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.

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.

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.

scholarly journals Functional outcome of minimally invasive plate osteosynthesis with the use of locking plate in fracture distal end of tibia

2020 ◽  
Vol 6 (6) ◽  
pp. 1239
Author(s):  
Prashant Kamble ◽  
Nandan Marathe ◽  
Sudhir Sharan ◽  
Ayush Sharma ◽  
Ashwin Sathe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Open Reduction ◽  
Plate Osteosynthesis ◽  
Distal Tibia ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Locking Plates ◽  
X Rays ◽  
Functional Scores ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

<p class="Body"><strong>Background : </strong>Distal tibia fractures or pilon fractures are usually the result of combined compressive and shearing forces, which may lead to instability of the metaphysis. Poor vascularity, lack of muscle cover and frequent intra-articular extension often make these fractures very challenging to manage. There are plenty of options available to treat a distal tibia fracture which includes intramedullary nailing, external fixation, open reduction and internal fixation and minimally invasive plate osteosynthesis (MIPO). The aim of this study was to evaluate the results of MIPO with respect to the healing of fracture site, the incidences of complications and to conclude whether MIPO circumvents the problems of formal open reduction and fixation with other implants.</p><p class="Body"><strong>Methods: </strong>A series of forty patients with fracture of the distal tibia on preoperative X-rays were treated with minimally invasive plate osteosynthesis using pre-contoured locking plates from June 2014 to October 2018 and followed up at regular intervals with X-rays and monitoring for complications.</p><p class="Body"><strong>Result: </strong>The functional scores were evaluated using Teeny and Wiss clinical rating system for ankle joints. Thirty-two patients had an ‘Excellent’ or ‘Good’ outcome. One patient was diagnosed with a soft tissue complication and delayed union and 3 patients were diagnosed with malunion without significant functional disability at follow up. <strong></strong></p><p class="Body"><strong>Conclusion: </strong>Minimally invasive plate osteosynthesis with pre-contoured locking plates is associated with high union rate and good functional outcomes. It is an effective treatment modality for distal tibia fractures.</p>

scholarly journals Extra-articular distal tibia fibula fracture managed with single posterolateral approach: a case report

2021 ◽  
Vol 7 (3) ◽  
pp. 683
Author(s):  
Neetin P. Mahajan ◽  
Prasanna Kumar G. S. ◽  
Tushar C. Patil ◽  
Kartik P. Pande ◽  
Harish Pawar
Keyword(s):  
Distal Tibia ◽  
Posterolateral Approach ◽  
Anterolateral Approach ◽  
Ankle Motion ◽  
Fibula Fracture ◽  
Left Ankle ◽  
Alternative Approach ◽  
Soft Tissue Problems ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

<p class="abstract">Extra-articular distal tibia fractures involve distal tibia approximately 4 cm within tibia plafond with no articular extension. The proper preoperative care, planning and selection of surgical approach is very essential to prevent postoperative wound-related complications. We present a case of a 29 year female patient, presented with left ankle pain and swelling with a wound over the medial aspect of the ankle. X-ray of the left ankle showed extra-articular distal tibia fibula fracture with no neurovascular deficit. We managed both the fractures with open reduction and internal fixation using a single posterolateral approach. At present 1 year follow-up, the patient is having a good range of ankle motion with radiological union with no implant failure and wound-related complications. Extra-articular distal tibia fibula fracture fixation using single posterolateral approach is a viable alternative approach to medial or anterolateral approach in cases of medial or anterior soft tissue problems. It helps in getting a better functional outcome, early mobilisation with less wound-related complications.</p>

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