Problems associated with tibial fractures with intact fibulae.

Teitz, Carol C.; Carter, D R; Frankel, Victor H.

doi:10.2106/00004623-198062050-00011

Cited by 119 publications

(63 citation statements)

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“…3 Progression of the number of patients with leg length discrepancy (lengthening or shortening) between day 0 and 2 years produces. The classical relationship between isolated tibial fracture and non-union [24] was not confirmed in our series. A risk of overgrowth of the fractured tibia exists.…”

Section: Discussioncontrasting

confidence: 74%

Elastic stable intramedullary nailing of tibial shaft fractures in children

Griffet

Leroux

Boudjouraf

et al. 2011

Journal of Children's Orthopaedics

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Purpose Tibial fractures in the skeletally immature patient are usually treated without surgery. Elastic stable intramedullary nailing (ESIN) is commonly used for other diaphyseal fracture locations. Its advantages are minimally invasive surgery with a short hospitalisation duration, primary bone union and early weight bearing. The purpose of this study was to assess the use of ESIN in displaced tibial fractures in children over 6 years old and in cases of polytrauma. Methods This study was carried out over a 6-year period. The protocol consisted in ESIN of shaft tibial fractures in children over 6. Frontal and sagittal angulation, shortening and lengthening were measured on days 0, 2, 15, 30 and 45. At 6 months, 1 and 2 years, the femoro-tibial axis and eventual shortening or lengthening were assessed. ResultsThe study involved 86 children (average age 11.8 years). As early as day 30, all patients had normal knee mobility and symmetrical foot progress angle. At 2-year follow-up, frontal angulation and leg length discrepancy had decreased and affected 2% of patients. Four patients (5%) suffered from superficial infections. There were no cases of osteomyelitis or refracture. Conclusions The fixation of paediatric diaphyseal tibial fractures with ESIN is a rapid, well-codified and effective method for treating long-bone closed fractures in children. Advantages over other fixation techniques include a lower infection rate, a lower refracture rate, ease of management, and an aesthetically pleasing scar.

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Section: Discussioncontrasting

confidence: 74%

Elastic stable intramedullary nailing of tibial shaft fractures in children

Griffet

Leroux

Boudjouraf

et al. 2011

Journal of Children's Orthopaedics

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“…In our series, however, nonunion equally common at all levels of open tibial fractures. Some studies indicate that an intact fibula contributes to the development of nonunion (Teitz et al 1980, Hooper et al 1981, Leffers and Chandler 1985, however, our findings and those of others (Werken et al1993) does not support this.…”

Section: Discussioncontrasting

confidence: 92%

Nonunion of tibial fractures treated with external fixation

Chatziyiannakis

Verettas

Raptis

et al. 1997

Acta Orthopaedica Scandinavica

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“…Flap (IIIB) Pro [11] Vascular injury Pro [7] Open injury Pro [2,5] Weightbearing status postoperatively Pro [15,26] Con [35] Fibular fracture fixation Pro [15,38] Con [39,42] …”

Section: Bilateral Tibial Fractures Nonementioning

confidence: 99%

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

O’Halloran

Coale

Costales

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Accurate prediction of tibial nonunions has eluded researchers. Reliably predicting tibial nonunions at the time of fixation could change management strategies and stimulate further research. Questions/purposes We asked (1) whether data from medical records, fracture characteristics, and radiographs obtained at the time of fixation would identify features predictive of tibial fracture nonunion; and (2) whether this information could be used to create a model to assess the chance of nonunion at the time of intramedullary (IM) nail fixation of the tibia. Methods We retrospectively reviewed all tibial shaft fractures treated at our center from 2007 to 2014. We conducted a literature review and collected data on 35 factors theorized to contribute to delayed bone healing. Patients were followed to fracture healing or surgery for nonunion. Patients with planned prophylactic nonunion surgery were excluded because their nonunions were anticipated and our focus was on unanticipated nonunions. Our cohort consisted of 382 patients treated with IM nails for tibial shaft fractures (nonunion, 56; healed, 326). Bivariate and multivariate regression techniques and stepwise modeling approaches examined the relationship between variables available at definitive fixation. Factors were included in our model if they were identified as having a modest to large effect size (odds ratio [ 2) at the p \ 0.05 level. Results A multiple variable logistic regression model was developed, including seven factors (p \ 0.05; odds ratio [ 2.0). With these factors, we created the Nonunion Risk Determination (NURD) score. The NURD score assigns 5 points for flaps, 4 points for compartment syndrome, 3 points for chronic condition(s), 2 points for open fractures, 1 point for male gender, and 1 point per grade of American Society of Anesthesiologists Physical Status and percent cortical contact. One point each is subtracted for spiral fractures and for low-energy injuries, which were found to be predictive of union. A NURD score of 0 to 5 had a 2% chance of nonunion; 6 to 8, 22%; 9 to 11, 42%; and[12, 61%. Conclusions The proposed nonunion prediction model (NURDS) seems to have potential to allow clinicians to better determine which patients have a higher risk of nonunion. Future work should be directed at prospectively validating and enhancing this model. Level of Evidence Level III, diagnostic study.

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Problems associated with tibial fractures with intact fibulae.

Cited by 119 publications

References 0 publications

Elastic stable intramedullary nailing of tibial shaft fractures in children

Elastic stable intramedullary nailing of tibial shaft fractures in children

Nonunion of tibial fractures treated with external fixation

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

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