scholarly journals Unreamed Intramedullary Nailing with Oblique Proximal and Biplanar Distal Interlocking Screws for Proximal Third Tibial Fractures

2009 ◽  
Vol 17 (1) ◽  
pp. 23-27 ◽  
Author(s):  
VK Singh ◽  
Y Singh ◽  
PK Singh ◽  
RK Goyal ◽  
H Chandra
Keyword(s):  
Compartment Syndrome ◽  
Intramedullary Nailing ◽  
Functional Outcomes ◽  
Knee Flexion ◽  
Delayed Union ◽  
Tibial Fractures ◽  
Entry Point ◽  
Implant Failure ◽  
Distal Locking ◽  
Distal Interlocking

Purpose. To assess the outcome of unreamed intramedullary nailing through the lateralised entry point using oblique proximal and biplanar distal interlocking screws. Methods. 15 men and 3 women aged 25 to 58 (mean, 37) years underwent unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws for proximal third metaphyseal tibial fractures. The entry point was kept proximal to the tibial tuberosity and slightly lateral to midline. Proximal locking was at 45° to the coronal and sagittal planes. Biplanar distal locking was in the coronal and sagittal planes. Results. 16 patients had bone union within 20 (mean, 17; range, 14–27) weeks; 2 underwent dynamisation for delayed union. Three patients had valgus angulation of <5°; 2 had a loss of terminal knee flexion; 3 had a loss of ankle dorsiflexion; and 3 had shortening of >0.5 cm. Functional outcomes were excellent in 13, good in 4, and fair in one patient. No patient endured neurovascular injury, compartment syndrome or implant failure. Conclusion. Unreamed intramedullary nailing with oblique proximal and biplanar distal interlocking screws for proximal third tibial fractures was effective in preventing malalignment.

scholarly journals Titanium Elastic Nailing System (TENS) for Tibia Fractures in Children: Functional Outcomes and Complications

2016 ◽  
Vol 55 (204) ◽  
pp. 55-60 ◽  
Author(s):  
Kapil Mani KC ◽  
Parimal Acharya ◽  
Arun Sigdel
Keyword(s):  
Functional Outcomes ◽  
Skin Irritation ◽  
Limb Lengthening ◽  
Delayed Union ◽  
Tibial Fractures ◽  
Entry Site ◽  
Superficial Infection ◽  
Non Union ◽  
Fractures In Children ◽  
Tibia Fractures

Introduction: Closed reduction and cast application is still regarded as first line treatment for pediatric tibial fractures. Over the past few decades, management of pediatric tibial fractures has shifted more towards operative intervention because of quicker recovery, shorter rehabilitation period, less immobilization, lack of stiffness of adjoining joints, and less psychological impact to the children. Flexible intramedullary nails not only fulfill the above advantage but also maintain alignment and rotation.Methods: This was a retrospective study of pediatric tibial fractures fixed with two titanium elastic nails through proximal ends of bones. Alignment of fracture, any infection, delayed union, non union, limb length discrepancy, motion of knee joint, and fracture union time were measured during follow-up examination.Results: Forty-five patients were enrolled into the study out of which 28 (62.2%) were male and 17 (37.8%) were female. Average age of patient was 9.48±2.17 years and average time taken to heal the fractures (both clinical and radiological) was 11.17±2.81 weeks. There were 2 (4.4%) of malunion, 4 (8.8%) of delayed union, 3 (6.6%) of limb shortening, 2 (4.4%) of limb lengthening, 6 (13.6%) of nail prominence and skin irritation, 2 (4.4%) of superficial infection at nail entry site and one case of re-fracture.Conclusions: Titanium elastic nail fixation is a simple, easy, rapid, reliable and effective method for management of pediatric tibial fractures in patients with operative indications. There may be the chances of complication following the TENS in tibia but these are avoidable as well as manageable with careful precautions. Keywords: complications; functional outcomes; tibia fractures. | PubMed

scholarly journals Distal interlocking for short trochanteric nails: static, dynamic or no locking? Review of the literature and decision algorithm

2020 ◽  
Vol 5 (7) ◽  
pp. 421-429
Author(s):  
Alexei Buruian ◽  
Francisco Silva Gomes ◽  
Tiago Roseiro ◽  
Claudia Vale ◽  
André Carvalho ◽  
...  
Keyword(s):  
Delayed Union ◽  
Medullary Canal ◽  
Cochrane Library ◽  
Decision Algorithm ◽  
Distal Locking ◽  
Distal Interlocking ◽  
Artery Branch ◽  
Unstable Fractures ◽  
Cephalomedullary Nails

