Intramedullary Nailing Of Tibia Research Articles

Functional outcome of distal third Metaphyseal Tibial fractures operated with reamed Intramedullary Tibia Nailing: Two versus three distal locking screws

Introduction: Fractures of the distal metaphysis of the tibia can be nailed if a sufficient amount of bone is available distal to the fracture site to insert two or three locking screws. However, fractures in this region operated with nail fixation provide less stability as a result of metaphyseal flare, which reduces the contact between the nail and the endosteal surface. Aim: The purpose of this retrospective study was to assess the union and complications associated with distal third tibial fractures which were operated with reamed tibia nail with two versus three distal locking screws. Materials & Methods: The study was carried out between 2017-2019 in which fifty-seven patients were included in the study. In 25 patients 2 distal screws were inserted and in 32 patients 3 distal screws. Patients were followed up to the tibial fracture union (5–12 months with a mean of 7 months). Results: Our results showed, 4% of delayed unions in distal third fractures with two distal screws compared to 3.12% who had three distal screws. This is statistically insignificant (p>0.01). None of the patients developed non-union nor had screw breakage and residual ankle or knee pain. Conclusion: Our study showed that there was no statistically significant difference in the time taken for radiographic union and complications such as delayed union and non-union in distal third tibia fractures operated with tibia nailing when two or three distal locking screws were used. Therefore, we conclude that two distal locking screws are a necessity and three are a luxury. The increased distal locking screws do not influence the fracture union.

Evaluation of Arm Length as a New Upper Limb Anthropometric Method for Preoperative Estimation of Tibial Intramedullary Nail Length.

Aim and objectiveTo assess the use of arm length (AL) for the estimation of tibial nail length preoperatively and compare its accuracy to various established upper and lower limb anthropometric parameters.Material and methodsThis prospective study of 54 patients assessed upper limb parameters as a possible alternative for intraoperatively measured tibial nail length. The anthropometric parameters measured independently by two observers were AL, olecranon to fifth metacarpal head (OMD), tibial tuberosity to medial malleolus (TT-MM), tibial tuberosity to medial malleolus minus 20 mm (TT-MM-20 mm) and knee joint line to medial malleolus minus 40 mm (KJL-MM-40) and compared to final nail size used intraoperatively. Two observers were used. Bland-Altman plots were constructed to assess the limits of agreement to intraoperative estimates of optimum nail length. A repeatability assessment was also assessed by both observers.ResultsNone of the anthropometric parameters showed limits of agreement within ±10 mm of nail length. AL showed the least average difference and best limits of agreement among all the anthropometric parameters. Among the lower limb parameters, the KJL-MM showed the least average difference but poorer limits of agreement to nail length. The OMD measurement showed a greater average difference than the AL indicating it is a poorer upper limb parameter for predicting nail length.ConclusionAL as measured between the angle of the acromion to the lateral epicondyle can be used as a preoperative upper limb anthropometric estimate of nail length to one nail size of the optimum length. Further studies with a larger sample size may reduce the confidence intervals and help justify its wider use.How to cite this articleSharma A, Sinha S, Gupta S, et al. Evaluation of Arm Length as a New Upper Limb Anthropometric Method for Preoperative Estimation of Tibial Intramedullary Nail Length. Strategies Trauma Limb Reconstr 2021;16(1):20–26.

Semi-extended intramedullary nailing of the tibia using an infrapatellar approach: a retrospective cohort study.

