No abstract

Background: Traditional external fixation used for open or soft tissue compromised tibial distal metaphyseal fractures is used both as a temporizing or definitive treatment to minimize more traumas to the soft tissue, but it has its own shortcomings such as joint spanning and bulky construct. Lower profile locked plates used as external fixation may overcome such problems. Methods: A series of 16 open or with soft tissue compromised tibial distal metaphyseal fractures were treated using locking plate as a definitive external fixator. Time to union, nonunion, malunion, device failure, function for the knee and ankle, and deep and pin tract infections were evaluated. Results: All fractures healed without any complications (nonunion, malunion, device failure, or infections including deep and pin tracts). The mean time of fracture healing was 18 weeks (ranged 12 to 26). After walking with full weight-bearing for 1 month, the patients underwent plate removal. The mean hospital for special surgery (HSS) score was 89 (ranged 84 to 100) and 95 (ranged 91 to 100), and the mean American orthopaedic foot and ankle society (AOFAS) score was 93 (ranged 89 to 100) and 95 (ranged 92 to 100) at 4 weeks postoperatively and final follow-up (mean period of 16 months). Conclusions: Application of the locking plate as an external fixator for definitive treatment of distal tibial fractures had the advantages of traditional external fixators and at the same time overcame its shortcomings due to its low-profile frame; therefore, it was more acceptable to patients and Joint-sparing frame gave the opportunity for early range of motion and function exercise. It was a safe and reliable technique with minimal complications and excellent outcomes.

Background: One of the most important objectives in the deformity correction surgery of spine is to achieve appropriate sagittal alignment, to improve patient outcome and reduce the risk of junctional failure. Intra-operative rod bending is crucial to achieve desired alignment. Objectives: Assessment of accuracy of rod bending by spine surgeons with or with-out template and/or correction. Methods: Spine surgeons were asked to bend two rods; one in-situ on three-dimensional (3D) printed moulage, designed based on schematic representation of a patient with Kyphoscoliosis, the other rod was asked to bend with correction angles. The differences were measured and correlated with experience and specialty. Results: 21 fellowship trained spine surgeons participated in this study, for in-situ rod, mean thoracic and lumbar bend were 65.2 (P = 0.033) and 49.3 (P = 0.077) degrees, respectively and for the correction rod, mean bend in thoracic and lumbar were 53.8 (P = 0.001) and 51.8 (P = 0.004) degrees, respectively, with significant difference from cut-off point. Each curve was over-bend and it was more pronounce in thoracic, both on in-situ and correction rods, 61.9 and 71.1 %, respectively. Level of experience showed positive correlation with degree of rod bending more than five years in thoracic in-situ bend (P = 0.003) and thoracic bend with correction (P = 0.004). Field of specialty showed positive correlation as well; with orthopedic in-situ bend (P = 0.002) and with correction (P = 0.003). Conclusions: Spine surgeons tend to over-bend rods, when given target angles and when correction is needed. However, when provided with template, a 3D printed moulage in our study, accuracy of rod bending improved significantly.

Tibia is one of the most common fractured long bone, which occurs most often in young people following high-energy trauma. Gold standard treatment of tibial diaphysis fractures is currently intramedullary nailing. In this study, we intend to examine the results of treatment of tibia diaphysis fractures with intramedullary interlocking nail without use of imaging (C-Arm) during surgery. In this cross-sectional study, 43 patients (36 males and 7 females with an average age of 31 years) were included, 40% were open fractures and 60% were closed. Just postoperatively, 12% of the cases had a problem with length and placement of nail and screws. A total of 18% had rotational deformity (78% less than 5 degrees) and 5% had only mild varus or apex anterior deformity. In cases where imaging during surgery is not possible for any reason, the use of intramedullary nailing along with distal jig could be performed for tibial shaft fractures.