scholarly journals Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures

2021 ◽  
Vol 64 (4) ◽  
pp. E371-E376
Author(s):  
Marc Swiontkowski ◽  
David Teague ◽  
Sheila Sprague ◽  
Sofia Bzovsky ◽  
Diane Heels-Ansdell ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Intramedullary Nailing ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Intramedullary Nails ◽  
Shaft Fractures ◽  
Fracture Management ◽  
Low Volume ◽  
Tibial Shaft Fractures

Background: Tibial shaft fractures are the most common long-bone injury, with a reported annual incidence of more than 75 000 in the United States. This study aimed to determine whether patients with tibial fractures managed with intramedullary nails experience a lower rate of reoperation if treated at higher-volume hospitals, or by higher-volume or more experienced surgeons. Methods: The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) was a multicentre randomized clinical trial comparing reamed and nonreamed intramedullary nailing on rates of reoperation to promote fracture union, treat infection or preserve the limb in patients with open and closed fractures of the tibial shaft. Using data from SPRINT, we quantified centre and surgeon volumes into quintiles. We performed analyses adjusted for type of fracture (open v. closed), type of injury (isolated v. multitrauma), gender and age for the primary outcome of reoperation using multivariable logistic regression. Results: There were no significant differences in the odds of reoperation between high- and low-volume centres (p = 0.9). Overall, surgeon volume significantly affected the odds of reoperation (p = 0.03). The odds of reoperation among patients treated by moderate-volume surgeons were 50% less than those among patients treated by verylow-volume surgeons (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28–0.88), and the odds of reoperation among patients treated by high-volume surgeons were 47% less than those among patients treated by very-low-volume surgeons (OR 0.53, 95% CI 0.30–0.93). Conclusion: There appears to be no significant additional patient benefit in treatment by a higher-volume centre for intramedullary fixation of tibial shaft fractures. Additional research on the effects of surgical and clinical site volume in tibial shaft fracture management is needed to confirm this finding. The odds of reoperation were higher in patients treated by very-low-volume surgeons; this finding may be used to optimize the results of tibial shaft fracture management. Clinical trial registration: ClinicalTrials.gov, NCT00038129

scholarly journals Radiographic cortical thickness parameters as predictors of rotational alignment in proximal tibial shaft fractures: a cadaveric study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander M. Keppler ◽  
Konstantin Küßner ◽  
Anna-Lena Schulze ◽  
Eduardo M. Suero ◽  
Carl Neuerburg ◽  
...  
Keyword(s):  
Cortical Thickness ◽  
Shaft Fracture ◽  
Diagnostic Tools ◽  
Transverse Diameter ◽  
Suitable Model ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Torsional Malalignment ◽  
Tibial Shaft Fractures

Abstract Aim The treatment of tibial fractures with an intramedullary nail is an established procedure. However, torsional control remains challenging using intraoperatively diagnostic tools. Radiographic tools such as the Cortical Step Sign (CSS) and the Diameter Difference Sign (DDS) may serve as tools for diagnosing a relevant malrotation. The aim of this study was to investigate the effect of torsional malalignment on CSS and DDS parameters and to construct a prognostic model to detect malalignment. Methods A proximal tibial shaft fracture was set in human tibiae. Torsion was set stepwise from 0° to 30° in external and internal torsion. Images were obtained with a C-arm and transferred to a PC for measuring the medical cortical thickness (MCT), lateral cortical thickness (LCT), tibial diameter (TD) in AP and the anterior cortical thickness (ACT) as well as the posterior cortical thickness (PCT) and the transverse diameter (TD) of the proximal and the distal main fragment. Results There were significant differences between the various degrees of torsion for each of the absolute values of the examined variables. The parameters with the highest correlation were TD, LCT and ACT. A model combining ACT, LCT, PCT and TD lateral was most suitable model in identifying torsional malalignment. The best prediction of clinically relevant torsional malalignment, namely 15°, was obtained with the TD and the ACT. Conclusion This study shows that the CSS and DDS are useful tools for the intraoperative detection of torsional malalignment in proximal tibial shaft fractures and should be used to prevent maltorsion.

scholarly journals Outcome of Elastic Stable Intramedullary Nailing (ESIN) for tibia fractures in children.

