Intramedullary Fixation Research Articles

Plate over nail and bone graft for management of tibial non union after intramedullary fixation

Abstract Non union after intramedullary nail fixation is difficult to treat. Many options are available for its management including nail exchange, bone graft while keeping the nail, nail removal and plating. Each method has its advantages and disadvantages. The aim of this study is to evaluate the results of management of tibial non union after intramedullary fixation using plate augmentation. Between January 2012 and December 2019, thirty four patients with nonunited fracture tibia previously treated with locked intramedullary nails were included in this study. The ages of patients ranged from 20 to 62 years ( an average age: 43 years). All patients were diagnosed to have aseptic nonunion. All patients achived bony union except 2. Bone union was achieved in a time ranged from 3 to 9 months (an average time 5 months). The average limb length discrepancy was 1 cm ( range 0 to 1.5 cm ). The reported complications were superficial wound infection in 2 cases, joint stiffness in 3 patients and nonunion in 2 cases. There were no intraoperative complications. All patients reported no pain at the fracture site during weight bearing at the final follow-up. We concluded that augmentation plate fixation is a good option for treatment of tibial nonunion after intramedullary nail.

METACARPAL FRACTURES TREATMENT: COMPARASION BETWEEN KIRSCHNER WIRE AND INTRAMEDULLARY SCREW.

Metacarpal fractures are common and can be treated surgically using Kirschner wires (K-wires) or intramedullary fixation with compression screws (IMCS). Analyze the postsurgical results from treating the metacarpal extra-articular fractures through the retrograde Kirschner wire technique, and compare it with the intramedullary compression screw fixation. Methods: Retrospective and quantitative studies were to analyze patients' medical records, and a postsurgical evaluation questionnaire was given to the patients, who were divided into K-wire and IMCS. The period of immobilization with a splint took six weeks for the K-wire group and four weeks for the IMCS group. The average time for consolidation took, respectively, fifty-seven days and forty-seven days. The first group could restart their activities twenty-two days after the other, and the average force value of the treated hand, when compared with its contralateral, was 93.9% and 95.4%, respectively. Between the operated hand and its contralateral, there was a difference of 16° in the total measures of the metacarpophalangeal and interphalangeal joint's range of movement among the K-wire group and 5° among the IMCS group. The patients who participated in this study showed excellent results after surgery, and both treatments were proven to be safe and reliable. Evidence level III; Retrospective comparative study .

Intramedullary fixation versus plate fixation in the treatment of midshaft clavicle fractures: a meta-analysis of randomized controlled trials.

The aim of this systematic review and meta-analysis is to assess the clinical efficacy of intramedullary fixation (IF) vs. plate fixation (PF) in the treatment of midshaft clavicle fractures. We conducted a computerized search of the electronic databases (PubMed, EMBASE, Cochrane Library, Medlineand Chinese Journal Full-text Database) from the establishment of the database to the end of November 2022. The quality of the included studies was assessed according to the Cochrane Collaboration's "Risk of bias". Comparisons between the two groups were based on 8 variables, including Constant score, disabilities of the arm, shoulder and hand (DASH) score, surgery time, length of incision, hospital stay; time to union, blood loss and infection. Thirteen randomized controlled trials (RCTs) comprising a total of 928 patients were included in our meta-analysis. The pooled results showed that IF can benefit midshaft clavicle fractures with a reduced surgery time and hospital stay, a smaller incision, a better shoulder function (DASH score), shorter time to union and lower rate of infection compared with PF. However, there was no significant difference between the two groups in terms of Constant score at 12-month follow-up. IF is superior to PF for the treatment of midshaft clavicle fractures.

Single Buried Intramedullary K-Wire Fixation in Nonthumb Metacarpal Shaft Fractures with Immediate Postoperative Mobilization without Any Immobilization.

