Intramedullary Tibia Research Articles

Operative Treatment of Acute Traumatic Dislocation of the Proximal Tibiofibular Joint with TightRope Fixation and Primary LCL Repair Following Tibial Intramedullary Nailing

Introduction/Objective Proximal tibiofibular joint (PTFJ) dislocation is a rare acute injury of the knee that is often misdiagnosed or overlooked. The diagnosis should be considered as part of the differential in any patient presenting with acute-onset lateral knee pain after an aggressive torsion trauma to a flexed knee. This case report detailing surgical fixation of a PTFJ dislocation is unique in that surgical lateral collateral ligament (LCL) repair was necessary and performed, and PTFJ fixation occurred following recent open reduction internal fixation (ORIF) of the tibia. This paper details specific technique and orientation of fixation to best return the PTFJ to anatomic alignment, as failure to do so can lead to instances of chronic morbidity. Case Report This case report describes surgical fixation of a traumatic posteromedial (Type III) PTFJ dislocation. During ORIF of the ipsilateral tibia, significant PTFJ laxity and displacement was noted intraoperatively. This necessitated a return to the operating room for definitive PTFJ surgical fixation with two TightRope syndesmotic suture button fixation devices with simultaneous intraoperative LCL repair with #2 Fiberwire. Discussion/Conclusions While few case reports have documented the use of TightRope syndesmotic fixation of the PTFJ, these authors present a novel method of orienting the fixation from the posterolateral fibula to the anteromedial tibia with simultaneous caudal to cranial direction in order to create orthogonal fixation of the PTFJ. This creates an orientation of fixation perpendicular to the anatomic alignment of the native PTFJ.We believe that this orientation of syndesmotic PTFJ fixation most physiologically replicates that of the native PTFJ, and will lead to effective surgical results and improved patient outcomes. We also believe that publications on this topic will help bring awareness to an underrecognized and underdiagnosed joint pathology, with the hopes that future patients will benefit and receive more thorough and efficient care.

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Background With the increasingly accepted method of suprapatellar tibial nailing for tibial shaft fractures, we aimed to compare intraoperative and postoperative outcomes of infrapatellar (IP) vs suprapatellar (SP) tibial nails. Methods This is a retrospective cohort analysis of 34 SP tibial nails over three years vs 24 IP tibial nails over a similar time frame. We comparedtotal radiation dose (TRD), patient positioning time (PPT), fracture healingand follow up time. Knee pain in the SP group was evaluatedutilising the Hospital for Special Surgery (HSS) Knee Injury and Osteoarthritis Outcome Score (KOOS). Results Fifty-eight patients with a mean age of 43 years were included. Mean intraoperative radiation dose for SP nails was 61.78 cGy (range: 11.60-156.01 cGy) vs 121.09 cGy (range: 58.01-18.03 cGy) for IP nails (p < 0.05). Mean PPT for SP nails was 10 minutes vs 18 minutes for IP nails (p < 0.05). All fractures united in the SP group vs one non-union in the IP group. Mean follow up was 5.5 months vs 11 months in the IP and SP groups, respectively. Mean KOOS was 7 (range: 0-22) at six months for the SP group. Conclusion The semi-extended position (SP group) leads to reduced TRD because of ease of imaging. Patients showed improved outcomeswith shorter follow up and fracture union in all patients (SP group). The KOOS revealed that SP nail patients had minimal pain and good knee function. This study establishes a management and patient-reported outcome measures (PROMs) baseline for ongoing evaluation of SP nails.

A retrospective study of intramedullary tibia nailing system intended for tibia fracture

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study was to investigate the performance of the intramedullary tibia nail in the treatment of tibia fractures, mostly shaft fractures. The objective of this study was to assess the post-operative complication due to the treatment involving tibia nails.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a retrospective study to study the results obtained after tibia nail surgery. A total of 32 patients were selected based on inclusion and exclusion criteria (25 males and 7 females; average age- 37 years). The fracture was classified according to AO classification, the nailing device is intended for 41-A1/A2, 42 and 43-A1/A2/A3 types of fractures. The patients with at least three visits within 180 days were selected for data collection.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The clinical outcomes include pain scale assessment from the baseline/enrolment to the last follow up which shows no pain (93.7%) and mild pain (6.7%) after 180 days. No implant-related problems like implant loosening.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; For the treatment of tibia shaft fracture which can either be closed or open, intramedullary tibia nailing devices like KN-2T and KN-5T have been concluded to be the good approach.&lt;/p&gt;

