The treatment of distal metaphyseal tibial fractures remains controversial. This study was performed to evaluate the results of intramedullary nailing of distal tibial fractures located within 5 cm of the ankle joint.
Over a sixteen-month period at two institutions, thirty-six tibial fractures that involved the distal 5 cm of the tibia were treated with reamed intramedullary nailing with use of either two or three distal interlocking screws. Ten fractures with articular extension were treated with supplementary screw fixation prior to the intramedullary nailing. Radiographs were reviewed to determine the immediate and final alignments and fracture-healing. The Short Form-36 (SF-36) and Musculoskeletal Function Assessment (MFA) questionnaires were used to evaluate functional outcome.
Acceptable radiographic alignment, defined as <5 degrees of angulation in any plane, was obtained in thirty-three patients (92%). No patient had any change in alignment between the immediate postoperative and the final radiographic evaluation. Complications included one deep infection and one iatrogenic fracture at the time of the intramedullary nailing. Six patients could not be followed. The remaining thirty fractures united at an average of 23.5 weeks. Three patients with associated traumatic bone loss underwent a staged autograft procedure, and they had fracture-healing at an average of 44.3 weeks. The functional outcome was determined at a minimum of one year for nineteen patients and at a minimum of two years (average, 4.5 years) for fifteen patients. At one year, there were significant limitations in several domains despite fracture union and maintenance of alignment, but there was improvement in the MFA scores with time.
Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. Simple articular extension of the fracture is not a contraindication to intramedullary fixation. Functional outcomes improve with time.
[Show abstract][Hide abstract] ABSTRACT: Background The number of citations of a paper gives an indication of an article's merit and importance within a medical specialty. We identify and analyse the 100 most cited papers in foot and ankle surgery.
The Science Citation Index Expanded was searched for citations in 15 respected journals containing foot and ankle articles. Papers were analysed for subject, authorship, institution, country and year of publication. The average yearly citation was compared to total number of citations.
3,501 foot and ankle papers were returned. The maximum number of citations was 1084 and the mean was 104. The top 100 papers were published between 1979 and 2007, with the majority published in the last decade. The ankle was the most important anatomical region discussed, and basic science and degenerative disease were popular topics. We found a large discrepancy between the total number of citations with average yearly citation.
Foot and ankle surgery is a young and rapidly developing sub-specialty within orthopaedics. Recently there has been a significant increase in influential papers published. Certain topics are popular indicating their importance within the field. This study highlights important papers in foot and ankle surgery giving an insight into readership.
The Foot 01/2013; 24(1). DOI:10.1016/j.foot.2013.11.003
"Varsalona and Liu reported that in extra-articular fractures of combined tibia and fibula, fixation of the fibula has no benefit and is not recommended . Nork et al. and Obremsky and Medina express no effect of fibular fixation on treatment outcome of patients with tibial fractures, also they reported that IMN is an effective alternative with less malalignment and complications for the treatment of distal metaphyseal tibial fractures  , that was correlated with our study. Third group of studies comment some beneficial effects of fibular fixation in same level combined tibial and fibular fractures and have suggested concurrent fibular fixation. "
[Show abstract][Hide abstract] ABSTRACT: Introduction
Combined fractures of the distal third of tibia diaphysis and fibula diaphysis are a common orthopedic injury. There is an ongoing debate about the necessity of fibular fixation when associated to distal third tibial fracture. This study aims at evaluating the role of fibular fixation in the treatment of distal third tibial fractures.
We hypothesized that fixation of the fibula increases the stability of fixation in distal third tibial and fibular fractures.
Materials and methods
In a randomized clinical trial, 53 patients with concomitant fractures of tibia and ipsilateral fibula at distal third level were recruited in this study during a 23-month period. Patients were randomized in two groups: patients with fibular fixation (case group) and without fibular fixation (control group). The patients were followed up for at least 6 months postoperatively.
There were seven cases exhibiting malalignment on immediate postoperative radiographs. Six of them were in group II (control group) and 1 was in group I (case group) (P = 0.084). We didn’t find nonunion in group I and we found three patients in group II (P = 0.141). Infection was 1 in group I and 2 in group II on gustillo II injuries (P = 0.516).
Despite its low count of patients, our study didn’t show any advantage to fix the fibula fracture associated to distal third of tibia diaphysis fracture. It didn’t show either an increase of complication after fibula open reduction and internal fixation.
Level of evidence
Level III. Randomized prospective study.
Revue de Chirurgie Orthopédique et Traumatologique 12/2012; 98(8):783–784. DOI:10.1016/j.rcot.2012.10.068
"The long lever arm and metaphyseal enlargement make fracture reduction and nailing technically difficult procedures. Other well-described patterns of difficulties are associated with this technique such as intra-articular extension, hardware failure or epiphysometaphyseal fixation difficulty  . Therefore, some authors advocate the use of plate osteosynthesis in the management of proximal   or distal   quarter tibial fractures. "
[Show abstract][Hide abstract] ABSTRACT: Intramedullary nailing of proximal and distal quarter tibia fractures is known to be a challenging procedure due to the metaphyseal enlargement, the reduced contact between implant and cortex and fracture comminution. Therefore, some authors suggest preferring the use of plate internal fixation in the management of these challenging fractures. The purpose of this manuscript is to present and describe our technique of minimally invasive locking plate osteosynthesis in the treatment of extra-articular proximal and distal tibia fractures. Osteosynthesis was performed by means of a locking screw plate system which construct characteristics usually allow immediate weight-bearing and early functional mobilization. This minimally invasive surgical procedure advantageously combines the principles of closed fixation with construct stability.
Orthopaedics & Traumatology Surgery & Research 11/2010; 96(7):800-9. DOI:10.1016/j.otsr.2010.03.025 · 1.26 Impact Factor
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