Nailing Of Tibial Fractures Research Articles

Effect of fracture level on the residual fracture gap during tibial intramedullary nailing for tibial shaft fractures.

The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6±1.7 and 6.0±1.7mm in proximal fractures and 0.3±2.4mm and 0.4±2.3mm in distal fractures, respectively (p<0.001 and p<0.001, respectively). The mean time to union was 21.9±2.9 weeks in the proximal fracture group and 16.7±2.4 weeks in the distal fracture group (p<0.000). The residual fracture gap amount significantly correlated with the level of fracture (r=0.811, p<0.001). Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates.

Treatment of FRI after intramedullary nailing of tibia fractures: assessment of nail retention and nail removal

Objectives: Fracture related infection (FRI) is a severe, potentially limb-threatening complication after fracture fixation. Dilemma exists with regard to removing or retaining implants while treating the infection. The purpose of this study was to compare primary bone union and infection clearance in patients who had an infection following intramedullary nailing of the tibia treated either by retaining the implant or by removing the implant. &#x0D; &#x0D; Methods: Patients from two level-I trauma centers were identified through billing registries and retrospectively reviewed between January 2013 and December 2020. We identified 44 patients who had a diagnosis of FRI within 90 days of their initial fixation and returned to the OR for operative treatment of the infection. The incidences of both primary union and infection clearance were calculated for both groups and multiple parameters that may be associated with success or failure were assessed. &#x0D; &#x0D; Results: Four patients did not have complete records and were excluded. Of the remaining patients, 20 (50%) achieved infection clearance. Twenty-three (59%) patients achieved primary union whereas 16 (41%) had a primary outcome of either delayed union, nonunion, or amputation (one additional patient excluded as healing status unknown). Further analysis showed no significant difference (X2 (39) = 1.13, p &lt; .29) in infection clearance between patients treated with nail retention (64%) versus nail removal (68%). No significant difference was seen in primary bone union (X2 (39) = 3.24, p &lt; .07) with 36% of patients treated with nail retention and 68% of patients treated with nail removal reaching primary union; however, this does trend toward an association. Fewer surgeries performed for infection and complication after initial fixation was positively associated with infection clearance (p &lt; .04, M=4.6, SD=2.13, df=39) and primary union (p &lt; .001, M=4, SD=2, df=38). &#x0D; &#x0D; Conclusion: Infection clearance seems similarly possible with both nail retention and nail removal strategies, with fewer number of surgeries performed for infection and complication improving the likelihood of infection clearance and bone union. This may suggest that more severe FRI’s are less likely to unite and clear infection. Nail removal may play a role in increasing primary bone union; however, a larger sample size is needed for more definitive assessment.

Difference in Pain, Complication Rates, and Clinical Outcomes After Suprapatellar Versus Infrapatellar Nailing for Tibia Fractures? A Systematic Review of 1447 Patients.

To assess the effectiveness of suprapatellar (SP)-nailing versus infrapatellar (IP)-nailing of tibia fractures in anterior knee pain, complications (retropatellar chondropathy, infection, and malalignment) and physical functioning and quality of life. A clinical question-driven and thorough systematic review of current literature is provided. PubMed and Embase databases were searched for studies published between 2010 and 2020 relating to SP and IP-nailing of tibia fractures. The study is performed in concordance with PRISMA-guidelines. Studies eligible for inclusion were randomized controlled trials, prospective and retrospective observational studies reporting on outcomes of interest. Data extraction was performed independently by 2 assessors. Methodological quality and risk of bias was assessed according to the guidelines of the McMaster Critical Appraisal. Continuous variables are presented as means with SD and dichotomous variables as frequency and percentages. The weighted mean, standardized weighted mean differences, and 95% confidence interval were calculated. A pooled analysis could not be performed because of differences in outcome measures, time-points, and heterogeneity. Fourteen studies with 1447 patients were analyzed. The weighted incidence of anterior knee pain was 29% after SP-nailing and 39% after IP-nailing, without reported significance. There was a significant lower rate of malalignment after the SP-approach (4% vs. 26%) with small absolute differences in all planes. No substantial differences were observed in retropatellar chondropathy, infection, physical functioning, and quality of life. This systematic review does not reveal superiority of either technique in any of the respective outcomes of interest. Definitive choice should depend on the surgeon's experience and available resources. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Lateral position: a friendly surgical position for intramedullary nailing of tibial shaft fractures via infrapatellar approach

