Letter to the editor concerning “M. Burkus, F. Tömböl and N. Wiegand et al., Physeal-sparing unreamed locked intramedullary nailing for adolescent tibial fractures, Injury, https://doi.org/10.1016/j.injury.2020.02.049”

Abstract Background Segmental tibial fractures are fractures in two or more areas of the tibial diaphysis resulting in a separate intercalary segment of the bone. Surgical fixation is recommended for patients with segmental tibial fractures as non-operative treatment outcomes are poor. The most common surgical interventions are intramedullary nailing (IMN) and circular frame external fixation (CFEF), but evidence about which is better is of poor quality. An adequately powered randomised controlled trial (RCT) to determine optimum treatment is required. STIFF-F aimed to assess the feasibility of a multicentre RCT comparing IMN with CFEF for segmental tibial fracture. Methods STIFF-F was a mixed-methods feasibility study comprising a pilot RCT conducted at six UK Major Trauma Centres, qualitative interviews drawing on Phenomenology and an online survey of rehabilitation. The primary outcome was recruitment rate. Patients, 16 years and over, with a segmental tibial fracture (open or closed) deemed suitable for IMN or CFEF were eligible to participate. Randomisation was stratified by site using random permuted blocks of varying sizes. Participant or assessor blinding was not possible. Interviews were undertaken with patients about their experience of injury, treatment, recovery and participation. Staff were interviewed to identify contextual factors affecting trial processes, their experience of recruitment and the treatment pathway. An online survey was developed to understand the rehabilitation context of the treatments. Results Eleven patients were screened and three recruited to the pilot RCT. Nineteen staff and four patients participated in interviews, and 11 physiotherapists responded to the survey. This study found the following: (i) segmental tibial fractures were rarer than anticipated, (ii) the complexity of the injury, study setup times and surgeon treatment preferences impeded recruitment, (iii) recovery from a segmental tibial fracture is challenging, and rehabilitation protocols are inconsistent and (iv) despite the difficulty recruiting, staff valued this research question and strived to find a way forward. Conclusion The proposed multicentre RCT comparing IMN with CFEF is not feasible. This study highlighted the difficulty of recruiting patients to an RCT of a complex rare injury over a short time period. Trial registration The study was registered with the International Standard Randomised Controlled Trials Number Registry: ISRCTN11229660

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Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures

Journal of Orthopaedic Surgery ◽

10.1177/230949901202000308 ◽

2012 ◽

Vol 20 (3) ◽

pp. 307-311 ◽

Cited By ~ 18

Author(s):

Sunil G Kulkarni ◽

Ankit Varshneya ◽

Shreenath Kulkarni ◽

Govind S Kulkarni ◽

Milind G Kulkarni ◽

...

Keyword(s):

Intramedullary Nailing ◽

Tibial Fractures ◽

Proximal Tibial Fractures

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Surgical Treatment of Extra-Articular or Simple Intra-Articular Distal Tibial Fractures: External Fixation versus Intramedullary Nailing

Journal of Orthopaedic Trauma ◽

10.1097/bot.0b013e3181da4682 ◽

2011 ◽

Vol 25 (2) ◽

pp. 101-105 ◽

Cited By ~ 12

Author(s):

Jukka Ristiniemi ◽

Patrik Luukinen ◽

Pasi Ohtonen

Keyword(s):

Surgical Treatment ◽

External Fixation ◽

Intramedullary Nailing ◽

Tibial Fractures ◽

Distal Tibial Fractures

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

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.09.004 ◽

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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Conversion of External Fixation to Definitive Intramedullary Nailing in Experimental Tibial Fractures

Journal of Investigative Surgery ◽

10.3109/08941930903564118 ◽

2010 ◽

Vol 23 (3) ◽

pp. 142-148 ◽

Cited By ~ 8

Author(s):

Ulf Sigurdsen ◽

Olav Reikeras ◽

Stein Erik Utvag

Keyword(s):

External Fixation ◽

Intramedullary Nailing ◽

Tibial Fractures

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Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

10.21203/rs.3.rs-36128/v1 ◽

2020 ◽

Author(s):

Yibo Xu ◽

Cheng Ren ◽

Zhong Li ◽

Kun Zhang ◽

Teng Ma ◽

...

Keyword(s):

Intramedullary Nailing ◽

Locking Compression Plate ◽

Tibial Fractures ◽

Cost Effectiveness Ratio ◽

Intraoperative Bleeding ◽

Distal Tibial Fractures ◽

Total Cost ◽

Final Treatment ◽

Compression Plate ◽

Surgical Duration

Abstract Background To analyze the clinical characteristic and economic of intramedullary nailing versus locking compression plate for the treatment of open distal tibial fractures.Methods A retrospective analysis was conducted by enrolling patients with open distal tibial fractures who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department，Xi’an Honghui Hospital from January 2016 to January 2019. The collected clinical materials and data included gender, age, injury mechanism, smoke and alcohol, comorbidity disease, Gustilo classification, days before operation, final treatment option, surgical duration, intraoperative bleeding loss, length of stay, complications, Johner-Wruhs criteria, total cost within 1 year after surgery (including hospitalization expenses and postoperative rehabilitation or follow-up expenses). All the patients were divided into two groups based on the final treatment options: Group IMN(intramedullary nailing) and Group LCP(locking compression plate). Cost data for each case within 1 year after surgery were analyzed for the cost-effectiveness ratio (CER)and incremental cost-effectiveness ratio (ICER) of IMN versus LCP.Results 49 consecutive cases were enrolled including 28 cases of Group IMN and 21 cases of Group LCP with the excellent and good rate of 82.1% (23 cases) and 85.7% (18 cases) respectively based on Johner-Wruhs criteria. The surgical duration (p=0.017) and intraoperative bleeding loss(p=0.046) were significantly lower in Group IMN than in Group LCP. Total cost within 1 year after surgery(p=0.048) was also less in Group IMN（126435.90±39093.98 CNY）than in Group LCP（147834.60±56821.12 CNY）. No statistically significant difference was discovered on the excellent and good rate of Johner-Wruhs criteria between the two groups(p＞0.05). The average cost for every 1% of excellent and good rate was 1540.02 CNY in Group IMN and 1725.02 CNY in Group LCP. Each 1% increasing of excellent and good rate cost 5944.08 CNY more in Group LCP compared with Group IMN.Conclusions Both the IMN and LCP could provide a satisfactory outcome for open distal tibial fractures. However the IMN was a more cost-effective management than LCP when the economic analysis was included.

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