Distal Tibial Shaft Fractures Research Articles

Internally rotated oblique x-ray to assess healing of distal tibial shaft fractures

Internally rotated oblique x-ray to assess healing of distal tibial shaft fractures

Nails and Plates for Distal Tibial Shaft Fractures Give Equivalent But Surprisingly Poor Functional Outcomes

Nails and Plates for Distal Tibial Shaft Fractures Give Equivalent But Surprisingly Poor Functional Outcomes

Factors Influencing Functional Outcomes After Distal Tibia Shaft Fractures

Surgical treatment of displaced distal tibia fractures yields reliable results with either plate or nail fixation. Comparative studies suggest more malalignment and nonunions with nails. Some studies have reported knee pain after tibial nailing. However, plates may be associated with soft tissue complications, such as infections or wound-healing problems. The purpose of this study was to assess functional outcomes after distal tibia shaft fractures treated with a plate or a nail. We hypothesized that tibial nails would be associated with more knee pain and that plates would be associated with pain from implant prominence, each of which would adversely affect functional outcome scores. Randomized prospective study. Level 1 trauma center. One hundred four patients with extra-articular distal tibia shaft fractures (OTA 42), mean age of 38 years (range, 18-95), and mean Injury Severity Score of 14.3 (range, 9-50). Patients were randomized to treatment with a reamed intramedullary nail (n = 56) or standard large fragment medial plate (n = 48). Ability to work was evaluated after a minimum of 12 months, with mean of 22 months. Foot Function Index (FFI) and Musculoskeletal Function Assessment (MFA) questionnaires were completed. Mean MFA was 27.5, and mean total FFI was 0.26; P < 0.0001 versus an uninjured reference population. Sixty-one of 64 patients (95%) employed at the time of injury had returned to work, although 31% had modified their work duties because of injury. Three patients were unable to find work. None reported unemployment secondary to their tibial fracture. Forty percent of all patients described some persistent ankle pain, and 31% had knee pain after nailing, versus 32% and 22%, respectively after plating. Both knee and ankle pain were present in 27% with nails and 15% with plates (P = 0.08), and rates of implant removal were similar after nails versus plates. Patients with malunion ≥5 degrees were more likely to report knee or ankle pain (36% vs 20%, P < 0.05). Except 1 patient with knee pain when kneeling, none reported modifying activity because of persistent knee or ankle pain, although knee and ankle pain were more frequent in the unemployed (P = 0.03). Unemployed patients requested implant removal more frequently (24% vs 9.2%, P = 0.07) and continued to report pain afterward. Although FFI and MFA scores were not related to plate or nail fixation, open fracture, fracture pattern, multiple injuries, Injury Severity Score, or age, both MFA and FFI scores were worse when knee pain or ankle pain was present (all Ps < 0.004) and in patients who remained unemployed (P < 0.0001). All 4 patients with work-related injuries had returned to employment but had worse FFI scores (P = 0.01). Mean MFA and FFI scores suggest substantial residual dysfunction after distal tibia fractures when compared with an uninjured population. Mild ankle or knee pain was reported frequently after plate or nail fixation but was not limiting to activity in most. Angular malunion was associated with both knee and ankle pain, and there was a trend toward more patients with knee and ankle pain after tibial nailing. No patients reported unemployment because of their tibia fracture, but unemployed people described knee and ankle pain more frequently and had the worst functional outcome scores.

The clinical results of intramedullary nails for distal tibial shaft fracture; comparison of single direction and multi direction insertion of distal interlocking screw

The clinical results of intramedullary nails for distal tibial shaft fracture; comparison of single direction and multi direction insertion of distal interlocking screw

Randomized, Prospective Comparison of Plate versus Intramedullary Nail Fixation for Distal Tibia Shaft Fractures

