title: Novel modification of second generation intramedullary PMMA cementing technique for narrow upper and lower extremity canals.
abstract: OBJECTIVE
  It is very difficult to cement intramedullary canals smaller than 10 mm with standard commercially available cement syringes due to mismatch in canal and syringe diameters. This is often encountered in children and in the upper limb. We describe a simple method of cementing, using cement gun with size-matched plastic endotracheal tube (ET).
  
  
  METHODS
  The medullary canal is prepared and the size determined. ET with outer diameter 0.5-1 mm smaller than the canal diameter is chosen. The standard cementing syringe nozzle is cut at the middle and fitted to Portex(®) tube with the adaptor connector, which comes with the ET. The plastic ET is cut to an appropriate length depending on canal length to be cemented. The nozzle is fitted to the syringe and cementing done in the usual way. We applied this new modification in the method to cement narrow canals of ulna, humerus, tibia and femur.
  
  
  RESULTS
  The method has proven to be consistently reliable and useful in cases of cementing stems into bones with narrow intramedullary diameters. Apart from femur and tibia in children, humerus and ulna in adults were also cemented. The cement mantle by this technique is uniform and uninterrupted. Special care should be taken to fit the connector properly to the syringe nozzle and to hold it firmly while cementing.
  
  
  CONCLUSIONS
  In our experience, this new technique has proven to be very useful, easy to use, reproducible and effective in cementing narrow canals.
authors.affiliation: Resident, Department of Orthopaedics, Hinduja National Hospital and MRC, Mahim, Mumbai, India.
authors.forename: Manit K
authors.initials: MK
authors.lastname: Gundavda
authors.affiliation: Fellow in Musculoskeletal Oncology at Mount Sinai Hospital, Toronto, Canada.
authors.forename: Prakash
authors.initials: P
authors.lastname: Nayak
authors.affiliation: Consultant Orthopaedic Oncologist, Department of Orthopaedics, Hinduja National Hospital and MRC, Mahim, Mumbai, India.
authors.forename: Manish G
authors.initials: MG
authors.lastname: Agarwal
keywords: Narrow intramedullary canals; Second generation cementing; Technique modification