Purpose The aim of this study was to review our experiences with tibial lengthening over an intramedullary nail in comparison to the conventional Ilizarov method. Methods We performed a retrospective comparison of tibial lengthening using the conventional Ilizarov method (group A: 23 limbs in 13 patients) versus over a nail (group B: 51 limbs in 26 patients). The percentage increase in tibial length, lengthening index, external fixation index, consolidation index and complications were assessed. Results The mean gain in tibial length was 7.4 cm, which represents a mean increase of 26.0%. There was no difference in lengthening index or consolidation index; however, the patients in group A wore the external fixator longer than those in group B (281.5 versus 129.0 days), which represents a larger external fixation index (40.0 versus 17.4 day/cm). Group A had a higher complication rate (1.0 versus 0.47 per tibia) than group B. Conclusions Tibial lengthening over an intramedullary nail confers advantages over the conventional Ilizarov method, including shorter time needed for external fixation and lower complication rates.

The meta-analysis showed that intramedullary nailing reduced the time of surgery and radiation and the risk of wound complications compared with plate fixation. Furthermore, union time and union complications were common following both treatments. Overall, intramedullary nailing is found to be taken priority for distal tibial metaphyseal fractures. More RCTs are required to support current evidence.

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Objective. To explore the applications of preoperative planning and virtual surgery including surgical windowing and elevating reduction and to determine the clinical effects of this technology on the treatment of Schatzker type III tibial plateau fractures. Methods. 32 patients with Schatzker type III tibial plateau fractures were randomised upon their admission to the hospital using a sealed envelope method. Fourteen were treated with preoperative virtual design and assisted operation (virtual group) and 18 with direct open reduction and internal fixation (control group). Results. All patients achieved primary incision healing. Compared with control group, virtual groups showed significant advantages in operative time, incision length, and blood loss (P < 0.001). The virtual surgery was consistent with the actual surgery. Conclusion. The virtual group was better than control group in the treatment of tibial plateau fractures of Schatzker type III, due to shorter operative time, smaller incision length, and lower blood loss. The reconstructed 3D fracture model could be used to preoperatively determine the surgical windowing and elevating reduction method and simulate the operation for Schatzker type III tibial plateau fractures.