Management of Tibial Shaft Fractures Distal to TKA Prosthesis by Intramedullary Nail: A Report of Three Cases

Devendra, Agraharam; P, Gupta Nishith; Jaffrulah, Mohd Zackariya; Armstrong, B R W; Dheenadhayalan, J.; Rajasekaran, Shanmuganathan

doi:10.1007/s43465-020-00142-2

Cited by 7 publications

(7 citation statements)

References 10 publications

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“…With a rising number of patients who receive or will receive total knee arthroplasty (TKA), the SEIP method is critical for tibial nailing, particularly to avoid intra-articular penetration. Devendra et al demonstrated a successful modified HFIP IMN approach in a case study involving 3 patients who presented with tibial shaft fractures distal to the location of TKA prostheses [ 38 ]. Similarly, Haller et al reported using an IMN with a modified HFIP procedure to correct DTF, whereby they successfully avoided the tibial baseplate and thus provided stable fracture fixation, which facilitated early weight bearing [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

Lü

Wang

et al. 2022

J Orthop Traumatol

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Background Malalignment is a common event during the intramedullary nailing (IMN) of distal tibia fractures (DTFs). Although it is reported that the semi-extended IMN techniques such as suprapatellar (SP) and parapatellar (PP) approaches may be superior in preventing malalignment, the application of these techniques is concerning owing to the intra-articular involvement. We thus developed an extra-articular semi-extended infrapatellar (SEIP) approach which utilizes the infrapatellar (IP) space while maintaining the knee in a semi-extended position. However, there are no studies on the safety and efficacy of SEIP in treating DTFs. Therefore, in this study, the SEIP technique was examined, particularly in terms of the potential alignment improvement of DTFs, and this technique was compared with the traditional hyperflexed infrapatellar (HFIP) procedure. Materials and methods This randomized clinical trial (RCT) compared IMN malalignment while correcting extraarticular and nondisplaced intra-articular DTFs between April 2018 and June 2021 using the HFIP and SEIP techniques at a level I trauma center in China. The study participants were clinically and radiographically examined for at least 12 months of follow-ups. Intraoperative fluoroscopy time, operation time, blood loss, hospitalization duration, functional ankle score, and complications were assessed as well. Results Among the 88 recruited participants, 45 (51%) underwent traditional HFIP IMN and 43 (49%) underwent SEIP IMN. Malalignment occurred in 9 patients (20.0%) from the HFIP cohort and in 2 patients (4.7%) from the SEIP cohort (P value = 0.030). In addition, the SEIP IMN technique significantly reduced the intraoperative fluoroscopy time, operation time, and improved the postoperative ankle function compared to the HFIP IMN technique. However, the intraoperative blood loss, hospitalization duration, infection, delay union, and nonunion remained the same between the two cohorts. Conclusions In summary, we demonstrated that the SEIP IMN provides markedly enhanced alignment of extraarticular and nondisplaced intra-articular DTFs compared to the traditional HFIP IMN procedure. The described technique represents an effective option for IMN of DTFs. Level of evidence Level 2. Trial registration The Chinese Clinical Trial Registry, ChiCTR2100043673. Registered 26 February 2021, retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=122263

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Section: Discussionmentioning

confidence: 99%

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

Lü

Wang

et al. 2022

J Orthop Traumatol

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“…Success with a transpatellar approach for IMN has been demonstrated by Devendra et al in one case study of 3 patients who sustained tibial shaft fractures distal to the location of total knee arthroplasty prostheses. 65 Similarly, Haller et al documented utilization of an IMN with a transpatellar technique in a fracture of the distal tibia, successfully avoiding the tibial baseplate, providing stable fracture fixation, and allowing for early weight bearing. 66 Therefore, the secondary goal of this study was to evaluate whether a lateral intramedullary tibial nail can be routinely placed extra-articularly without compromising the integrity of the joint capsule which would be paramount in patients with an infected or grossly contaminated tibia or with total knee implants present.…”

