Distal Tibial Fractures Research Articles

Tibial pilon fracture treatment with staged open reduction and internal fixation with LCP versus primary hybrid fixation: A randomized prospective study

Introduction: Distal tibial fractures remain one of the most substantial therapeutic challenges for orthopedic traumatology. Despite the advances that have been made in management, these fractures can be challenging to deal with, especially when associated with significant soft-tissue injury. Treatment of pilon fractures ranges from nonoperative to various operative options. Among operative, the two most controversial methods include the Staged procedure using open reduction internal fixation and using a primary hybrid fixator. Objective: This study aims to compare the outcomes of tibial pilon fracture treatment with staged open reduction and internal fixation with LCP and primary hybrid fixation and evaluate its results. Material & Methods: This Prospective Randomized comparative study was done in a tertiary level health care center. The patients were included in the study after fulfilling inclusion and exclusion criteria. The patients were then randomized in either of the two groups and treated accordingly by a single orthopaedic surgeon to avoid the bias. Follow-up was done after 3 weeks and then reviewed every one month up to 6 months. At 6 months IOWA score was assessed. Fracture union was assessed based on clinical and radiographic criteria. Clinically the ability to fully weight bear with no pain at the fracture was considered to represent the clinical union. Results: According to the IOWA ankle score, 32% in group A and 40% in group B had an excellent results, 40% in group A and 52% in group B had a good results, 20% in group A and 8% in group B had a fair result and 8% had a poor result in group A due to deep infections (osteomyelitis) in bone. The mean IOWA Ankle Score at the Final follow-up in Group A was 82.64±10.27 and of Group B was 86.96±5.07, which was non-significant. In terms of functional results, the excellent result was observed in 8 patients in Group A and 10 in Group B. Conclusion: The management of pilon fracture with both of them procedure were equally effective, but aims was to reduce surgical tissue trauma, deep infection and preservation of periosteal vascular integrity and osteogenic fracture haematoma all cause early union, which was much more possible by hybrid fixator group.

Functional outcome of distal tibia fracture fixation with locking compression plate (LCP) using MIPO technique in a tertiary care hospital in eastern India

Background: The precarious blood supply and the scarcity of soft tissue envelope and the proximity to ankle joint makes the treatment of distal tibia fractures challenging. Over the years multiple modalities ranging from conservative measures to surgical interventions have been marred by an array of complications. Minimally Invasive Plate Osteosynthesis minimises soft tissue compromise while maintaining vascular integrity of the fractured fragments and the preserves the osteogenic haematoma. While using locking compression plate allows uncomplicated fracture healing and early return to function by providing a rigid biomechanical construct. Methods: A total of 32 patients with distal tibial fractures treated by MIPO technique with LCP fixation were studied from August 2017 to May 2019 and were followed up at regular intervals for a period of 36 weeks. Result: All fractures united within a range of 14-24 weeks and the mean time of radiological union/ weight bearing was 16.72 weeks. Superficial skin infection was observed in two patients (5.5%) which settled down well with antibiotics and antiseptic dressing. Conclusion: MIPO technique using LCP offers an attractive option for the management of closed fractures of the distal tibia while preserving the blood supply of soft tissue and bone as compared to the other treatment options. This study recommends its usage in such complex injuries.

Clinical Results and Technical Note of a Novel Therapeutic Method for Distal Tibial Fracture: A Multicenter Prospective Study on the Use of the Distal Tibial Nail

Clinical Results and Technical Note of a Novel Therapeutic Method for Distal Tibial Fracture: A Multicenter Prospective Study on the Use of the Distal Tibial Nail

Purposive bone shortening––a technique which aided soft-tissue coverage in a Grade III Gustillo–Anderson Open Distal Third Leg Fracture: A case report and treatment strategy

