scholarly journals Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking

2021 ◽  
Author(s):  
Julia Greenfield ◽  
Philipp Appelmann ◽  
Felix Wunderlich ◽  
Dorothea Mehler ◽  
Pol Maria Rommens ◽  
...  
Keyword(s):  
Tibial Fracture ◽  
Distal Tibia ◽  
Torsional Stiffness ◽  
Distal Interlocking ◽  
Distal Screw ◽  
Interfragmentary Movement ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Surgical Options ◽  
Biomechanical Evaluation

Abstract Objectives Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology. Methods Six Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations. Results The removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading. Conclusions The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.

Biomechanical evaluation of a new treatment method for distal tibia fractures

2015 ◽  
Vol 18 (sup1) ◽  
pp. 1952-1953
Author(s):  
J. R. F. Greenfield ◽  
S. Kuhn ◽  
D. Mehler ◽  
F. Puel ◽  
P. M. Rommens
Keyword(s):  
Distal Tibia ◽  
Treatment Method ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Biomechanical Evaluation ◽  
New Treatment

scholarly journals A comparative biomechanical study of the Distal Tibia Nail against compression plating for the osteosynthesis of supramalleolar corrective osteotomies

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julia Greenfield ◽  
Philipp Appelmann ◽  
Yoann Lafon ◽  
Karine Bruyère-Garnier ◽  
Pol Maria Rommens ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Biomechanical Study ◽  
Worst Case ◽  
Lateral Cortex ◽  
Torsional Testing ◽  
Interfragmentary Movement ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Von Mises ◽  
Force Displacement

AbstractThe Distal Tibia Nail (DTN; Mizuho, Japan) has demonstrated higher biomechanical stiffness to locking plates in previous research for A3 distal tibia fractures. It is here investigated as a fixation option for supramalleolar corrective osteotomies (SMOT). Sixteen Sawbones tibiae were implanted with either a DTN (n = 8) or Medial Distal Tibia Plate (MDTP; n = 8) and a SMOT simulated. Two surgical outcome scenarios were envisaged: “best-case” representing an intact lateral cortex, and “worst-case” representing a fractured lateral cortex. All samples were subjected to compressive (350 N, 700 N) and torsional (± 4 Nm, ± 8 Nm) testing. Samples were evaluated using calculated construct stiffness from force–displacement data, interfragmentary movement and Von Mises’ strain distribution. The DTN demonstrated a greater compressive stiffness for the best-case surgical scenario, whereas the MDTP showed higher stiffness (p < 0.05) for the worst-case surgical scenario. In torsional testing, the DTN proved more resistant to torsion in the worst-case surgical setup (p < 0.05) for both ± 4 Nm and ± 8 Nm. The equivalent stiffness of the DTN against the MDTP supports the use of this implant for SMOT fixation and should be considered as a treatment option particularly in patients presenting vascularisation problems where the MDTP is an inappropriate choice.

scholarly journals Hindfoot Alignment Changes after Internal Fixation of Distal Tibial Fracture: Comparing Radiological and Clinical Outcomes of Patients Treated with Standard Plating vs Intramedullary Nailing

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
Young Yi ◽  
Dong Il Chun ◽  
Jae-Ho Cho ◽  
Sung-Hun Won ◽  
Ja-hyung Kim
Keyword(s):  
Tibial Fracture ◽  
Distal Tibia ◽  
Fracture Site ◽  
Inclusion Criteria ◽  
Distal Tibial Fracture ◽  
Hindfoot Alignment ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Transverse Rotation ◽  
Foot Alignment

Category: Trauma Introduction/Purpose: Until now, many papers Traditionally concerned for union of the fracture, changes of alignment, clinical symptoms and complication. However, there are no studies on changes in foot alignment, hid foot and related clinical changes. The Purpose of this study to evaluate clinical outcome and radiological outcome including hind foot alignment using Plate versus IM nail fixation of distal tibia fracture and to evaluate influence factors of hindfoot alignment alteration among the radiologic parameters. Methods: Overall, 92 patients with distal tibial metaphyseal fractures (AO-OTA 43-A1, 43-A2) with simple or no articular involvement treated from 2002 to 2013. Among them, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Inclusion criteria were applied for patient group. Union rate and complication rate compared both group. Radiographic measurements were evaluated at a minimum of 1-year follow-up. Radiological parameters of hindfoot angulation and moment arm were measured at the Saltzman view, calcaneal pitch angle and Meary angle were measured at the lateral standing radiograph. Hindfoot alignment changes after surgery were compared between both groups using student T-test. Alignment changes after fracture site union were evaluated simple radiograph and computed radiograph; coronal plane angulation, saggital plane angulation and transverse plane rotation were measured. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment Results: We studied 92 patients with distal tibia fractures treated with IMN (39 patients) and SP (53 patients). 37 patients in the IMN group and 47 in the IMN group met inclusion criteria. All patients ultimately healed, with the average time to union of 26 weeks in both the groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch and Mearly angles showed no difference between the groups. But moment arm was increased valgus in the IMN group. Angulation at fracture site on the coronal and hindfoot alignment changes were showed low significant relationship(R=0.38). But transverse rotation and hindfoot alignment changes were showed high significant relationship(R=0.79). And only transverse rotation has a strong correlation with hindfoot alignment changes after regression analysis. Conclusion: Similar union rate and complication were seen when treating nonarticular metaphyseal distal tibia fractures with SP compared with IMN. Angulation on coronal plane after internal fixation may a little affect to change hindfoot alignment due to compensation on the subtalar joint. However, rotation on the transverse plane has intactly influenced hindfoot alignment alteration. Therefore, regardless of the fixed method, the patients treated distal tibial fracture required close attention to changes in hindfoot alignment due to transverse rotation during surgery.

The Retrograde Tibial Nail: Presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures

Injury ◽  
2014 ◽  
Vol 45 ◽  
pp. S81-S86 ◽  
Author(s):  
Sebastian Kuhn ◽  
Philipp Appelmann ◽  
Philip Pairon ◽  
Dorothea Mehler ◽  
Pol M. Rommens
Keyword(s):  
Distal Tibia ◽  
Tibial Nail ◽  
Tibia Fractures ◽  
Distal Tibia Fractures ◽  
Biomechanical Evaluation

Percutaneous ORIF of Periarticular Distal Tibia Fractures, Perspective 2

2015 ◽  
pp. 1-7
Author(s):  
Francesco Oliva ◽  
Rodrigo Buharaja ◽  
Alessio Giai Via ◽  
Nicola Maffulli
Keyword(s):  
Distal Tibia ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

scholarly journals Distal Tibia Metaphyseal Fractures: Which is Better, Intra-medullary Nailing or Minimally Invasive Plate Osteosynthesis?

2018 ◽  
Vol 24 (1) ◽  
pp. 66-71
Author(s):  
Kawalkar Abhijit Chandrakant ◽  
Badole Chandrashekher Martand
Keyword(s):  
Intramedullary Nailing ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Early Weight Bearing ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

Introduction Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPPO technique. Methods The study was conducted between Jan 2011 to Dec 2012. 63 patients with extra-articular distal tibia fracture treated with intramedullary nailing and MIPPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results 31 patients were treated with intramedullary nail & 32 with MIPPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPPO group. Conclusion Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures & helps in early weight bearing and ambulation of patient with fewer complications.

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