Malalignment has been frequently reported after intramedullary stabilization of distal tibia fractures. Nails have also been associated with knee pain in several studies. Historically, plate fixation has resulted in increased risks of infection and nonunion. Our purposes were to compare plate and nail stabilization for distal tibia shaft fractures by assessing complications and secondary procedures. We hypothesized that nails would be associated with more malalignment and nonunion. Randomized, prospective study. Level I trauma center. One hundred four skeletally mature patients with extra-articular distal tibia shaft fractures with a mean age of 38 years (range, 18-95 years) and mean Injury Severity Score of 13.5 (range, 9-50). The majority had high-energy injuries. Patients were randomized to a reamed intramedullary nail (n = 56) or a large fragment medial plate (n = 48). Forty fractures (39%) were open. Twenty-eight (27%) had concomitant fibula fractures that were stabilized. Malunion, nonunion, infection, and secondary operations. The two treatment groups were evenly matched with respect to age, gender, Injury Severity Score, fracture pattern, and presence of open fracture. Six patients (5.8%) developed deep infection with equal numbers in the two groups. Eighty-three percent of infections occurred after open fracture (P < 0.001). Four patients (7.1%) developed nonunion after nailing versus two (4.2%) after plating (P = 0.25) with a trend for nonunion in patients who had distal fibula fixation (12% versus 4.1%, P = 0.09). All nonunions occurred after open fracture (P = 0.0007); the primary union rate for closed fractures was 100%. Primary angular malalignment of 5° or greater occurred in 13 patients with nails (23% of all nails) and four with plates (8.3% of all plates; P = 0.02 for plates versus nails). Six additional patients experienced malalignment after immediate weightbearing against medical advice. Valgus was the most common deformity (n = 16). Malunion was more common after open fracture (55%, P = 0.04). Eighty-five percent of patients with malalignment after nailing did not have fibula fixation. Eleven patients underwent 15 secondary procedures after plating, five of which were for prominent implant removal. This was not significantly different from patients treated with nailing: 10 patients had 14 procedures and five for prominent implant removal. High primary union rates were noted after surgical treatment of distal tibia shaft fractures with both nonlocked plates and reamed intramedullary nails. Rates of infection, nonunion, and secondary procedures were similar. Open fractures had higher rates of infection, nonunion, and malunion. Intramedullary nailing was associated with more malalignment versus plating. Fibula fixation may facilitate reduction of the tibia at the time of surgery. The effect of fibula fixation on tibia healing deserves further study. Economic assessment and functional outcomes data for this population will help to enhance our treatment decision-making.

Results of a Computed Tomography Protocol Evaluating Distal Third Tibial Shaft Fractures to Assess Noncontiguous Malleolar Fractures

Intra-articular tibia fractures are reported to occur in 1% to 25% of tibia diaphyseal fractures. The objective of this study was to create a standard protocol to evaluate noncontiguous malleolar fractures associated with distal third tibial diaphyseal fractures using computed tomography (CT). Sixty-six patients with 67 distal third tibia fractures were treated at a level one trauma center from December 2005 to November 2007. These patients were then evaluated using a CT protocol to assess the ankle joint. There were 45 men and 21 women with average age of 44 years (range 18-69 years). All films were independently examined by two orthopedic traumatologists and one musculoskeletal radiologist. Twenty-nine of 67 (43%) distal third tibial shaft fractures had associated intra-articular fractures determined by CT scan. There were 23 posterior malleolus fractures, 3 anterolateral fragments, and 3 medial malleolus fractures. Twenty-seven of 29 fractures (93%) were associated with spiral type fracture patterns (p = 0.001). Seventeen of 29 (59%) intra-articular fractures required operative fixation. Seventy-six percent were noncontiguous fractures. The radiologist detected 20 of 29 (69%) intra-articular fractures using high-resolution monitors, and the orthopedic surgeons averaged 13 of 29 (45%) using initial injury radiographs in the emergency department. Plain radiographs are often insufficient for detecting posterior malleolus fractures in conjunction with ipsilateral distal third diaphyseal tibia fractures. Using a preoperative CT protocol for tibial shaft fractures can significantly improve the ability to diagnose associated intra-articular fractures that may not be evident on plain radiographs. Knowledge of these associated intra-articular fractures may prompt fracture stabilization and can prevent displacement during intramedullary nailing of tibia shaft fractures.

The “communication line” suggests occult posterior malleolar fracture associated with a spiral tibial shaft fracture

To demonstrate radiographical characteristics of the relationship between distal spiral tibial shaft fractures and associated occult posterior malleolar fractures (PMF) that confirmed by CT and MRI. X-rays for a ninety-six patients with spiral tibia fracture and associated PMF were reviewed. All patients additionally had an ankle CT. Patients with a negative CT scans underwent an ankle MRI. Radiographic observations included fracture location, characteristics, and a presence of a fracture line between the two injuries. The spiral tibia fracture line was contiguous with PMF in 89 of 96 cases after evaluation with the CT and MRI. The line connecting the two injuries, which occurs between the medial inferior apex of the spiral tibia fracture line and the posterior superior apex of the PMF was identified as the "communication line". In 47 of the 89 conjunction fractures, the "communication line" was detectable preoperatively and in 12 cases postoperatively by anteroposterior radiograph. By using the CT and MRI scans, we found that no "communication line" was present in only 7 cases. It is important to understand the nature of the association between distal spiral tibial shaft fractures and occult posterior malleolar fractures for optimal stabilization of the fracture and for appropriate rehabilitation. The "communication line" is a useful diagnostic clue for early recognition the occult PMF and alerts a closer evaluation of the lateral view and further CT examination.

