Case Report Program

Fracture Management

Field Orthopaedics is committed to supporting the continued improvement of clinical practice. We appreciate that one of the best ways to do this is through the sharing of best practices. Our case report program provides a collection of user experiences with the Micro Screw and NX Nail across a variety of indications.

If you are interested in contributing to the program, please click on the button below to view the process and get in touch either directly via marketing@fieldorthopaedics.com or your local representative.

Using NX Nail for fixation of an oblique fracture of the second metacarpal.

A 22-year-old male presented to Dr Shah after sustaining an injury to his right hand after he dropped a dresser while moving house. Radiographs confirmed there was a short oblique fracture of the second metacarpal shaft. With a desire to return to his active lifestyle, the decision was made to proceed surgically with anatomic reduction of the fracture and definitive fixation with an NX Nail from Field Orthopaedics.

Using NX Nail for a distal ulna fracture in a high energy wrist injury.

A 25-year-old right-hand-dominant male presented with a high energy injury to the right wrist after a motorcycle accident. X-rays showed fractures of the distal radius, distal ulna, scaphoid and hook of hamate. The patient was treated with a combination of the Field Orthopaedics 4.0mm NX Extremity Nail to provide fixation to the distal ulna, a dorsal bridge plate to temporarily stabilize and maintain the length of the distal radius and parallel headless compression screws with bone graft for the scaphoid waist fracture.

Using NX Nail for unstable fractures of the 3rd & 4th metacarpals.

A 25-year-old right-hand-dominant female presented to Dr Wurapa three days after being involved in a motor vehicle accident. X-rays showed unstable fracture patterns involving the third and fourth metacarpal shafts. Given her young age, dominant hand involvement and fracture patterns; reduction and fixation was recommended and achieved with the NX Nail.

Using NX Nail for fixation of a spiral fracture of the 4th metacarpal.

A 56-year-old female presented to Dr Grier after sustaining an injury to her left hand while riding an E-bike. Radiographs confirmed a spiral fracture of the fourth metacarpal diaphysis with displacement in both the coronal and sagittal planes. With a desire to return to her active lifestyle and a concerning degree of malrotation present, the decision was made to stabilise the fracture with an NX Nail from Field Orthopaedics. At follow-up the patient demonstrated full active range of motion of the ring finger, was able to make a fist and had all motor function intact. With preserved implant alignment and no evidence of hardware failure, the patient was able to resume normal function without restriction.

Using NX Nail for a comminuted P2 phalanx fracture.

A 20-year-old female professional Australian Football League (AFLW) player suffered an injury to the ring finger of her dominant right hand in a collision at training. She was seen by Dr Couzens the next day and presented with pain, swelling and an angulated finger. Radiographs showed a comminuted fracture of the middle P2 phalanx. Dr Couzens achieved definitive fixation with a 2.0mm x 22mm NX Nail through a percutaneous approach. The operative finger was buddied to the middle finger initially and the patient was seen by a hand therapist for provision of a training and playing splint. By six weeks she was cleared to return to contact ball work with no restrictions in the gym. In this instance, Dr Couzens was able to treat a painful and debilitating injury for a young patient whose vocation requires the full use of her hand and fingers.

Using NX Nail for fixation of a displaced fourth metacarpal shaft fracture.

A 25-year-old male presented to the local emergency department for treatment of a painful and swollen right hand after a fall. Upon review by Dr Wurapa six days later, radiographs revealed a displaced shaft fracture of the fourth metacarpal. Incidentally, there was a small plate present on the fifth metacarpal in the same hand from a prior remote injury. With the patient adamant to avoid the painful and prolonged recovery he had previously experienced, Dr Wurapa opted for a 3.5mm diameter, 50mm length NX Nail to provide definitive fixation. Six days postoperatively the patient had good hand motion and was given a splint to aid in his return to work. By eight weeks he reported no pain or functional limitations. In this case, Dr Wurapa was able to treat a young patient who was keen to return to work with a superior alternative to plate fixation.

Using NX Nail for fixation of a fifth metacarpal fracture involving the distal diaphysis with comminution.

