Taylor Spatial Frame or Reamed Intramedullary Nailing for Closed Fractures of the Tibial Shaft: A Randomized Controlled Trial

Frihagen, Frede; Madsen, Jan Erik; Sundfeldt, Mikael; Flugsrud, Gunnar B; Andreassen, Joakim Stray; Andersen, Mette Renate; Andreassen, G

doi:10.1097/bot.0000000000001802

Cited by 16 publications

(24 citation statements)

References 36 publications

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“…To our knowledge, this is the first multicenter randomized clinical trial in the U.S. comparing modern external ring fixators to internal fixation for severe open tibial shaft fractures. Although there have been smaller randomized trials comparing external and internal fixation, those studies either did not examine modern external ring fixators or did not focus on severe open injuries 24-28 . The strengths of our trial include the multicenter randomized design with well-balanced treatment groups.…”

Section: Discussionmentioning

confidence: 99%

Modern External Ring Fixation Versus Internal Fixation for Treatment of Severe Open Tibial Fractures

2022

Journal of Bone and Joint Surgery

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Major Extremity Trauma Research Consortium (METRC)*Background: Modern external ring fixation has been hypothesized to reduce complications requiring hospital readmission compared with internal fixation when treating patients with high-energy open tibial shaft fractures. In this study, the 1-year probability of a major limb complication was compared between external and internal fixation of severe open tibial fractures.Methods: This multicenter randomized clinical trial included patients 18 to 64 years of age with severe open tibial shaft fractures randomly assigned to either modern external ring fixation (n = 127) or internal fixation (n = 133). The primary outcome was a major limb complication within 365 days after randomization; these complications included amputation, infection, a soft-tissue problem, nonunion, malunion, and a loss of reduction/implant failure.Results: Of 260 randomized patients, 254 were included in the final analysis. Their mean age (standard deviation) was 39 (13) years; 214 (84%) were men. The probability of at least 1 major limb complication was higher for external fixation (62.1% [95% confidence interval (CI): 53.4% to 70.8%]) than internal fixation (43.7% [95% CI: 35.5% to 52.9%]), with a risk difference of 18.4% (95% CI: 5.8% to 30.4%); p = 0.005). The most notable difference was in loss of reduction/implant failure, the rate of which was higher for external fixation (risk difference: 14.4% [95% CI: 7.0% to 21.6%]; p = 0.002). There was no appreciable difference in the probability of deep infection between external fixation (26.1%) and internal fixation (29.7%) (risk difference: 23.5% [95% CI: 214.8% to 7.8%]; p = 0.54). There were also no appreciable differences in the probabilities of amputation, nonunion, soft-tissue problems, malunion, or fracture healing between the groups.Conclusions: These results argue against routine use of modern external ring fixation for the treatment of these severe open tibial fractures.Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Open tibial shaft fractures are common injuries associated with poor outcomes and high rates of complications [1][2][3][4][5][6][7][8][9][10][11][12] . Traditional treatment protocols utilize intramedullary nails or plates for fracture fixation, which involve placing metal at the open fracture site. Studies indicate that infection rates increase when an implant is placed within a wound, likely due to the difficulty that the immune system has in clearing bacteria from biofilm that can develop on metallic surfaces [13][14][15] . Treatment with modern external ring fixation, which does not place any implant at the fracture site, is therefore thought to reduce rates of deep infection and potentially also reduce overall complication rates.Although there is a theoretical basis to support an advantage of modern external ring fixation 4,6,16 , it is unknown if this treatment performs better than the more commonly used internal fixation in terms of major complicati...

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Section: Discussionmentioning

confidence: 99%

Modern External Ring Fixation Versus Internal Fixation for Treatment of Severe Open Tibial Fractures

2022

Journal of Bone and Joint Surgery

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“…At 12 months, these disturbances were still present in 18% and 54% of patients in the transverse and longitudinal incision group, respectively (p < 0.001). A study comparing a Taylor Spatial Frame (TSF; Smith & Nephew) and reamed intramedullary nailing for the treatment of closed tibial shaft fractures found that the TSF group had less knee pain (VAS score of 0.5 [SD, 1.2] versus 2.4 [SD, 2.2] at 1 year; p < 0.001]) 21 . With increasing awareness of anterior knee pain after tibial nailing, new surgical techniques intended to address this issue have been described in recent years.…”

Section: Discussionmentioning

confidence: 99%

Effect of Transverse Versus Longitudinal Incisions on Anterior Knee Pain After Tibial Nailing (TRAVEL)

