Expert Tibial Nail Research Articles

A Prospective Study on Tibial Shaft Fractures Treated with Suprapatellar Approach.

Tibial diaphysis represents the primary location for tibial fractures, accounting for 80% of such cases, often accompanied by fibular fractures. In terms of surgical management, the recommended technique for addressing both displaced and undisplaced tibial shaft fractures in adults is intramedullary nail fixation. Additionally, there is a growing consideration for suprapatellar nailing, which involves performing the procedure with the knee in a semi-extended position, as a potentially safe and efficacious alternative. To evaluate the clinical and functional union amongst tibial shaft fracture cases, managed by nailing in the suprapatellar approach, and to study the complications associated with it. Our study with prospective observational design was conducted for 18 months on 30 patients with tibial shaft fractures. Following comprehensive laboratory assessments and confirmation of surgical fitness, the patients underwent surgical intervention through a specialised suprapatellar approach employing expert tibial nailing. The mean age of the subjects was 42.83 ± 11.47 years, and the majority were males (70.0%). Notably, there was a statistically significant reduction in Visual Analogue Scale scores and a concurrent increase in Lysholm Knee Scoring Scale scores during the follow-up period, indicating substantial enhancements in both clinical and functional outcomes. Delayed union was the complication observed in three individuals. We found that the younger the age of the subjects, the earlier the surgery after an injury, the better the functional outcome. Expert tibial nailing with a suprapatellar approach was successful in yielding clinical and functional union amongst the subjects with tibial shaft fractures. In addition, delayed union was the complication observed in the approach, which was evident in a few cases.

Gentamicin[sbnd]coated tibial nail is an effective prevention method for fracture-related infections in open tibial fractures

Fracture-related infection (FRI) is a common complication following open tibia fracture (OTF), especially in patients with high-energy trauma or comorbidities. The use of gentamicin-coated nail (GCN) has been proposed as a local adjuvant to prevent FRI in high-risk patients.Hypothesis: The incidence of FRI is expected to be lower in OTF treated with a GCN, alongside with no detrimental effects on fracture healing time.Objectives: This study aimed to evaluate the effectiveness of GCNs as a definitive fixation method and prophylaxis for FRI in OTFs. Secondary outcomes included non-union rates and time to healing.Methods: The study design was a mixed cohort, including a prospective group of patients treated with GCN (Expert Tibial Nail PROtect™, Depuy Synthes, Johnson&Johnson Company Inc, New Jersey, USA) and a retrospectively evaluated group treated with non-gentamicin-coated nail (NGCN). Patients with at least 12 months of follow-up were included. The treatment protocol consisted of timely administration of antibiotics, surgical debridement, and early soft-tissue coverage. Exclusion criteria included protocol infringement, traumatic amputation, and loss of follow-up.Statistical analysis was performed using Stata v14.0, with a significance level of p < 0.05.Results: The study included 243 patients, 104 in GCN group and 139 NGCN group. External Fixator use was higher in the NGCN group, but this did not significantly affect the FRI rate.GCN use was associated with a significantly lower incidence of FRI (2.88% GCN group vs. 15.83% NGCN group, OR 0.16, p < 0.01). Furthermore, GCN use was found to be a protective factor against tibial non-union (OR 0.41, p = 0.03). There were no adverse effects attributed to locally administered gentamycin. The NGCN cohort had a higher incidence of polytrauma, although the difference was not statistically significant. A longer time to heal as well as more FRI and Non-union according to the progression in Gustilo-Anderson classification was observed in the GCN group.Conclusion: Our findings suggest that GCN is an effective prophylactic method to reduce the risk of FRI in open tibial fractures at 12-month follow-up, as well as, probably derived from this protective effect, leading to lower fracture consolidation times when compared with cases treated without GCN.