A Clinical Case Report: Closed Extraction of a Broken Distal Piece of the Tibial Intramedullary Nail Remaining for 8 Years

Aim: Closed extraction of a broken distal piece of the intramedullary nail is very challenging. We herein report a case of the broken distal piece of the tibial intramedullary nail remaining for 8 years, which was successfully extracted by closed method using a self-made broken nail extractor.&#x0D; Case Presentation: A 51-year-old male patient was admitted to our hospital for extraction of the broken distal piece of the tibial intramedullary nail for 8 years. The preoperative X-ray films showed the broken intramedullary nail was cannulated and the outer diameter is 10 mm, larger than the isthmus of the medullary cavity.&#x0D; Results: After reaming with Φ 11 mm drill, the self-made broken nail extractor was inserted into the medullary cavity from the nail entry point and passed through the canal of the broken nail, and successfully pulled out the broken nail.&#x0D; Conclusion: Our technique is a simple reproducible alternative that has high extraction success rate for broken distal piece of cannulated intramedullary nails.

Improvement of Knee Function in Patients with Tibial Shaft Fracture Treated by Suprapatellar Approach and Suprapatellar Approach with Tibial Intramedullary Nail

Improvement of Knee Function in Patients with Tibial Shaft Fracture Treated by Suprapatellar Approach and Suprapatellar Approach with Tibial Intramedullary Nail

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

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

Clinical performance of intramedullary nailing system for tibia fractures: a retrospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In this study, we aimed to investigate the performance of the intramedullary tibia nailing system while treating the tibia fracture fixation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this retrospective study, studied the results of intramedullary tibia nail in treatment of tibia fracture. A total of 25 consecutive patients were included in this study (11 male, 14 female and average age 42.9 years). Fracture type was classified as per the Muller AO classification of fracture.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The outcomes of clinical treatment were obtained in our study; no pain (92%), mild pain (8%) after 2 year follow up. The follow up of patients were taken on 1 month, 6 months, 1 year and 2 years according to visual analog scale (VAS) score. Paired t test was performed for statistical data analysis using minitab and values of p&amp;lt;0.05 were taken to indicate significant value with confidence interval of 95%. No implant related problem have been found like loosening, bending and corrosion.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our outcomes with interlocking cannulated and expert tibial interlocking nailing are empowering and exhibit the advantages of new nailing framework. It has been concluded that intramedullary tibia nailing system is best method for treatment of tibia fracture with good results and outcomes.&lt;/p&gt;

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.

Defining the Ideal "Nail Exit Path" of a Tibial Intramedullary Nail-A Computed Tomography Analysis of 860 Tibiae.

To identify the ideal distal nail position in the distal tibia, using a computed tomography analysis. Three-dimensional models of 860 left tibiae were analyzed using the Stryker Orthopaedic Modeling and Analytics software (SOMA, Stryker, Kiel, Germany). The nail axis was defined by 7 center points at the middle of the inner cortical boundary. The point where this line fell relative to the center of the tibial plafond in both the anteroposterior and mediolateral planes was calculated. The mean mediolateral offset of the tibial nail exit path was 4.4 ± 0.2 mm (95% confidence interval) lateral to the center of the tibial plafond. The mean anteroposterior offset of the tibial nail exit path was 0.6 ± 0.1 mm anterior to the center of the tibial plafond. We have presented an anatomic study analyzing the ideal nail exit path using computed tomography scans of 860 tibiae. We defined that the ideal nail exit path of a tibial nail is lateral with respect to the center of the tibial plafond. This is supported by previous clinical studies and has significant implications for preventing malalignment when treating distal tibial fractures with intramedullary nailing.

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.