The semi-extended tibial intramedullary nailing method would enable easier and improved reductions for tibial fractures as well as facilitate fluoroscopic imaging; however, its in-articular nature remains controversial. The aim of this study was to compare the clinical and functional outcomes of the semi-extended infrapatellar (SEIP) approach and hyper-flexed infrapatellar (HFIP) approach for intramedullary nailing to treat tibial shaft fractures. This study involved the retrospective analysis of the medical records of patients with tibial shaft fractures that were fixed through either the SEIP approach or the HFIP approach of intramedullary nailing and who were admitted to a level 1 trauma centre. The minimum patient follow-up period was 12 months and the clinical and functional outcomes were estimated at the 12-month visit. Of the 80 patients whose medical records were analyzed, 40 (50%) underwent SEIP nailing and the remaining 40 (50%) underwent the traditional HFIP nailing. Compared with the HFIP group, patients in the SEIP group had a higher Lysholm knee score (median, 92 [interquartile range, 88-95] vs median, 88 [interquartile range, 81-92]; p = .01), a shorter intra-operative fluoroscopy time (median, 93 [interquartile range, 78-105] s, vs median, 136 [interquartile range, 110-157] s; p < .001), and operation time (mean, 88.1 [SD, 17.8] min vs mean, 98.7 [SD, 19.3] min; p = .01). The VAS score was significantly lower in the SEIP group (median, 0; interquartile range, 0-0) than in the HFIP group (median, 0; interquartile range, 0-2) (p = .03). There were two cases (5%) in the SEIP group and 10 cases (25%) in the HFIP group of moderate AKP (p = .03). Meanwhile, there was no significant difference in malalignment, nonunion, delayed union, infection, and other complications, as well as SF-36 physical and mental scores. We found that the SEIP approach to tibia intramedullary nailing was superior to the HFIP approach based on the intra-operative and post-operative outcomes. Thus, this novel technique provides an infrapatellar option for semi-extended tibial nailing.

A comparison of anterior knee pain, kneeling pain and functional outcomes in suprapatellar versus infrapatellar tibial nailing.

Anterior knee pain and kneeling pain are some of the most common complications following intramedullary nailing of tibial shaft fractures. With the increased uptake of suprapatellar nailing at our institution, we undertook a service evaluation to assess anterior knee pain and kneeling pain in patients who underwent the suprapatellar tibial nailing technique compared with the infrapatellar approach. Data from all consecutive intramedullary tibial nailing operations between January 2014 and July 2017 were analysed from a prospectively collected database. All acute diaphyseal fracture nailing procedures were included. All patients were reviewed between six-month and four-year post-operation. Each patient was asked to complete a standardised questionnaire with three main outcome measures: pain on kneeling, presence of anterior knee pain and the severity of pain. After exclusions, a total of 148 patients were identified. A total of 102 responses were received, 41 in the infrapatellar group (73.2%) and 61 in the suprapatellar group (66.3%). A longer time from surgery to telephone follow-up response was noted in the infrapatellar group: 32.4months (interquartile range, 16.1) vs. 19.3months (interquartile range, 17.4), p < 0.001. A trend towards lower reported anterior knee pain was noted in the suprapatellar group (67.9% VS 53.7%). Most patients reported mild or no pain on kneeling, with no significant difference between the two groups. There was also no significant difference in severity of knee pain between the two groups and no significant effect on the Kujala score. With the comparable pain outcomes between the two groups, our analysis supports the continued use of the suprapatellar tibial nailing technique for tibial shaft fractures at our institution.

Increasing the Educational Value of the Orthopaedic Subinternship: The Design and Implementation of a Fourth-Year Medical Student Curriculum.

Introduction:Most orthopaedic subinternships function as month-long interviews. These rotations remain relatively unstructured and lack standardization, and their overall educational value has been called into question. The goals of this educational initiative were to create a structured subinternship curriculum for orthopaedic applicants and to shift the focus of the subinternship from a month-long interview to an organized educational experience.Methods:After review of knowledge and skills expected for early orthopaedic residency under the structure of the Accreditation Council for Graduate Medical Education Milestones, a curriculum dedicated to orthopaedic subinternships was created. Students who completed the curriculum filled out anonymous Likert scale evaluations (rating their comfort/knowledge from 0 to 10 before and after their rotation) and answered open-ended qualitative questions.Results:Forty-six subinterns participated in the program over 3 years. Four weekly learning modules were designed and taught by orthopaedic residents, with faculty oversight of content and structure. Each monthly rotation began with an orthopaedic surgical skills laboratory and concluded with a case-based oral presentation. Weeks two and three covered different milestone-based topics and included didactic and skills development. Data analysis revealed that students reported notable improvement in knowledge and familiarity with each of the topics. The greatest improvements were in tibia intramedullary nailing and applying a tension band to an olecranon fracture. When asked which surgical skills station was the most helpful, 70% chose lag screw insertion and basic plating techniques. All students felt that creating their case presentation was productive.Conclusion:This educational initiative resulted in the successful design and implementation of a milestone-based orthopaedic surgery subinternship curriculum. The program was well received by students, contributed to learning and competency, and provided teaching opportunities for residents. The format and content of this subinternship curriculum can easily be adapted to regional and national teaching programs.

