Extra-articular Proximal Tibial Fractures Research Articles

Proximal Extra-articular Tibial Fractures Associated with Soft-tissue Impairment in Geriatric Patients: Definitive Treatment by Hybrid External Fixation

Fractures in the elderly population are a major increasing issue for any healthcare institution, associated with the growing life expectancy. Proximal tibial fractures affect the metaphyseal bone with or without articular extension, in 5 to 11% of all tibia fracture. Treatment options such as plate fixation, intramedullary nailing or even primary total knee arthroplasty are accepted valuable options. However, specific age-related risk factors such as osteoporosis, arthritis, multiple comorbidities and soft-tissue impairment shall also be taken in consideration as they may lead to severe complications if not fully understood. Therefore, a hybrid tibio-tibial external fixator may be considered as a valid surgical option for primary and definitive treatment care of these fractures especially if associated with soft-tissue damage. We report a retrospective observational analysis of three cases of closed extra-articular proximal tibia fractures associated with soft-tissue impairment in a geriatric population and treated with a hybrid external fixator (TenXor, Stryker). The fractures were classified according to the AO, as metaphyseal fractures (AO 41A2.1, 41A3.3). The post-operative protocol was standardized, with immediate full weight bearing. Complete consolidation of the fractures was obtained at 6 months. There were no pin tract infection and removal of the material has been done at 6 months. No cut-out of the proximal tibial wires was observed. The primary and definitive care of proximal tibial fractures by a hybrid external fixator appears to be a valuable surgical option in geriatric patients especially when associated with poor soft tissue coverage. The major advantage of this technique, acknowledging the longer bone consolidation process, is to avoid additional insult to the soft tissues. This surgical option gathers further treatment perspectives in the elderly population especially in cases of soft tissue limitations.

Management of Extra-articular Proximal- third Tibia Fractures by Expert Tibia Nail and its Functional Outcome: A Longitudinal Cohort Study

Introduction: Tibia, being anatomically placed subcutaneously throughout its length, is very prone to fractures. Incidence of extra-articular proximal tibia fractures accounts for 5-11% of all tibia shaft fractures. Among the various treatment modalities available, locked intramedullary nailing is a safe and adequate modality with fewer complications. Expert tibia nail is anatomically designed with multi-directional locking, which attains better angular stability and thereby allowing fixation of very proximal fractures. Aim: To analyse and assess the functional and radiological outcome of expert tibia nailing used for treating extra-articular proximal-third tibia fractures. Materials and Methods: A longitudinal cohort study was conducted for a duration of three years and five months, which included 31 patients. Standard descriptive statistical method was used to describe parameters. All these patients had extra-articular proximal- third tibia fractures and were managed with expert tibia nail. All patients underwent clinical and radiological evaluation based on the Klemm and Borner scoring system at a regular interval of six weeks, three months, six months, and at one year. Results: The most common mode of injury was road traffic accidents (80.64%). Patients were in the age group of 26-63 years with an average mean of 41.80±9.7 years. The male to female ratio was 4.16:1, suggestive of male predominance. According to the Klemm and Borner scoring system, 71.42% of patients belonged to the excellent group, 17.85% were in good, 7.14% in fair and 3.57% in poor. Radiological union was achieved in an average period of 20.9±2.09 weeks. Conclusion: In this study, scores obtained on the basis of Klemm and Borner scoring system, depicts that intramedullary expert tibia nailing is a good treatment modality for the management of extra-articular proximal-third tibia fractures, which provides good angular stability and adequate fixation resulting in early rehabilitation and union with excellent functional outcome and mere complications. It is also a safer treatment modality in case of compromised surrounding soft tissue.

