Intramedullary Nailing of Distal Metaphyseal Tibial Fractures

Nork, Sean E.; Schwartz, Alexandra; Agel, Julie; Holt, Sarah K.; Schrick, Jason L; Winquist, Robert A.

doi:10.2106/jbjs.c.01135

Cited by 152 publications

(111 citation statements)

References 45 publications

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“…The P value using unpaired t -test is <0.0001. In our study, we allowed partial weight bearing only after signs of the union in form of bridging callus on at least three cortices out of four cortices on radiograph and clinically as the absence of tenderness and movement at the fracture site7 which was usually by 6–8 weeks. The majority of the cases, having fulfilling above criteria around 6–8 weeks and were allowed partial weight-bearing on the affected limb.…”

Section: Discussionmentioning

confidence: 99%

“…Active range of movements of knee and ankle joint along with quadriceps strengthening exercises were started on the next day of surgery. Weight bearing was started after radiographic assessment showed signs of union as bridging callus in three out of four cortices and clinically as the absence of tenderness and movement at the fracture site 7. This finding suggested the fracture site has sufficiently consolidated so as to allow partial weight bearing which usually occurs by 6–8 weeks.…”

Section: Methodsmentioning

confidence: 98%

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A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures

Daolagupu

Mudgal

Agarwala³

et al. 2017

IJOO

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Background:Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO).Materials and Methods:42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation.Results:In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant (P < 0.0001). Average time required for partial and full weight bearing in the nailing group was 4.95 weeks and 10.09 weeks respectively which was significantly less (P < 0.0001) as compared to 6.90 weeks and 13.38 weeks in the plating group. Lesser complications in terms of implant irritation, ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67.Conclusion:IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 98%

A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures

Daolagupu

Mudgal

Agarwala³

et al. 2017

IJOO

View full text Add to dashboard Cite

show abstract

“…He concluded that fixation stability of intramedullary nail is not significantly influenced by distal locking screw orientation in response to sagittal, coronal, or rotational forces [13]. On the contrary, Smucker et al found two parallel locking bolts being a better construct than perpendicular locking bolts in their study [14]. …”

Section: Discussionmentioning

confidence: 99%

“…In distal third fractures, fibular plating, one cross screw across fracture site as lag screw, use of large reduction forceps, temporary unicortical plating, percutaneous manipulation with Shanz pins, femoral distracter and cutting the distal few millimeters of nail distal to the distal screw hole to allow two cross locking screws in the distal fragment, have been the supplementary procedures used to achieve the alignment [14–24]. …”

Section: Discussionmentioning

confidence: 99%

Distal Tibial Metaphyseal Fractures: Does Blocking Screw Extend the Indication of Intramedullary Nailing?

et al. 2014

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Aim. To evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail. Main Outcome Measurement. Alignment and reduction preoperatively, postoperatively, and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup. Patients and Methods. This was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between August 2006 and September 2007 with a maximum followup of 3 years. Medullary canal diameter was measured at the levels of fracture and isthmus. Results. The mean diameter of tibia at the level of isthmus was 11.9 mm and at the fracture site was 22.9 mm. Mean length of distal fracture segment was 4.6 cm. Mean varus/valgus alignment was 10.3 degrees preoperatively and 1.7 degrees immediatly postoperatively and was maintained till union. Using Karlstrom-Olerud score the outcome was excellent to good in 90%. Conclusion. We conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing.

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“…[2021] Other two studies reported no effect of fibular fixation on the treatment outcome of patients with tibial fractures. [2223]…”

Section: Discussionmentioning

confidence: 99%

The Role of Fibular Fixation in the Treatment of Combined Distal Tibia and Fibula Fracture: A Randomized, Control Trial

2017

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Background:This randomized, parallel-group, non-blinded study was designed to determine the role of fibular fixation in the treatment outcomes of combined distal tibia and fibula fractures.Materials and Methods:Sixty patients with distal tibial and fibular fractures were randomly divided in two groups of case and controls. In the case group, fibula was fixed prior to the fixation of tibia. In the control group, tibia was fixed without fibular fixation. Primary outcomes were varus–valgus angulation, anterior–posterior angulation, union and side effects. Follow-up visit and radiographs were taken 2 and 4 weeks as well as 3, 6 and 9 months after surgery.Results:During the follow-up, 11 out of 60 patients in case and control groups were excluded. We recruited 24 and 25 patients in the case and control group, respectively. Intramedullary nailing was used in 8 patients of case and 11 patients of control group. Plate and screw were used in 16 patients in the case and 14 patients in the control group. Varus/valgus and anterior–posterior angulation were not statistically significant between two groups (P ≥ 0.05). The frequency of tibial and fibula union after 1, 3, 6 and 9 months in case and controls groups were not statistically significant (P ≥ 0.05). The frequency of nonunion of tibia and fibula, infection and nerve injury in studied groups were not statistically significant (P ≥ 0.05).Conclusion:We did not observe any significant improvement using fibular fixation in the treatment outcomes of tibia distal fractures.

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Intramedullary Nailing of Distal Metaphyseal Tibial Fractures

Abstract: 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.

Cited by 152 publications

References 45 publications

A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures

A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures

Distal Tibial Metaphyseal Fractures: Does Blocking Screw Extend the Indication of Intramedullary Nailing?

The Role of Fibular Fixation in the Treatment of Combined Distal Tibia and Fibula Fracture: A Randomized, Control Trial

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