3.41.2"},"reference-count":34,"publisher":"Begell House","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Long Term Eff Med Implants"],"published-print":{"date-parts":[[2025]]},"abstract":"<p>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.\n<\/p>","DOI":"10.1615\/jlongtermeffmedimplants.2025055433","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T11:13:51Z","timestamp":1744974831000},"page":"77-89","source":"Crossref","is-referenced-by-count":0,"title":["Intramedullary Fixation of Tibial, Femoral, and Humeral Fractures Using an Expandable Nail: Case Series and Systematic Review of the Existing Literature"],"prefix":"10.1615","volume":"35","author":[{"given":"Stamatios A.","family":"Papadakis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margarita- Michaela","family":"Ampadiotaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Pallis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Labrini","family":"Agapitou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stavros","family":"Lykos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Tsivelekas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spyridon","family":"Galanakos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"613","reference":[{"key":"2","doi-asserted-by":"crossref","unstructured":"Alho A, Benterud JG, Hogevold HE, Ekeland A, Stromsoe K. Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures. Clin Orthop Relat Res. 1992;(277):243-52.","DOI":"10.1097\/00003086-199204000-00030"},{"key":"3","doi-asserted-by":"crossref","unstructured":"Pfeifer R, Sellei R, Pape HC. The biology of intramedullary reaming. Injury. 2010;41(2 Suppl):S4-8.","DOI":"10.1016\/S0020-1383(10)70002-4"},{"key":"4","doi-asserted-by":"crossref","unstructured":"Shih CY, Kor CT, Hsieh CP, Chen CL, Lo YC. Does nail size or difference between canal and nail diameter influence the likelihood of union or time to union of femoral shaft fractures treated with intramedullary nailing? A retrospective cohort study. BMC Musculoskelet Disord. 2022;23:826. doi: 10.1186\/s12891-022-05781-0. PMID: 36045444; PMCID: PMC9429295.","DOI":"10.1186\/s12891-022-05781-0"},{"key":"5","doi-asserted-by":"crossref","unstructured":"Lepore S, Capuano N, Lepore L, Romano G. Preliminary clinical and radiographic results with the Fixion intramedullary nail: An inflatable self-locking system for long bone fractures. J Orthop Traumatol. 2000;3:135-40.","DOI":"10.1007\/s101950070005"},{"key":"6","doi-asserted-by":"crossref","unstructured":"Folman Y, Ron N, Shabat S, Hopp M, Steinberg E. Peritrochanteric fractures treated with the Fixion expandable proximal femoral nail: Technical note and report of early results. Arch Orthop Trauma Surg. 2006;126(3):211-4.","DOI":"10.1007\/s00402-006-0110-0"},{"key":"7","unstructured":"AO Foundation. AO\/OTA Fracture and Dislocation Classification Compendium-2018. Available from: https:\/\/www.aofoundation.org\/trauma\/clinical-library-and-tools\/journals-and-publications\/classification."},{"key":"8","unstructured":"Orthobullets. Tscherne classification. Available from: https:\/\/www.orthobullets.com\/trauma\/1002\/tscherne-classification."},{"key":"9","unstructured":"Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2000. Available from: http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"10","unstructured":"Gierisch JM, Beadles C, Shapiro A, Smith VA, McDuffie JR, Kendrick A, Nagi A, Williams JW Jr. Health disparities in quality indicators of healthcare among adults with mental illness [Internet]. Washington, DC: Department of Veterans Affairs (US); 2014 Oct. Available from: https:\/\/europepmc.org\/article\/nbk\/nbk299080."