Problems faced in open fractures of the distal third tibia are usually associated with soft-tissue coverage, infection control, and union of the bone. Tibia is commonly associated with impaired healing if soft tissues are severely damaged. Not all cases can be treated with flaps due to its unavailability in acute settings, high learning curve, and cost. We present the outcomes of a case of an open Grade III-B Gustillo–Anderson distal tibia fracture treated with debridement and deliberate bony shortening which helped in primary closure of the wound. A 61-year-old gentleman, a known hypothyroid, had an alleged history of accidental cut injury over right lower limb by a machine used for cutting trees. He sustained a 7 cm × 4 cm laceration over the anteromedial aspect of the distal tibia with blown-out soft tissues and bone exposed. Wound debridement and stabilization with ankle spanning external fixation were immediately done. Wound could be primarily closed because the tibia and fibula were deliberately shortened during the external fixation. Many free bone fragments were removed during debridement leaving a bony void. One week later bone graft was used to fill the void after redebridement of the wound and wound could be primarily closed. Negative wound therapy was used as an adjuvant. One month later the external fixator was converted to Ilizarov fixator, which was removed at the end of 5 months, showing a fully healed fracture without soft-tissue complications at the end of 6 months follow-up. Debridement and shortening of the open tibia is a powerful technique to provide bony apposition and allow primary wound closure without tension, averting the need for any secondary reconstructive procedures.

Regional Anesthesia Decreases Early Perioperative Opioid Demand but Increases Late Opioid Demand in Ankle and Distal Tibia Fracture Surgery

Category:Ankle; TraumaIntroduction/Purpose:Regional anesthesia (RA) is commonly used in ankle and distal tibia surgery. However, the pragmatic effects of this treatment on inpatient and outpatient opioid demand are unclear. The hypothesis was that RA would decrease inpatient opioid consumption and have little effect on outpatient opioid demand in patients undergoing ankle and distal tibia fracture surgery.Methods:All patients ages 18 and older undergoing ankle and distal tibia fracture surgery at a single institution between 7/2013 and 7/2018 were included in this study (n=1,310). Inpatient opioid consumption (0-72 hours post-operative) and outpatient opioid prescribing (1-month pre-operative to 90-days post-operative) were recorded in oxycodone 5-mg equivalents (OE's). Adjusted models were used to evaluate the impact of RA on inpatient and outpatient opioid demand.Results:Adjusted models demonstrated decreased inpatient opioid consumption in patients with RA (12.1 estimated OE's without RA vs 8.8 OE's with RA from 0-24 hours post-op, p<0.001) but no significant difference after that time (9.7 vs 10.4 from 24-48 hours post-op, and 9.5 vs 8.5 from 48-72 hours post-op). Estimated cumulative outpatient opioid demand was significantly increased in patients receiving RA at all timepoints (112.5 OE's without RA vs 137.3 with RA from one-month pre-op to two- weeks, 125.6 vs 155.5 OE's to 6-weeks, and 134.6 vs 163.3 OE's to 90-days, all p-values for RA <0.001). Figure demonstrates a histogram of the inpatient opioid consumption in patients with and without RA.Conclusion:In ankle and distal tibia fracture surgery, RA was associated with decreased early inpatient opioid demand but significantly increased outpatient opioid demand after adjusting for baseline patient and treatment characteristics. These findings provide information on the real-world impact of RA and temper enthusiasm for perioperative nerve blockade.

Study of a novel economical method of surgical management of complex distal tibia fractures with hybrid external fixator