This study aims to evaluate the outcomes of single intramedullary K-wire fixation in nonthumb, metacarpal shaft fractures with immediate postoperative hand mobilization without any immobilization. This is a retrospective case series conducted from January 2019 to December 2022. We included patients with closed, simple transverse, or short oblique metacarpal shaft fracture treated with single, 1.4 mm, intramedullary K-wire fixation. Gentle postoperative range of motion exercise was encouraged in every patient without any hand, finger, or wrist motion restriction material. Clinical outcomes were evaluated with total active flexion; grip strength; disability of arm, shoulder, and hand (DASH) score; and the American Society for Surgery of the Hand Total Active Flexion (ASSH TAF) score. This study included 34 patients, 25 males and 9 females with a mean age of 33.14 years (ranging 18-59). A total of 43 metacarpal shafts were treated. The mean DASH score at two and 6 weeks postoperative was 41.5 (ranging 19.16-60.34) and 9.58 (ranging 0.83-23.27). The mean final DASH score at last follow-up was 3.48 (ranging 0-8.33). Mean TAF at 2 weeks postoperative, 6 weeks postoperative, and at final follow-up was 203.8 (ranging 185-240), 238.2 (ranging 220-270), and 259.25 (ranging 240-270) degrees, respectively. The mean grip strength of the injured hand was 66.14 and 86.1% of the uninjured hand at 6 weeks and 3 months postoperative. There was no nonunion, malrotation, or infection. In conclusion, single intramedullary K-wire fixation gives excellent outcomes in the treatment of single or multiple, simple, metacarpal shaft fractures without the need of postoperative immobilization.

Early results of intramedullary nail fixation in distal tibia oblique osteotomy for the reduction of soft tissue complications.

During distal tibial oblique osteotomy, external fixators can increase pin site infection risk, whereas plates can cause wound necrosis, necessitating a compromise between soft-tissue position and length. We provide the first report of the early results of intramedullary nail fixation in these osteotomies for avoiding soft tissue complications. Ten ankles, classed as Takakura-Tanaka stages 3a to 4 and unclassified and treated via distal tibial oblique osteotomy for ankle osteoarthritis between 2017 and 2021, were included. Osteotomy was performed obliquely from the distal medial tibia to the tibiofibular joint. The distal tibial fragment was rotated distally in the coronal plane for realignment. An intramedullary nail fixation was applied for stabilization. The resulting gap was filled with iliac bone graft. Ankles were evaluated on the Japanese Society for Surgery of the Foot ankle-Hindfoot Scale and Self-Administered Foot Evaluation Questionnaire before surgery and at final follow-up. Radiographic assessments were performed. Bone union was achieved within 3 months in all patients. There were no cases of wound necrosis or correction loss postsurgery. Japanese Society scale scores significantly improved from 40.3 ± 15.9 to 87.5 ± 12.6 (P < 0.01). Mean self-evaluation scale scores (pain and pain-related, physical functioning and daily living, social functioning, general health and well-being) improved significantly. shoe-related scores did not change significantly but improved. There was no correction loss after surgery, with an average widening of 24.2 mm and opening angle of 22.6° at the osteotomy site. Our study showed that intramedullary nail for fixation of the osteotomy site in distal tibial oblique osteotomy effectively prevents soft tissues complications even in osteotomy sites with large openings.

Enhancing Tibial and Fibular Fracture Healing: A Case Report on the Value of Dynamization

Background: Tibial and fibular fractures, commonly resulting from high-energy traumas such as road traffic accidents, present difficulties in their management due to displacement, instability, and the requirement for surgical intervention. Case presentation: We present a 27-year-old male patient with a tibial and fibular fracture managed with intramedullary nail fixation and subsequent dynamization. The aim is to highlight the clinical significance of dynamization in addressing delayed healing and non-union in fractures. Clinical assessment and radiographic evaluation were performed to diagnose the tibial and fibular fractures. The patient underwent intramedullary nail fixation followed by dynamization. The utilization of intramedullary nail fixation demonstrated consistent outcomes with established literature. However, delayed healing and non-union were observed. The introduction of dynamization after failed healing attempts led to significant improvements in callus formation and fracture healing. Conclusions: This case emphasizes the value of dynamization as a strategy to enhance fracture healing, particularly in cases of delayed union or non-union. Dynamization represents a promising adjunctive approach in orthopedic fracture management.