A brief review of tibial shaft fractures treated using interlocking intramedullary nail

Tibial shaft fractures are treated surgically by different methods. In the last few years interlocking intramedullary nailing has emerged as a gold standard for tibia shaft fracture. The clinical and radiological outcome is better and the complications like compartment syndrome, neurovascular injuries, infection, non-union are relatively less for interlocking intramedullary nailing of tibia. The use of ILIM nail also shows the reduce risk of reoperation. Nail is considered better as it is a load sharing device, it also neutralises both axial and torsional deforming forces. Other contributory factors for the better and natural process of bone healing in case of nail is that closed intramedullary nailing leads to minimum injuries of soft tissue, neurovascular structures and hematoma at fracture site. The nail is also locked at proximal and distal fragments which decreases the prevalence of mal-union of comminuted fractures. One distinct advantage in patients treated with interlocking nailing is their early return to weight bearing and work.

Does immediate weight-bearing following intramedullary tibial nailing affect union rates? The results from a single UK trauma unit

Introduction Extra-articular diaphyseal tibial fractures are a common injury and are often treated with intramedullary nailing (IMN). Weight-bearing (WB) of simple tibial fractures treated with an IMN immediately as pain allows is now standard practice. Our aim was to assess the impact of varied WB on fracture union following IMN of diaphyseal tibia fractures. Methods We conducted a retrospective cohort study of tibial fractures treated with IMN in our department between 2012-2017. WB status was recorded in the post-operative note and subsequently reviewed in the patients’ follow-up appointments. Patients were divided in three groups; Group I: immediate full-WB, Group II: non-WB for 6 weeks and Group III: 2 weeks non-WB, 4 weeks increasing partial-WB and full-WB at 6 weeks. Radiographic union score for tibial fractures (RUST) of ≥10 at a painless fracture site was considered as evidence of fracture union. Results 92 patients with comparable pre-operative demographics [mean age 40 y (16-88)] were included. The median union time in weeks for each group was: Group I 17.3, Group II 21.7 and Group III 19.5 (F 1.09, p 0.34). Survival analysis and log rank test did not show any difference in union times between the three groups (x2 1.1, p 0.57). 12 delayed unions were identified across all groups. Multiple logistic regression identified three factors that could increase the rate of delayed union – non-WB, smoking and IMN size 11/12 mm - however the results were not statistically significant. Conclusion Immediate post-operative WB does not adversely affect union time in statically locked IMNs. In fact, although our data show no statistically significant difference in fracture healing between the three groups, full WB seems to decrease overall time to union. In conclusion, we could suggest that full WB after IMN in patients with AO 42-A/B type fractures is safe practice.

Quantitative Evaluation of Embolic Load in Femoral and Tibial Shaft Fractures Treated With Reamed Intramedullary Fixation.

