Intramedullary nailing of extra-articular distal tibial fractures

2021 ◽  
Vol 103-B (2) ◽  
pp. 294-298
Author(s):  
Michael M. Hadeed ◽  
Hans Prakash ◽  
Seth R. Yarboro ◽  
David B. Weiss
Keyword(s):  
Intramedullary Nail ◽  
Sagittal Alignment ◽  
Weight Bearing ◽  
Biomechanical Model ◽  
Tibial Fractures ◽  
Fracture Model ◽  
Coronal Alignment ◽  
Oblique Fracture ◽  
Distal Locking ◽  
Fracture Patterns

Aims The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. Methods A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals. Results The spiral and oblique fracture patterns withstood simulated weight-bearing with minimal displacement. The multifragmented model had early implant failure with breaking of the distal locking screws. The spiral fracture model shortened by a mean of 0.3 mm (SD 0.2), and developed a mean coronal angulation of 2.0° (SD 1.9°) and a mean sagittal angulation of 1.2° (SD 1.1°). On average, 88% of the shortening, 74% of the change in coronal alignment, and 75% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. The oblique fracture model shortened by a mean of 0.2 mm (SD 0.1) and developed a mean coronal angulation of 2.4° (SD 1.6°) and a mean sagittal angulation of 2.6° (SD 1.4°). On average, 44% of the shortening, 39% of the change in coronal alignment, and 79% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. Conclusion For spiral and oblique fracture patterns, simulated weight-bearing resulted in a clinically acceptable degree of displacement. Most displacement occurred early in the test period, and the rate of displacement decreased over time. Based on this model, we offer evidence that early weight-bearing appears safe for well reduced oblique and spiral fractures, but not in multifragmented patterns that have poor bone contact. Cite this article: Bone Joint J 2021;103-B(2):294–298.

scholarly journals Fixation of Distal Tibial Fractures by Intramedullary Nail with Multidirectional Distal Locking Screws

2019 ◽  
Vol 87 (September) ◽  
pp. 3435-3442
Author(s):  
MOHAMED E. TAHA, M.Sc.; ALI M. EMRAN, M.D. ◽  
KAMAL M. HAHEZ, M.D.; NABIL O. GHARBO, M.D.
Keyword(s):  
Intramedullary Nail ◽  
Tibial Fractures ◽  
Distal Tibial Fractures ◽  
Distal Locking ◽  
Locking Screws

scholarly journals Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

2020 ◽  
pp. 145749692095783
Author(s):  
E. Ekman ◽  
K. Lehtimäki ◽  
J. Syvänen ◽  
M. Saltychev
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Intramedullary Nail ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Weight Bearing ◽  
Tibial Fractures ◽  
Controlled Trials ◽  
Complication Rates ◽  
Distal Tibial Fractures

Background and Aims: To evaluate evidence on the superiority of plate fixation over intramedullary nail fixation in the treatment of distal tibial fractures regarding functional outcomes and complication rates. Material and Methods: Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched in December 2019. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework. Results: The search resulted in 514 records, the final sample included 10 randomized controlled trials (782 patients). There were statistically significant differences in operating time (−11.2, 95% confidence interval: −16.3 to −6.1 min), time to partial weight bearing (−0.96, 95% confidence interval: −1.8 to −0.1 weeks), time to full weight bearing (−2.2, 95% confidence interval: −4.32 to −0.01 weeks), the rates of deep infections (risk ratio = 0.37, 95% confidence interval: 0.19 to 0.69), and the rates of soft-tissue complications (risk ratio = 0.52, 95% confidence interval: 0.33 to 0.82) favoring intramedullary nail. Intraoperative blood loss (127.2, 95% confidence interval: 34.7 to 219.7 mL) and postoperative knee pain and stiffness (relative risk = 5.6, 95% confidence interval: 1.4–22.6) showed significant differences favoring plate fixation. When combining all complication rates, the difference was risk ratio = 0.77 (95% confidence interval: 0.63 to 0.95) favoring intramedullary nail. No significant differences in radiation time, length of incision, length of hospital stay, time to return to work, time to union, the rates of healing complications or secondary procedures, ankle pain or stiffness, or functional scores were found. Conclusion: This meta-analysis suggests that intramedullary nail might be slightly superior in reducing postoperative complications and result in slightly faster healing when compared to plate fixation.

scholarly journals Intramedullary Nailing Combined With Adjunct Plate or Blocking Screw for Proximal Tibial Fractures