A 37-year-old male sustained a crush injury to his non-dominant hand at work. He was initially evaluated at a local emergency department before presenting to Dr Wurapa three days later. Upon evaluation, he had a dorsal laceration and a fifth metacarpal fracture of the right hand which involved the distal diaphysis with comminution. After discussing operative and nonoperative treatment options for the fracture, the patient elected to proceed with open reduction internal fixation to minimize limitations during his recovery and return to work. Dr Wurapa achieved definitive fixation with a 4.0mm diameter, 45mm length NX Nail following debridement and repair of the dorsal wound. By four weeks post-operatively the patient reported no pain, had weaned splint use, and returned to normal daily activities and work tasks with full digital motion. At his final appointment he was deemed to have completed a full clinical recovery with solid consolidation at the fracture site. In this case, the NX Nail offered Dr Wurapa a solution for treating a complex fracture while maintaining length, restoring version, and controlling angulation1 .

Using Micro Screw for a Bennett’s Fracture of the thumb.

A 20-year-old right-hand dominant male presented to Dr Larson complaining of thumb pain, three days after falling off his skateboard. Radiographic examination revealed a displaced Bennett’s fracture and a relatively small and mildly comminuted Bennett’s fragment. Given the patient’s young age and dominant hand involvement, a closed reduction with percutaneous fixation using the Micro Screw was performed.

Using Micro Screw for a PIPJ Fracture.

A 17-year-old right-hand-dominant male presented with a flexed, swollen and painful right ring finger ten days following an injury sustained when his hand got caught in a dog leash. X-ray revealed a PIP joint fracture, involving a large P2 volar lip fragment and comminution from the base of the middle phalanx. Dr Malone achieved definitive fixation using a volar approach with two 1.5mm cannulated Micro Screws.

Using Micro Screw for a P2 Corrective Osteotomy.

14-year-old right-hand dominant female competitive equestrian rider presented with a malunited radial condylar fracture of the middle phalanx of the left ring finger. The patient presented to Dr. Couzens with a cosmetic deformity defined by 20 degrees of angulation. Dr Couzens elected to manage the deformity with a sliding osteotomy using a 1.5x8mm and a 1.5x10mm FO microscrew.

Using Micro Screw for a dorsal lunate fracture.

19 year-old right-hand dominant male student presented with right wrist stiffness, weakness and pain at the extremes of motion and on palpation of the dorsal lunate. X-ray and CT indicated a dorsal lunate fracture with an established non-union. Dr Anderson elected to perform a lunate Open Reduction Internal Fixation (ORIF) with a FO 1.5x12mm microscrew.

Contraindications, potential complications, warnings and precautions:

In any surgical procedure, the potential for complications and adverse reactions exists. Contraindications include cases of inflammation, cases of active or suspected sepsis / infection and osteomyelitis, patients with certain metabolic diseases and applications that are not defined by the indications.

The risks and complications with these implants can include loosening, deformation or fracture of the implant, acute post-operative wound infections and late infections with possible sepsis, thrombosis and embolism, wound hematoma and delayed wound healing, temporary and protracted functional neurological perturbation, tissue reactions resulting from allergy or foreign body reaction to dislodged particles and corrosion with localised tissue reaction and pain. All complications listed here are not typical of the Field Orthopaedics (FO) Bony Trauma Extremity System (BTES) but can be in principle observed with any implant.

Warnings and precautions related to the use of the FO BTES include; re-operation to remove or replace implants may be required at any time due to medical reasons or device failure, if corrective action is not taken complications may occur; use of an undersized screw/nail in areas of high functional stresses may lead to implant fracture and failure; plates and screws, wires, or other appliances of dissimilar metals should not be used together in or near the implant site; the FO Screws, NX Nails, Plates, Pins and K-Wires, and FO drill bits are intended for single use only, re-use may cause product failure and could lead to disease transmission; instruments, guide wires and screws/nails are to be treated as sharps; Field Orthopaedics branded instrumentation is recommended for use in conjunction with FO BTES Implants.

These devices have not been evaluated for safety and compatibility in the MR environment. For further details, please consult the instructions for use.