Background and Objectives: Fractures of the distal tibia, especially complex open fractures have been historically difficult to manage due to the poor soft tissue envelope around the bone and the precarious blood supply. In this study, we aim at devising an economical model of a hybrid external fixator for complex distal tibia fractures by using reused Ilizarov rings and A O rods after adequate methods of sterilization and study the functional outcome, time to union and complications associated with it.Objectives: To devise an economical model of hybrid external fixator for the management of complex distal tibia fractures and to study the Functional outcome, Time to union and associated complications.Methods: Total 16 patients with complex distal tibia [AO type 43(A1-A3, B1-B3, C1-C3)] fractures were treated in our institution with an economical model of hybrid external fixator using reused Ilizarov rings and A O rods after adequate methods of sterilization between June 2019 to December 2021. Patients were followed up every 6 weeks till 6 months and then at the end of 1 year. Patients were evaluated for functional and radiological outcome using the Ovadia and Beals scoring criteria. Time to union and Immediate and late complications were analyzed.Results: Total 16 patients were evaluated postoperatively for functional and radiological outcome using Ovadia and Beals criteria which showed 3 patients (18.75%) had well to excellent and 13(81.25%) patients had fair outcome. The average duration for fracture union was 33.25 weeks. 6(37.5%) patients had pin tract infection which was treated with adequate antibiotics and pin tract care. No deep infections were noted. There were 7(43.75%) cases of joint stiffness, 5(31.25%) cases of mal union and 2(12.5%) cases of delayed union. Reusing the non invasive components of the fixator helped us in reducing the overall operating cost of the surgery by 35-40%.Interpretation and Conclusion: In our study, we found that reusing the non invasive components of a hybrid external fixator is an economical treatment option for complex distal tibia fractures when combined with minimal internal fixation of fibula fracture, adequate antibiotic coverage, wound and pin tract care and aggressive physiotherapy.

Comparative Study of Minimally Invasive Percutaneous Plate Osteosynthesis versus Reamed Intramedullary Nail Fixation for Extra Articular Distal Third Tibial Fractures

Introduction: Extraarticular distal third tibial fractures are highly controversial and difficult to treat despite of numerous methods of fixation. The most common methods of treating these fractures are minimally invasive percutaneous plate osteosynthesis (MIPPO) and reamed intramedullary nailing (RIMN). Aims: The aim of this study is to compare and assess its demographic status, preoperative status and functional outcomes of these two groups of patients with extraarticular distal third tibial fractures. Methods:This prospective hospital based observational study of 36 patients with extra articular distal third tibial fractures was carried out from January 2018 to January 2021 at Nepalgunj Medical College Teaching Hospital, Kohalpur. Thirty-six patients were included in the study and were divided into two groups of 18 each and were treated with MIPPO and RIMN methods and were followed up regularly. Clinical and functional outcome were evaluated at 12 months. Results: Out of 36 patients 20 were male and 16 were female. Mean age was 37.63with SD ± 11.43 years. Twenty two were right sided and 14 were left sided. Mean duration of surgery in MIPPO group was 75.33 with SD ± 14.64minutes and in RIMN group was 98.33with SD ± 18.96 minutes. There were 24 cases of associated fibular fractures. Two cases of surgical site infection and two cases of K-wire impingement on fibular side were encountered in MIPPO group whereas three cases of postoperative blisters were seen in RIMN group. All fractures united. The mean average time for fracture healing in MIPPO group was 25.55 weeks and in RIMN group was 27.55 weeks. The clinical and functional outcome were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) scoring system, the mean score in MIPPO group was 91.22 and in RIMN group was 90.77. Conclusion: There was a good outcome in MIPPO group than RIMN group for extra articular distal third tibial fractures.

EVALUATION OF FUNCTIONAL OUTCOME OF DISTAL TIBIAL FRACTURES STABILIZED WITH DISTAL TIBIAL LOCKING PLATE

Background: The present study is an attempt to evaluate the results of locking compression plate for distal tibia in lower tibial fractures using open reduction internal fixation and minimally invasive plate osteosynthesis technique.&#x0D; Methods: The patients attending the OPD/Emergency OPD in post graduate institute of medical education and research, chandigarh during September 2018 to August 2019 with distal tibial fractures. The patients treated with locking compression plates using MIPO or ORIF are reviewed for inclusion and exclusion criteria’s. Patients fitting into inclusion criteria has formed the study group.&#x0D; Results: Out of 52 patients, 48.4% patients undergo open reduction internal fixation had excellent results and 28.6% patients undergo MIPPO technique had excellent results. p value is 0.352 which is not significant. Overall 40.4% patients had excellent results.&#x0D; Conclusion: We observed excellent/ good functional outcome in 65.3% of patients.&#x0D; Keywords: Functional outcome, MIPPO, Tibia

Feasibility of Machine Learning and Logistic Regression Algorithms to Predict Outcome in Orthopaedic Trauma Surgery.