Extra-Articular Proximal Tibia fractures: Proximal tibia plate versus intramedullary nailing

Introduction: Extra-articular promixal tibial fracture make up to around 10%(1) of all shaft tibia fractures which are most commonly due to high velocity injury. Both conservative and operative management options are available, but conservative management has resulted in many complications. Intramedullary nailing and minial invasive plating are the preferred techniques of the available modalities of operative management. There is not enough evidence regarding the superiority of one of the two techniques. The purpose of this study is to compare these different approaches based on hospital stay, blood loss, union rates, mal/non-union, post-operative range of motion of knee ,period of non-weight bearing , infection rates and implant removal rate. Material and Methods:This is a randomized prospective study conducted on 50 osteoporotic patients with extra-articular proximal tibia fractures treated with minimally invasive proximal tibial plating vs intramedullary nailing at Department of Orthopedics, BJ medical college, Civil hospital Ahmedabad between June 2016 and May 2017. Observation and Results:Patients with intramedullary nailing had lesser duration of stay, lower cost, less infection rate, less implamt removal rate but higher malunion and union rates compared to plating patients. Operative time, time to full weight bearing and range of motion was found to be similar in both. Conclusion:Intramedullary nailing is preferred operative modality over plating because of decreased hospital stay, faster union, decreased operative time and decreased infective rate. However there was no significant difference in range of motion of knee, rate of malunion and nonunion Keywords: Proximal tibia fracture, Intramedullary nailing, Plating

Intramedullary Nailing Versus Plating for Proximal Tibia Fractures: A Systematic Review and Meta-analysis.

Extra-articular proximal tibia fractures make up to one-tenth of all tibia shaft fractures. Treatment options include conservative, nailing, plating and external fixation. There is no consensus on which method is superior if the patient is to be managed surgically. We conducted a systematic review and meta-analysis to know which definitive surgical treatment option (nailing or plating) is better for extra-articular proximal tibia fracture. We used search engines like PubMed, Embase, Scopus, Ovid Medline and Google Scholar to find articles comparing the results of nailing versus plating. We could identify only 4 articles regarding this and data was extracted and meta-analysis was done. Delayed union was common in the nailing group with odds ratio of 8.29 favoring the plating group (95% CI 1.77, 38.80, p = 0.007) while malunion showed no difference in both groups. Rate of infection was higher in the plating group while anterior knee pain was common in the nailing group with odds ratio of 5.54 favoring the plating group (95% CI 1.49, 13.88, p = 0.008). Range of motion showed no difference between both groups, fractures in the nailing group united early and the difference was significant (p = 0.005, odds ratio - 4.48) (95% CI - 8.29, - 1.47).The surgical duration was less in the nailing group but was not significant. Considering lesser time for union, early weight bearing, lower chances of infection and lesser surgical duration, nailing seems to be more promising for extra articular proximal tibia fractures.Further research is required on this topic to provide a definitive evidence.

Suprapatellar intramedullary nailing of the tibia

Objective: To report our experience with intramedullary fixation and osteosynthesis of the tibia with suprapatellar approach and semiextended positioning. Methods: This study retrospectively assessed 6 patients with tibial fracture treated with suprapatellar intramedullary nail fixation and osteosynthesis from September 2015 to September 2018. Results: There was acceptable bone fixation. Mean healing time was 6 months (range: 4-10 months). Postoperative pain was assessed using a visual analog scale, and the knee was divided into 9 quadrants to help locate the specific site of pain; all participants reported that pain was located at distal quadrants. Knee function was completely restored. Conclusion: Suprapatellar approach with the knee in the semiextended position is a good surgical technique for extra-articular proximal tibial fractures or those associated with soft tissue involvement at the conventional infrapatellar entry site. Thus, this analysis led us to believe that the technique should also be applicable to middle diaphyseal fractures or fractures in general, regardless of their location. Level of Evidence IV, Therapeutic Studies; Case Series.

A comparative study of intramedullary nailing verus minimally invasive percutaneous plate osteosynthesis for extra-articular proximal tibia fracture: A prospective study

