Management Of Tibial Shaft Fractures Research Articles

Stabilization of Tibial Fractures at Risk of Complications With the Bactiguard Intramedullary Nail: Early to Medium Results With a Novel Metal-Coated Device.

The purpose of this study was to investigate the safety and early clinical results from the use of a novel, noble metal-coated titanium tibial nail for the definite stabilization of tibial shaft fractures at risk of developing complications. This is a retrospective case series with prospectively collected data. Level I Trauma Centre in the United Kingdom. Thirty-one patients who were managed with the Bactiguard-coated Natural Nail and achieved a minimum of a 12-month follow-up. The main outcomes of this study were the incidence of adverse events (related to implant safety), complications (particularly infection), and reinterventions. Thirty-one patients with a mean age of 41.6 years were included in this study. Active heavy smokers or intravenous drug users were 25.8% and 9.7% of them were diabetic. Five fractures were open while 13 had concomitant soft-tissue involvement (Tscherne grade 1 or 2). Twenty-seven patients healed with no further intervention in a mean time of 3.3 months. Three patients developed nonunion and required further intervention. The overall union rate was 96.7%. One patient developed deep infection after union (infection incidence 3.2%). Six patients (6/31; [19.3%]) required reinterventions [2 for the treatment of nonunion, 3 for removal of screws soft-tissue irritation, and 1 for the management of infection). The management of tibial shaft fractures with a noble metal-coated titanium tibial nail demonstrates encouraging outcomes. Further studies are desirable to gather more evidence in the performance of this innovative implant. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Asthma and Its Impact on Pediatric Patients Undergoing Surgical Management of Tibial Shaft Fractures.

Introduction Tibial shaft fractures are a common presenting injury amongthe pediatric population. Asthma is also a common diagnosis that is frequently encountered in this population and has a significant impact on healthcare utilization, quality of life, and mortality.Given the high prevalence of these conditions and risks of peri-anesthetic respiratory complications, the purpose of this study was to evaluate an association between asthma and the incidence of 30-day postoperative complications following the surgical management of tibial shaft fractures in the pediatric population. Methods The National Surgical Quality Improvement Program-Pediatric database was used to identify pediatric patients who underwent surgical treatment for tibial shaft fractures from 2013-2019. Patients were categorized into two groups: patients with a history of asthma and patients without a history of asthma. Differences in patient demographics, comorbidities, and postoperative complications were assessed using bivariate and multivariate analyses. Results Of the 2,649 patients who underwent surgical treatment for tibial shaft fractures, 115 (4.3%) had asthma. Compared to those without asthma, patients with a history of asthma were more likely to have other medical comorbidities. After controlling for the differences in baseline characteristics between the two groups, patients with asthma had an increased risk of prolonged hospital stay (OR 5.78; 95% CI 1.67 to 20.00; p=0.006). Conclusion Pediatric patients being surgically treated for tibial shaft fractures with asthma had an increased risk of prolonged hospital stay. It is important that proper preoperative workup, perioperative care, and understanding of the implications of asthma on postoperative recovery are appreciated to reduce prolonged hospitalization lengths and minimize hospital costs associated with tibial shaft fracture surgery.

Management of tibial shaft fractures with closed intra medullary interlocking nail among Indians.

It is of interest to document data on the well Reamed Intramedullary Nailing in Isolated Tibial Diaphyseal Fractures without Fibular Osteotomy among Indians. 120 patients with isolated tibial diaphyseal fractures were treated with IMIL nail (84 closed fractures, 16 type I open fractures, and 20 type II open fractures) were involved in this study. Research was carried out over a five-and-a-half-year period, from July 2013 to December 2018.According to Johner and Wruh's criteria, good functional findings were achieved in 70% of patients, better operational results in 15%, reasonable functional results in 5%, and poor functional results in 10% of cases after surgery. The percentage of union in the present analysis was 90%. The average time for union was 5 months, with 84 fractures healing before 5 months. Intramedullary Interlocking Nailing reduces length of stay in hospital, lowers the financial load, and promotes early return to work without the need for further surgical treatment such as partial fibular osteotomy.

Mortality and morbidity following operative management of tibial shaft fractures in octogenarians.

