Dia-metaphyseal distal tibial fractures — treatment with a shortened intramedullary nail

Dogra, Ankit; Ruiz, Angel; Thompson, Neil S.; Nolan, Patrick

doi:10.1016/s0020-1383(00)00129-7

Cited by 94 publications

(61 citation statements)

References 8 publications

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“…Nonunion occurred in 8 % of the fractures in this study. This compares favourably to the reports by Im and Tae [6] and Vallier et al [32] nailing groups, whereby the rate of delayed and non-union after nailing distal tibial fractures vary between 0 and 23 % in the literature [3,6,8,13,14,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Screw failure remains a common problem with small diameter nails [2,15,16].…”

Section: Discussionsupporting

confidence: 74%

“…On the other hand, a study by the AO centre in Davos analysing tibial fractures in Swiss clinics from 1994 to 1997 showed delayed union in 17 out of 94 cases treated by unreamed nailing that had revision surgery, from which ten were simple distal fractures without severe soft tissue damage or complicating factors [18]. Other authors reported good union with reamed nails in distal tibial fractures despite the technically demanding procedure [13,14,22,24,[27][28][29][30][31][32]. In a multicentre European study, Attal et al reported on 91 distal third tibial fractures treated with the Expert tibial nail (ETN®).…”

Section: Discussionmentioning

confidence: 99%

“…Poller screws or percutaneously placed successive K-wires help orient the nail in the desired position and prevent it from going where it should not by reducing the metaphyseal space [24,30,37]. Shortened nails allow fixation of distal fourth tibial fractures (with or without articular extension) by removing the distal one centimetre of the nail and thereby allowing reliable static nail locking [14,27,31]. As regards distal locking, the use of at least two screws, multidirectional distal locking and angle stable interlocking bolts have been shown to decrease screw failure and fracture nonunion and help improve biomechanical stability of the nail construct in distal tibial fractures [38][39][40].…”

Section: Discussionmentioning

confidence: 99%

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Unreamed intramedullary nailing in distal tibial fractures

Salem

2013

International Orthopaedics (SICOT)

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Purpose Unreamed nailing has gained acceptance in the treatment of diaphyseal long bone fractures, especially in cases with polytrauma or high-energy injuries. Its application in distal tibial fractures, however, remains controversial. Methods In this study, 101 distal tibial fractures treated using closed unreamed nailing were reviewed after a mean followup of 32 months. There were 59 type A und 42 type B fractures. The most common fracture pattern was the A1 spiral fracture (n = 40) followed by the B2 wedge fracture (n = 18). Intra-articular extension was encountered in 14 cases. One-fourth of the patients (n = 24) had open injuries. Forty-seven patients had additional injuries, and nearly onethird of them were polytraumatised. Results Union occurred after a mean time of 23.9 (range, 11-134) weeks. There were 13 cases of delayed union and seven non-unions; all healed eventually with additional surgery in only six fractures. Malunion was seen in 12 cases (five valgus, two varus and five external torsion), ten of which were associated with unplated fibular fractures. Three fractures (two open) were treated for deep infection. The most common complication seen was fatigue failure of the locking screws (27 cases). Conclusions Unreamed nailing of distal tibial fractures is associated with a rather high rate of bone healing complications and locking screw failure. The decision for its use in the notoriously challenging fractures of this segment should be critically considered.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Unreamed intramedullary nailing in distal tibial fractures

Salem

2013

International Orthopaedics (SICOT)

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“…치료의 종류는 도 수 정복 후 석고 고정, 금속판을 이용한 관혈적 정복술, Ilizarov 등의 기기를 이용한 외고정술, 그리고 골수강내 금 속정을 이용한 내고정술 등이 있다 3,17,20) . 그 중 금속판을 이 용한 관혈적 정복술은 골절의 해부학적 정복을 얻을 수 있고 견고한 고정이 가능하다는 장점이 있지만 골절 주위의 연부 조직을 파괴하고 수술창으로 인한 합병증의 위험이 있다 5,7,19) .…”