Исходы хирургического лечения пострадавших пожилого возраста с переломом проксимального отдела бедренной кости

The purpose — to study the efficacy of intramedullary osteosynthesis and hip arthroplasty in the treatment of proximal femoral fractures in elderly people with various weight and height characteristics. Material and methods. A prospective analysis of the results of treatment of 181 patients aged 60 to 93 years from 2016 to 2021 was performed. We analyzed 77 cases with extraarticular fractures of the proximal femur operated on by arthroplasty and 104 cases treated by intramedullary block osteosynthesis. Conclusions. The treatment of fractures of the vertebral femur in patients with a femoral fracture should be based on intramedullary fixation with the use of a locking pin. A similar tactic is presented in the draft of the relevant Russian clinical guidelines. However, the presence of concomitant pathology in some patients (coxarthrosis on the affected side, severe osteoporosis, obesity, etc.) necessitates the inclusion of endoprosthesis in the primary surgical treatment of extraarticular fractures of the proximal femur. During treatment, increasing risks associated with the patients’ comorbid background should be considered and prevention of possible intra- and postoperative complications should be performed.

Intertrochanteric femur fractures: a current concepts review

Intertrochanteric fractures are common injuries around the hip, especially among the elderly. With the rising incidence of these injuries, they are expected to double by 2050. Incidence rates are higher in females than males and in white patients than black African patients. Osteoporosis weakens the local trochanteric anatomic support leading to an increased susceptibility to fractures. Disruption of the posteromedial calcar region results in fracture instability. Optimal lag screw position and fracture reduction are significant determinants for postoperative outcomes. The tip apex distance and reduction criteria determine lag screw cut-out risk and fracture reduction quality, respectively. A calcar-referenced tip apex distance is comparable if not better than the tip apex distance in predicting cut-out risk. Optimal reduction is in slight valgus, a positive medial cortex apposition and smooth anterior cortex apposition. High mortality rates are observed with non-surgical treatment. Surgical management is therefore the gold standard for intertrochanteric fractures. Treatment options are categorised into extramedullary fixation, intramedullary fixation and proximal femur replacement. They include the dynamic hip screw (DHS), cephalomedullary nails (CMN) and arthroplasty. Although still in use, the proximal femur locking plate is falling out of favour due to high complication rates. Fracture stability and pattern influence the treatment choice. There is, however, a growing use of CMNs which has been attributed to surgical training background. Modification of older CMN designs has improved treatment outcomes. Systematic meta-analyses of randomised controlled trials (RCTs) do not show superiority of one treatment option over another; therefore, there is no consensus on the best treatment choice. The proximal femur nail antirotation (PFNA) has better outcomes compared to other fixation options with respect to intraoperative blood loss and Harris hip scores. As a group, CMNs have a better 120-day postoperative quality of life compared to the DHS. No significant difference in complications has been found between treatment options. In light of the anticipated increased incidence of intertrochanteric fracture, more work is needed in planning national resource allocation, devising preventative methods and improving clinical interventions in South Africa. Level of evidence: Level 5

Современные импланты для остеосинтеза переломов проксимального отдела плечевой кости

