Would your intraoperative results differ if you were a four-handed orthopedist in intramedullary nail surgery for tibial fractures?

Abstract

The present study aimed to present the intraoperative results of a fixation device that assists in fracture reduction during closed intramedullary nail application in tibial shaft fractures and provides a temporary stable fixation until the last stage of surgery. The fixation device used in our study consists of two custom-made bone clamps and a joint system that connects the clamps. Patients diagnosed with closed tibial shaft fracture between 01.01.2020 and 20.12.2021 were included in our retrospective study. Twenty-one patients who underwent closed intramedullary nailing and used a fixation device in the intraoperative period (Group 1) and 21 patients who underwent closed intramedullary nailing without a fixation device (Group 2) were included in the study. Both groups were compared in terms of duration of the operation, amount of bleeding, wound infection, intraoperative fluoroscopy time, preoperative period, follow-up time, varus and valgus deformity, limb shortness, malrotation, nonunion, and deep vein thrombosis. In Group 1, the mean duration of operation was 72.62±8.78minutes; the mean amount of bleeding was 31.10±6.13ml, and the mean intraoperative fluoroscopy time was 76.81±11.83 s. In Group 2, the mean duration of operation was 87±13.12 minutes; the mean amount of bleeding was 29.81±6.01ml and the mean intraoperative fluoroscopy time was 100.71±11.50 s. Intraoperative fluoroscopy time, varus deformity, and malrotation were significantly different between the groups (p=0.001, p=0.030, p=0.001, respectively). In the study, it was observed that the intraoperative fixation device decreased intraoperative fluoroscopy time, varus, and rotational deformity. It was considered that the fixation device would reduce the radiation exposure of the health personnel in the intraoperative period and reduce the malunion rate due to varus and rotational deformity.