Electronic Letters to:

Lower Limb: M. Lemon, H. S. Somayaji, A. Khaleel, and D. S. Elliott Fragility fractures of the ankle: STABILISATION WITH AN EXPANDABLE CALCANEOTALOTIBIAL NAIL J Bone Joint Surg Br 2005; 87-B: 809-813 [Abstract] [Full text] [PDF]

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Reply to Khan and Kelly from the authors

Michael Lemon   (18 August 2005)

Fragility fractures of the ankle

Amer Khan, Andrew Kelly   (12 July 2005)

Reply to Khan and Kelly from the authors 18 August 2005
Michael Lemon, Orthopaedic SpR St Peter's Hospital, Chertsey, UK Send letter to journal: Re: Reply to Khan and Kelly from the authors michael_lemon{at}hotmail.com Michael Lemon	Sir, We would like to thank Messrs Khan and Kelly for their interest in our paper. They have raised a very important point of which we were unaware. The manufacturers of the Fixion expandable nail (Disc Orthopaedic Technologies) accept this risk of significant explosion with cremation. As a result, they have amended their product literature to include the following line in their post-operative care section: 'In case of patient cremation, drill a hole in the nail body, to release pressure, or remove the nail, prior to cremation.' This information should therefore form part of the consent procedure for insertion of these implants. The patient’s next of kin must also be made aware of the risk of explosion in order that they can pass on this information in the event of a proposed cremation. Despite these measures we agree with the Secretary of the Federation of British Cremation Authorities who has suggested that a patient register may be the safest way to avoid the unwitting cremation of a body which has a pressurised expandable nail in situ. The expense of such a register might be justified by it minimising both the risk of serious damage to a cremator, and the extreme distress caused to a family of the deceased patient by such an explosion. M. LEMON, MRCS St Peter’s Hospital, Chertsey, UK.
Fragility fractures of the ankle 12 July 2005
Amer Khan, Orthopaedic SpR Musgrove Park Hospital, Taunton, Somerset TA1 5DA, Andrew Kelly Send letter to journal: Re: Fragility fractures of the ankle amerkhan441{at}hotmail.com Amer Khan, et al.	Sir, We read this article with interest. It addresses an important issue about which the optimal treatment remains uncertain. The authors recommend using the Fixion IM expandable nail to stabilise these fractures. They advise removal of the nail after healing to reduce the potential risk of fracture around the implant. The implants were retained in half of their series. Yet Fixion IM expandable nails may cause complications even after the death of their recipients. There is case report evidence of cremation causing a violent explosion with risk of damage to the cremator.1 The presumed mechanism is rapid heating of the enclosed expansion chamber, which is inflated on insertion to 70 bar. As a result of this risk, our local crematorium has refused to cremate any bodies containing this implant. According to its Secretary, this position may soon be adopted by the Federation of British Cremation Authorities. We use calcaneotalotibial nailing in the management of these difficult fractures. Surgeons choosing an expandable implant in order to avoid conventional interlocking should be aware of this potential complication. A. KHAN, BSc(Hon), FRCS(Ed) A. KELLY, MA, FRCS Musgrove Park Hospital, Taunton, UK. 1. Ward C. Fixion Intramedullary Nailing System Problems Encountered at St Faith`s Crematorium. Resurgam 2004;47:150.