2021 ◽  
Vol 28 (01) ◽  
pp. 16-21
Author(s):  
Kashif Khurshid Qureshi ◽  
Imran Anjum ◽  
Rao Tayyab Mehmood ◽  
Iram Habib ◽  
Ahmed Jasra ◽  
...  
Keyword(s):  
Case Series ◽  
Sampling Technique ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Fractures In Children ◽  
Case Series Study ◽  
Medullary Nailing ◽  
Tibial Shaft Fractures

Objectives: To determine outcome in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing. Study Design: Descriptive, Case Series study. Setting: Department of Orthopedic, Bahawal Victoria Hospital, Bahawalpur, HBS Medical & Dental College, Islamabad and HITEC-IMS Taxila Cantt, Pakistan. Period: 2012 to 2019. Material & Methods: A total of 62 cases of displaced tibial shaft fracture presenting within 7 days of the injury, 6 to 11 years of age of either gender were included. Patients with segmental tibial shaft fractures and open tibial shaft fractures, Gustilo Grade II & III were excluded. The titanium elastic nails system (TENS) was used in all patients according to the departmental protocols. The sampling technique was consecutive with non-probability. All the patients were followed up in OPD at 2 weeks interval up to 24 weeks after surgery and union of fracture was recorded at 24th week. Results: Mean age was8.55 ± 1.77 years. Out of these 62 patients, 45 (72.58%) were male and 17 (27.42%) were females with ratio of 2.65:1. Mean duration of fracture was 3.10 ± 1.95 days. Mean duration of union in displaced tibial shaft fracture in children treated with elastic stable intra-medullary nailing was 19.40 ± 3.35 weeks. Conclusion: This study concluded that use of elastic stable intra-medullary nailing for displaced tibial shaft fracture in children leads to shorter duration of union reliably with minimal complications.

scholarly journals Single center experience in treatment of tibial shaft fractures using Ilizarov technique

2020 ◽  
Vol 148 (3-4) ◽  
pp. 167-172
Author(s):  
Danilo Jeremic ◽  
Filip Vitosevic ◽  
Boris Gluscevic ◽  
Nemanja Slavkovic ◽  
Milan Apostolovic ◽  
...  
Keyword(s):  
Linear Regression Analysis ◽  
Shaft Fracture ◽  
Pain Reduction ◽  
Tibial Shaft Fracture ◽  
Ilizarov Technique ◽  
Tibial Shaft ◽  
Single Center Experience ◽  
Shaft Fractures ◽  
Common Location ◽  
Tibial Shaft Fractures

Introduction/Objective. Since tibial shaft is a common location of opened and closed tibial fractures, it is very important to determine the best method of treating these fractures. Our objective was to assess whether the Ilizarov technique is appropriate in terms of complications, outcomes, and pain reduction in treatment of patients with tibial shaft fracture. Methods. Retrospective analysis included all consecutive patients with tibial shaft fracture treated with the Ilizarov technique in the period from January 2013 to June 2017 at the Banjica Institute for Orthopaedic Surgery, Belgrade, Serbia. Demographic and clinical data on patients were collected. Pain was assessed using visual analogue scale of pain. Two models of uni- and multi-variate linear regression analysis were performed. Results. The study showed that the overall rate of complications was low, and that hypertension, administration of antibiotics, and reoperation prolonged fixation. Also, severe fractures and longer procedure time delay mobilization. Significant reduction of pain was observed. Conclusion. The Ilizarov technique is a safe and reliable method in the treatment of patients with tibial shaft fractures and is followed by pain reduction, overall improvement of functioning, good outcomes, and is not commonly associated with complications.

scholarly journals Evaluation of Results of Management of type IIIB Open Tibial Shaft Fractures Using Local Fasciocutaneous Flaps in Adults

1970 ◽  
Vol 22 (1) ◽  
pp. 119-122
Author(s):  
MR Haque ◽  
MQ Parvez ◽  
F Hamid
Keyword(s):  
Shaft Fracture ◽  
Healing Time ◽  
Fasciocutaneous Flap ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Fasciocutaneous Flaps ◽  
Type Iii ◽  
Shaft Fractures ◽  
Orthopedic Rehabilitation ◽  
Tibial Shaft Fractures

Use of local fasciocutaneous flap is gaining popularity as an effective method of treating type III B open tibial shaft fracture in adults. We treated 16 fractures at National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka during the period between March 1993 and December 1994 to evaluate the result of management of type III B open tibial shaft fracture using local fasciocutaneous flaps in adults. Of the 16 tibial fractures the mean healing time was 6.13 months (3.5 to 11 months). The major post operative complications were deep infections (43.75%), non-union (31.25%) and malunion (12.5%). The results were excellent in 18.75%, good in 37.5%, fair in 18.75% and poor in 25% cases. Salvage of the limb should be the primary aim of management of type III B open tibial shaft fracture. We conclude that use of local fasciocutaneous flap is an easy and effective method of management of open type III B tibial shaft fractures. DOI: 10.3329/taj.v22i1.5033 TAJ 2009; 22(1): 119-122

scholarly journals Medial Malleolus Fracture Fixation in the Setting of Concomitant Tibial Shaft Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Stephen Barchick ◽  
Samuel Adams ◽  
Andrew Matson
Keyword(s):  
Shaft Fracture ◽  
Medial Malleolus ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Tibial Nail ◽  
Fixation Techniques ◽  
Medial Malleolus Fracture ◽  
Buttress Plate ◽  
Tibial Shaft Fractures