Functional and radiological outcome of distal tibia fractures managed with expert tibia nail: a prospective clinical study

Leg bone fractures come at the top because it is actively involved in locomotive system with distal tibia fractures having second highest incidence due to its subcutaneous location with very less muscle mass around it. Such fractures are mostly comminuted fractures with extensive soft tissue injuries. These are the fractures which extend within approximately 4 cm. from the tibial plafond. As these fractures occur in proximity of weight bearing surface of ankle joint, a slight maladjustment may lead to permanent disability. Non operative treatment/ open reduction and internal fixation with medial or anterolateral plating of these fractures is associated with multiple post-operative complications like infection, wound dehiscence and non-union. Operative treatment allows proper length and anatomical alignment of the limb, early mobilization and hence excellent final results. The present study of 25 cases was done to evaluate the clinical and radiological functional outcome of extra-articular AO type A simple and compound (Gustilo type I and type II) fractures of distal tibia managed with expert tibial nail and complications (post-operative) if any of patients of either sex, same demographic profile admitted through emergency in a tertiary institute of Punjab. Clinico-radiologically results were assessed using Johner and Wruh’s criteria. Authors got excellent results in 88%, good to fair in 08% of the cases. Expert tibia nail provides good mechanical and rotational stability due to multiple, multidirectional distal locking options available in distal tibia fractures.

Expert tibial nail (ETN) versus minimally invasive plate osteosynthesis techniques in the treatment of distal tibia fractures in young adults: A randomized controlled trial

Abstract Purpose To compare anatomical locked plates inserted in a minimally invasive pattern (MIPO) versus expert tibial nailing (ETN) for fixation of extra-articular fractures of the distal tibia in young adults. Patients and methods The study included 120 patients, 84 males and 36 females. The mean follow-up time was 13.5 months, with at least 12 months of follow-up. Cases were equally divided and randomized by the closed-envelope technique into two groups, group A: fixed by anatomical locked plate through a minimally invasive approach, and group B: fixed by ETN. Results The average operative time was significantly higher in the MIPO group (94 min) compared with the ETN group (81.67 mins). Also, the radiological exposure time was also higher (87.6 secs) in group A versus 78.4 in group B. Although there was an incidence of deformity in few cases of the ETN group (eight patients), that was not significant enough to warrant correction by revision surgery. There were no significant differences in the union time (P value: 0.09) and American Orthopedic Foot and Ankle Society (AOFAS) scores (P value: 0.78) between the two groups. Furthermore, the infection and the need for further surgeries did not show significant differences among both groups. Conclusion Both MIPO and ETN are valid treatment options for distal tibia fractures, AO type 43 A. Both methods resulted in acceptable union time, and American Orthopedic Foot and Ankle Society scores, with no reported cases of nonunion. Level of evidence. Therapeutic study, level I

Analysis of functional outcome following expert tibial nail fixation for distal tibial fractures

Analysis of functional outcome following expert tibial nail fixation for distal tibial fractures

Extra articular metadiaphyseal fractures of distal tibia managed by tip locking intramedullary Nailing: A case series

Introduction: Distal tibial fractures are commonest, often a result of high-energy trauma causing significant soft tissue injury and comminution. Being subcutaneous with tenuous soft tissue coverage it is poorly vascularized with more risk of infections, delayed union and non-union. This study is intended to know the efficacy of closed reduction with tip locking intramedullary nail, in distal extra articular metadiaphyseal tibia fractures with at least 4-5cm of intact distal fragment. Materials and Methods: This study is conducted on 18 skeletally mature patients, 14 male and 4 female, between December 2019 to December 2020 who fulfilled the inclusion criteria, using an Expert Tibial Nail System (ETNS)/tip locking IM nail. Patients were assessed clinically and radiologically at regular intervals for fracture union, functional ROM and any residual symptoms. Results: Average time of fracture union was 15.2 weeks. The functional ROM in majority of patients was as pretrauma level at end of 15.2 weeks without any complications and residual symptoms on full weight bearing. Evaluated American Orthopaedic Foot and Ankle Society (AOFAS) ankle score was 80.Conclusion: ETNS/tip locking IM nail is an excellent option in tackling distal tibia fractures. It is a minimal invasive biomechanical procedure, giving stability even in osteoporotic bone. Minimal soft tissue complications with advantage of early fracture union and ambulation.

