| Summary: | 博士 === 國立臺灣大學 === 臨床醫學研究所 === 86 === In order to promote our national industry and develop our own orthopedic impla
nt for oriental people, we attempted to design and manufacture our own intrame
dullary nails. Material science, material mechanics are the basic knowledge fo
r implant design. Additionally, failure mechanics and metal workingprocess are
also important for implant manufacture. In the beginning of the current book,
we first described the basic biomechanics of the interlocking nails as well a
s the history of the development of the intramedullary nails. Since the advent
of the interlocking nails, the use of the intramedullary nailshas been expand
ed and become moreand more competent. However, some problemsconcerning the des
ign and surgical technique of the interlocking nails are still existing and re
quirement more investigation. The traditional surgical treatment of humeral sh
aft fractures has been challenged with different sorts of complications. The m
ostly commonly used method is platefixation. It has the disadvantages of exten
sive soft tissue stripping, risk of radial nerve injury and insecurity for ost
eoporotic bone. The main content in the book is discussing a newly developed H
L nail that preserves the advantages of plate fixation and avoid its disadvant
ages. Following the chapter ofbiomechanical basis, we described our experience
in developing humeral locked nails. Because the design of the nails should be
based on the anatomicalstructure, the geometry and dimension of the human hum
eri were studied in the second Chapter. The length, proximal humeral offset, d
istal humeral offset and the canal width of the humeri were investigated. Furt
hermore, axillary nerve which is very important during operation of proximal h
umeri was also studied. The anatomical pathway and the risk of injury by locki
ng screws were measured and recorded. This can guide the operator to prevent i
njury of this important nerve. In the Chapter 3, we did mechanical testing to
measure the mechanical property of our nails. They were loaded in 3-point bend
ing and torsional tests and compared to normal humeri and other locked nails.
We found this nail was strong enough to with stand the load across the humeri
and could provide sufficient stability for immediate postoperative motion exer
cise of the upper extremity without an external support. Furthermore, we found
the nail could provide better fixation stability when inserted from short to
long segment. The rigidity was higher and initial instability was lower. In th
e subsequent chapters, we described ourclinical experience in using this nails
for humeral fractures. Chapter 4 presents the details of surgical technique o
f retrograde nailing in acute fractures, nonunions and pathological fractures.
We found retrograde nailing could yield a satisfactory clinical result. Chapt
er 5 concerns about using this nail for humeral nonunion and delayed union. Hu
meral nonunion is a thorny task for orthopedic surgeons. Plate fixation is the
most preferred method at present; however, it is threatened by all kinds of c
omplications. The humeral locked nails prowided better fixation stability and
decreased the incidence of complications. Humeral locked nailing has been show
n to be an excellent alternative for treatment of humeral fractures. We have a
lready published several papers in the national and international orthopedic j
ournals.
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