Category: Ankle, Trauma Introduction/Purpose: The association between tibial shaft fractures and concomitant posterior malleolus fractures has been well-studied; however less is known about tibial shaft fractures and concomitant medial malleolus fractures. Treatment of tibial shaft fractures with a plate or intramedullary nail in the setting of concomitant medial malleolus fracture may pose obstacles to standard medial malleolus fractures fixation due to hardware that impedes optimal screw placement. The purpose of this study is to report the presentation and management strategies used to treat medial malleolus fractures in the setting of concomitant tibial shaft fractures. Methods: From 2011 to 2015, seven (1.4%) patients were identified with concomitant tibial shaft fractures and isolated medial malleolus fractures. Data was collected through review of patient charts, radiographs, and operative reports including the following variables: demographics, injury patterns, fixation techniques, and outcomes. Five male patients and two female patients with a mean age of 39.1 years (range, 13.9-67.9 years) were included. Three patients reported tobacco use. Mechanisms of injury included motor vehicle accident (n=4), fall from standing (n=2), and pedestrian versus vehicle (n=1). Average medial malleolus fracture fragment length was 19.1 mm (range, 14.3-29.4 mm). Tibial shaft fractures were open in four cases, and included five transverse patterns, one spiral pattern, and one segmental fracture. All patients were treated surgically for tibial shaft and medial malleolus fractures simultaneously. All medial malleolus reductions were anatomic. The average time to union for medial malleolus fractures was 3.12 months (range 1.53 to 5.93 months). Results: Fixation techniques included screw (n=5) or buttress plate (n=2) fixation for the medial malleolus, and intramedullary nailing (6) or blade plate fixation (n=1, prior TKA) for the tibial shaft. Of the five medial malleolus fractures treated with screw fixation, screws were positioned anteriorly (n=2) or medially (n=2) to tibial shaft fixation implant in four cases; in one case the distal extent of the tibial nail was proximal to the medial malleolar screws. One buttress plate was placed with screws distal to the tibial nail, another was placed angling one proximal screw anterior and one posterior to the tibial nail. Two patients reported complications following surgery: one with chronic pain and one with wound dehiscence and delayed union at the open tibial shaft fracture site. Conclusion: Seven patients were treated operatively for concomitant tibial shaft and medial malleolus fractures, requiring careful attention to placement of medial malleolar screws or buttress plate due to the presence of implant used to treat the tibial shaft fracture. Medial malleolar screws can safely be redirected anteriorly or medially to accommodate the tibial shaft fracture implant, with acceptable fracture union outcomes in this small case series. Further biomechanical and long-term data may help to validate these adjustments to standard techniques.

scholarly journals Poor Retention after Closed Reduction and Cast Immobilization of Low-Energy Tibial Shaft Spiral Fractures

2002 ◽  
Vol 91 (2) ◽  
pp. 191-194
Author(s):  
T. Borg ◽  
T. Melander ◽  
S. Larsson
Keyword(s):  
Closed Reduction ◽  
Shaft Fracture ◽  
Low Energy ◽  
Operative Intervention ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Cast Immobilization ◽  
Shaft Fractures ◽  
Fibular Fracture ◽  
Tibial Shaft Fractures

Background and Aims: The aim of this retrospective study was to analyze retention in cast after closed reduction of low-energy two-fragment tibial shaft fractures. Material and Methods: The material consisted of 72 closed tibial shaft fractures AO/ASIF type A treated with closed reduction and plaster cast. Fractures were subgrouped according to the AO/ASIF classification and the initial fracture displacement was measured. Final alignment and the frequency of operative intervention due to early loss of reduction were analyzed. Results: 40 % of all fractures lost reduction and were operated on. The largest subgroup was A1.2 fractures, a spiral tibial shaft fracture with a fibular fracture at another level. Out of the 28 fractures in this group 61 % were converted from cast to early operative intervention. Conclusion: Closed reduction and cast treatment of spiral tibial shaft fractures AO/ASIF type A1.2 had a high failure rate.

scholarly journals Reamer Breakage during Intramedullary Nailing in Tibial Shaft Fractures: A Case Report and Review of Literature

2021 ◽  
Author(s):  
Mahlisha Kazemi ◽  
Mohammadhasan Sharafi ◽  
Ramin Shayan-Moghadam
Keyword(s):  
Case Report ◽  
Surgical Technique ◽  
Intramedullary Nailing ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Review Of Literature ◽  
Quick Method ◽  
Standard Equipment ◽  
Tibial Shaft Fractures

Background: Interlocked intramedullary nailing is the most common treatment for closed tibial fractures. Reaming is a fundamental step in this surgical technique, and reamer breakage is a rare yet challenging complication during this operation. Case Report: A 34-year old male with a tibial shaft fracture was admitted for early closed tibial nailing. During the reaming process, the reamer broke and stuck in the medulla at the isthmus level. We extracted the broken piece by back hammering a cannulated T-handle placed on the ball tip guide pin. Conclusion: In this closed and quick method, we did not use any extra device other than standard equipment of intramedullary nailing.

Sign in / Sign up

Export Citation Format

Share Document