As the geriatric population continues to grow, the incidence of tibial shaft fractures in octogenarians is projected to increase. There is significant variation in the functional and physiologic status within the geriatric population. The purpose of this study is to compare the complications following operative treatment of tibial shaft fractures for patients who are 65- to79-year-old compared to patients who are 80- to 89-year-old. Data were collected through the National Surgical Quality Improvement Program database for the years 2007-2018. All isolated tibial shaft fractures that were treated with open reduction internal fixation (ORIF) or intramedullary nail (IMN) were identified. Patients were divided into a 65- to 79-year-old group and an 80-to 89-year-old group. Primary and secondary outcomes were studied and included 30-day mortality. Univariate and multivariate analyses were performed with a significance set at p < 0.05. In total, 434 patients with tibial shaft fractures were included in the study. Of these, 333 were 65- to 79-year-old and 101 were 80- to 89-year-old (Table 1). On multivariate analysis, there was no significant difference in complication rates between the two cohorts. After controlling for demographics and comorbidities, age was not independently associated with 30-day mortality or any other peri-operative complications between patients aged 80 to 89 and patients aged 65 to 79 following operative management of tibial shaft fractures. In appropriately selected octogenarian patients, operative management of tibial shaft fractures represents a relatively safe treatment modality that may promote early rehabilitation.

Management of tibial shaft fractures with reamed intramedullary interlocking nail: A prospective study

Management of tibial shaft fractures with reamed intramedullary interlocking nail: A prospective study

Do Hospital or Surgeon Volume Affect Outcomes After Surgical Management of Tibial Shaft Fractures?

To determine whether hospital and surgeon volume are associated with outcomes after operative fixation of tibial shaft fractures. Adults (≥18 year old) who underwent operative fixation of diaphyseal tibial fractures were identified in the New York Statewide Planning and Research Cooperative System data set from 2001 to 2015. Reoperation, nonunion, and other adverse event rates were compared across surgeon and hospital volume using multivariable Cox proportional hazards regression, adjusting for clinical and demographic factors. Low-volume providers (lowest 20%) were compared with high-volume providers (highest 20%). Low volume constituted <5 cases/year for hospitals and 1 case/year for surgeons. High volume constituted ≥40 cases/year for hospitals and ≥8 cases/year for surgeons. Nine thousand one hundred forty-seven patients were included. Relative to high-volume surgeons, low-volume surgeons experienced slightly higher rates of pneumonia [2% vs. 1%, hazard ratio (HR) 2.50, 95% confidence interval (CI) 1.38-4.53, P = 0.003], and respiratory failure (5% vs. 3%, HR 1.88, 95% CI 1.30-2.71, P = 0.001). Compared with high-volume hospitals, low-volume hospitals experienced slightly lower rates of compartment syndrome (1% vs. 3%, HR 0.45, 95% CI 0.24-0.85, P = 0.01) and fasciotomies (3% vs. 7%, HR 0.57, 95% CI 0.38-0.85, P = 0.005). The rates of all other reoperations and adverse events compared among hospitals and surgeons were not significantly different. We did not detect a clinically meaningful volume-outcome relationship for either surgeons or hospitals despite the use of a robust database with rigorous statistical methodology. Of note, these findings should not be applied to rare complex injuries such as those with extensive bone loss or articular extension, which are not well represented by this study population. Therefore, we conclude that typical tibial shaft fracture, including open or closed injuries, can be safely managed in the vast majority of orthopaedic settings and that this care does not necessarily require transfer to a specialty centers. Future research into orthopaedic volume-outcome relationships could be strengthened by the use of functional outcomes (which would likely require well-organized multicenter prospective registries). Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Obesity is associated with increased postoperative complications after operative management of tibial shaft fractures

ObjectivesTo assess the association of obesity and postoperative complications after operative management of tibial shaft fractures. MethodsPatients who underwent operative management of a tibial shaft fracture were identified in a national database by Current Procedural Terminology (CPT) codes for: (1) open reduction and internal fixation (ORIF) and (2) intramedullary nailing (IMN) procedures in the setting of International Classification of Diseases, Ninth Revision (ICD-9) codes for tibial shaft fracture. These groups were then divided into non-obese, obese, and morbidly obese cohorts using ICD-9 codes. Each cohort was then assessed for grouped complications within 90 days, removal of implants within 6 months, and nonunion within 9 months postoperatively. Odds ratios and 95% confidence intervals were calculated. ResultsFrom 2005 to 2012, 14,638 patients who underwent operative management of tibial shaft fractures were identified, including 4425 (30.2%) ORIF and 10,213 (69.8%) IMN. Overall, 1091 patients (7.4%) were coded as obese and 820 (5.6%) morbidly obese. In each operative group, obesity and morbid obesity was associated with a substantial increase in the rate of major and minor medical complications, venous thromboembolism, infection, procedures for implant removal, and nonunion. ConclusionsIn patients who undergo either ORIF or IMN for tibial shaft fractures, obesity and its related medical comorbidities are associated with significantly increased rates of postoperative medical complications, infection, nonunion, and implant removal compared to non-obese patients.