},{"key":"11","doi-asserted-by":"crossref","unstructured":"Steinberg EL, Luger E, Arbel R, Steinberg Y, Chechik A. Early results of retrograde expandable nail fixation of 29 distal femoral fractures. Surg Innov. 2011;18(4):400-5.","DOI":"10.1177\/1553350611403768"},{"key":"12","unstructured":"Bekmezci T, Baca E, Kocaba\u015f R, Kaynak H, Tonbul M. Early results of treatment with expandable intramedullary nails in femur shaft fractures. Acta Orthop Traumatol Turc. 2006;40(1):1-5."},{"key":"13","unstructured":"Bekmezci T, Baca E, Kocaba\u015f R, Kaynak H, Tonbul M. Tibia \u015faft kiriklarinda geni\u015fleyebilir intramed\u00c3\u00bcller \u00c3\u00a7ivilerle erken d\u00c3\u00b6nem tedavi sonu\u00c3\u00a7lari. Acta Orthop Traumatol Turc. 2005;39(5):421-4."},{"key":"14","doi-asserted-by":"crossref","unstructured":"Ben-Galim P, Rosenblatt Y, Pessach Y, Nyska M, Dekel S. Intramedullary fixation of tibial shaft fractures using an expandable nail. Clin Orthop Relat Res. 2007;455: 234-40.","DOI":"10.1097\/01.blo.0000238827.57810.27"},{"key":"15","unstructured":"Bi Q, Zhu DJ, Qiu BS, Hong JF, Zhang SJ, Xia B. Comparative study on treatment of midshaft tibial fracture with expandable and interlocking intramedullary nails. Chin J Traumatol. 2007;10(4):228-32."},{"key":"16","unstructured":"Capelli RM, Galmarini V, Molinari GP, De Amicis A. The Fixion expansion nail in the surgical treatment of diaphyseal fractures of the humerus and tibia. Chir Organi Mov. 2003;88(1):57-64."},{"key":"17","doi-asserted-by":"crossref","unstructured":"Fortis AP, Dimas A, Lamprakis AA. Expandable nailing system for tibial shaft fractures. Injury. 2008;39(8):940-6.","DOI":"10.1016\/j.injury.2008.01.022"},{"key":"18","doi-asserted-by":"crossref","unstructured":"Ozturk H, Altay MA, Dogrul A, Eren OT, Kaya A. Extreme complications of Fixion nail in the treatment of long bone fractures. Arch Orthop Trauma Surg. 2008;128:301-6.","DOI":"10.1007\/s00402-007-0458-9"},{"key":"19","doi-asserted-by":"crossref","unstructured":"Franck WM, Olivieri M, Jannasch O, Hennig FF. Expandable nail system for osteoporotic humeral shaft fractures: Preliminary results. J Trauma. 2003;54:1152-8.","DOI":"10.1097\/01.TA.0000066146.13247.CA"},{"key":"20","doi-asserted-by":"crossref","unstructured":"Jovanovic A, Pirpiris M, Semirli H, Doig SG. Fixion nails for humeral fractures. Injury. 2004;35:1140-2.","DOI":"10.1016\/j.injury.2004.01.020"},{"key":"21","unstructured":"Dall'Oca C, Lavini F. Fixion intramedullary nailing: An inflatable system in humeral diaphyseal fractures. Orthop Procs. 2005;87-B(Suppl II):179."},{"key":"22","doi-asserted-by":"crossref","unstructured":"Zoccali C, Di Francesco A, Ranalletta A, Flamini S. Clinical and radiological midterm results from using the Fixion expandable intramedullary nail in transverse and short oblique fractures of femur and tibia. J Orthop Traumatol. 2008;9(3):123-8.","DOI":"10.1007\/s10195-008-0018-2"},{"key":"23","doi-asserted-by":"crossref","unstructured":"Maher SA, Meyers K, Borens O, Suk M, Grose A, Wright TM, Helfet D. Biomechanical evaluation of an expandable nail for the fixation of midshaft fractures. J Trauma. 2007;63(1):103-7.","DOI":"10.1097\/01.TA.0000243205.24809.3f"},{"key":"24","doi-asserted-by":"crossref","unstructured":"Kapoor SK, Kataria H, Boruah T, Patra SR, Chaudhry A, Kapoor S. Expandable self-locking nail in the management of closed diaphyseal fractures of femur and tibia. Indian J Orthop. 