Extra-Articular Proximal and Distal Metaphyseal Tibial Fracture Fixation by Intramedullary Expert Nail and Locking Plate: A Prospective Study

Background: Extra-articular proximal and distal metaphyseal fractures of tibia pose a significant challenge to the surgeons. Debate continues regarding choice of fixation devices. Evaluate these fractures fixation with intramedullary expert tibial nail and extramedullary locking plate and screws.&#x0D; Materials and methods: This is a prospective interventional study which had been conducted in the Department of Orthopaedics &amp; Traumatology, Chittagong Medical College Hospital, Chattogram from July, 2018 to June, 2019. Total 60 cases (30 cases in each group) with proximal and distal metaphyseal tibial fractures (AO/OTA 41A2 to A3 and 43A1 to A3) were taken. Functional assessment was done atleast 6th month of surgery using Tegner Lysholm knee scoring scale and Kaikkonen ankle scale.&#x0D; Results: According to assessment scale, excellent outcome was observed in 20 (66.7%) patients, good in 05 (16.7%), fair in 03 (9.9%) and poor in 2 (6.7%) patients in ETN group while in LPS group, 18 (60%) patients were excellent, 05 (16.7%) good, 04 (14.3%) fair and 03 (9.9%) patients were poor. Difference in functional outcome in both the groups was statistically non-significant.&#x0D; Conclusions: There was no significant difference statistically in functional outcome of patients treated with intramedullary and extramedullary fixation method.&#x0D; JCMCTA 2021 ; 32 (1) : 59-64

Comparison of the results of expert tibial nailing with results of distal tibial plating in patients with distal 1/3rd extraarticular tibial fractures

Background: The tibia constitutes one of two bones of the leg. Recently, minimally invasive percutaneous medial locked plating has been described in the literature with promising results. Expert Tibial Nail currently represents an effective approach to the treatment of complex extraarticular distal tibial fractures. Hence; the present study was undertaken for comparing the results of Expert Tibial nailing with results of Distal Tibial Plating in patients with Distal 1/3rd extraarticular Tibial Fractures. Materials & Methods: The study was conducted on 40 patients with extraarticular distal 1/3rd tibia fractures. All the patients were divided into two study groups randomly with 20 patients in each group as follows: Expert Tibial Nailing group, & Distal Tibial Plating group. All the patients underwent procedures according to their respective study groups. During the postoperative phase, static quadriceps exercises & toe movements, as tolerated were started from 1st postoperative day. Full weight-bearing was allowed after 10 to 12 weeks, depending on the radiographic signs of fracture healing. Patients were followed up for 6 months after operation and evaluated as per Johner and Wruss Criteria. Results: The mean age of the patients of the expert tibial nailing group and distal tibial plating group was 48.12 years and 49.71 years respectively.Mean operative time among the patients of the expert tibial nailing group was 83.15 minutes and was significantly lower in comparison to the patients of the distal tibial plating group (101.2 minutes). Mean intraoperative blood loss was compared between expert tibial nailing and distal tibial plating. Torniquet was used in all the cases. Mean intraoperative blood loss among the patients of the expert tibial nailing group was 51.6 ml and was significantly lower in comparison to the patients of the distal tibial plating group (89.1 ml). Mean postoperative weight-bearing time among the patients of expert tibial nailing was 8.95 weeks and was significantly lower in comparison to the patients of the distal tibial plating (14.35 weeks). Mean fracture union time among the patients of the expert tibial nailing group was 18.6 weeks and was significantly lower in comparison to the patients of the distal tibial plating group (25.84 weeks). Excellent results were obtained in 80 percent of the patients of the expert tibial nailing group and 55 percent of the patients of the distal tibial plating group respectively. Conclusion: The results of present study with expert tibial interlocking nailing are encouraging and demonstrate the benefits of new nailing system. Changes in the design of the nail for improved proximal and distal locking enable it to use in proximal and distal metaphyseal fractures of tibia.