To compare the volume of embolic load during intramedullary fixation of femoral and tibial shaft fractures. Our hypothesis was that tibial intramedullary nails (IMNs) would be associated with less volume of intravasation of marrow than IM nailing of femur fractures. Prospective observational study. Urban Level I trauma center. Twenty-three patients consented for the study: 14 with femoral shaft fractures and 9 with tibial shaft fractures. All patients underwent continuous transesophageal echocardiography, and volume of embolic load was evaluated during 5 distinct stages: postinduction, initial guide wire, reaming (REAM), nail insertion, and postoperative. Volume of embolic load was measured based on previously described luminosity scores. The embolic load based on fracture location and procedure stage was evaluated using a mixed effects model. The IMN procedure increased the embolic load by 215% (-12% to 442%, P = 0.07) in femur patients relative to tibia patients after adjusting for baseline levels. Of the 5 steps measured, REAM was associated with the greatest increase in embolic load relative to the guide wire placement and controlling for fracture location (421%, 95% confidence interval: 169%-673%, P < 0.01). Femoral shaft IMN fixation was associated with a 215% increase in embolic load in comparison with tibial shaft IMN fixation, with the greatest quantitative load during the REAM stage; however, both procedures produce embolic load. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Systematic Review and Analysis of the Quality of Randomized Controlled Trials Comparing Reamed and Unreamed Intramedullary Nailing of Tibial Fractures.

To evaluate the quality of research and reporting of randomized controlled trials comparing the use of reamed and unreamed intramedullary nails for tibial fractures with validated scoring systems. PubMed using the search terms "tibia" AND "reamed OR unreamed" AND "intramedullary OR nail." Filters were applied for the years 1991-2019, full articles, human subjects, and English language. Inclusion criteria were (1) prospective and randomized trials, (2) studies reported >80% follow-up, and (3) articles amenable to scoring with the chosen scoring systems. Exclusion criteria were (1) skeletally immature patients or (2) incomplete data sets. Articles were assessed with the Coleman Methodology Score, the Consolidated Standards of Reporting Trials systems, and Cowan's Categorical Rating by 2 independent observers. Scores for individual articles were averaged for the 2 observers. The total and subcategory scores for all included articles were also averaged with SD from both observers. Categories from the 2 grading systems with deficient reporting were measured as a percentage based on grading from both observers. Data were analyzed using kappa statistic and correlation coefficient to assess agreement and reliability. All included articles supported the use of reamed tibial intramedullary nails, but the overall quality of the literature fell in the middle of both the modified Coleman Score and Consolidated Standards of Reporting Trials grading scheme ranges despite being Oxford Level 1. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Comparison between midline tendon splitting and lateral parapatellar approach for intramedullary nailing of tibia

Introduction: Tibial fracture unites well with classical midline tendon splitting approach but are associated with complications. So fractures stabilization with IMILN via lateral parapatellar approach is useful to prevent complications. Methods: In our comparative study 30 patients in each MTS and LP approach, underwent IMILN. Main Outcome Measurements: Anterior knee pain based on a visual analog scale and functional outcomes based on Lysholm knee score. Results: Results were excellent in 20% of patients, good in 80% of patients in lateral parapatellar approach. Whereas, in midline tendon splitting approach results were excellent in 7% of patients, good in 67 % of patients, fair in 27 % patients at 1 year, according to LKS. The descending order of the activities with respect to severity of knee pain was kneeling, squatting, running, and stair ascending. VAS analysis revealed that the LP group had significantly less severe pain for all eight activities examined than the MTS group. However, at 1 yr both are comparable. Conclusion: IMILN with lateral parapatellar approach has good functional outcome and is better than midline tendon splitting approach.

Intramedullary tibial nailing using infrapatellar and suprapatellar approaches: A systematic review and meta-analysis