Treatment of patients with fractures of the proximal humerus remains an urgent problem of modern traumatology and orthopedics. The most commonly used methods of fracture fixation are extramedullary fixation with a locking plate and intramedullary fixation with a rod. However, as many experts report, osteosynthesis with a blocking plate often causes the development of aseptic necrosis of the head of the humerus, pseudoarthrosis, and screw migration. The results of intramedullary, including antegrade, osteosynthesis with nails of the first and second generations showed a high level of complications, especially iatrogenic damage to the tendons of the rotator cuff of the shoulder. In this regard, promising studies make it possible to improve implants for both external and intraosseous osteosynthesis of complex fractures of the proximal humerus.The purpose of this work is to study implants for extramedullary and intramedullary osteosynthesis of tracheal fractures.Analysis of literature sources indexed in the Scopus, PubMed, Google Scholar, Lilacs and Cuiden databases, devoted to the study of the method of extramedullary and intramedullary osteosynthesis of tracheal fractures.In the literature review, we structured implants for intramedullary osteosynthesis of fractures of the proximal humerus based on their advantages and fixation properties.Conclusions. The problem of choosing the optimal implant for fixing fractures of a given localization will continue to be discussed among specialists. Further study of this issue will allow researchers to identify the main problems in the treatment of fractures and note promising areas of surgical treatment of such injuries.Key words: fracture, humerus, osteosynthesis, extramedullary osteosynthesis, intramedullary osteosynthesis, metal structure

Management of pediatric unstable diaphyseal both-bone forearm fractures (AO 22-D4 and AO 22-D5), A comparison between the results of intramedullary nailing using titanium elastic nail systems versus K-wires in the rural Indian children: A prospective study

Background: Forearm fractures constitute the largest group of injuries in the pediatric age group. When treating these injuries, we seek to achieve a complete union while also restoring the appropriate axis and arm length, which determine the upper limb's normal function. Intramedullary fixation (IM fixation) is becoming an increasingly common choice for fracture fixation. Aim: The aim of this study was to compare the functional and radiological results of IM nailing by Titanium Elastic Nail Systems (TENS) versus K-wire in the pediatric displaced diaphyseal both-bone forearm fracture. Settings and Design: This prospective comparative study was conducted in the department of orthopedics at a rural tertiary care center in North India from April 2016 to November 2019. Materials and Methods: In total, 44 children between the age of 8 and 12 years with displaced diaphyseal fracture of both-bone forearm either closed or open were available for follow-up and included in the study. They were divided into two groups randomly. Reduction was done under general anesthesia and fluoroscopic images. First, a close reduction was tried, and if it failed, open reduction was tried. IM fixation was done subsequently either by TENS (Group-A, n = 23) or K-wire (Group-B, n = 21). Patients were followed up for 12 months. Functional and radiological outcomes and complications were compared between both groups. Conclusions: IM nailing is a safe, effective, and valid technique in treating displaced both-bone forearm fractures in the pediatric age group. Both TENS and K-wire are equivalent in terms of clinical results, fracture union time, surgical time, or complication rates.

A pediatric forearm fracture case with delayed union, re-fracture, and COVID-19 pandemics-related surgical delay

While several complications are described after intramedullary fixation using Titanium Elastic Nails (TEN) for pediatric forearm fractures, delayed union rates are reported to be around 4%. A 12-year-old patient, who underwent TEN after a forearm fracture, was recommended to have a secondary surgery due to nonunion at the ulna after 16 weeks of follow-up. Unfortunately, the existing callus formation was lost after the patient received a second blow during the preoperative preparation process. Moreover, the family refused the operation because of the fear of the COVID-19 pandemic. The patient’s family gave consent after 35 weeks, and the patient was taken under the operation. The complete union was achieved with a full range of motion after 6 months of follow-up. In conclusion, in pediatric forearm fractures, one should be careful about the delayed union, carry out close follow-up and thorough evaluation, and secondary surgery should not be avoided when necessary.

Olecranon Fractures: A Critical Analysis Review.

Olecranon fractures account for 10% of all elbow fractures and are more likely to result from a low-energy injury. A displaced fracture with a stable ulnohumeral joint (Mayo type 2) is the most common type of injury. The management of an isolated olecranon fracture is based on patient factors (age, functional demand, and if medically fit to undergo surgery) and fracture characteristics including displacement, fragmentation, and elbow stability. Nonoperative management can be successfully used in undisplaced fractures (Mayo type 1) and in displaced fractures (Mayo type 2) in frail patients with lower functional demands. Patients with displaced olecranon fractures with a stable ulnohumeral joint without significant articular surface fragmentation (Mayo type 2A) can be managed with tension band wiring, plate osteosynthesis (PO), intramedullary fixation, or suture repair. PO is advocated for multifragmentary fractures and fractures that are associated with ulnohumeral instability. It is essential to consider the variable anatomy of the proximal ulna during surgery.