Intramedullary Expert Tibial Nailing of Distal Tibial Fractures

Background: The tibial diaphysis is the most common site of fracture in the tibia and approximately 80% of these fractures have associated fibular fractures. Expert Tibia Nail System (ETNS) system provides extra stability in comparison to conventional intramedullary tibial nail due to multiaxial locking system. Objective: The aim of this study was to evaluate the midterm functional outcome of distal tibial fractures using the ETN. Materials and Methods: This prospective study was conducted from June 2016 to August 2019 comprising a total of 30 cases who were treated by Expert tibial nail fixation for distal tibial fractures. Clinical evaluation was done at each follow-up and final evaluation was done at 9 months postoperatively. The evaluation method at 9 months follow-up was the clinical examination and radiographic imaging. Results: Of 30 patients, majority were men. Male-to-female ratio was 3:1 with 22 men (73.33%) and 8 women (26.66%). The mean age of patients was 32 years with a range from 20 to 60 years. Left limb was involved more 16 (53.33%) frequently than right 14 (46.66%). Majority of the patients had trauma due to road traffic accidents (46.66%), fall from height/stairs (26.66%), twisting injuries (23.33%), and sports injuries (3.33%). There were 1 patient with superficial infection which resolved with wound care and antibiotics, 2 with anterior knee pain, 1 with malunion, 1 with delayed union, and 1 patient with nonunion. According to Johner and Wruh’s criteria, excellent results were achieved in 20 patients, good in 5 patients, fair in 4 patients, and poor in 1 patient. Conclusions: Expert tibial nailing is a new and innovative procedure for distal tibial fractures. It is safe and effective with the added advantage of providing additional stability and preventing rotational malalignment for distal third tibial fractures in comparison to conventional nailing. Further studies need to be conducted to validate the advantages of this procedure over conventional nailing.

Clinical Performance of Intramedullary Nailing system for Tibia Fractures: A Retrospective study

Background: The tibia, or shinbone, is the common fracture long bone in body. There are two option includes, reamed and unreamed of surgical treatment of fractures. Reamed nail has some advantage but they significantly harmful the endosteal circulation. Unreamed nail surplus the endosteal circulation but provide a less stable fixation. Afterward, because of ability to lock the nail proximally and distally, closed intramedullary nailing turned into an acknowledged treatment for closed shaft cracks during the ninth decade. Aim: The main objective is to treat the tibia fractures by implanting the Intramedullary nailing system (Interlocking cannulated tibia nail and Expert tibia nail) manufactured by Auxein Medical Private Limited, Sonipat, India. Material and Methods: In this retrospective study, studied the results of intramedullary tibia nail in treatment of tibia fracture. A total of 25 consecutive patients were included in this study (11male, 14 female and average age 42.9 years). Fracture type was classified as per the Muller AO classification of fracture. Results: The outcomes of clinical treatment were obtained in our study; No pain (92%), Mild pain (8%) after 2 year follow up. The follow up of patients were taken on 4-week, 1-year, 2-year according to VAS score. Paired t test was performed for statistical data analysis using Minitab and values of p&lt;.05 were taken to indicate significant value with confidence interval of 95%. No implant related problem have been found like loosening, bending, corrosion etc. Conclusion: Our outcomes with interlocking cannulated and Expert tibial interlocking nailing are empowering and exhibit the advantages of new nailing framework. It has been concluded that intramedullary tibia nailing system is best method for treatment of tibia fracture with good results and outcomes.

Functional outcome of proximal 1/3rd, distal 1/3rd and diaphysial tibial fractures in adults operated with expert tibial nailing

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of the tibial shaft are increasing due to high velocity trauma and industrialisation. Not only they are common but also difficult to treat. Until recently surgeons had to rely on non-operative treatment, V nailing, plates and screws and external fixator but they had their drawbacks like prolonged immobilisation infection, delayed union and non-union. Numerous modifications in nail and screw design have led to development of the expert tibial nail. Multidirectional interlocking screws ensure that alignment can be well maintained and stability preserved in short proximal or distal tibial segments.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 30 patients were admitted and operated during September 2014 to September 2016 in Mamata general hospital Khammam. All patients were evaluated with Klemm Borner’s criteria and complications following surgery.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 87% of patients achieved good or excellent results, fair results were obtained in 3 (10%) patient and poor result in one (3%) patient. 2 (6%) patients had malunion, 2 (6%) patients had delayed union, 1 (3%) patient had deep infection led to implant failure.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intramedullary nailing is a safe and effective technique for the treatment of tibial metaphyseal fractures. It avoids the additional soft-tissue dissection associated with traditional open procedures as well as the complications associated with external fixators. Expert tibial nail can give excellent functional and clinical results. Complications such as failure of the bone-implant construct or post-operative malallignment are avoidable if careful pre-operative planning is allied with meticulous surgical technique.&lt;/p&gt;

Management of distal tibial metaphyseal fracture by expert tibial nail using suprapatellar approach