2020 ◽  
Author(s):  
Jie Li ◽  
Qian Wang ◽  
Yao Lu ◽  
Zhong Li ◽  
Kun Zhang
Keyword(s):  
Intramedullary Nail ◽  
Weight Bearing ◽  
Operation Time ◽  
Tibial Fractures ◽  
Plate Versus ◽  
Full Weight Bearing ◽  
Plate Group ◽  
Proximal Tibial Fractures ◽  
Screw Group

Abstract Objective: To compare the traditional approach of intramedullary nail with an extra plate versus the nail combined with blocking screws for proximal tibia fractures without the knee involved.Methods: From January 2013 to January 2017, a total of 36 patients who suffered from proximal tibial fractures unaffecting the knee were enrolled into this prospective study, and divided into two groups by random number table method. Of them, 19 patients received an interlocking intramedullary nail combined with an extra plate for internal fixation of the fractures (the plate group), while the remaining 17 patients had fractures fixed with the nail combined with blocking screws (the screw group). The perioperative, follow-up and radiographic data were compared between the two groups.Results: All the 36 patients underwent operation smoothly without iatrogenic neurovascular injuries. The plate group proved superior the screw group regarding to operation time and intraoperative X-ray exposure (P＜0.05) , nevertheless the former was inferior to the latter in implant cost and hospital stay (P＜0.05) . The follow-up period lasted for 12～24 months with a mean of (15.62±4.71) months. There were no statistically significant differences in the time to return ambulation and the time to full weight-bearing activity between the two groups (P＞0.05) . At the latest follow up, no statistically significant differences were found between the two groups regarding knee range of motion and Johner-Wruhs grades for clinical consequences (P＞0.05) . In terms of anterior knee pain, the difference between the two groups was not statistically significant (P＞0.05) . In respect of radiographic assessment, the plate group had significantly less residual malalignment than the screw group, including anteroposterior and lateral displacements, as well as angulations in coronal and sagittal planes (P＜0.05) . To the latest follow up, all patients in both group got bony healing of the fractures without a statistical difference in fracture healing time between them (P＞0.05) , and no loosening or breaking of the implants were showed on images in anyone of them.Conclusion: Both the nail plus plate and nail plus blocking screw do achieve satisfactory clinical outcomes for proximal tibial fractures unaffecting the knee. By comparison, the nail combined with plate facilitates to regain and maintain better alignment of the leg regardless of higher implant cost.

scholarly journals Intramedullary Nailing Combined With Adjunct Plate or Blocking Screw for Proximal Tibial Fractures

2021 ◽  
Author(s):  
Jie li ◽  
Qian Wang ◽  
Zhong Li ◽  
Kun Zhang
Keyword(s):  
Intramedullary Nail ◽  
Weight Bearing ◽  
Operation Time ◽  
Tibial Fractures ◽  
Plate Versus ◽  
Full Weight Bearing ◽  
Plate Group ◽  
Proximal Tibial Fractures ◽  
Screw Group

Abstract Objective: To compare the traditional approach of intramedullary nail with an extra plate versus the nail combined with blocking screws for proximal tibia fractures without the knee involved. Methods: From January 2013 to January 2017, a total of 36 patients who suffered from proximal tibial fractures unaffecting the knee were enrolled into this prospective study, and divided into two groups by random number table method. Of them, 19 patients received an interlocking intramedullary nail combined with an extra plate for internal fixation of the fractures (the plate group), while the remaining 17 patients had fractures fixed with the nail combined with blocking screws (the screw group). The perioperative, follow-up and radiographic data were compared between the two groups. Results: All the 36 patients underwent operation smoothly without iatrogenic neurovascular injuries. The plate group proved superior the screw group regarding to operation time and intraoperative X-ray exposure (P＜0.05) , nevertheless the former was inferior to the latter in implant cost and hospital stay (P＜0.05) . The follow-up period lasted for 12～24 months with a mean of (15.62±4.71) months. There were no statistically significant differences in the time to return ambulation and the time to full weight-bearing activity between the two groups (P＞0.05) . At the latest follow up, no statistically significant differences were found between the two groups regarding knee range of motion and Johner-Wruhs grades for clinical consequences (P＞0.05) . In terms of anterior knee pain, the difference between the two groups was not statistically significant (P＞0.05) . In respect of radiographic assessment, the plate group had significantly less residual malalignment than the screw group, including anteroposterior and lateral displacements, as well as angulations in coronal and sagittal planes (P＜0.05) . To the latest follow up, all patients in both group got bony healing of the fractures without a statistical difference in fracture healing time between them (P＞0.05) , and no loosening or breaking of the implants were showed on images in anyone of them. Conclusion: Both the nail plus plate and nail plus blocking screw do achieve satisfactory clinical outcomes for proximal tibial fractures unaffecting the knee. By comparison, the nail combined with plate facilitates to regain and maintain better alignment of the leg regardless of higher implant cost.