IntroductionIntramedullary nailing of diaphyseal tibial fractures has become the gold standard method of fixation with high rates of union and low complication rates reported. The suprapatellar (SP) approach may have many advantages over the traditional infrapatellar (IP) approach. Controversy exists due to potential damage to the patellofemoral joint leading to persistent anterior knee pain. This systematic review and meta-analysis aims to evaluate the clinical and procedural outcomes of the SP approach in comparison to the traditional IP approach. MethodIn this PRISMA compliant systematic review and meta-analysis, five databases including MEDLINE, EMBASE, Web of Science, Cochrane Library and CINAHL were searched from inception until May 2020. Randomised controlled trials (RCTs) and comparative observational studies involving adults with tibial fractures treated with intramedullary nail fixation using either the suprapatellar or infrapatellar approach were included. Data extracted included demographics, functional knee scores, fluoroscopy exposure, insertional accuracy and adverse events. The primary outcome was validated functional knee scores. Risk of bias was calculated using the Cochrane risk of bias tool version 2 (RoB 2) and Newcastle-Ottawa Scale (NOS). ResultsIn total 16 studies were included consisting of 5 RCTs and 11 comparative observational studies. This included 1750 total operations with 810 in the SP group and 940 in the IP group. Meta-analysis was performed on the studies where appropriate data was reported. The SP approach demonstrated superior Lysholm scores (Mean Difference (MD) 5.63 [95% Confidence Interval (CI): 2.81 to 8.44]), reduced fluoroscopy times (MD -38.12 sec [95% CI: -47.96 to -28.28]) and increased entry point accuracy (Standard Mean Difference (SMD) -0.90 [95% CI: -1.22 to –0.59]). No differences in complication rates or blood loss were found. ConclusionBased on the data presented in this review, intramedullary nailing of the tibia using the SP approach demonstrates superior Lysholm knee scores, greater entry point accuracy and reduced fluoroscopy exposure with equivalent risk of developing complications when compared to the IP approach.

Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial

Artificial reality technologies are currently being explored as potential options to improve surgical education. Previous studies have primarily examined the efficacy of artificial reality in laparoscopic procedures, but to our knowledge, none have been performed in orthopaedically relevant procedures such as intramedullary tibial nailing, which calls for more versatile large-scale movements. Does a virtual reality simulator with or without a standard technique guide result in (1) a higher proportion of participants who completed the insertion of an intramedullary tibial nail in a synthetic bones model and (2) greater procedural accuracy than does training with a technique guide alone? Twenty-five first- and second-year medical students without prior exposure to intramedullary tibial nail insertion were recruited. Participants were randomly assigned to the technique guide control group (n = 8), the virtual reality group (n = 8), or the virtual reality and technique guide group (n = 9). The technique guide was adapted from a commercially available technique guide, which participants in the assigned groups could use to prepare as much as desired. The virtual reality simulation was based on the same procedure, and we used a commercially available virtual reality simulator that we purchased for this task. Participants in the virtual reality experimental groups completed the simulation on three separate sessions, at a set interval of 3 to 4 days apart. After 10 to 14 days of preparation, all participants attempted to insert an intramedullary nail into an intact, compact bone-model tibia that lacked surrounding soft tissue. Participants were given written hints if requested, but no other assistance was given. A procedure was considered complete if the nail and screw were properly placed. Procedural accuracy was defined as the number of incorrect steps normalized out of the 16 possible performed. After the procedure, one orthopaedic surgeon assessed a blinded video of the participant performing it so the assessor could not recognize the individual or that individual's gender. Additionally, the assessor was unaware of which group each participant had been randomized to during the evaluation. A higher proportion of participants in the virtual reality group (6 of 8) and the virtual reality and technique guide group (7 of 9) completed the intramedullary nail than did participants in the technique guide group (2 of 8; p = 0.01). There was no difference in completion between the virtual reality groups (p = 0.89). Participants in the virtual reality and virtual reality and technique guide had fewer normalized incorrect steps than did participants in the technique guide group (3.2 ± 0.1 of 16 and 3.1 ± 0.1 of 16 versus 5.7 ± 0.2 of 16, respectively; p = 0.02 for comparisons of virtual reality groups to technique guide, p = 0.63 between the virtual reality group). Virtual reality increased both procedural accuracy and the completion proportion compared with a technique guide in medical students. Based on our findings, virtual reality may help residents learn the procedural workflow and movements required to perform surgical procedures. Future studies should examine how and when exactly the technology can be applied to residencies and its impact on residents. Level I, therapeutic study.

CORR Insights®: Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial.

CORR Insights®: Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial.