Background: Distal tibial metaphyseal fractures are common lower limb injuries and results in extensive musculoskeletal damage due to paucity of soft tissue coverage. Fixation methods include open reduction and internal fixation (ORIF) with plates, minimally invasive percutaneous plate osteosynthesis (MIPPO) and intrameduallary nailing. Extensive exposure for ORIF leads to wound complications,nonunion and infection. Intramedullary nailing is the preferred for diaphyseal tibial fracture however conventional nailing is less suited for distal tibial metaphysis due to diameter mismatch between the nail and the bone leading to very little nail effect and impaired stability. Expert tibial nail with multiplanar locking options at the proximal and distal end allows for secure stabilization of the metaphyseal fragments. Infrapatellar approach is traditionally used for tibial nailing however suprapatellar approach is emerging as an alternative as semi-extended positioning makes it technically easier to nail the proximal and distal fractures. Materials and Methods: This is a prospective study conducted from February 2019 to February 2020. 14 patients fulfilling the inclusion criteria underwent intramedullary nailing using the suprapatellar approach. The functional outcomes were measured at 6 months using the Lysholm knee score and the SF-36 physical and mental score. The obtained data was analyzed using SPSSv16. Result: The average time of fracture union was 17.8 weeks. The mean SF-36 physical and mental score were 42.4 and 44.5 respectively. The average Lysholm score was 84. The mean arc of motion in the involved knee was 110ᵒ. Secondary procedure in the form of dynamization was done in 2 cases. Anterior knee pain was observed in 3 patients.Conclusion: Expert tibial nailing using suprapatellar approach appears to be a suitable fixation method for distal tibial metaphyseal injuries as it provides good functional and clinical outcome at the same time minimizing the violation of delicate soft tissue structures.

Expert Tibial Intramedullary Nailing For proximal and Distal Tibial Fractures

Fractures of the proximal or distal thirds of the tibia are one of the most challenging injuries in orthopedic. A few strategies have been portrayed m the decision of procedure relies upon numerous elements including crack arrangement, bone quality, delicate tissue injury and accessible equipment.Intramedullary nailing might be powerful in dealing with these breaks even with straightforward articular augmentation, yet care should be taken with decrease and sufficient screws locking to forestall malalignment and ceaseless knee agony may likewise be an issue. This investigation included 20 patients with distal and proximal tibial breaks rewarded with intramedullary nail with multidirectional proximal and distal locking screws (Expert tibial nail). The time of follow up was up to 6months utilizing certain scoring frameworks. The suggestive and useful assessment results were reviewed by the models by Johner and Wruh's Criteria According to Johner and Wruh's measures, 45.0% of patients indicated great rules, 30.0% were brilliant, 15.0% were reasonable and just 10.0% were poor. Two cases created deferred association (10%), two cases built up Sudeck's decay (10%), one case created malunion (5%), one case created nonunion(5%) and foremost knee torment was found in four cases (20%). So front knee torment spoke to the most widely recognized intricacy in this study.Treatment of proximal and distal thirds tibial cracks utilizing master tibial intramedullary nail (with multidirectional locking screws) is a protected and acknowledged strategy option in contrast to customary nail and plating procedure. This structure of the embed helps in accomplishing stable obsession and improved securing most extraarticular tibial cracks.

Implications of three-dimensional modeling of tibia for intramedullary nail fixation: A virtual study on Asian cadaver tibia

IntroductionTo determine the optimal entry point (EP) of intramedullary nail (IMN) fixation and introduce a consistent landmark for practical application by analyzing three-dimensional (3D) modeling and virtual implantation. Materials and methodsA total of 104 cadaveric femurs (50 males and 54 females) underwent continuous 1.0 mm slice computed tomography (CT) scans. CT images were imported into Mimics® software to reconstruct 3D model of tibiofibular bone with medullary canal. Expert Tibial Nail (ETN®, Ø12mm/Length 315 mm) was processed into a 3D model at the actual size and optimally implanted in the tibia. After IMN was aligned in a neutral position, it was defined as a true AP projection. In the true AP projection, optimal EP and relationship with adjacent structures were assessed based on the degree of tibial rotation. ResultsEP was placed eccentrically around the lateral tibial spine in cephalad view and in true AP projection in all models. In true AP projection, the overlapping point between fibular tip and cortical margin of lateral condyle was placed lateral to the fibular tip in 62 models, and exactly matched with fibular tip in 42 models. As tibia rotates, the position of EP in the AP view changes. When tibia was externally rotated, EP was located to the lateral, not the medial side of the lateraltibialspine. The obliquity of guide wire also changed withtibialrotation; the obliquity of guide wire aligned in a straight in true AP projection. ConclusionOptimal determination of EP and guide wire direction should be performed by considering the overlapping point that should be placed to just or lateral side of fibular tip in AP projection. Compared with fibular bisector line, the overlapping point is also useful as a practical landmark for making true AP projection and determining optimal EP.