scholarly journals Supracondylar rotation osteotomy of the femur influences the coronal alignment of the ankle

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Christian Konrads ◽  
Marc-Daniel Ahrend ◽  
Myriam R. Beyer ◽  
Ulrich Stöckle ◽  
Sufian S. Ahmad
Keyword(s):  
Subtalar Joint ◽  
Distal Femur ◽  
External Rotation ◽  
Weight Bearing ◽  
Orientation Angle ◽  
Osteotomy Site ◽  
Limb Alignment ◽  
Coronal Alignment ◽  
Rotational Osteotomy ◽  
Rotation Osteotomy

Abstract Purpose Osteotomies represent well-established treatment-options for the redistribution of loads and forces within and around the knee-joint. Effects of these osteotomies on the remaining planes and adjacent joints are not fully understood. The aim of this study was to determine the influence of a distal-femoral-rotation-osteotomy on the coronal alignment of the ankle. It was hypothesized that supracondylar-external-rotation-osteotomy of the distal femur leads to a change in the coronal orientation of the ankle joint. Methods Long-leg standing radiographs and CT-based torsional measurements of 27 patients undergoing supracondylar-rotational-osteotomy of the femur between 2012 and 2019 were obtained and utilized for the purpose of this study. Postoperative radiographs were obtained after union at the osteotomy-site. The hip-knee-ankle-angle (HKA), the mechanical-lateral-distal-femur-angle (mLDFA), and Tibia-Plafond-Horizontal-Orientation-Angle (TPHA) around the ankle were measured. Comparison between means was performed using the Wilcoxon-Mann–Whitney test. Results Twenty-seven patients with high femoral antetorsion (31.3° ± 4.0°) underwent supracondylar-external-rotation-osteotomy. The osteotomy led to a reduced antetorsion (17.4 ± 5.1; p < 0.001) and to a valgisation of the overall limb-alignment. The HKA decreased by 2.4° ± 1.4° (p < 0.001). The TPHA decreased by 2.6° (p < 0.001). Conclusions Supracondylar external rotation osteotomy of the femur leads to lateralization of the weight bearing line at the knee and ankle due to valgisation of the coronal limb alignment. The mobile subtalar joint has to compensate (inversion) for the resulting valgus orientation of the ankle to ensure contact between the foot and the floor. When planning a rotational osteotomy of the lower limb, this should be appreciated – especially in patients with a preexisting valgus alignment of the lower extremities or restricted mobility in the subtalar joint.

scholarly journals Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ramy Khojaly ◽  
Ruairí Mac Niocaill ◽  
Muhammad Shahab ◽  
Matthew Nagle ◽  
Colm Taylor ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Multicentre Trial ◽  
Short Form ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Fracture Patterns ◽  
Randomised Controlled

Abstract Background Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures. Trial registration ISRCTN Registry ISRCTN76410775. Retrospectively registered on 30 June 2019.

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 Treatment of Pathological Fractures of the Humerus with a Locked Intramedullary Nail

2003 ◽  
Vol 11 (1) ◽  
pp. 34-37 ◽  
Author(s):  
AJ Bauze ◽  
MT Clayer
Keyword(s):  
Adjuvant Therapy ◽  
Intramedullary Nail ◽  
Cement Augmentation ◽  
Retrograde Nailing ◽  
Common Site ◽  
Pathological Fractures ◽  
Distal Locking ◽  
Local Progression ◽  
Increased Risk ◽  
Progression Of Disease

Purpose. The humerus is a common site for metastasis. Intramedullary nail fixation has been reported to be the best form of fixation for this disease but complications occur. This study aimed to assess the use of a new humeral nail to treat pathological fractures and impending pathological fractures of the humerus. Methods. 29 patients received 31 Austofix locked intramedullary humeral nails: 25 for pathological fractures and 6 for impending fractures; 24 nails were inserted anterograde and 7 retrograde. Cement augmentation was applied in 4 patients, and adjuvant therapy was used in 28 patients. Complications occurred in 12 patients. Results. Fixation failed in 6 patients: 2 due to intra-operative fractures during retrograde nailing, one due to a fracture through screw holes postoperatively, and 3 due to local progression of disease. Difficulty in distal locking of the nail was encountered in 4 patients. Locked intramedullary nailing resulted in a stable humerus in 80% of patients. Conclusion. Retrograde insertion of the nail is associated with an increased risk of intra-operative fracture, and disease progression can occur, despite the administration of adjuvant therapy.

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