Statistical models using machine learning (ML) have the potential for more accurate estimates of the probability of binary events than logistic regression. The present study used existing data sets from large musculoskeletal trauma trials to address the following study questions: (1) Do ML models produce better probability estimates than logistic regression models? (2) Are ML models influenced by different variables than logistic regression models? We created ML and logistic regression models that estimated the probability of a specific fracture (posterior malleolar involvement in distal spiral tibial shaft and ankle fractures, scaphoid fracture, and distal radial fracture) or adverse event (subsequent surgery [after distal biceps repair or tibial shaft fracture], surgical site infection, and postoperative delirium) using 9 data sets from published musculoskeletal trauma studies. Each data set was split into training (80%) and test (20%) subsets. Fivefold cross-validation of the training set was used to develop the ML models. The best-performing model was then assessed in the independent testing data. Performance was assessed by (1) discrimination (c-statistic), (2) calibration (slope and intercept), and (3) overall performance (Brier score). The mean c-statistic was 0.01 higher for the logistic regression models compared with the best ML models for each data set (range, -0.01 to 0.06). There were fewer variables strongly associated with variation in the ML models, and many were dissimilar from those in the logistic regression models. The observation that ML models produce probability estimates comparable with logistic regression models for binary events in musculoskeletal trauma suggests that their benefit may be limited in this context.

Outcome of Minimally Invasive Plate Osteosynthesis in Distal Tibial Fractures

Outcome of Minimally Invasive Plate Osteosynthesis in Distal Tibial Fractures

Management of distal tibial fractures by Ilizarov fixator with or without minimal internal fixation

Management of distal tibial fractures by Ilizarov fixator with or without minimal internal fixation

Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking

ObjectivesRetrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology.MethodsSix Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations.ResultsThe removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading.ConclusionsThe DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.

Long-Term Incidence of Total Knee Arthroplasty after Open Reduction and Internal Fixation of Proximal Tibial and Distal Femoral Fractures: A Nationwide Cohort Study

Knee fractures often require open reduction internal fixation (ORIF) for knee function recovery. More than one fifth of patients with knee fractures subsequently develop posttraumatic arthritis, and over 5% of them need total knee arthroplasty (TKA). We conducted this nationwide retrospective cohort study using the data of 2,000,000 people in the general population who received TKA and were followed up in the 17-year period 2001–2017, through random sampling of the Taiwan National Health Insurance Research Database. We matched the ORIF and non-fracture groups by a propensity score, based on age, sex, index date of surgery, and comorbidities enrolled in CCI calculated at a 1:1 ratio. The average proportion of subjects receiving TKA after ORIF for distal femoral or proximal tibial fractures was 2.0 per 1000 person-years, which was significantly higher than that in the non-fracture group. Patients aged 20–65 years and males represented a significantly higher proportion of subjects receiving TKA after ORIF than that in the non-fracture group. The proportion of subjects receiving TKA for the 20–65-year subgroup of the ORIF group was 4%, and that for the male subgroup was 1.5%; both rates increased over the 17-year follow-up period. More aggressive intraoperative and postoperative adjuvant therapies may be necessary for these subgroups.

Unusual Occurrence of Incarceration and Breakage of the Coiled Shaft of the Intramedullary Reamer during Closed Intramedullary Nailing of Tibia.