Section: 서 론unclassified

Comparative Study of Intramedullary Nailing and Plate for Metaphyseal Fractures of the Distal Tibia

et al. 2007

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Purpose:To compare the radiological and clinical results between intramedullary nailing and plate fixation in the treatment of distal tibial fractures. Materials and Methods: 19 cases of distal tibial metaphyseal fractures within 4 cm of the ankle joint line were enrolled. Ten patients were treated with interlocking intramedullary nail and the others with plate and screws. Results: The mean union time was 14 weeks in nailing group and 16 weeks in plate group. The average angulation in AP view was 4.1 degrees in nailing group and 3.1 degrees in plate group. The average angulation in lateral view was 1.7 degrees in nailing group and 2.7 degrees in plate group. The rotational deformity was 2.8 degrees in nailing group and 1.7 degrees in plate group in average. There was no implant failure and soft tissue problem. Conclusion: There was no difference in clinical and radiological results between intramedullary nailing and plate in the treatment of the distal tibial fractures and, considering the preservation of the soft tissue, the intramedullary nails are a reliable method for managing distal metaphyseal fractures of the tibia.

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“…Kapalı intramedüller çivi (İMÇ) veya perkütan kilitli plak (PKP) gibi az hasarlı cerrahi teknik ile yapılan tespit tipi bu bölge kırıklarının tedavisindeki en seçkin cerrahi yöntemlerin başında gelir. [1][2][3][4][5][6][7][8] Kırık hattını köprüleyen PKP, içeriden uygulamalı bir eksternal fiksatör olup, dengeli bir tespit sağlar. [9,10] Kapalı redüksiyon sonrası İMÇ ile yapılan osteosentezde, en az derecede yumuşak doku hasarı oluşmaktadır.…”

Section: Introductionunclassified

Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing

Bilgili¹

2015

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Bu çalışmada AO 42A ve 42B tipi tibia kırıklarında uygulanan perkütan kilitli plak (PKP) ve intramedüller çivi (İMÇ) tespit sonuçlarının geriye dönük analizi yapıldı. Tespit tipinin kaynama zamanı ve fonksiyonel sonuçlar üzerinde etkisinin olup olmadığı ve komplikasyonları sorgulandı. GEREÇ VE YÖNTEM:Bu geriye dönük çalışmaya 2006-2010 yılları arasında eklem dışı tibia distal uç kırığı tanısıyla cerrahi tedavi edilen 42 hasta dahil edildi. Hastaların 18'i kapalı İMÇ ile (Grup 1), 24'ü ise PKP (Grup II) ile tedavi edildi. Ortalama yaş 41 (dağılım: 16-70) yıl olan hastaların 32'si erkek, 10'u kadındı. Kırıklar AO sınıflamasına göre sınıflandırıldı. Hastaların kaynama zamanları, fonksiyonel sonuçları ve komplikasyonları (kaynamama, kötü kaynama, enfeksiyon, implant çıkarma) karşılaştırıldı. Fonksiyonel sonuçların karşılaştırılmasında The American Orthopaedic Foot and Ankle surgery (AOFAS) skorlaması kullanıldı. BULGULAR:Ortalama takip süresi Grup I için 20 (12-32) ay, Grup II için 22 (13-34) aydı. Kırık kaynama zamanı Grup 1'de 16 (12-24) hafta, Grup II 'de 19 (16-24) haftaydı. Kırık kaynama zamanı İMÇ ile tespit edilen hastalarda anlamlı derecede daha kısaydı (p=0.002). Son kontroldeki AOFAS skoru Grup I için 85 (dağılım: 69-100 puan), Grup II için 81 puan (dağılım: 60-95 puan) bulundu, aralarındaki fark istatistiksel açıdan anlamlı değildi (p=0.06). Grup II'deki iki hastada kaynamama görüldü. Grup 1'de iki hastada, Grup II'de bir hastada dizilim kusuru görüldü. Grup 1'de iki hastada, Grup II'de ise üç hastada yüzeyel enfeksiyon oluştu. SONUÇ:İntramedüller çivi ile tespit edilen kırıklarda kaynama daha erken oluştu. İstatistiksel olarak anlamlı olmasada İMÇ yapılanlar-da komplikasyonlar daha az, fonksiyonel sonuçlar daha iyiydi.Anahtar sözcükler: Distal tibia; intramedüller çivi; kırıklar; perkütan kilitli plak.

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Dia-metaphyseal distal tibial fractures — treatment with a shortened intramedullary nail

Cited by 94 publications

References 8 publications

Unreamed intramedullary nailing in distal tibial fractures

Unreamed intramedullary nailing in distal tibial fractures

Comparative Study of Intramedullary Nailing and Plate for Metaphyseal Fractures of the Distal Tibia

Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing

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