Primary clinical application of traction reductor for lower limb fracture

To develop a traction reductor for the reduction of lower limb fractures during the minimally invasive surgery and explore its safety and efficacy. From February 2007 to March 2009, closed or limited open reduction plus percutaneous plate and screw internal-fixation were conducted in 34 patients with fracture of distal femur and tibia metaphysic, among which there were 3 distal femoral fractures (2 33-B, 1 33-C), 14 proximal tibial fractures (9 41-A, 3 41-B, 2 41-C) and 17 distal tibial fractures (9 43-A, 5 43-B, 3 43-C, 2 Gustilo I a), according to the Association for Osteosynthesis-Orthopaedic Trauma Association (AO-OTA) classification. Besides, closed reduction plus interlocking intramedullary nailing on tibial shaft fracture were applied in 36 patients (7 42-A, 21 42-B, 8 42-C, 2 Gustilo I a). All the 70 patients, with an average age of 37.6 years (range: 17 to 63 years) and average time before surgery of 4.7 d (range: 0.7 to 12.0 d), underwent reduction by self-designed traction reductor for lower limb fracture in the surgery. The reduction duration and C-arm fluoroscopy time were recorded. Recovery of the force line of affected limbs after surgery was determined by whether the line from anterior superior iliac spine to the interdigit between the first and second toe-web passed the patella center. And the distance from bilateral anterior superior iliac spine to medial malleolus tip as well as the difference between lower limbs were recorded to determine the recovery of length after surgery. Meanwhile, the varus-valgus and anteroposterior angulations after reduction were measured by AP and lateral X-ray. The reduction duration was 12.7 min (range: 7 to 31 min); X-ray fluoroscopy time, 1.3 min (range: 0.4 to 3.0 min); length difference between both lower limbs (6.5 ± 1.1) mm; and axial alignment difference (7.0 ± 1.8) mm. The X-ray result showed that varus-valgus angle was (2.75 ± 0.16)°; and anteroposterior angulation (5.13 ± 0.51)°. The traction reductor for lower limb fracture could achieve satisfying fracture reduction in the minimally invasive surgery of distal femur, tibia metaphysic and tibial shaft fracture.

Die synchrone OSG- und Unterschenkelfraktur

The combination of a distal tibia fracture with an additional upper ankle joint injury is a challenge. Apart from various implants the intraoperative problem is the handling of these two injuries with appropriate reduction and retention. The existing and further developing soft tissue damage has to be taken into consideration. The aim of this study is to evaluate the surgical management of this type of fracture. Between 2000 and 2007 we treated 22 patients with tibia fractures and coexisting upper ankle fractures. All patients could be traced for follow-up examinations. We deduced the impact energy of the trauma and the soft tissue damage. The tibial and ankle fracture sites were categorised. The time elapsed until full weight bearing was measured. The ankle joint function was inspected. A high energy trauma existed in 10 and a low energy trauma in 12 patients. In the high energy group we found in 5 cases A3, in 2 cases B1 and 1 B2 and 1 B3 and 1 C2 fracture of the tibia. In 5 cases a bimalleolar ankle injury existed, once a medial ankle fracture und in 3 cases an isolated distal fibula fracture. One patient had an open ankle joint luxation. In some cases an additional fibula shaft fracture was seen. "Fracture communication" between the tibia fracture and the ankle injury was not seen at all. An intramedullary nail stabilisation was used in 9 cases, while in 1 patient due to the soft tissue damage an external fixator was applied. In the low-energy group there were 4 B1, 4 B2 and 4 C1 fractures of the tibia. We found 6 injuries of the posterior plafond and 6 cases with a central fracture line of the pilon. A fracture communication between ankle and tibial shaft was detected in all cases. In 7 patients we used a minimally invasive locking plate and in 5 cases a nailing technique for stabilisation of the tibia fracture. Overall, we saw 1 distraction fault, 1 valgus misfitting of the fracture, 1 pin infection and 2 soft tissue necrosis as postoperative complications. The time interval until osseous union was 3.5 months. Monoarticular fractures of the upper ankle joint had better results according to the Weber score. One can divide the distal articular tibial shaft fracture into two groups. In the high energy entity the ankle joint injury happens first, and afterwards the tibial shaft fracture occurs. Therefore, both fracture sites are usually not communicating, which means they are in fact two types of fracture. On the other hand, in the low energy group, both fractures are communicating. Here, the tibial shaft fracture is equal to the inner ankle fracture in a classic bimalleolar fracture. Therefore we have only one fracture site.

Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing

The purposes of this study were to review distal tibia shaft fractures treated with a plate or a nail and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures. Retrospective review. Two Level I trauma centers. We retrospectively reviewed 111 patients with 113 extra-articular distal tibia fractures between 4 and 11 cm proximal to the plafond. Seventy-six were treated with an intramedullary nail and 37 were treated with a medial plate. Twenty-nine (27%) of the concomitant fibula fractures were fixed. Complications and secondary procedures were evaluated in 111 patients after a mean of 24 months (range, 12-84 months). A total of 111 patients with 113 fractures of the distal tibia were reviewed. Their mean age was 39.1 years, 69% were men, and 30% had open fractures. Four patients underwent additional procedures for soft tissue coverage. None of these had infection. Five patients (4.4%) developed osteomyelitis: four after intramedullary nailing (5.3%) and one after plating (2.7%). Nine patients (12%) had delayed union or nonunion after nailing. One patient (2.7%) had a nonunion after plating (P = 0.10). Nonunion was more common after concurrent fixation of the fibula (14% versus 2.6%, P = 0.04). Angular malalignment of > or =5 degrees occurred in 22 patients with nails (29%) and 2 with plates (5.4%, P = 0.003). Eight patients had malunions of > or =10 degrees. Valgus was the most common deformity (n = 16). Malunion was more common after open fracture (38%, P = 0.006) but was not related to fibula fixation. Painful hardware was removed in six patients (7.9%) with nails and in two patients (5.4%) with plates. Distal tibia fractures may be treated successfully with plates or nails. Delayed union, malunion, and secondary procedures were more frequent after nailing. Randomized prospective assessment may further clarify these issues and provide information about costs associated with these fractures.

High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

Associations between fracture patterns are important and can ensure proper diagnosis and guide treatment. Occult posterior malleolus fractures associated with distal spiral tibia fractures often are underrecognized and the morbidity of a missed posterior malleolus injury can be substantial. We determined the association between the two injuries and evaluated the ability of a new protocol to improve management of these associated fractures. Of 62 consecutive patients with fractures of the distal third of the tibia, we retrospectively evaluated the first 39 patients and prospectively used a diagnostic protocol including computed tomography of the ankle in the subsequent 23 patients. The minimum followup was 3 months (mean, 25 months; range, 3-68 months). Twenty-four patients (39%) had fractures of the posterior malleolus. Before initiation of the protocol, intraarticular fractures were recognized in 33% (with one delayed diagnosis and one missed diagnosis), and after institution of the protocol, the detection rate was 48% with no known missed injuries and complete followup; however, with the limited power the detection rates were similar without and with the protocol. A spiral distal tibial shaft fracture with a proximal fibula fracture should alert the surgeon to investigate an occult ankle injury, particularly of the posterior malleolus. A protocol including computed tomography of the ankle may detect more injuries in a larger study. Level II, prognostic study.

Locking Compression Plate with Minimally Invasive Plate Osteosynthesis in diaphyseal and distal tibial fracture: A retrospective study of 32 patients

With the introduction of Locking Compression Plates (LCP), Minimally Invasive Plate Osteosynthesis (MIPO) has become widely used. The plates act as internal fixators in a bridging manner, thus resulting in secondary bone healing. We retrospectively evaluated the healing pattern and the clinical evolution of diaphyseal and distal tibial shaft fractures over two and a half years in 32 patients (6 females, 26 males). Fractures were classified according to AO classification and included all 42A-C, 43A-B and 43C1-2 types. For open fractures, Gustillo Anderson classification was used. Plates consisted of the 4.5mm LCP and 3.5mm LCP-Pilon form plate. Clinical and radiological assessment was performed at 6 weeks, and at 3, 6, 9, and 12 months. Two patients were lost to follow-up. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and posterior-anterior X-ray, and full, painless weight bearing. Ten patients at 3 months, 23 at 6 months, and 27 at 9 months met the criteria for a healed fracture. Plate bending was observed in one patient and called for re-operation at 5 months. Two patients required re-operation at 13 months secondary to pseudoarthrosis. Though MIPO seems more advantageous for soft tissue and bone biology, prolonged healing was observed in simple fracture patterns when a bridging plate technique was used.