Aims: To compare the clinical and radiological outcome of extra-articular proximal tibial fractures treated with Intramedullary Nail And Minimally Invasive Percutaneous Plate Osteosynthesis with objectives -To assess the outcome in terms of fracture union by means of clinical and radiological features and outcome after surgical procedures, complications in these two methods of treatment Methods: Our study consists of 40 cases of extra-articular proximal tibia fractures. All cases aged were more then 18 were operated at Sanjay Gandhi Institute of trauma and orthopaedics from December 2017 to June 2019.Clinical outcome was assessed through knee society score. All the cases in the study were post-traumatic. Mean duration of follow up was 6 months. Results: Out of 40 patients, 36 were males and 4 were females. Average age of the patients was 38.40 years and 38.30 years in MIPPO group and IMN group respectively. 57.5% of the patients sustained a right sided fracture and 42.5% had left sided fracture. Mean knee society score of group 1 and group 2 at all visit of follow-up i.e 1 month, 2 month, 3 month, 6 month and 12 month were not significantly different from each other. Complication in both groups was also comparable. Conclusion: Extra- articular Proximal tibial fractures can be effectively treated by interlocking intra medullary nails with multi directional locking options as well as with MIPPO with excellent results, There is no significant difference between two mode of treatment as far as early post-operative mobilization, intra operative blood loss, Hospital stay, knee society score and complication. The operative technique was simple and short. No significant difference were there in complications encountered in our study. It can be concluded that both the technique were equally effective and choice of methods depends on the surgeon own experience, setup and patient choice.

Comparison between plating by MIPPO and IMLN in proximal tibia extra-articular fractures: Our experience at a tertiary care hospital

Objective: To assess the effectiveness of the two techniques (MIPPO & IMILN) & Compare outcome.Methods: This is a Prospective, Randomized control trial involving 52 cases of extra-articular proximal tibial fractures treated either with MIPPO or IMILN in the Department of Orthopaedics, IMS and SUM Hospital, Bhubaneswar during September 2017 to September 2019. Functional outcome was calculated with Lower extremity functional scale and Knee society score and final outcome with Johner Wruhs criteria.Results: Each group had 26 cases in them, cases were followed-up for an average duration of 11.9 months. 2 cases from MIPPO group and 4 from IMILN group lost follow up. The average time to radiological union in MIPPO group was 16.1 weeks and that in IMILN group was 16.9 weeks. IMILN group had a higher rate of mal-reduction (19.1%) than MIPPO (15.4%). anterior angulation of the proximal fragment was commonest. Superficial infection occurred in 8.3% cases of MIPPO group and 4.5% in IMILN group. Non-union occurred in 1 (4.2%) and 1 delayed union (4.2%) in MIPPO group. Non- union developed in 1 case in IMILN group (4.5%) and 2 cases of delayed union (9.1%). Implant irritation was seen in 2 of our cases (8.3%) in MIPPO group. Anterior knee pain was observed in 2 patients in IMILN group (9.1%). LEFS in MIPPO was 45.8% and IMILN was 40.9%. Final outcome showed excellent result in 50% and 45.4% in MIPPO and IMILN respectively. Conclusions: If principles of treatment are correctly followed, most of cases will have excellent result with either modality of treatment.

A study of functional outcome of expert tibia nail in upper third tibia fractures

Background & Objectives: The tibia is the second longest bone of the body, located at medial side of the leg. Among all the fractures in the body, tibia is the single largest bone that is commonly involved in injuries. Owing to the increase in vehicular accidents and industrial mishaps, high velocity trauma produces tibial fractures in increasing numbers. By its location and by being subcutaneous in most of its length tibia fractures tend to be open very commonly. Due to its precarious blood supply and scanty soft tissue coverage orthopedic surgeons around the world have been fighting infections and union problems. Extra-articular proximal tibial fractures account for 5–11% of all tibial shaft fractures. This study was performed to analyze nailing for proximal tibia extra-articular fractures. Methods: In this study we studied results of expert tibia nail for extra articular proximal 1/3rd tibia fractures. For this we have taken a sample size of 20 patients. The study period was from February 2017 and to September 2018. Patients were evaluated clinically and radiologically according to modified KLEMM and Borner scoring at the interval of 6 weeks, 3 months, 6 months, 1 year and at yearly intervals. The patients were followed up in the outpatient department. Patient follow up was for a minimum of 6 months to a maximum of 24 months (2 years). Results: There were 10 male and 10 female patients. The male to female ratio of our study population was 1.2:1 having slight male predominance. In our study, patients were in the age group of 20-80 years with the mean age being 38 years. 10 patients out of 20 belonged to 21-40 year age group. Both right and left side were equally involved. Road traffic accident (75%) was most common mechanism of injury. According to Modified KLEMM and Borner Scoring System 75% patients had excellent results and rest 25% had good results in nailing. Conclusion: From this study, after counting the score with the KLEMM and Borner classification and counting the average and SD value of all sample size and after getting the p value, it has been concluded that expert nailing is better for extra articular proximal tibia fracture with good results and better functional outcome.

