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.
- SourceAvailable from: Güven Bulut01/2014; 25(1):46-52. DOI:10.5505/jkartaltr.2014.14632
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ABSTRACT: Background Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series. Methods From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years. Results The mean fracture healing time was 21.4 weeks (range 16–32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%). Conclusion MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.08/2014; DOI:10.1016/j.jcot.2014.07.010
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ABSTRACT: Background To compare the clinical outcomes of external fixator (EF) and intramedullary nails (IN) in the treatment of open tibial fractures.Methods We searched seven electronic databases (PubMed, MEDLINE, EMBASE, OVID, Cochrane library, CNKI, and CBM) for trials of tibial fracture fixation published from 1980 to 2013. The indicators including postoperative infection, malunion, nonunion, soft tissue injury, delayed healing, and healing time were used for quantitative outcome assessments.ResultsA total of nine trials involving 532 patients (EF, n¿=¿253; IN, n¿=¿279) with open tibia fractures were included in this meta-analysis. The results indicated that the patients undergoing IN had lower incidence of postoperative infection (risk radio [RR]¿=¿3.85; 95% confidence intervals [CI], 2.67¿5.54; P¿<¿0.0001), malunion (RR¿=¿2.31; 95% CI, 1.40¿3.81; P¿=¿0.001), nonunion (RR¿=¿1.41; 95% CI, 1.06¿1.88; P¿=¿0.02) and less healing time (weighted mean difference [WMD]¿=¿6.19; 95% CI, 1.42¿10.96; P¿=¿0.01) compared with EF. However, regarding to the soft tissue injury (RR¿=¿0.74; 95% CI, 0.34¿1.62; P¿=¿0.45) and delayed healing (RR¿=¿1.38; 95% CI, 0.79¿2.43; P¿=¿0.26), there is no significantly difference between EF and IN approach.Conclusion In conclusion, the use of IN is more effective than EF and may be considered as first-line approach in fixation of open tibial fractures.Journal of Orthopaedic Surgery and Research 08/2014; 9(1):75. DOI:10.1186/s13018-014-0075-6 · 1.58 Impact Factor