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

AbstractBackground: Fractures of the distal tibia involve the diaphyseo-metaphyseal area of the bone, and may be either extra-articular or intrarticular. Several methods have been described for the treatment of these fractures, including casting, external and internal fixation.Aim of Study: The aim of the work was to evaluate the results of fixation of distal tibial fractures by intramedullary nail with multidirectional distal locking screws (Expert tibial nail).Methods: This study included 21 patients with distal tibial fractures treated between October 2017 and October 2018 (including follow-up period) at Tanta University Hospital with intramedullary nail with multidirectional distal locking screws (Expert tibial nail). Clinical and radiological data were analyzed.Results: According to Tenny & Wiss scoring systems for distal tibial fractures the clinical results were graded as excellent in six patients (28.6%), good in nine patients (38.1 %), fair in four patients (19%) & poor in two patients (9.5%).The excellent and good results were considered as satisfactory results while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 15 patients (71.43%), and the unsatisfactory results were found in six patients (28.57%).Conclusion: Treatment of distal tibial fractures using intramedullary nail with multidirectional distal locking screws (Expert nail) is a safe and accepted method alternative to conventional nail and plating technique. It provides additional biomechanical stability than the conventional nails and plate osteosynthesis.

Comparison of functional outcome between expert tibial nail and distal tibial medial locking plate by mippo technique for closed extra articular distal tibial fracture

Comparison of functional outcome between expert tibial nail and distal tibial medial locking plate by mippo technique for closed extra articular distal tibial fracture

Evaluation of Results of Combined Blocking Screw and Interlocking Intramedullary Nail in the Treatment of Diaphyseo-Metaphyseal Tibial Fractures

AbstractBackground: Diaphyseo-metaphyseal tibial fractures tend to malalign while treatment by interlocking intramedullary nail. Multiple techniques are used to avoid malalignment as provisional unicortical plate, percutaneous clamping, universal distractor, fibular plating in distal tibia and blocking screw.Aim of Study: Was to evaluate the results of combined blocking screw and interlocking intramedullary nail in the treatment of diaphyseo-metaphyseal tibial fractures.Patients and Methods: This study was done on 21 patients with closed proximal or distal diaphyseo-metaphyseal tibial fractures, admitted at Tanta University Hospital. The distri-bution of patients was according to age, sex, and side, mode of trauma, and AO type of fracture, medical history, smoking, fracture level, time lag, fibular fixation and design of inter-locking nail. Fixation was done by interlocking intramedullary nail and the reduction was assisted by blocking screw in the coronal plane for varus or valgus malalignment and in the sagittal plane for recurvatum or procurvatum malalignment. Clinical evaluation was according to Hospital of Special Surgery Knee Rating Scale.Results: There were significant statistical correlation between the final clinical result and interlocking nail design either conventional or expert tibial nail or the time for union. There were significant statistical correlation between the time of union and sex of patients, mode of trauma, type of fracture, fibular fracture fixation and smoking.Conclusion: Blocking screw is a simple technique that assist in the reduction of diaphyseo-metaphyseal tibial fractures while fixation by interlocking nail, maintenance of the reduc-tion and stability of the fracture.

The functional outcome following the use of expert tibial nails for proximal 1/3rd and distal 1/3rd tibial metaphyseal fractures in adults

There is no universally accepted method of management of proximal and distal tibial fractures till date. Various modalities of treatment of fracture shaft of tibia are conservative gentle manipulation and use of short leg or long leg cast, open reduction and internal fixation with plates and screws, external fixation and intramedullary fixation with flexible nails (ender pins) and interlocking intramedullary nails with or without reaming. In total number of 25 patients admitted, there were 17 males (68%) and 8 females (32%). There were 20 closed fractures (80%) and 5 open fracture (20%) (GA type I-3, GA type II-2). Functional results were graded according to the criteria by Klemm and Borner (1986). 92% of patients achieved good or excellent results, fair results were obtained in one patient and in one patient, the functional results were poor.