Comparative analysis of closed reduction and expert tibia nailing and open reduction and plate & screw fixation in the treatment of proximal tibia extraarticular fractures

Introduction: Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and Methods: 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results: Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was < 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion: In treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended.

COMPARATIVE ANALYSIS OF CLOSED REDUCTION AND EXPERT TIBIA NAILING WITH OPEN REDUCTION AND PLATE &amp; SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES

Introduction:- Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and methods:- 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results:- Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was &lt; 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion:- in treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended&#x0D; &#x0D; Key words: intramedullary nailing (IMN), Extraarticular tibialn fracture, Surgical site infection.

Analysis of proximal plating versus intramedullary nailing in the treatment of extra-articular proximal tibial fractures

Extraarticular fractures of proximal tibia has been a challenging situation to most of the surgeons today. Treatment of these injuries is extremely challenging because of the inherent unstable fracture region, difficult reduction & fixation and severely compromised blood supply at the region. For the past decades, closed reduction and minimally invasive plating and intramedullary nailing have both become widely used treatment modalities for proximal and distal tibial metaphyseal fractures. This study was performed to compare the functional and radiological results of locking compression plateosteosynthesis over intramedullary nailing. This randomized prospective clinical study was conducted on 29 patients with a closed extra-articular fracture of the proximal tibia treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) or intramedullary nailing by Tibia interlocking nail at a tertiary trauma center. Postoperative hospital stay, time to full weight-bearing, and union time were significantly less in the IMN group than in the PTP group, but there was no clear advantage of either technique in terms of operative time, infection rate, range of motion of the knee, or degrees of malunion and nonunion. Both implants have shown promising results in extra-articular proximal tibial fractures, and provide rigid fixation that prevents secondary fracture collapse.

PECULIARITIES OF INTRAMEDULLARY NAILING IN TREATMENT OF EXTRAARTICULAR PROXIMAL TIBIAL FRACTURES

From the biological and biochemical points of view closed blocking intramedullary osteosynthesis is an optimum technique for the treatment of extraarticular proximal tibial fractures. The disadvantage of the technique is the complexity of reposition achievement and maintenance. Great number of surgical methods and implants with different efficacy and safety has been proposed to solve these problems. The review presents the analysis of literature dedicated to different methods of reposition achievement and maintenance in intramedullary osteosynthesis of extraarticular proximal tibial fractures.

Comparison of intramedullary nailing versus proximal locking plating in the management of closed extra-articular proximal tibial fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To compare the outcomes of closed reduction and expert tibial nailing (ETN) versus minimally invasive proximal tibial plating in treating proximal extraarticular tibial fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study included 30 cases of extraarticular proximal tibial shaft fractures. They were admitted to our department between March 2014 and June 2016 and treated respectively by closed reduction and ETN (group A, n=15) or minimally invasive proximal tibial plating (group B, n=15). To compare the therapeutic effects between two groups, the intraoperative condition, post-operative function, related complications and malalignment were investigated.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the patients were successfully followed up till radiological union. The average union time for group A was 14.2 months and for group B was 16.7 months. 3 patients in group A developed delayed union and was treated with dynamization and ultimately lead to union whereas 1 patient developed non-union in group B. There were 3 cases of superficial infection in group B cured by antibiotics and repeated dressing change. Moreover, group A showed better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. Functional scores as calculated by the knee rating scale of the hospital for special surgery, 12 (80%) had excellent results in group A compared to 10 (66.66%) in group B which was not statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat extra articular proximal tibial fractures.&lt;/p&gt;

Application of locking intramedullary nail and locking plate in traumatic extraarticular proximal tibial fractures