‘In-Out-In’ K-wires sliding in severe tibial deformities of osteogenesis imperfecta: a technical note

Severe infant osteogenesis imperfecta requires osteosynthesis. Intramedullary tibia’s osteosynthesis is a technical challenge given the deformity and the medullar canal’s narrowness. We describe an extramedullary technique: ‘In-Out-In’ K-wires sliding. We performed an anteromedial diaphysis approach. The periosteum was released while preserving its posterior vascular attachments. To obtain a straight leg, we did numerous osteotomies as many times as necessary. K-wires (‘In’) were introduced into the proximal epiphysis, and the medial malleolus (‘Out’) bordered the cortical and (‘In’) reach their opposite metaphysis. K-wires were cut, curved and impacted at their respective epiphysis ends to allow a telescopic effect. All tibial fragments are strapped on K-wires, and the periosteum was sutured over it. Our inclusion criteria were children with osteogenesis imperfecta operated before 6 years old whose verticalization was impossible. Seven patients (11 tibias) are included (2006–2016) with a mean surgery’s age of 3.3 ± 1.1 years old. All patients received intravenous bisphosphonates preoperatively. The follow-up was 6.1 ± 2.7 years. All patients could stand up with supports, and the flexion deformity correction was 46.7 ± 14.2°. Osteosynthesis was changed in nine tibias for the arrest of telescoping with flexion deformity recurrence and meantime first session-revision was 3.8 ± 1.7 years. At revision, K-wires overlap had decreased by 55 ± 23%. Including all surgeries, three distal K-wires migrations were observed, and the number of surgical procedures was 2.5/tibia. No growth arrest and other complications reported. ‘In-Out-In’ K-wires sliding can be considered in select cases where the absence of a medullary canal prevents the insertion of intramedullary rod or as a salvage or alternative procedure mode of fixation. It can perform in severe infant osteogenesis imperfecta under 6 years old with few complications and good survival time.

Intramedullary tibia nailing with external fixation.

This study introduces an intramedullary nailing technique with external fixation and aims to determine the safest position of Schanz screws for this technique. Patients undergoing intramedullary nailing were evaluated by computed tomography to assess the anteroposterior (AP) length of the medullary canal and the distance between the posterior cortex and the posterior border of the nail at the level of interest in the proximal and distal tibia. In this cadaveric study, screws were inserted at the level of interest, followed by a determination of the anatomical relationship between inserted screws and nearby neurovascular structures. The safe area for inserting Schanz screws in the medial to lateral direction in the proximal tibia was found to be 1.5-4.5cm distal to the knee joint line on the AP view, 1cm anterior to the posterior cortex at the distal 4.5cm level, and ≤ 24mm from the posterior cortex on the lateral view. In males, the area 1.5-3.0cm proximal to the tibial plafond and 0.5cm anterior to the posterior cortex on the lateral view was found to be a safe zone. However, in females, the safe zone was defined as an area 1.5cm proximal to the tibial plafond and just anterior to the posterior cortex. This study defined the safe zones of Schanz screws for intramedullary nailing with an external fixator. These safe zones would be helpful for external fixation during intramedullary tibia nailing.

Radiographic Evaluation of the Tibial Intramedullary Nail Entry Point.

Tibia fractures are common injuries that can often be effectively treated with intramedullary nail (IMN) fixation. The ideal starting point for IMN reaming and nail placement is well described and regarded as a crucial aspect in the technique. The purpose of this study is to determine the accuracy and precision with which the starting point is established and if this is maintained after nail insertion during fracture fixation. Fifty consecutive tibia fractures treated by IMN fixation sized 9 to 13 mm through an infrapatellar or medial parapatellar approach and 50 treated with a suprapatellar approach were evaluated. The starting point for reaming and IMN placement was measured using intraoperative fluoroscopy. Postoperative radiographs were used to determine the center of the IMN after placement. The distance between the measured points and the ideal starting point was measured. Deviation from the ideal entry point on intraoperative fluoroscopy averaged 4.6 ± 4.0 mm medially, 2.9 ± 3.7 mm anteriorly, and 2.7 ± 3.3 mm distally. In 30% of cases, the final IMN position varied from the entry point by greater than one SD in the coronal or sagittal plane. No difference between approaches was appreciated. Although the ideal starting point for tibial IMN fixation is known, this is frequently not the starting point accepted in practice. Final position of the IMN is independent of IMN size or approach and is not markedly different than the obtained starting point. Therapeutic level III.

Suprapatellar nailing of fractures of the tibia.

Intramedullary nailing of tibia fractures via asuprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures. Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries. Gustilo grade3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point. Via asuprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20-30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics. In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17patients had adistal third fracture, 8sustained aproximal third fracture and 36 had ashaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.

