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

2011 ◽  
Vol 25 (2) ◽  
pp. 101-105 ◽  
Author(s):  
Jukka Ristiniemi ◽  
Patrik Luukinen ◽  
Pasi Ohtonen
Keyword(s):  
Surgical Treatment ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
Tibial Fractures ◽  
Distal Tibial Fractures

scholarly journals Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): a mixed methods feasibility study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Caroline B. Hing ◽  
Elizabeth Tutton ◽  
Toby O. Smith ◽  
Molly Glaze ◽  
Jamie R. Stokes ◽  
...  
Keyword(s):  
Mixed Methods ◽  
External Fixation ◽  
Intramedullary Nailing ◽  
Feasibility Study ◽  
Online Survey ◽  
Tibial Fracture ◽  
Tibial Fractures ◽  
Circular Frame ◽  
Pilot Rct ◽  
Randomised Controlled

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

RhBMP-7 accelerates the healing in distal tibial fractures treated by external fixation

2007 ◽  
Vol 89-B (2) ◽  
pp. 265-272 ◽  
Author(s):  
J. Ristiniemi ◽  
T. Flinkkilä ◽  
P. Hyvönen ◽  
M. Lakovaara ◽  
H. Pakarinen ◽  
...  
Keyword(s):  
External Fixation ◽  
Tibial Fractures ◽  
Distal Tibial Fractures

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

2010 ◽  
Vol 23 (3) ◽  
pp. 142-148 ◽  
Author(s):  
Ulf Sigurdsen ◽  
Olav Reikeras ◽  
Stein Erik Utvag
Keyword(s):  
External Fixation ◽  
Intramedullary Nailing ◽  
Tibial Fractures

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

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.

Intramedullary Nailing of Distal Tibial Fractures: A Technique to Prevent Malalignment

Orthopedics ◽  
2003 ◽  
Vol 26 (2) ◽  
pp. 183-185 ◽  
Author(s):  
George V Russell ◽  
Albert W Pearsall
Keyword(s):  
Intramedullary Nailing ◽  
Tibial Fractures ◽  
Distal Tibial Fractures

scholarly journals Pilon Fracture: A Case Report of a 45-Year-Old Dental Technician

2014 ◽  
Vol 8 (1) ◽  
pp. 433-436 ◽  
Author(s):  
Pouya Mafi ◽  
James Stanley ◽  
Sandip Hindocha ◽  
Reza Mafi
Keyword(s):  
Lower Extremity ◽  
External Fixation ◽  
Motor Vehicle ◽  
High Energy ◽  
Tibial Fractures ◽  
Pilon Fracture ◽  
Distal Tibial Fractures ◽  
Vehicle Accidents ◽  
Dental Technician ◽  
Fall From Height

Pilon fractures are complex and difficult-to-treat fractures of the lower extremity that account for about 1% of all lower extremity fractures and up to 10% of tibial fractures. The injury is caused by high energy axial load either from motor vehicle accidents or a fall from height. The treatment of these fractures has caused controversy among surgeons due to mixed outcomes. Here we report a case of pilon fracture in a 45 year old male patient who has sustained the injury as a result of a fall from a height of approximately 12 feet. We describe why it is absolutely crucial that the patient is treated with external fixation initially and evaluate its merits and drawbacks as well as ways to minimize the complications associated with external fixation of open intra-articular distal tibial fractures.

Surgical Treatment of Extra-articular or Simple Intra-articular Distal Tibial Fractures: MIPO Versus Supercutaneous Plating

Orthopedics ◽  
2014 ◽  
Vol 37 (10) ◽  
pp. e925-e931 ◽  
Author(s):  
Xianfeng He ◽  
Jingwei Zhang ◽  
Ming Li ◽  
Yihui Yu ◽  
Limei Zhu
Keyword(s):  
Surgical Treatment ◽  
Tibial Fractures ◽  
Distal Tibial Fractures

scholarly journals Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

2014 ◽  
Vol 20 (1) ◽  
pp. 44-49
Author(s):  
Șerban Al. ◽  
Obadă B. ◽  
Turcu R. ◽  
Anderlik St. ◽  
Botnaru V.
Keyword(s):  
Internal Fixation ◽  
External Fixation ◽  
Ankle Joint ◽  
Plate Osteosynthesis ◽  
Weight Bearing ◽  
Distal Tibia ◽  
Tibial Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Surgical Trauma ◽  
Distal Tibial Fractures

ABSTRACT Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours) open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68). The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks). All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks) showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

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