Objective To investigate the application of locking intramedullary nail and locking plate in traumatic extraarticular proximal tibial fractures. Methods 150 patients with traumatic extraarticular proximal tibial fractures were chosen in the research.According to the internal fixation program, the patients were divided into observation group and control group, with 75 cases in each group.The observation group was treated with multifunctional locking intramedullary nail, the control group was treated with locking plate.After treatment for 3 months, the fracture repairing effects, blood loss, operation time, bleeding duration and adverse reaction between the two groups were compared. Results The patients were followed up after operation, the average fracture healing time of the observation group was (9.17±2.84) months, which of the control group was (9.25±2.65) months, there was no statistically significant difference between the two groups(t=0.252, P>0.05). The repairing effect of the observation group was better than that of the control group, the difference was statistically significant(u=4.341, P 0.05). Conclusion Multifunctional locking intramedullary nail can reduce the incidence rate of adverse reaction and blood loss in traumatic extraarticular proximal tibial fractures, the fracture repairing effect is better than locking plate internal fixation. Key words: Tibial fractures; Fracture fixation, internal; Bone nails

Peculiarities of intramedullary nailing in treatment of extraarticular proximal tibial fractures

From the biological and biochemical points of view closed blocking intramedullary osteosynthesis is an optimum technique for the treatment of extraarticular proximal tibial fractures. The disadvantage of the technique is the complexity of reposition achievement and maintenance. Great number of surgical methods and implants with different efficacy and safety has been proposed to solve these problems. The review presents the analysis of literature dedicated to different methods of reposition achievement and maintenance in intramedullary osteosynthesis of extraarticular proximal tibial fractures.

Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures

BackgroundProximal tibia fractures are one of the most familiar fractures. Surgical approaches are usually needed for anatomical reduction. However, no single treatment method has been widely established as the standard care. Our present study aims to compare the stress and stability of intramedullary nails (IMN) fixation and double locking plate (DLP) fixation in the treatment of extra-articular proximal tibial fractures.MethodsA three-dimensional (3D) finite element model of the extra-articular proximal tibial fracture, whose 2-cm bone gap began 7 cm from the tibial plateau articular surface, was created fixed by different fixation implants. The axial compressive load on an adult knee during single-limb stance was imitated by an axial force of 2500 N with a distribution of 60% to the medial compartment, while the distal end was fixed effectively. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis.ResultsThe maximal equivalent von Mises stress value of the system in the IMN model was 293.23 MPa, which was higher comparing against that in the DLP fixation model (147.04 MPa). And the mean stress of the model in the IMN model (9.25 MPa) was higher than that of the DLP fixation system in terms of equivalent von Mises stress (EVMS) (P < 0.0001). The maximal value of displacement (sum) in the IMN system was 8.82 mm, which was lower than that in the DLP fixation system (9.48 mm).ConclusionsThis study demonstrated that the stability provided by the locking plate fixation system was superior to the intramedullary nails fixation system and served as an alternative fixation for the extra-articular proximal tibial fractures of young patients.

Randomized controlled trial comparing outcome of intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures

Background: Extra-articular fracture of proximal tibia is one of common injury.The study is randomized controlled trial in which individuals sustaining a fracture of the proximal metaphysis of the tibia will be operatively managed by one of two strategies. The first strategy involves fixation of the fracture with a reamed, interlocking intramedullary nail (Nail Group). The second treatment strategy involves percutaneous fixation of the fracture with a locking plate (Plate Group).Objective: To compare the functional outcome of intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures in adults in terms of procedure time, time to achieve union, functional outcome, blood loss, cost of treatment, complication if any. Methods: It is randomised controlled trial study. The patients were randomized into two groups, each of size 60: Group A (IMIL group) Group B (Locking Plate group). During procedure patients were evaluated for blood loss, procedure time or any complications. Immediate post operative complications were taken into account and post operative radiological parameters measured.Results: A total of 120 patients (75 male and 45 female) were included in the study. Fifty five patients were less than 25 years age group followed by 30 patients between 25-40 yrs, 25 patients less than 25 age group and 10 patients more than 55 years. The average blood loss is 95 ml in IMIL group and 105 ml in locked plate group.Conclusion: IMIL is more expensive than percutaneous locked plates IMIL came out as a shorter surgery with little blood loss however at the same time much costlier to locked plating. Health Renaissance 2015;13 (3):