The entry point of intramedullary tibia cutting guide should vary according to the individual tibia morphology in TKA.

In total knee arthroplasty (TKA) using the intramedullary tibial cutting guide (IMTCG), the positioning of the IMTCG is important for accurate tibial bone resection. The aim of this study was to evaluate the ideal entry point of IMTCG and affecting radiologic factors. From May 2017 to February 2018, 91 consecutive TKAs for osteoarthritis were included. From preoperative full-length radiographs, we measured the medial proximal tibia angle (MPTA), lateral distal tibia angle (LDTA), tibial bowing angle (TBA), medial to lateral width of the tibial plateau, tibial length, and ideal coronal entry point. In preoperative short knee lateral radiographs, we measured the anterior to posterior length of the tibial plateau, tibial posterior slope angle (TPSA), metaphysio-diaphyseal angle (MDA), and ideal sagittal entry point. The ideal coronal and sagittal entry points were defined as the points crossing the tibial plateau and tibial anatomical axis on the coronal and sagittal radiographs, respectively. The ideal entry point was 51.4 ± 4.3% (SD) from the medial margin and 27.0 ± 5.8% (SD) from the anterior margin of the tibial plateau. However, the range varied from 39.8 to 60.5% on the coronal plane and from 9.6 to 37.7% on the sagittal plane, respectively. As the MPTA (rho = -0.490) and TBA (rho = -0.433) were increased, the coronal entry point moved medially. As TPSA (rho = -0.761) and MDA (rho = -0.495) were increased, the sagittal entry point moved anteriorly. The ideal entry point of IMTCG should vary according to the individual tibial morphology.

Study of interlocking nail in shaft tibia fracture

Introduction: The tibia is the most commonly fractured long bone in the body and understanding of the mode of injury, fracture pattern is necessary to decide an operative management. Tibia shaft fractures are commonly managed by interlocking nail. This study is to assess the surgical management and assess the functional outcome of tibia shaft fractures.Materials and Method: The study consist of 50 patients with tibia shaft fracture treated with tibia interlocking nail. Clinical outcome and function results were evaluated by Alho & Ekland’s criteria.Result: In this study, we have operated a total 50 cases with tibia interlocking nail in tibial shaft fractures. The average union time was 17.68 weeks. The study yielded about 82 % of excellent result.Conclusion: The present study shows that closed fractures of the tibia shaft treated with interlocking intramedullary tibia nailing involves minimal surgical trauma and negligible blood loss. It provides the advantages of early ambulation, lower rates of infection and non-union. A significant advantage of interlocking nail in addition to early joint mobilisation, is early weight bearing which allows earlier return to work. Hence the study concluded that closed interlocking intramedullary nail is the treatment of choice in closed tibia shaft fracture.

Soft-tissue reconstruction for exposed orthopedic implants in injured extremities

Background: Exposure of orthopedic implants before fracture union is quite frequent in clinical practice. There is no definite rule as of now whether to retain or replace the exposed implant with an external fixator. Objectives: The aim of the study was to find the ultimate outcome after retaining the exposed implant and providing a skin and soft-tissue cover. Materials and Methods: Thirty-two patients with exposed orthopedic implants reported to us with an average of 6 weeks after the original orthopedic procedure. The local soft-tissue infection was treated with a targeted antibiotic therapy. There was delay in the soft-tissue reconstruction for an average of 24 days. Six patients also received “negative pressure wound therapy.” The soft-tissue defects (ranging from 4 cm × 3 cm to 25 cm × 10 cm) were compounded with exposure of olecranon plate in four and intramedullary tibia nails in five, and 23 exposed plates and screws. The various muscle and fasciocutaneous flaps were used according to the region of the defect. Results and Conclusions: All the flaps behaved well except one. One of the patients suffered from wound discharge and chronic sinus, but none suffered from pain or fracture nonunion up to 9 months follow-up. Removal of the implant was required in only one patient because of sharp edge. Thus, coverage of exposed implants should always be considered as the first option before replacing it with external fixator.

In Displaced Distal Tibial Fractures, Intramedullary Nail and Locking Plate Fixation Did Not Differ in Terms of 6-Month Disability.

In Displaced Distal Tibial Fractures, Intramedullary Nail and Locking Plate Fixation Did Not Differ in Terms of 6-Month Disability.