Pertrochanteric hip fractures are among the most common and the use of short cephalomedullary nails as the treatment of choice is increasing. A systematic review regarding distal locking options for short cephalomedullary nails was undertaken using Medline/PubMed®, Embase® and Cochrane Library® in order to evaluate current indications, associated complications and to provide treatment recommendations. The results seem to support the use of distal static locking for unstable fractures, dynamic locking for length stable/rotational unstable fractures and no locking for stable fractures. Complications associated with distal locking include iatrogenic fractures, thigh pain, delayed union and nonunion, implant failure, screw loosening and breaking, drill bit breaking, soft tissue irritation, femoral artery branch injury, intramuscular haematoma and compartment syndrome. It is also associated with longer operative time and radiation exposure. In unlocked constructs, dorsomedial comminution and nail/medullary canal mismatch contribute to peri-implant fractures. Anterior cortical impingement is associated with cut-out and nonunion. Most studies comparing distally locked and unlocked nails report a short follow-up. Distal locking mode should be based on the fracture’s stability. Cite this article: EFORT Open Rev 2020;5:421-429. DOI: 10.1302/2058-5241.5.190045

Distal Locking Screws for Intramedullary Nailing of Tibial Fractures

Orthopedics ◽  
2016 ◽  
Vol 39 (2) ◽  
pp. e253-e258 ◽  
Author(s):  
Filon Agathangelidis ◽  
Georgios Petsatodis ◽  
John Kirkos ◽  
Pericles Papadopoulos ◽  
Dimitrios Karataglis ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Tibial Fractures ◽  
Distal Locking ◽  
Locking Screws

Analysis of Centromedullary Nailing with Implant Failure

2015 ◽  
Vol 638 ◽  
pp. 130-134 ◽  
Author(s):  
Ioan Cristescu ◽  
Iulian Vasile Antoniac ◽  
Daniel Vilcioiu ◽  
Florin Safta
Keyword(s):  
Surgical Technique ◽  
Intramedullary Nailing ◽  
Delayed Union ◽  
Fracture Pattern ◽  
Fracture Site ◽  
Implant Failure ◽  
Implantation Technique ◽  
Long Bones ◽  
Metallic Implant ◽  
Non Union

Centromedullary nailing is the most preferred surgical technique for the treatment of lower limb fractures and sometimes also on the upper extremity. It is a minimal invasive surgical intervention used mainly for long bones fractures that permits treatment without opening the fracture site thus preserving the local vascularization. With the improved knowledge and understanding of the fracture pattern and of the implantation technique good stability and rapid bone healing is obtained.We present a study on 8 patients with long bones fractures (femur, tibia, humerus) that were surgically treated with intramedullary nailing which failed due to non-union. Implant failure usually occured at 6 to 10 months after surgery. In our group of patients the primary causes of non-union was improper fracture reduction, infection and faulty surgical technique. The implant usually failed several months after loading when the nail was not sharing but bearing all the weight. In this cases the metallic implant usually fails due to fatigue in its weakest point. Loss of reduction, inadequate fixation, a need to change implant and breakage of nails were considered as implant failure.Inappropriate usage of intramedullary nailing technique will lead to nonunion or delayed union and after loading the affected limb the metallic implant will bear all the mechanical forces. This will lead to implant failure and a new difficult surgery for the patients.Revision surgery should address both the biological part and the mechanical part of bone union .

scholarly journals Outcome of Two Ring Hybrid Ilizarov Fixator in the Management of Proximal Tibial Fractures in Adults

2021 ◽  
Vol 15 (10) ◽  
pp. 3485-3487
Author(s):  
Mohammad Younas ◽  
Syed Usman Shah ◽  
Naseer Ullah Khattak ◽  
Amina Gul Shehzar Khan ◽  
Sultan Shah ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Delayed Union ◽  
Tibial Fractures ◽  
Definitive Treatment ◽  
Chi Square ◽  
Schatzker Type ◽  
Proximal Tibial Fractures ◽  
Ilizarov Fixator

Objective: The aim of this study is to determine the outcomes of using two ring hybrid ilizarov fixator for the management of proximal tibial fractures in adult patients. Study Design: Descriptive Study Place and Duration: Methods: There were 60 patients of both genders were presented in this study. Patients were aged between 25-65 years. Informed written consent was taken from all the patients for detailed demographics age, sex, body mass index and cause of fracture. All the patients had proximal tibial fractures were included, type of fractures were assessed by schatzker technique. Outcomes were assessed by using Rasmussen score in terms of excellent, good and fair. Radiological outcome was measured by fracture healing on radiography. Student t-test and chi square test was used. SPSS 24.0 was used to analyze all of the data. Results: There were 45 (75%) patients were males and 15 (25%) were female patients. Mean age of the patients was 42.3±7.43 years with mean BMI 25.07±6.29 kg/m2. Falling was the most common cause of fracture found in 33 (55%), followed by road traffic accidents in 17 (28.3%) and 10 (16.7%) fractures by assault. Majority of the patients were schatzker type VI fractures 34 (56.7%) followed by schatzker type V fractures in 11 (18.3%), metaphyseal fractures found in 8 (13.3%) cases and proximalone third shaft fractures in 7 (11.7%) cases. Mean surgery time was 4.2±6.17 hours and mean union time of fractures was 19.8±6.61 weeks. According to Rasmussen score 39 (65%) cases showed excellent results with knee flexion more than 90 degree, good results found in 17 (28.3%) patients and fair results in 4 (6.7%) cases. Pin tract infection was the most common complication found in 12 (20%) cases, followed by compartment syndrome in 4 (6.7%) and delayed union in 3 (5%). No any poor outcome was assessed in this study. Conclusion: We concluded in this study that the use of two ring hybrid ilizarov fixator in the management of proximal tibial fractures were effective and useful in terms of excellent and good outcomes of knee flexion. The ilizarov approach allowed for early definitive treatment with a low rate of complications and a favourable clinical outcome. Keywords: Proximal Tibial fracture, Ilizarov Fixator, Shatzker, Rasmussen score, Outcomes