A comparative analysis of the infrapatellar and suprapatellar approaches for intramedullary nail fixation in tibia fractures

A comparative analysis of the infrapatellar and suprapatellar approaches for intramedullary nail fixation in tibia fractures

Comparative study between intramedullary kirschner wires fixation and cast immobilisation in pediatric displaced diaphyseal both bones of forearm fractures

Abstract Background Forearm fractures involving the diaphysis are the third most frequent form of fracture in paediatrics. Conservative management is associated with higher risks of complications; therefore, the author aim to compare Kirschner (K) wire fixation with conservative management. Methods 56 children with displaced diaphyseal ulnar and radial fractures were allocated and randomized into two groups at Kasr Al-Ainy University Hospital: the first group was managed by conservative management with cast immobilisation, and the second group was managed by K wire fixation. The primary outcomes were the degrees of postoperative ulnar and radial angulations, the required time of union, the limitation of movement degrees, and the functional outcomes. The secondary outcome was the rate of complications. Results K wire fixation had better significant results compared with the cast immobilisation regarding the residual radial angulation (P &lt; 0.001), ulnar angulation degree (P &lt; 0.001), the range of movement of forearm supination or supination (P = 0.003), and the functional outcome (P = 0.049); however, the time of union was significantly longer in the K wire group compared with the cast group (P = 0.003). Both groups were not significantly different in the complication rate (P = 0.163). Conclusion Cast immobilisation is safe in managing displaced diaphyseal in both bones of forearm fractures; however, K wire fixation is preferred and shows better results, especially when a good reduction cannot be achieved by conservative cast immobilisation.

Complications Following Short Femoral Nail Fixation for Intertrochanteric Hip Fractures: A Retrospective Study.

The incidence of proximal femur fractures is increasing due to aging of the population. Intramedullary nails are the mainstay of treatment for intertrochanteric hip fractures mainly due to their better biomechanical properties compared to dynamic hip screw devices, shorter operative time, and less blood loss during surgery. However intramedullary nail fixation is not devoid of complications. The purpose of this study is to look at complications related to intramedullary nailing for intertrochanteric hip fractures in a major trauma center. A retrospective study was conducted including all patients having suffered an intertrochanteric femur fracture and treated with intramedullary nails from October 1, 2020, to October 1, 2022, in the Orthopaedic Surgery Clinic. The intramedullary hip systems used were the Stryker Gamma3 Nail and the VITUS PF Nail. All complications following the postoperative period were recorded in detail. Overall, 240 patients with a mean age of 82.3 years treated with hip intramedullary devices were identified. Superior cutout of the lag screw in two patients (females 90 and 87 years old) was identified 8 and 10 weeks following initial surgery. Avascular necrosis (AVN) of the femoral head was identified in one patient (male 81 years old) which occurred 12 weeks postoperatively. All three cases were revised by replacing the nail with cemented hemiarthroplasty. Periprosthetic fractures occurred in an 88-year-old male and a 73-year-old female following an injury distal to the stem and were managed by replacing the nail with a long stem device (Long Gamma3). One case of metalwork fracture was also recorded. There are many advantages in managing intertrochanteric hip fractures with intramedullary hip devices such as shorter theater time, less blood loss, and improved biomechanical properties. However, complications such as cutout of the lag screw, AVN, and periprosthetic fracture are serious and require complex revision surgery.