2009;43(3):264-70.","DOI":"10.4103\/0019-5413.53457"},{"key":"25","doi-asserted-by":"crossref","unstructured":"Smith WR, Ziran B, Agudelo JF, Morgan SJ, Lahti Z, Vanderheiden T, Stall A. Expandable intramedullary nailing for tibial and femoral fractures: A preliminary analysis of perioperative complications. J Orthop Trauma. 2006;20(5):310-4. doi: 10.1097\/00005131-200605000-00005.","DOI":"10.1097\/00005131-200605000-00002"},{"key":"26","unstructured":"Mallick E, Hazarika S, Assad S, Scott M. The Fixion nailing system for stabilising diaphyseal fractures of the humerus: A two-year clinical experience. Acta Orthop Belg. 2008;74(3):308-16."},{"key":"27","unstructured":"Kazzaz S, Kumar P, Mahapatra A. Expandable Fixion nail system as a successful treatment option for closed tibial diaphyseal fracture. Orthop Procs. 2013;95-B(19 Suppl):5."},{"key":"28","unstructured":"Logan K, Costa M, Patel A. The Fixion humeral nail: The Norwich experience of 42 cases. Orthop Procs. 2005;87-B(III Suppl):336-7."},{"key":"29","doi-asserted-by":"crossref","unstructured":"Sipahioglu S, Sencan B, Bulut O, Uruc V, Tuncay I. Comparison of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur. Niger J Clin Pract. 2017;20(7):792-8.","DOI":"10.4103\/1119-3077.212452"},{"key":"30","doi-asserted-by":"crossref","unstructured":"Panidis G, Asimakopoulos A, Papakostas I, Aloupis G, Bekiaris T, Dimas A. The use of an innovative inflatable self-locking intramedullary nail in treating and stabilizing long bone fractures. Technique-preliminary results. Osteosynth Trauma Care. 2003;11(1 Suppl):108-12.","DOI":"10.1055\/s-2003-42310"},{"key":"31","unstructured":"Briant-Evans T, Gollop J, Packer G. Faster surgery, faster union, but less stable fixation in 50 tibial fractures treated with the Fixion expandable intramedullary nail compared with a matched series of interlocked nails. Orthop Procs. 2013;95(1 Suppl):22."},{"key":"32","unstructured":"Ghafil D, Ackerman P, Baillon R, Verdonk R, Delince P. Expandable intramedullary nails for fixation of tibial shaft fractures. Injury. 2012;39(2):202-9."},{"key":"33","doi-asserted-by":"crossref","unstructured":"Chechik O, Khashan M, Brin YS, Butnaru D, Bor N. Favorable radiographic outcomes using the expandable proximal femoral nail in the treatment of hip fractures-A randomized controlled trial. J Orthop. 2014;11(2):103-9.","DOI":"10.1016\/j.jor.2014.04.004"},{"key":"34","doi-asserted-by":"crossref","unstructured":"Fletcher CK, McDowell D, Naparla C. Open locked nailing using an expandable nail-an alternative approach. MOJ Orthop Rheumatol. 2014;1(1):14-7.","DOI":"10.15406\/mojor.2014.01.00004"},{"key":"35","doi-asserted-by":"crossref","unstructured":"Zhou ZT, Song YC, Zhou XZ, Zhou HB, Luo ZP, Dong QR. Femoral midshaft fractures: Expandable versus locked nailing. Orthopedics. 2015;38(4):e314-8.","DOI":"10.3928\/01477447-20150402-60"}],"container-title":["Journal of Long-Term Effects of Medical Implants"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.dl.begellhouse.com\/download\/article\/13e4de3a2b2d2c91\/JLT-55433.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T15:33:43Z","timestamp":1752852823000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.dl.begellhouse.com\/journals\/1bef42082d7a0fdf,1a2841753be9f164,13e4de3a2b2d2c91.html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1615\/jlongtermeffmedimplants.2025055433","relation":{},"ISSN":["1050-6934"],"issn-type":[{"type":"print","value":"1050-6934"}],"subject":[],"published":{"date-parts":[[2025]]}}}