Introduction:Intramedullary (IM) nailing is a well-established method of treating closed tibia shaft fracture. We hereby describe an unusual incidence of the incarceration of the flexible IM reamer in the distal fracture fragment with breakage of the coiled shaft of the reamer in the proximal third of tibia during closed IM nailing. This case report highlights the usefulness of making a small window in the tibia to aid retrograde removal of incarcerated reamer.Case Presentation:A 26-year-old male patient had road traffic accident and sustained a close fracture of the right distal 3rd tibia along with segmental fracture of the adjacent fibula. The tibia nailing was done under combined spinal and epidural anesthesia. The proximal tibia was approached by a midline incision with splitting of the patellar tendon. The reduction of the fracture fragments was done and the guide wire was inserted. The medullary canal was narrow and hence the initial reaming was started with the smallest available, that is, 8 mm reamer. After crossing the fracture site, we noticed that reamer coiled shaft got broken into multiple pieces in the medullary cavity at proximal 3rd tibia. The fracture site was exposed and a linear osteotomy was done in distal tibial fragment. Through this window, the broken reamer was pushed in the retrograde manner and was delivered out. Most of the broken metal pieces of the reamer shaft were removed with pituitary rongeur. An 8 mm solid IM nail was passed in antegrade manner across the fracture site and was locked distally and proximally. The operative wounds were irrigated and closure was done in layers. The patient was allowed partial weight bearing at 3 weeks post-surgery with gradually progressing to full weight bearing at 10 weeks after confirming clinical and radiological union.Conclusion:To handle this unusual occurrence one needs to stay calm, make a small window to aid retrograde removal of reamer and remove the fragmented pieces of the coiled shaft of the reamer. In tight medullary canal, it is desirable to have smaller diameter reamers, that is, 6 mm during the surgery.

Peripheral Nerve Stimulator for Treating Sural and Posterior Tibial Neuralgias – Case Report

BACKGROUND: Sural neuralgia is persistent pain in the distribution of the sural nerve that provides sensation to the lateral posterior corner of the leg, lateral foot, and fifth toe. Sural neuralgia is a rare condition, but can be challenging to treat and cause significant limitations. Posterior tibial neuralgia, also known as tarsal tunnel syndrome, is an injury or stretch affecting the tibial nerve at the medial border of the ankle and heel. We present one case of sural neuralgia complicated by superimposed posterior tibial neuralgia resistant to conservative management that were effectively treated with a peripheral nerve stimulator placement. CASE REPORT: A 60-year-old man developed sural and posterior tibial neuralgias after a motorcycle accident resulting in severe injury of his left lower extremity. He underwent surgery for his open left distal tibia fracture. The patient continued to have pain which was not alleviated with physical therapy and conservative management. Six years after the initial injury and failing conservative management, he underwent successful sural and posterior tibial nerve blocks followed by placement of a peripheral nerve stimulator with improvement in pain and daily function. CONCLUSIONS: Peripheral nerve stimulators may be a safe and effective treatment for both sural and posterior tibial neuralgias that do not respond to conservative therapy. However, large scale studies are needed to elucidate its effectiveness and safety profile. KEY WORDS: Peripheral nerve stimulator, posterior tibial neuralgia, sural neuralgia

Distal Tibial Fractures Managed by Minimally Invasive Plating Osteosynthesis: A Prospective Study