Современная система интрамедуллярной фиксации вертельных переломов бедренной кости: Обзор литературы

The problem of treating patients with trochanteric fractures of the femur is relevant, due to the high incidence of fractures among the elderly due to increased life expectancy along with osteoporosis and the difficulty in choosing implants for osteosynthesis. Implants for intramedullary osteosynthesis are the method of choice for fixing such fractures. The purpose of this review: to study the advantages of implants for intramedullary osteosynthesis of trochanteric femoral fractures.The article provides an analysis of literature sources indexed in the Scopus, PubMed, Google Scholar, Lilacs and Cuiden databases, devoted to the study of the method of intramedullary osteosynthesis of trochanteric femoral fractures. The results made it possible to establish that modern intramedullary implants provide stable fixation of fragments even in osteoporosis, minimal blood loss during surgery, shortening of surgery time, early postoperative load and are safe and effective.The modern system of intramedullary fracture fixation is recognized as a highly effective method, especially in unstable trochanteric and subtrochanteric fractures of the femur, provides high antirotational stability of structures, overcomes the “Z” effect, medial migration of the cervical screw and minimally invasive intervention. Further research allows us to note the promising directions of the surgical method of treating patients with trochanteric fractures of the femur. Optimization of implants for intramedullary osteosynthesis of trochanteric fractures is a promising direction in traumatology and orthopedics.Key words: trochanteric fracture, femur, osteosynthesis, intramedullary osteosynthesis, metal structures, osteoporosis.

WEDGE FRAGMENT VARIATIONS OF TIBIAL SHAFT FRACTURES WITH INTRAMEDULLARY NAILING.

Tibial shaft fracture is the most common long-bone fracture, and the standard treatment is intramedullary (IM) nail fixation. Regardless of the development of this technique pseudoarthrosis remains prevalent. Evaluate the correlation between wedge fragment size and displacement, displacement of the main fragments of the 42B2 type, and pseudoarthrosis incidence. We retrospectively assessed all patients with 42B2 type fracture treated with IM nailing between January, 2015 and December, 2019. Six radiographic parameters were defined for preoperative radiographs in the anteroposterior (AP) and lateral views. Another six parameters were defined for postoperative radiographs at three, six, and 12 months. The Radiographic Union Score for Tibial Fractures score was used to assess bone healing. Of 355 patients with tibial shaft fractures, 51 were included in the study. There were 41 (82.0%) male patients, with a mean age of 36.7 years, 37 (72.5%) had open fractures, and 28 (54.9%) had associated injuries. After statistical analysis, the factors that correlated significantly with nonunion were wedge height > 18 mm, preoperative translational displacement of the fracture in the AP view > 18 mm, and final distance of the wedge in relation to its original anatomical position after IM nailing > 5 mm. Risk factors for nonunion related to the wedge and42B2 fracture are wedge height > 18 mm, initial translation in the AP view of the fracture > 18 mm, and distance > 5 mm of the wedge from its anatomical position after IM nailing. Evidence level III; Retrospective comparative study .

Management Outcome of an Open Intertrochanteric with Associated Neck of Femur Fracture: A Rare Case Series

Abstract Introduction: Intertrochanteric hip fractures are rare in young adults due to numerous soft tissue around the bone in the proximal femur. These fractures present a significant challenge for orthopedic surgeons in managing soft tissues, fracture reduction, fixation, and maximizing functional outcomes. Treatment of such injuries aims to prevent infection and achieve stable fixation and fracture union while reducing pain. Objective: This paper aims to present the series of open proximal femur fractures successfully managed with delayed intramedullary fixation, with a satisfactory functional and radiological outcome. Materials and Methods: Patients with an open proximal femoral fracture from Jan 2021 to Jan 2023 were evaluated retrospectively. Primary debridement was done at the earliest, and once the wound healed around 10–14 days later, definitive internal fixation by cephalo-medullary nailing was done. Patients were followed regularly at monthly intervals for 3 months, then every third month till the last follow-up at the end of 1 year to assess functional and radiological outcomes. Results: Three male patients with a mean age of 36 years with AO type 31A2.3 fracture were presented at a mean duration of 4 h, where primary debridement was done at a mean interval of 3.67 h from presentation, and the mean duration of definitive fixation was noted to be 12 days. Fracture union was noted at a mean interval of 26 weeks. There was no evidence of osteonecrosis of the femoral head after union. At the final follow-up, all patients had a VAS of 2/10 and a mean HHS of 82.6. Conclusion: In open intertrochanteric with the neck of femur fractures, delayed cephalomedullary fixation after aggressive primary debridement and after soft tissue recovery helps to decrease the risk of infection and provides the advantage of early mobilization and favorable functional and radiological outcomes.

