Comparison of Tibial Intramedullary Nailing Guided by Digital Technology Versus Conventional Method: A Prospective Study

Abstract

BackgroundThis prospective study aimed to compare clinical effects of intramedullary nailing guided by digital and conventional technologies in treatment of tibial fractures.Material/MethodsThirty-two patients (mean age 43 years, 18 males and 14 females) who were treated for tibial fractures from October 2010 to October 2012 were enrolled. They were sequentially randomized to receive intramedullary nailing guided by either digital technology (digital group, n=16) or conventional technology (conventional group, n=16). The operation time, fluoroscopy times, fracture healing time, distance between the actual and planned insertion point, postoperative lower limb alignment, and functional recovery were recorded for all patients.ResultsThe mean operation time in the digital group was 43.1±6.2 min compared with 48.7±8.3 min for the conventional technology (P=0.039). The fluoroscopy times and distance between the actual and planned insertion point were significantly lower in the digital group than in the conventional group (both P<0.001). The accuracy rate of the insertion point was 99.12% by digital technology. No difference was found in fracture healing time and good postoperative lower limb alignment between the digital and conventional groups (P=0.083 and P=0.310), as well as the effective rate (100% vs. 87.50%, P=0.144).ConclusionsIntramedullary nailing guided by digital technology has many advantages in treatment of tibial fractures compared to conventional technology, including shorter operation time, reduced fluoroscopy times, and decreased distance between the actual and planned insertion point of the intramedullary nail.

Computer-Assisted Preoperative Planning of Bone Fracture Fixation Surgery: A State-Of-The-Art Review

“…16 studies reported on operation time (Li et al, 2015(Li et al, , 2019Zhang et al, 2015;Liu et al, 2017;Chen et al, 2018Chen et al, , 2019Chen et al, , 2020Hung et al, 2019;Huang et al, 2020;Wang et al, 2020cWang et al, , 2020aBoudissa et al, 2021aBoudissa et al, , 2021bLong et al, 2021;He et al, 2022;Zheng et al, 2022). All studies, except for , found that using computer-assisted planning leads to a significantly shorter operation time compared to conventional planning.…”

“…All studies that investigated fluoroscopy frequency (Liu et al, 2017;Chen et al, 2018Chen et al, , 2020Huang et al, 2020;Wang et al, 2020c;Long et al, 2021;He et al, 2022) found that using VSP leads to significantly less intra-operative fluoroscopies. The meta-analysis resulted in an overall standardized mean difference of -2.18 (95% CI: -2.75, -1.61), see Figure 4C.…”

“…Four studies investigated fracture healing time differences between the VSP and conventional planning groups (Liu et al, 2017;Huang et al, 2020;Wang et al, 2020c;Zheng et al, 2022). However, Wang et al (2020c) reported the fracture healing time as median (25%, 75% quartile) with 18.00 (15.50, 19.00) weeks for the VSP group and 18.00 (16.00, 20.00) weeks for the conventional group (p > 0.05).…”

“…15 studies reported on reduction quality (Li et al, 2015(Li et al, , 2019Liu et al, 2017;Maini et al, 2018;Totoki et al, 2018;Chen et al, 2019;Hung et al, 2019;Yoshii et al, 2019b;Huang et al, 2020;Ramanathan et al, 2020;Wang et al, 2020a;Boudissa et al, 2021aBoudissa et al, , 2021bLong et al, 2021;Zheng et al, 2022), using different scoring systems, including the Matta scoring system (Matta and Tornetta, 1996), residual displacement (mm) and/or level of alignment compared to the healthy contralateral side. 12 studies reported on functional clinical scores (Li et al, 2015;Liu et al, 2017;Chen et al, 2018Chen et al, , 2019Chen et al, , 2020Huang et al, 2020;Jia et al, 2020;Ramanathan et al, 2020;Wang et al, 2020c;Long et al, 2021;He et al, 2022;Zheng et al, 2022) using scoring systems such as the VAS score, Harris score, Merle d'Aubigne score and range of motion (ROM). Since the reported reduction and functional scores are highly heterogeneous between studies or not clearly specified, no meta-analysis was performed on these outcome measures.…”

Main Vectors of Medical Rehabilitation in Diaphyseal Fractures Treatment

“…У разі добре виконаного остеосинтезу та відповідного перебігу консолідації, причиною інвалідності у більшості випадків є нераціональний вибір тактики, або навіть повне нехтування реабілі-таційного лікування [4,6,8,9]. Ряд питань, пов'яза-них з так званою "остеогенною недостатністю", залишаються невирішеними [3,5,6,8,10].…”