Leliveld

Lieshout

Polinder

et al. 2022

Journal of Bone and Joint Surgery

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Background:Anterior knee pain is common after tibial nailing, and its origin is poorly understood. Literature suggests it may be related to infrapatellar nerve injury. The aim of this study was to compare the effect of a transverse (potentially infrapatellar nerve-sparing) incision versus a longitudinal incision for the insertion of a tibial nail with respect to anterior knee pain.Methods:Patients with a tibial shaft fracture undergoing treatment with use of an intramedullary nail were randomized to a transverse incision (n = 68) or longitudinal incision (n = 68) in multiple centers. The primary outcome measure was kneeling pain based on a numeric rating scale (NRS). Secondary outcome measures included knee pain during daily activities, functional outcome (Short Musculoskeletal Function Assessment and Lower Extremity Functional Scale), quality of life (EuroQol-5 Dimensions), activity resumption, complications, reoperations, and costs within 1 year after trauma.Results:At 12 months, the estimated marginal mean for kneeling pain was 2.4 (95% confidence interval [CI], 1.6 to 3.2) in the transverse incision group and 3.7 (95% CI, 3.0 to 4.5) in the longitudinal incision group. Regression analysis showed no significant difference between the groups over time. Knee pain scores for daily activities, functional outcome scores, and quality of life were also comparable between the groups. Signs of infrapatellar nerve injury were found less often after a transverse incision (18% versus 54%; p < 0.001). The median total (direct and indirect) costs per patient were €10,468 in the transverse incision group and €11,066 in the longitudinal incision group. Loss of productivity accounted for 67% and 52% of the total costs in the 2 groups, respectively.Conclusions:A transverse incision reduces injury to the infrapatellar nerve, but anterior knee pain scores and function are comparable after use of a transverse or longitudinal incision for tibial nail insertion.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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“…To achieve a good surgical effect requires continuous study and reflection. The application of TSF can solve the shortcomings of traditional HTO surgery [ 10 ]. It improves the accuracy of osteotomy through 3D preoperative planning.…”

Section: Discussionmentioning

confidence: 99%

Opening Wedge High Tibial Osteotomy with Combined Use of Patient-Specific 3D-Printed Plates and Taylor Spatial Frame for the Treatment of Knee Osteoarthritis

Duan

Cao

et al. 2021

Pain Research and Management

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Background. High tibial osteotomy (HTO) is used to treat medial degeneration of the osteoarthritis (OA) knee. However, shortcomings still exist in the current procedure, like unprecise creation, inability to correct knee rotation, and internal fixed failure. Here, we reported a novel procedure: patient-specific 3D-printed plates for opening wedge high tibial osteotomy (OWHTO) combined with Taylor spatial frame (TSF). The detailed technique was described, and the clinical outcomes were evaluated. Methods. We prospectively evaluate outcomes of patient-specific 3D-printed plates for OWHTO with use of TSF in 25 patients with knee OA and varus alignment. Postoperative efficacy was evaluated using the HSS knee score, pain visual simulation score (VAS), and knee joint motion (ROM), and lower limb alignment was evaluated by measuring femorotibial angle (FTA) and hip-knee-ankle (HKA). Results and Conclusion. All patients did not experience complications such as wound infection, nerve damage, or bone amputation. 25 patients were followed up for 6–18 months. The bony union at bone amputation was achieved in 3 months after surgery, and the pain symptoms were significantly alleviated or disappeared. The VAS score was significantly reduced in 6 months after surgery compared with preoperative; the HSSS score was significantly added in 6 months after surgery compared with preoperative. The ROM of knee joint increased significantly 6 months after operation compared with that before operation, and the difference was statically significant ( P < 0.05 ). The FTA and HKA after operation were significantly superior to that before operation, and the difference was statically significant ( P < 0.01 ). Conclusions. Our study showed that patient-specific 3D-printed plates for HTO with the use of TSF have the advantages of small trauma, few complications, simple operation, and fast recovery in treating knee OA and varus alignment.

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Taylor Spatial Frame or Reamed Intramedullary Nailing for Closed Fractures of the Tibial Shaft: A Randomized Controlled Trial

Cited by 16 publications

References 36 publications

Modern External Ring Fixation Versus Internal Fixation for Treatment of Severe Open Tibial Fractures

Modern External Ring Fixation Versus Internal Fixation for Treatment of Severe Open Tibial Fractures

Effect of Transverse Versus Longitudinal Incisions on Anterior Knee Pain After Tibial Nailing (TRAVEL)

Opening Wedge High Tibial Osteotomy with Combined Use of Patient-Specific 3D-Printed Plates and Taylor Spatial Frame for the Treatment of Knee Osteoarthritis

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