Section: Lateral Parapatellarmentioning

confidence: 99%

A Review of Proximal Tibia Entry Points for Intramedullary Nailing and Validation of The Lateral Parapatellar Approach as Extra-articular

et al. 2022

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Tibial shaft fractures are the most common long bone injury and are often treated surgically in an attempt to minimize complications. Although treatment options for tibial shaft fractures vary based on factors including open injury, severity of fracture, and soft tissue status, intramedullary nailing in adults has emerged as the preferred definitive option for stabilization. Therefore, the primary purposes of this review and cadaveric study were to evaluate the entry points for reamed tibial nails and the risks, benefits, and advantages of each approach. Due to concerns of violating the joint capsule and the generalized applicability to everyday practice of the extra-articular lateral parapatellar semi-extended technique, the secondary goal of this manuscript was to evaluate whether an intramedullary tibial nail can be consistently placed extra-articularly using the lateral parapatellar technique described by Kubiak et al. and generalizability to surgeons of varying experience.

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“…5 Weight-bearing restrictions are necessary for both casting and plate osteosynthesis which may lead to complications such as losses of muscle strength and endurance or even thromboembolic events. 4,6 Intramedullary nails (IMNs) are the preferred implant in treating diaphyseal tibial fractures as they may allow for earlier weight-bearing; however, in the presence of a TKA, such treatment is technically demanding because of the presence of the tibial base plate and cement proximally, which may interfere with an accurate starting point.…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of diaphyseal tibial shaft fractures distal to TKA remains controversial. 4 Stable fractures with minimal displacement have historically been treated nonoperatively with cast immobilization. 4 Displaced diaphyseal fractures have been treated with plate osteosynthesis.…”

Section: Introductionmentioning

confidence: 99%

“…4 Stable fractures with minimal displacement have historically been treated nonoperatively with cast immobilization. 4 Displaced diaphyseal fractures have been treated with plate osteosynthesis. 5 Weight-bearing restrictions are necessary for both casting and plate osteosynthesis which may lead to complications such as losses of muscle strength and endurance or even thromboembolic events.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Diaphyseal Tibial Fractures Distal to a Total Knee Arthroplasty by Intramedullary Nailing Is Safe and Effective

Shaath

Avilcuea

Kerr

et al. 2022

Journal of Orthopaedic Trauma

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Objectives: To report the clinical result of a series of patients who underwent intramedullary nailing (IMN) of tibial shaft fractures distal to a total knee arthroplasty (TKA).Design: Retrospective case series.Setting: Level-1 trauma center.Patients/Participants: Patients who sustained a tibial shaft fracture distal to a TKA treated with an IMN.Intervention: IMN of tibial shaft fractures distal to a TKA. Main Outcome Measurements:Postoperative weight-bearing status, readmissions, and complications or failure of treatment within 90 days; Knee Injury and Osteoarthritis Outcome Scores at the final follow-up; failure of treatment; and revision surgery.Results: Nine patients were included. The average age was 71.4 years (range 55-87 years). All TKAs were cemented. The average distance between the tibial keel and the cortical density of the tibial tubercle was 24.1 mm (range 19.5-26.7 mm). Six nails were inserted using an infrapatellar portal, 2 were inserted using a suprapatellar portal, and 1 was inserted using a lateral parapatellar approach. The median nail diameter was 10 mm (range 9-12 mm). All fractures were healed at the final follow-up. There were no infections or arthroplasty-related complications. Knee Injury and Osteoarthritis Outcome Scores ranged from 100% to 74% (median 82%). Conclusion:Overall, we report on the largest cohort in the literature undergoing IMN of a tibial shaft fracture distal to a TKA. We demonstrate that IMN of diaphyseal tibial fractures distal to a TKA can be performed safely. We additionally demonstrate that this treatment is highly effective in achieving fracture union with no arthroplasty-related complications.

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Management of Tibial Shaft Fractures Distal to TKA Prosthesis by Intramedullary Nail: A Report of Three Cases

Cited by 7 publications

References 10 publications

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

A Review of Proximal Tibia Entry Points for Intramedullary Nailing and Validation of The Lateral Parapatellar Approach as Extra-articular

Treatment of Diaphyseal Tibial Fractures Distal to a Total Knee Arthroplasty by Intramedullary Nailing Is Safe and Effective

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