The Incidence of Venous Thromboembolism Following Pelvic and Lower Extremity Trauma Despite Adherence to Modern Prophylactic Protocols.

Describe the incidence of venous thromboembolism (VTE) in patients with pelvic and lower extremity long bone trauma in the setting of modern prophylaxis. Retrospective health-system database study. Multi-center health care system. Database query from 2010 to 2017 identified 11,313 adult trauma patients who received open reduction internal fixation of pelvic, acetabular, femoral neck, or intertrochanteric fractures, or received intramedullary nailing (IMN) of the femoral or tibial shaft. Patients with incomplete prophylaxis, prior history of VTE, coagulopathy, or concomitant lower extremity fracture were excluded. Mechanical and chemical VTE prophylaxis following pelvic or lower extremity fracture fixation. VTE rates. The overall VTE rate was 0.82% [0.39% deep venous thromboses (DVT); 0.43% pulmonary emboli (PE)]. By procedure, pelvic open reduction and internal fixation (ORIF) and femoral IMN had the highest VTE rates 1.70% (0.98% DVT; 0.78% PE) and 1.33% (0.75% DVT; 0.58% PE), whereas tibial IMN had the lowest incidence of VTE 0.34% (0.17% DVT; 0.17% PE). Among hip fractures, femoral neck ORIF had a VTE rate of 0.98% (0.59% DVT; 0.39% PE), whereas intertrochanteric ORIF had lower rates of 0.59% (0.20% DVT; 0.39% PE). Despite adherence to modern VTEp protocols, nonpreventable VTE occur in 0.82% of pelvic and lower extremity orthopaedic trauma patients. Incidence ranged between 0.34% and 1.70% depending on injury/fixation method with the highest rate observed in pelvis ORIF followed by femoral IMN. In the era of pay for quality performance, it is important for health systems and auditing agencies to reconcile the difference between preventable and nonpreventable VTEs. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Carbon Fiber–Reinforced PEEK Versus Titanium Tibial Intramedullary Nailing: A Preliminary Analysis and Results

Standard titanium nails (TN) or carbon fiber-reinforced PEEK nails (CFN) were compared to evaluate impact of material on fracture union, healing time, knee/ankle, and barometric pain. Longitudinal cohort evaluated retrospectively comparing 2 periods using 2 implant types. Single surgeon series at one Level II Trauma Center. Standardized treatment protocol. Fifty-six tibial fracture patients suitable for intramedullary nailing over 5-year period. First period-TN; second period-CFN. Measurements: standard demographic data: OTA/AO fracture classification, fracture location, and nail type. cumulative healing at standard time intervals, infection/nonunion, associated injuries, knee/ankle, barometric pain, and implant removal. Statistical analysis comparing incident healing. Patient populations were not statistically different regarding demographics and fracture type/location, although there was a trend toward greater fracture severity/more associated injuries in CFN group. In 56 patients, 26 received CFN and 30 received TN. Healing rates were reported at each time interval. 8 weeks: TN-0%, CFN-19%; 12 weeks: TN-17%, CFN-69%; 16 weeks: TN-57%, CFN-92%; 20 weeks: TN-87%, CFN-96%; and 24 weeks: TN-97%, CFN-96% (P < 0.0001 every interval except 24 weeks). Each group had one infected nonunion in an open fracture that healed with subsequent treatment. There was a trend toward less barometric pain with CFN that did not reach statistical significance (P = 0.065). No statistical differences with knee/ankle pain (P = 0.109)/removal of implant (P = 0.269) potentially due to low power of pilot study. In this pilot study evaluating CFR-PEEK intramedullary nail for tibial shaft fractures, there was a demonstrated accelerated healing times compared to titanium with a potential for less barometric pain. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Performance evaluation of tibia nail using finite element analysis and mechanical testing.