Comparison of Intramedullary Nailing of Distal Third Tibial Shaft Fractures: Before and After Traumatologists

We hypothesized that less malalignment and complications occur with intramedullary nailing of distal third tibia fractures (42A, B, C) after the implementation of orthopedic trauma surgeons to this level II community hospital. We also hypothesized that patients with < or =5 degrees of malalignment have poorer function as measured by the MODEMS functional outcome scale. Two cohorts of distal third tibia fractures were identified by discharge diagnosis or by the Orthopaedic Trauma Association database. Group I (n = 39) patients were stabilized with an intramedullary nail by community orthopedic surgeons. Group II (n = 18) patients were treated by orthopedic trauma surgeons. In Group I (community), 9 (23%) patients treated by the community surgeons exhibited >5 degrees of angulation in at least one direction. Five (13%) of these patients displayed angulation in more than one direction, and 3 of these patients exhibited >10 degrees of angulation. In Group II (trauma) 1 (5%) patient had >5 degrees angulation in any plane (P < .05). No differences were noted in time to union, nonunion, delayed union, hardware failure or infections between the two groups. Functional outcomes were assessed using the MODEMS lower limb module. In comparison of the patients with and without significant angulation, the P value for bodily pain was 0.042. Patients treated by the community orthopedic surgeons had a higher incidence of malalignment, as compared to those treated by orthopedic trauma specialists.

Effect of Smoking on Long Bone Shaft Fracture Healing

Purpose: To evaluate the effect of smoking on the union time of the long bone shaft fractures. Materials and Methods: We retrospectively analysed eighty-four patients with a long bone shaft fracture who were treated during the last four years. Patients with polytrauma, severe comminuted fracture, open fracture over grade III, ESRD or other internal diseases were excluded. In this study we separated the groups into smoking and non-smoking groups. Also we observed whether there was any significant difference in the union time and other factors such as the age, sex, fracture location and configuration, and method of fixation by using medical records and radiographs. Results: A significant difference in union time was found between the smoking group and the non-smoking group (p=0.041), especially in the tibia. The average union time was 12.541.62 weeks in the smoking group and 11.532.59 weeks in non-smoking group. There were three non-union cases in the smoking group and one in the non-smoking group. Other factors appeared to have no significant influences. The negative effect of smoking was more obvious in patients in their 5th and 6th decades with a distal tibia shaft fractures. Conclusion: It seems highly beneficial that patients be recommend to quit smoking while being treated for a fracture, because smoking prolongs the healing time.

Minimally Invasive Percutaneous Plate Fixation for Distal Tibia Shaft Fractures

Purpose: To review the efficiency of the minimally invasive plate fixation technique for distal tibia shaft fractures. Materials and Methods: Between April 1999 and March 2001, 15 patients with distal tibia fractures were treated operatively by minimally invasive percutaneous plate osteosynthesis. There were 10 men and 5 women with an average age of 51 years (range, 20 to 72 years). The patients were followed for an average of 19 months (range, 12 to 30 months). In all patients, the center of fracture was in the distal tibia and either entirely extraarticular or with minimally displaced extension into the ankle joint. The type of fracture was evaluated using the AO/OTA classification. So far as general condition of patients permitted, temporary reduction of fractures with or without passive traction or distractor was performed under intraoperative fluoroscopy. About a 2 cm to 3 cm incision was made in the metaphyseal region proximal or distal to the fracture site, and screws fixation was performed percutaneously. A clinical assessment was evaluated according to Olerud and Molander ankle score. Results: All of the fractures healed with an average time of 15 weeks (range, 10 to 25 weeks). No patient had an angular deformity more than 5 degrees, or shortening of more than 1 cm. All patients had an excellent or satisfactory ankle function. Checkrein deformity was observed in one patient and superficial infections occurred in two, but no patient experienced deep infection or skin necrosis. Conclusion: As compared with conventional open reduction and internal plate fixation, minimally invasive percutaneous plate osteosynthesis technique was found to be an effective method of treating distal tibia fractures, because it facilitates the rehabilitation more rapid patient rehabilitation, and induces osteosynthesis with reduced of the rates of infection and nonunion.