Calcaneotalotibial arthrodesis by retrograde intramedullary nailing using expert tibia nail for charcot osteoneuropathy of the foot: A case series

IntroductionCharcot osteoneuroarthopathy (CN) is a progressive degenerative arthropathy determined by the interaction of neuropathy, osteopaenia and proinflammatory cytokines. The aim of treatment is to maintain the foot on plantigrade position, recover foot deformity, osseous stability, and prevent ulceration. Intramedullary fixation in calcaneotalotibial arthrodesis has been described in promotion of rigid internal fixation with minimal soft tissue violation producing deformity correction, minimal periosteal aggression, vascular damaged and good functional outcome, with less postoperative fusion time and able to achieve fusion of the ankle and the subtalar joint after failed fusion. Presentation of caseTwo patients with charcot foot underwent tibiocalcaneal arthrodesis with retrograde intramedullary technique by Expert Tibial Nail (ETN). The patients are both male 59 years with right ankle deformity 9 months prior to admission and history of trauma and 40 years old with history of Type 2 Diabetes Mellitus. Visual analog scale (VAS), AOFAS and SF score were assessed pre and post operative. DiscussionA good stability, plantigrade ankle and painless foot on both patients were achieved with a mean score 9 for satisfaction. Pre and 3 months post operative VAS were 4 and 1, AOFAS Scale were 58 and 83, mean of SF-36 were 28.4 and 48.6 for physical condition, 37.3 and 67.2. for mental condition consecutively. No severe postoperative complication were recorded ConclusionTibiotalocalcaneal arthrodesis with retrograde intramedullary technique using ETN system was proven to have a good option for ankle joint salvage with improvement of clinical and functional score. Hence, its application in the charcot joint is promising.

Functional outcome of metaphyseal and diaphyseal fractures of tibia treated with expert tibial interlocking nail: A prospective study

Introduction: Tibia is the most commonly fractured bone due to road traffic accidents and other high-energy trauma and surgical management is required for most of these fractures, with either internal or external fixation. Locked intramedullary nailing has been widely accepted as a satisfactory treatment of tibial fracture. The indications of their use have been extended to fractures closer to proximal / distal fragments with introduction of expert tibial nail. It is a new kind of low, multidirectional locking tibial intramedullary nail developed to attain increased angular stability and to enhance the axial and lateral stability of fracture fragments.Aim: To study the functional outcome and duration of union of metaphyseal and diaphyseal fractures of tibia treated with expert tibial interlocking nail.Methodology: Study was done in 30 patients with fresh tibial metaphyseal/diaphyseal fractures treated surgically with expert tibial nail between October 2016- March 2018. Patients were followed up at 6 weeks, 3 months, and 6 months. The intra-operative blood loss, duration of surgery, intra operative complications, post-operative complication, and duration of hospital stay were studied. Functional outcome was assessed based on Johner and Wruh's Criteria.Results: Among the 30 patients treated with expert tibia nail for metaphyseal/diaphyseal tibial fractures, 25 were male and 5 were females. Most of patients were in the age group ranging from 20-30 years with a mean age group of 40.1 years. The mode of injury for 24 patients was road traffic accidents which accounted for about 80 %, 5 were due to fall which accounted for 16.67 % and 1 was due to assault which accounted for 3.33 %.16 cases sustained right side tibia fracture and 14 cases sustained left side tibia fracture. The average period of commencement partial weight bearing was 7 weeks and full weight bearing was 13.43 weeks. Excellent results were seen in 43.33% cases, Good results were seen in 33.33%, Fair results in 16.67 %, poor results in 6.67% according to Johner and Wruh's Criteria.Conclusion: Our results with expert tibial interlocking nailing are encouraging and demonstrate the benefits of new nailing system. Changes in the design of the nail for improved proximal and distal locking enables it to use in metaphyseal/diaphyseal fractures of tibia. A better stabilization of small fragments has been achieved by the availability of locking option in three planes, thus providing a higher stability of the bone implant construct. Complications were comparable to other studies.