scholarly journals Semi-extended Intramedullary Nailing of the Tibia Using an Infrapatellar Approach

2020 ◽  
Author(s):  
Ke Lu ◽  
Yi-jun Gao ◽  
Hong-zhen Wang ◽  
Zhi-qiang Wu ◽  
Chong Li
Keyword(s):  
Intramedullary Nailing ◽  
Medical Records ◽  
Functional Outcomes ◽  
Operation Time ◽  
Delayed Union ◽  
Interquartile Range ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Significant Difference ◽  
Tibial Shaft Fractures

Abstract Background The semi-extended tibial intramedullary nailing method would enable easier and improved reductions for tibial fractures as well as facilitate fluoroscopic imaging; however, its in-articular nature remains controversial. The aim of this study was to compare the clinical and functional outcomes of the semi-extended infrapatellar (SEIP) approach and hyper-flexed infrapatellar (HFIP) approach for intramedullary nailing to treat tibial shaft fractures.MethodsThis study involved the retrospective analysis of the medical records of patients with tibial shaft fractures that were fixed through either the SEIP approach or the HFIP approach of intramedullary nailing and who were admitted to a level 1 trauma center. The minimum patient follow-up period was 12 months and the clinical and functional outcomes were estimated at the 12-month visit. ResultsOf the 80 patients whose medical records were analyzed, 40 (50%) underwent SEIP nailing and the remaining 40 (50%) underwent the traditional HFIP nailing. Compared with the HFIP group, patients in the SEIP group had a higher Lysholm knee score (median, 92 [interquartile range, 88-95] vs median, 88 [interquartile range, 81-92]; p = .01), a shorter intraoperative fluoroscopy time (median, 93 [interquartile range, 78-105] s, vs median, 136 [interquartile range, 110-157] s; p < .001), and operation time (mean, 88.1 [SD, 17.8] min vs mean, 98.7 [SD, 19.3] min; p = .01). The VAS score was significantly lower in the SEIP group (median, 0; interquartile range, 0-0) than in the HFIP group (median, 0; interquartile range, 0-2) (p = .03). There were two cases (5%) in the SEIP group and 10 cases (25%) in the HFIP group of moderate AKP (p = .03). Meanwhile, there was no significant difference in malalignment, nonunion, delayed union, infection, and other complications, as well as SF-36 physical and mental scores.ConclusionWe found that the SEIP approach to tibia intramedullary nailing was superior to the HFIP approach based on the intraoperative and postoperative outcomes. Thus, this novel technique provides an infrapatellar option for semi-extended tibial nailing.

Effect of Distal Interlocking Screw Number and Position After Intramedullary Nailing of Distal Tibial Fractures

2015 ◽  
Vol 29 (2) ◽  
pp. 98-104 ◽  
Author(s):  
Daniel S. Chan ◽  
Aniruddh N. Nayak ◽  
Greg Blaisdell ◽  
Chris R. James ◽  
Antony Denard ◽  
...  
Keyword(s):  
Intramedullary Nailing ◽  
Tibial Fractures ◽  
Distal Tibial Fractures ◽  
Distal Interlocking

COMPARATIVE ANALYSIS OF CLOSED REDUCTION AND EXPERT TIBIA NAILING WITH OPEN REDUCTION AND PLATE & SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES

2018 ◽  
Author(s):  
Anil Pandey ◽  
Setul Shah ◽  
Deepak S Maravi ◽  
S Uikey
Keyword(s):  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Proximal Tibia ◽  
Plate Fixation ◽  
Surgical Site Infections ◽  
Delayed Union ◽  
Large Sample Size ◽  
Multicentric Study ◽  
Group A ◽  
Group B

Introduction:- Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary  nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and methods:- 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results:- Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was < 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion:- in treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended   Key words: intramedullary nailing (IMN), Extraarticular tibialn fracture, Surgical site infection.

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