Background: Distal tibial fracture is a common results of road traffic accidents and fall injuries. The treatment of tibial fractures is very important and this bone is very subcutaneous associated with soft tissue injury and precarious blood supply. Distal tibial fractures require accurate reduction, followed by perfect articular reduction then stable fixation with minimally stripping of soft tissues. Aim: Distal tibial fractures managed by minimally invasive plating osteosynthesis: a prospective study. Methodology: The prospective study was taken in GMC Jammu from 2019 -2020 in Department of Orthopaedics. All patients are approved by the ethical clearance of the same hospital from 2019-2020. 32 cases of the distal tibial fracture is were admitted according to which twenty two male and ten females. All the necessary data collected and reported to separate sheets. Results: In our study two age group were taken 19-40 and 41-60. About 19-40 group was majority in fractures distal tibia. In our observation around 22 males and around 10 females were noted. Around 68.7% were males and around 31.2% were females they were affected. In our observation closed or open fractures is noted and around 75% (24) patients are closed and 25% (8) patients were open. In our observation AO/OTA classification 43-A1 is the most common classification which was around 65.6% (21) patients then 43-A2 is the 15.6%, 43-A3 is about 12.5% and 43-B1 is around 6.2%. Conclusion: In our study it is concluded that all the fracture are due to road traffic accidents and fall from height. In our patients around superficial infection, varus angulation and implant failures are very less and similar to other studies done by other authors. Soft tissues handling and the minimally invasive plating osteosynthesis (MIPPO) allows early rehabilitation and excellent functional outcome. Keywords: disital tibia, MIPPO, closed fractures.

Determining your implant: Templating a nail for the distal tibia fracture

The goal of this article is to aid the orthopedic surgeon in determining whether an intra-medullary (IM) device for fixation of a distal tibia fracture is feasible. Using Computed Tomography (CT) scans of the fracture, this review demonstrates a simple way to determine whether two or even three distal interlocking screws are achievable in stable bone. Additionally, this paper offers a summary chart of commonly used tibial nails which can be used for planning purposes. Finally, a clinical summary of very distal tibial shaft fractures treated with IM fixation is provided.

AO external fixator for definitive treatment of an open distal tibia fracture during the COVID-19 pandemic

BackgroundThe accepted gold standard for primary treatment of long bone open fractures consists of aggressive debridement, irrigation and temporary external fixation. Removal of the external fixator followed by definite internal fixation is recommended within the first two weeks after the injury to obtain a more stable fixation, alleviate rehabilitation and to avoid pin infection. Materials & MethodsHere, we report a case of a Gustilo IIIB open tibia fracture with extended soft tissue degloving of the distal tibia. Following removal of the AO external fixator, plate fixation and soft tissue coverage with a free flap, implant loosening occurred warranting a return to external fixation. The patient did not return for follow-up due to a prolonged COVID-19-quarantine and no further treatment was installed. Results & ConclusionsThe patient returned after 6 months with the fractures and soft tissues fully healed. In specific situations, the external fixator may be used as a definitive form of treatment.

A STUDY ON OUTCOME OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN EXTRA ARTICULAR FRACTURE OF DISTAL 1/3RD TIBIA.