Analysis of extra articular proximal third tibial fractures treated with interlocked intramedullary nailing

Background: Fractures of the proximal third of tibia shaft have historically higher malunion rates than those of the midshaft. These fractures have been notoriously difficult to treat. With the advent of deepened understanding of the surrounding anatomy, several techniques have been developed to help maintain proper alignment without early failure or malunion. Aims and Objectives: To study the results of intramedullary interlocking nail fixation in proximal third tibial fractures. Method: A total of 20 patients were treated with intramedullary interlocking nail fixation and were followed up from 3 months to 3 years and their results were assessed according to Modified Klemm and Borner scoring system. Results: According to Modified Klemm and Borner scoring system, we had 80% excellent to fair results and 20% poor results due to delayed union or non-union at the fracture site. Conclusion: Interlocked intramedullary nailing of proximal third tibial fractures is an accepted modality of treatment. Stable and adequate intraoperative anatomical reduction is the key to early union and yields superior functional outcome.

Less invasive stabilization system versus open reduction and internal fixation of closed proximal tibial fractures in adults

Objective The aim of this study was to compare the clinical and radiological outcome between less invasive stabilization system (LISS) and open reduction with internal fixation (ORIF) for the treatment of extra-articular proximal tibia fractures through the lateral approach. Background Proximal tibial fractures present a difficult treatment challenge with historically high complication rates. ORIF has been in vogue for long time with good outcome. However, it is associated with problems, especially overlying skin conditions, delayed recovery, and rehabilitation with limited functional outcome. LISS is an emerging procedure for the treatment of proximal tibial fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods Thirty patients with closed proximal tibial fractures were included in this study. They were randomly divided into two groups. Group I (n = 15) patients were treated with LISS and group II (n = 15) with ORIF. Major characteristics of the two groups were similar in terms of age, sex, mode of injury, fracture location, and associated injuries. All patients were followed up at least 6 months. Results In each group, 12 patients showed union, two patients showed nonunion, and one patient showed delayed union. The mean operative time in LISS patients was 79.3 min, whereas in ORIF patients it was 122 min. All patients of the LISS group were exposed to radiation, whereas only 40% of patients in the ORIF group were exposed to radiation. The mean time of union in LISS patients was 10.87 weeks. However, in ORIF patients, the mean time of union was 21.13 weeks. There was no significant difference between the two groups as regards the postoperative complications. Functional outcome was satisfactory in both groups. Conclusion LISS achieves comparable results with ORIF in extra-articular fractures of the proximal tibia. Although LISS potentially has the radiation hazard, it reduces the perioperative complications with a shortened operation time and minimal soft tissue dissection.

Suprapatellar nailing of tibial fractures–Indications and technique

Intramedullary nailing is the standard procedure for surgical treatment of closed and Gustilo-Anderson Grade I-II° open fractures of the tibial shaft. The use of intramedullary nailing for the treatment of proximal metaphyseal tibia fractures is frequently followed by postoperative malalignment, whereas plate osteosynthesis is associated with higher rates of postoperative infection. Intramedullary nailing of tibial fractures is generally performed through an infrapatellar approach. The injured extremity must be positioned at a minimum of 90° of flexion in the knee joint to achieve optimal exposure of the correct entry point. The tension of the quadriceps tendon causes a typical apex anterior angulation of the proximal fragment.The suprapatellar approach improves reduction of the fracture and reduces the occurrence of malalignment during intramedullary nailing of extra-articular proximal tibial fractures. The knee is positioned in 20° of flexion to neutralise traction forces secondary to the quadriceps muscle, thus preventing an apex anterior angulation of the proximal fragment. An additional advantage of the technique is that it allows the surgeon to avoid or minimise further soft tissue damage because of the distance between the optimal incision point and the usual area of soft tissue damage.