Intramedullary nailing of distal metaphyseal tibial fractures
ABSTRACT 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.
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ABSTRACT: Angular stable locking of intramedullary nails has been shown to enhance fixation stability of tibial fractures in biomechanical and animal studies. The aim of our study was to assess whether use of the angular stable locking system or conventional locking resulted in earlier full weight-bearing with minimum pain for patients with a distal tibial fracture treated with an intramedullary nail. A prospective multicenter, randomized, patient-blinded trial was conducted with adults who had a distal tibial fracture. Patients' fractures were managed with an intramedullary nail locked with either an angular stable locking system or conventional locking screws. Outcomes were evaluated at six weeks, twelve weeks, six months, and one year after surgery. Time to full weight-bearing with minimum pain was calculated with use of daily entries from patient diaries. Secondary outcomes included pain at the fracture site under load, quality of life, gait analysis, mobility, radiographic findings, and adverse events. One hundred and forty-two patients were randomly allocated to two treatment groups: seventy-five to the group receiving intramedullary nailing with the angular stable locking system and sixty-seven to the group receiving conventional intramedullary nailing. No clinically important differences were found for either the primary or secondary outcome parameters between the groups during the entire follow-up period. Use of an angular stable locking system with intramedullary nailing did not improve the outcome compared with conventional locking screws in the treatment of distal tibial fractures. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.The Journal of Bone and Joint Surgery 11/2014; 96(22):1889-97. DOI:10.2106/JBJS.M.01355 · 4.31 Impact Factor
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ABSTRACT: Background: In this study our aim is to evaluate the radiological and clinical results of MIPPO (minimally invasive percutanous plate osteosynthesis) of distal tibia fractures localized at metaphysis or diaphysis. Methods: Thirty tibia fractures of 30 patients operated with MIPPO for distal tibia fractures who have regular follow-up and who meet the study criteria are included in the study. The mean age of the patients is 39.1 (18-62), including 20 males (66.6%) and 10 females (33.3%). Twenty-five (83%) patients have closed and 5 (17%) have open fractures. Fracture types according to AO classification are 15 A1, 9 A2, 5 A3, and 1 C1. Radiological union time/duration, malunion, and nonunion, clinical infection rate, additional surgical procedures and AOFAS (American Orthopaedic Foot and Ankle Society) scores were evaluated. Results: In 2 cases infection was observed. The mean union duration was 16.6 (8-20) weeks. Delayed union was observed in 2 patients. Malunion was seen in 2 patients. The mean follow-up period of our cases was 15.3 months (8-32); mean AOFAS score was 84 (60-92). Conclusion: In treatment of distal metaphysial and diaphysial fractures of tibia MIPPO technique is a successful procedure with low complication rates. Key words: Distal tibia fracture; locked plates; MIPPO.01/2014; 25(1):46-52. DOI:10.5505/jkartaltr.2014.14632
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ABSTRACT: The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient's condition and the local fracture situation allow it.Wiener klinische Wochenschrift 03/2015; DOI:10.1007/s00508-015-0730-x · 0.79 Impact Factor