BACKGROUND: Fractures of the distal tibia can be challenging to treat because of the limited soft tissue, the subcutaneous location, and poor vascularity. There is a considerable debate regarding the best method for treating distal tibial fractures. In present study we have treated distal tibial fractures using MIPPO technique OBJECTIVES: To evaluate the functional outcome following use of MIPO technique in lower 1/3rd fractures of tibia. MATERIAL AND METHODS: This is a longitudinal follow up study. In this study a total of 30 patients with fracture distal 1/3rd tibia admitted to CMRI hospital will be selected for treatment with MIPO technique according to inclusion and exclusion criteria. All patients were reviewed in CMRI Hospital and radiographs (Tibia AP and lateral views) obtained after surgery and then at 1 month, 3 months and nally at 6 months. From 5 weeks onwards symptoms and functions will be assessed using the scoring system of Olerud and Molander(1984). Statistical analysis of categorical variables was expressed as number of patients and percentage of patients and continuous variables are expressed as descriptive statistics. The statistical software SPSS version 20 has been used for the analysis. RESULTS: The age of patients ranged from 22-65 years. Fracture was most common in 4th and 5th decade of life. Average mean age was 44.03±10.74yrs. In this study majority of 17(56.7%) patients were male and there were 13(43.3%) were female. Road Trafc accident (RTA) was the main cause to produce lower end tibia fractures (83.3%) in our study. In this study right side (60%) was involved more than left (40%). In this study only 3 (10%) patients had open grade 1 injury. Majority of patients 27 (90%) had closed injury. In our study 66.67% (20) of patients had associated injuries and 33.33% patients had no associated injury. Average injury operation interval in this study was 3.27±1.53 days. Average no. of plate holes were 10.50±1.72. Average duration of hospital stay in this study was 10.07±2.75 days. Average duration of surgery in this study was 88.03±16.36 minutes. In this study 26 patients (86.7%) had no early post-op complications and 4 (13.3%) had complications. 3 patients (10%) had delayed wound healing and 1patient (3.3%) had supercial infection of suture lines. There was 1 non-union and majority of patients 21(70%) took 20-25 weeks for union. 7(23.4%) patients took less than 20 weeks and 1(3.33%) patient took more than 25 weeks. Average time of union in this study was 21.17±2.17 weeks. Average time of weight bearing was 17.72±1.91 weeks in this study. Most frequent late complication seen was swelling with frequency of 7 followed by stiffness and pain. 1 patient had malunion and 1 patient had non-union. In this study there were 28(93.3%) patients which showed union, 1 (3.3%) patient showed coronal malunion and 1(3.3%) had non-union. There were 21 patients (70 %) with excellent result, 7 patients (23.3%) with good result and 2 patients (6.7%) with fair result in our cases of study. Average clinical Olerud &amp; Molander score was 81.17±16.07 in this study. CONCLUSION: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in peri-articular fractures. Biological xation of complex fractures gives stable as well as optimal internal xation and complete recovery of limb function at an early stage with minimal risk of complications.

Angular stable locking in a novel intramedullary nail improves construct stability in a distal tibia fracture model

IntroductionIntramedullary nails are frequently used for treatment of unstable distal tibia fractures. However, insufficient fixation of the distal fragment could result in delayed healing, malunion or nonunion. Recently, a novel concept for angular stable nailing was developed that maintains the principle of relative stability and introduces improvements expected to reduce nail toggling, screw migration and secondary loss of reduction. The aim of this study was to investigate the biomechanical competence of the novel angular stable intramedullary nail concept for treatment of unstable distal tibia fractures, compared to a conventional nail locking in a human cadaveric model under dynamic loading. Materials and methodsTen pairs of fresh-frozen human cadaveric tibiae with a simulated AO/OTA 42-A3.1 fracture were assigned to 2 groups for reamed intramedullary nailing using either a conventional (non-angular stable) Expert Tibia Nail (ETN) with 3 distal screws or the novel Tibia Nail Advanced (TNA) system with 2 distal angular stable locking low-profile retaining screws. The specimens were biomechanically tested under conditions including initial quasi-static loading, followed by progressively increasing combined cyclic axial and torsional loading in internal rotation until failure of the bone-implant construct. Both tests were monitored by means of motion tracking. ResultsInitial nail toggling of the distal tibia fragment in varus and flexion under axial loading was lower for TNA compared to ETN, being significant in flexion, P = 0.91 and P = 0.03. After 5000 cycles, interfragmentary movements in terms of varus, flexion, internal rotation, axial displacement, and shear displacement at the fracture site were all lower for TNA compared to ETN, with flexion and shear displacement being significant, P = 0.14, P = 0.04, P = 0.25, P = 0.11 and P = 0.04, respectively. Cycles to failure until both interfragmentary 5° varus and 5° flexion were significantly higher for TNA compared to ETN, P = 0.04. ConclusionFrom a biomechanical perspective, the novel angular stable intramedullary nail concept provides increased construct stability and maintains it over time while reducing the number of required locking screws without impeding the flexibility of the nail itself and resists better towards loss of reduction under dynamic loading, compared to conventional locking in intramedullary nailed unstable distal tibia fractures.