Intramedullary Nailing of Unstable Diaphyseal Fractures of the Tibia with Distal Intraarticular Involvement

Konrath, Gregory A.; Moed, Berton R.; Watson, J. Tracy; Kaneshiro, Steven; Karges, David E.; Cramer, Kathryn E.

doi:10.1097/00005131-199704000-00011

Cited by 87 publications

(65 citation statements)

References 19 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%

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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%

Unreamed intramedullary nailing in distal tibial fractures

Salem

2013

International Orthopaedics (SICOT)

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“…Nonoperative management has been recommended for treatment of spiral tibial shaft fractures and associated ankle fractures [7,17]. The current treatment recommendations are predominantly operative [4,10,13,14]. This makes preoperative diagnosis of the associated posterior malleolus fracture imperative.…”

Section: Discussionmentioning

confidence: 99%

“…Based on our experience and that of others, however, the potential for late displacement of the posterior malleolus warrants early detection and stabilization of these injuries. In a study which reported on open and closed diaphyseal fractures with distal intraarticular fracture extension and displacement less than 5 mm, the authors recommend limited open reduction and internal fixation or percutaneous lag screw fixation of the articular component followed by intramedullary nailing [10].…”

Section: Discussionmentioning

confidence: 99%

“…Although various treatment options have been described, two studies advocated internal fixation when associated with tibial shaft and ipsilateral ankle fractures [10,14]. Early knee and ankle mobilization is crucial to prevent postsurgical stiffness, and thus stable fixation of the posterior malleolus is particularly important in combined injuries.…”

Section: Introductionmentioning

confidence: 99%

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High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

Boraiah

Gardner

Helfet

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Associations between fracture patterns are important and can ensure proper diagnosis and guide treatment. Occult posterior malleolus fractures associated with distal spiral tibia fractures often are underrecognized and the morbidity of a missed posterior malleolus injury can be substantial. We determined the association between the two injuries and evaluated the ability of a new protocol to improve management of these associated fractures. Of 62 consecutive patients with fractures of the distal third of the tibia, we retrospectively evaluated the first 39 patients and prospectively used a diagnostic protocol including computed tomography of the ankle in the subsequent 23 patients. The minimum followup was 3 months (mean, 25 months; range, 3-68 months). Twenty-four patients (39%) had fractures of the posterior malleolus. Before initiation of the protocol, intraarticular fractures were recognized in 33% (with one delayed diagnosis and one missed diagnosis), and after institution of the protocol, the detection rate was 48% with no known missed injuries and complete followup; however, with the limited power the detection rates were similar without and with the protocol. A spiral distal tibial shaft fracture with a proximal fibula fracture should alert the surgeon to investigate an occult ankle injury, particularly of the posterior malleolus. A protocol including computed tomography of the ankle may detect more injuries in a larger study.

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Advances in Tibial Nailing

Hsu¹,

Dickson²

Practice of Intramedullary Locked Nails

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Intramedullary Nailing of Unstable Diaphyseal Fractures of the Tibia with Distal Intraarticular Involvement

Abstract: The indications for intramedullary nailing of unstable diaphyseal tibia fractures may be extended to include certain fractures with distal extension into the ankle joint, as well in a tibial shaft fracture occurring in combination with a noncontiguous ipsilateral ankle fracture.

Cited by 87 publications

References 19 publications

Unreamed intramedullary nailing in distal tibial fractures

Unreamed intramedullary nailing in distal tibial fractures

High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

Advances in Tibial Nailing

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