Background: Premature failure of the nail with an unstable fracture may lead to non-union, nail migration and shortening. The objective of the study was to determine the mechanical properties of Intramedullary Tibia nail. Materials and methods: In a basic concern, the intramedullary nail was used to enhance the bone healing in spite of external fixator. Finite element analysis was performed to examine the performance of titanium alloy based nail under three type load (axial, lateral and torsion). Mechanical testing (Static bending, fatigue and torsional testing were conducted on titanium alloy (Ti-6Al-4V) Tibia nail. The stiffness of the implant-bone construct and movement of the fragments were tested under axial loading and torsion. The constructs were tested to failure under cyclic fatigue loading. Results: The maximum stress was concentrated at contact area of standard nail. For the new nail the maximum stress was showed at contact area when same force applied. Moreover, the stress developed in the new nail was similar as standard nail. The mean bending stiffness was 120.62 N/mm while the maximum run-out bending moment was 22.8 Nm at 600 N load without any fracture under fatigue load. The mean torque was 65.56 Nm when IMFD was set to be a maximum angle of 100 degrees. Conclusion: From biomechanical point of view, this titanium based nailing system is more preferable implant for tibia fracture osteosynthesis.

Total knee arthroplasty following intramedullary tibial nailing

Introduction/purposeTotal knee arthroplasty (TKA) in the setting of previous periarticular hardware increases resource utilization, readmissions, complications, and revision rates. Despite the frequency of intramedullary nail (IMN) fixation for tibial fractures, little guidance exists on the management of these patients and no series have reported on outcomes of patients undergoing TKA in the setting of a retained or removed IMN.MethodsThis is a retrospective case series of patients who underwent TKA after IMN fixation of tibial fractures. Patient and case data, including need for hardware removal, staged vs non-staged procedures, operative time, and need for revision implants, were recorded. Postoperative data, including complications and revision, were recorded. Oxford Knee Score (OKS) was performed at follow-up.ResultsNine patients were identified consisting of eight women and one man. Follow-up ranged from 0.8–13 years. Non-staged removal of the intramedullary hardware occurred in three cases that had increased operative lengths recorded. There were no complications related to wound healing or infection. No patients required revision. Two of the three patients who underwent non-staged TKA developed arthrofibrosis requiring manipulation. OKS scores in patients who underwent non-staged surgery were consistently low.ConclusionsConversion TKA after tibial IMN fixation can result in satisfying outcomes in many patients. However, intramedullary hardware presents challenges to TKA similar to more extensively studied conversion TKA scenarios. Removing hardware in either a staged or non-staged fashion results in increased resource utilization and imparts perioperative challenges with only theoretical benefits of one approach compared to the other. Increased stiffness may be associated with a non-staged approach to hardware removal and TKA. Several technical factors may permit component positioning without removal of hardware. Despite limitations, this is the first series to discuss this challenging clinical scenario and provides surgeons with technical guidance and data on operative outcomes.

Mechanical properties of regionally (India) manufactured versus internationally manufactured intramedullary tibial nails - A pilot study

Mechanical properties of regionally (India) manufactured versus internationally manufactured intramedullary tibial nails - A pilot study - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.015, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Expert Tibial Intramedullary Nailing For proximal and Distal Tibial Fractures

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

Bone grafting of the regenerate: a previously undescribed case and surgical technique

&lt;p&gt;Distraction osteogenesis can occasionally be complicated with poor-quality regenerated bone. Several factors have been identified in the literature in order to reinforce the maturation of the regenerate. We would like to present a case in a 40 years old patient who presented with shortening and uniplanar varus angulation at his proximal tibia. The patient was treated with distraction osteogenesis using a circular frame. He had significant delay in the maturation of the 4-5 cm gap, and it was decided to use a non-vascularized fibular graft that was introduced using the tibial intramedullary nailing instrumentation. The graft led to an impressive acceleration of the maturation of the regenerate, mostly posteriorly and laterally with poor progression at the anterior part of the tibia. As this is the first such case presented in the international literature it is difficult to speculate why the regenerate was stimulated only in specific areas. Further reporting is necessary to reach safe conclusions.&lt;/p&gt;