Total Wrist Arthrodesis: An Update on Indications, Technique and Outcomes.

Painful end-stage wrist osteoarthritis (OA) unresponsive to conservative treatment is frequently managed with total wrist arthrodesis (TWA), which might render pain alleviation and ameliorate function, pain, and grip strength. Usual indications for TWA include inflammatory arthritis, idiopathic degenerative OA and posttraumatic OA, Kienböck's illness, brachial plexus palsy, cerebral paralysis, infraclavicular brachial plexus blocks and other spastic and contracture base illnesses, scapholunate advanced collapse, scaphoid nonunion advanced collapse, and failure of other surgical techniques such as after failed total wrist arthroplasty, four-corner fusion, proximal row carpectomy and severe ligament injuries (this procedure iscarried out when all other treatment alternatives have failed to control the individual's symptoms). TWA is commonly carried out with a dorsal plate fixed from the distal radius to the third metacarpal. However, other surgical procedures have been reported, including intramedullary fixation and new implants that do not cross the third carpometacarpal joint or some procedures without utilizing hardware for example using a vascularized fibular grafting In individuals with rheumatoid arthritis. TWA has been shown to give persistent and painless stability for 20 years or more. The rate of adverse events for TWA ranges from 0.1% to 6.1%, though some authors have published that it can be as high as 27%. The most common adverse events are tendon ruptures, peri-implant fractures of the third metacarpal, the need for hardware removal, and constant pain at the third carpometacarpal joint. In idiopathic degenerative OA, the reoperation rate following TWA has been reported as high as 63%. While TWA can render foreseeable pain alleviation and ameliorate function, orthopedic surgeons should remember that this surgical technique is not without its risks and that the accessibility of many surgical procedures requires orthopedic surgeons to scrupulously contemplate the risks and benefits of each alternative for the individual in front of them.

Immediate Weight Bearing as Tolerated Is Safe Following Intramedullary Fixation of Extra-articular Metaphyseal Proximal Tibia Fractures (OTA/AO 41-A).

To determine whether immediate weight bearing after intramedullary fixation of extra-articular proximal tibia fractures (OTA/AO 41A) results in change of alignment before union. Retrospective Review. Level I and Level II Trauma Center. Thirty-seven patients with 37 proximal tibial fractures, all whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 41-A2, and 19 were OTA/AO 41-A3. Intramedullary nailing of extra-articular proximal tibia fractures. Change in fracture alignment or loss of reduction. The average change in coronal alignment at the final follow-up was 1.22±1.28 degrees of valgus and 1.03 ± 1.05 degrees of extension in the sagittal plane. Twenty-five patients demonstrated excellent initial alignment, 10 patients demonstrated acceptable initial alignment, and 2 patients demonstrated poor initial alignment. Five patients demonstrated a change in alignment from excellent to acceptable at the final follow-up. No patient went from excellent or acceptable initial alignment to poor final alignment. Five patients required unplanned secondary surgical procedures. Two patients required return to the operating room for soft-tissue coverage procedures, 2 patients required surgical debridement of a postoperative infection, and 1 patient underwent debridement and exchange nailing of an infected nonunion. No patient underwent revision for implant failure or loss of reduction. Immediate weight bearing after intramedullary fixation of extra-articular proximal tibia fractures (OTA/AO 41A) led to minimal change in alignment at final postoperative radiographs. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.