English

INTRODUCTION: Tibial shaft fractures of tibia are most common due to increase in road traffic accidents and fall from height. Presently the intramedullary Interlocking is the surgical treatment of choice for the closed and type 1, 2 and 3A fractures. Here I conducted a study for the management of tibial shaft fractures using intramendullary interlocking. MATERIALS AND METHODS: Sixty cases of closed, type1, 2 and 3A open fractures of tibia were managed with intramedullary interlocking nail between March 2010 and April 2014. And post operatively followed at 6, 12, 24 weeks and results were evaluated using Johner and Wruh’s criteria. RESULTS: We achieved 76.67% excellent, 15% good and 8.33% fair results. CONCLUSION: Intramedullary interlocking nail is an excellent method for closed, type1, 2 and 3A open fractures of tibia. This has excellent functional outcome.

Comparative study between interlocked nail and plating for management of tibial shaft fractures

Comparative study between interlocked nail and plating for management of tibial shaft fractures

The Effect of Intramedullary Reaming on a Diaphyseal Bone Defect of the Tibia

The effect of intramedullary reaming on diaphyseal tibial defects has not been examined in the literature. The present aim was to relate the extent of reaming to angiogenesis and bone formation occurring around a critical-sized defect in the tibia for two scenarios, namely, when the bone defect is left empty and when the bone defect is treated with autograft. Eleven canines were allocated into two groups, namely, empty (n=5) or iliac crest autograft (n=6). All tibiae were reamed to 7.0 mm and fixed with a 6.5-mm statically locked intramedullary nail after creation of an 8.0-mm diaphyseal defect. The extent of reaming of the canal was dependent on the cross-sectional area of the tibia, because all tibiae were reamed to 7.0 mm. Fluorescent markers were administered at different times: calcein green (6 weeks), xylenol orange (9 weeks), and tetracycline (11 weeks and 14 weeks). Animals were sacrificed at 15 weeks and perfused with a barium compound. Analysis consisted of radiography, micro-computed tomography scan, and histology. Linear regression analysis of percent bone volume and canal area provided a Pearson correlation coefficient of r=0.925 (p=0.025) for empty samples and r=0.244 (p=0.641) for autograft samples. Linear regression analysis of percent vasculature volume and canal area provided a Pearson correlation coefficient of r=0.784 (p=0.117) for empty samples and r=-0.146 (p=0.783) for autograft samples. Bone formation rates were reported as the distance between the fluorescent labels and were less within the endosteum, cortex, and periosteum, with extensive reaming in empty samples. The results suggest that limited reaming may be beneficial to the acute management of tibial shaft fractures with a bone defect.

Current management of tibial shaft fractures: A survey of 450 Canadian orthopedic trauma surgeons

Background and purpose Strategies to manage tibial fractures include nonoperative and operative approaches. Strategies to enhance healing include a variety of bone stimulators. It is not known what forms of management for tibial fractures predominate among Canadian orthopedic surgeons. We therefore asked a representative sample of orthopedic trauma surgeons about their management of tibial fracture patients.Methods This was a cross-sectional survey of 450 Canadian orthopedic trauma surgeons. We inquired about demographic variables and current tibial shaft fracture management strategies.Results 268 surgeons completed the survey, a response rate of 60%. Most respondents (80%) managed closed tibial shaft fracture operatively; 47% preferred reamed intramedullary nailing and 40% preferred unreamed. For open tibial shaft fractures, 59% of surgeons preferred reamed intramedullary nailing. Some surgeons (16%) reported use of bone stimulators for management of uncomplicated open and closed tibial shaft fractures, and almost half (45%) made use of this adjunctive modality for complicated tibial shaft fractures. Low-intensity pulsed ultrasound and electrical stimulation proved equally popular (21% each) and 80% of respondents felt that a reduction in healing time of 6 weeks or more, attributed to a bone stimulator, would be clinically important.Interpretation Current practice regarding orthopedic management of tibial shaft fractures in Canada strongly favors operative treatment with intramedullary nailing, although respondents were divided in their preference for reamed and unreamed nailing. Use of bone stimulators is common as an adjunctive modality in this injury population. Large randomized trials are needed to provide better evidence to guide clinical decision making regarding the choice of reamed or unreamed nailing for tibial shaft fractures, and to inform surgeons about the actual effect of bone stimulators.