Percutaneous plating of distal tibial fractures: Preliminary results in 21 patients

We describe the surgical technique and report the outcome after closed reduction and percutaneous plating in 21 closed extraarticular distal tibial fractures using titanium LC-DCP. A long plate was pushed subcutaneously through a small incision at the medial malleolus and fixed with screws through stab incisions. Fracture reduction was anatomical or nearly anatomical without angular displacement in 14 cases, and considered acceptable in four cases. Two patients were reoperated because of malreduction. Seventeen fractures healed within 6 months. There were two delayed unions, and two non-unions. There were two deep infections, both in diabetic patients. Follow-up by an independent observer at on average 14 (5–25) months showed various symptoms such as slightly reduced ankle mobility (9/20), reduced walking ability (11/20) or tenderness around the plate (11/20). No patient complained of knee symptoms related to the surgery. Operative treatment of closed distal tibial shaft fractures with a long titanium plate provided good anatomical results and allowed in most patients early weight-bearing. In patients with soft tissues in good condition and no risk factor for infection percutaneous plate osteosynthesis might become an attractive treatment option for fractures in the distal tibia.

Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing

Unreamed nailing favors biology at the expense of the achievable mechanical stability. It is therefore of interest to define the limits of the clinical indications for this method. The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, to identify the mechanical reasons for the unfavorable clinical results, and to identify borderline indications due to biomechanical factors. In a three-dimensional finite element model of a human tibia, horizontal defects were stabilized by means of unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The loading of the bone, the loading of the implant and the inter-fragmentary strains were computed. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. The results suggest that mechanical conditions are advantageous to unreamed nailing of proximal and mid-diaphyseal defects. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures by means of unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

Treatment of tibial fractures by interlocking intramedullary nailing

The adequate treatment of tibia fracture is one of the most difficult due to severe commiuntion, open wound, delayed union, angulation deformity and infection. We treated 38 fractures of the tibia by Interlocking intramedullary nail from Feb. 1983 to Mar. 1993, 35 cases of the tibia fracture were fresh, 13 cases of fracture were open. The other 3 cases were delayed union and nonunion. The Mean follow-up was 14.0 months. The results were as followings. 1. Of the 38 fractures, 37 fractures united and the mean union time was 18.7 weeks. 2. Interlocking intramedullary nail could be used to the majority of fractures of the proximal & distal tibia shaft fractures. 3. The Interlocking nail had rigid rotational stability and was appropriate for the treatment in severe unstable fractures, commninution and open with bone loss. 4. Delayed union or nonunion was a good indication for intramedullary nailling. 5. The major complication were valgus deformity of 2 cases, varus deformity of 1 case, 1 case deep infection. 6. Interlocking intramedullary nailing provided rigid fixation of fracture and then made early joint motion exercise and ambulation.

大腿骨，けい骨遠位部骨折に対するＭａｙ Ａｎａｔｏｍｉｃａｌ Ｂｏｎｅ Ｐｌａｔｅの使用経験

We treated 4 distal femoral shaft fractures, and 6 distal tibial shaft fractures with May plates in 6 men and 4 women. The average age was 58 years. According to our results, nine cases achieved excellent results. However there was one case of nonunion in which the desired compression of the fracture was not achieved. May plates are useful for obtaining anatomical alignment, and they provide stable fixation thereby allowing early mobilization. However compression of the fracture in not always achieved as the May plate is not a self compression type of plate and it has round holes. If theses disadvantages could be solved, the May plate would be more useful.

けい骨骨幹遠位端骨折の治療経験

We treated 24 distal tibial shaft fractures in 19 men and 5 women with their average age being 41.8 years old and the average objective term being one year and two months, which included 15 open fractures, from Jan. '86 to Oct. '90.We treated the following cases as a primary treatment: 2 conservative cases, 4 cases used with external fixations, 6 with Ender nails, 3 with T plates, 5 with AO plates and 4 with May plates.Considering each case about the term of union, the degree of malunion and the operative result, we could get the following consequence. It took 12.0 weeks for the Ender nail group to union and 8.7 weeks for the plates group on an average. The valgus angulation developed more in the Ender nails group than the plates group. A better result could be found in the plates group, in which the treatment using May plate was extremely good.