BackgroundThe conventional infrapatellar approach to intramedullary nailing of tibial fractures adopts the supine high-flexion knee position. However, this has disadvantages including difficulty in obtaining the proximal tibial anteroposterior view during intraoperative fluoroscopy, prolonged duration of fluoroscopy. Accordingly, the present study investigated the utility of the lateral position in the infrapatellar approach to intramedullary nailing of tibial shaft fractures.MethodsThe present study was a retrospective analysis of 112 patients who sustained closed tibial shaft fractures and treated with intramedullary nailing via the infrapatellar approach. Patients were divided into two groups according to surgical position: lateral or supine. The demographic and clinical data were collected and analyzed.ResultsThere were 54 patients in the lateral and 58 in the supine position groups. The duration of surgery and fluoroscopy was shorter in the lateral group than the supine group (p < 0.05). Blood loss during surgery was lower in the lateral compared with supine position group (p < 0.05). The malunion rate was lower in the lateral position group as compared with the supine position group (p < 0.05); moreover, fewer surgical assistants were needed than in the supine group (p < 0.05). There were no significant differences in fracture healing time, other complications between the two groups (p > 0.05).ConclusionsThe lateral position was a more convenient choice for intramedullary nailing of tibial shaft fractures via infrapatellar approach.

A new ultradistal locking tool in intramedullary nailing for tibial fractures

Objective To evaluate the clinical application of our self-designed ultradistal locking tool in the intramedullary nailing for tibial fractures. Methods From January 2014 to May 2016, 175 patients with tibial fracture were treated at our department. They were 119 men and 56 women, from 19 to 73 years of age (average, 46.3 years). They were divided into 2 groups according to the different targeting devices used in the intramedullary nailing. Conventional locking tools were used in the 83 patients from January 2014 to January 2015 and our self-designed new ultradistal locking tools in the 92 patients from February 2015 to May 2016. The 2 groups were compared in terms of operation time, frequency of intraoperative fluoroscopy, and successful rate of one-time locking. Results There were no significant differences between the 2 groups in general clinical data(P >0.05), showing similarities of the 2 groups. The operation time(59.8±4.3 min), frequency of intraoperative fluoroscopy(11.0±2.1 times), and rate of one-time successful locking[94.4%(238/252)] in the ultradistal locking group were significantly better than those in the conventional locking group[73.6±5.3 min, 23.0±3.8 times and 85.7% (180/210), respectively](P< 0.05). Conclusions Our new ultradistal locking tools are superior to the conventional ones in that they lead to shorter operation time, less intraoperative fluoroscopy and higher successful rate of one-time locking. Additionally, the new locking tools are easy to handle and incur no extra costs. Key words: Tibial fractures; Fracture fixation, intramedullary; Bone nails

OS1-06 Intramedullary nailing of tibial fractures: results and complications

OS1-06 Intramedullary nailing of tibial fractures: results and complications

To compare and assess the clinical results of interlocking nailing in closed fractures of shaft of tibia by reamed and unreamead technique

Introduction: The successful use of unreamed nailing in patients with open tibial fractures has led some investigators to recommend this technique for closed fractures as well. Potential advantages of unreamed nailing over the reamed technique include shorter operative time, less blood loss and less disruption of the endosteal blood supply in patients with severe closed soft tissue injuries. Materials and Methods: This study consists of 34 cases of fracture both bones of leg, tibia treated by internal fixation with interlocking tibia, of which 17 cases are reamed and 17 cases are unreamed from August 2009 to July 2011, and followed upto November 2011. The study was conducted to assess the functional outcome and complications of reamed over unreamed nailing in tibial fractures. Results and Conclusion: In our study group there are no definitive criteria for using reamed and unreamed procedures, age groups are comparable and both procedures are applied randomly. 2 superficial infections are noted in unreamed cases and one deep infection noted in reamed cases. Knee pain complained in two cases of reamed nailing compared to one case of unreamed nailing. Odema of leg noted in one case of unreamed nailing. Earliest union noted in reamed nailing compared to unreamed.

Reamed versus unreamed intramedullary locked nailing in tibial fractures

The purpose of this prospective observational study is to identify whether or not reaming of tibial shaft fractures has benefits over unreamed intramedullary locked nailing. Eighty-four adult patients with recent open and closed tibial shaft fractures were treated with reamed or unreamed intramedullary locked nail fixation. We followed up for 12 months 39 of 43 patients in the unreamed and 38 of 41 patients in the reamed group, respectively. There were no significant differences between the two groups regarding the average time to healing for both clinical (3.2 vs 3.4 months, p = 0.65) and radiological (4.1 vs 4.5 months, p = 0.43) evaluations. The mean duration of surgery was shorter (p = 0.025) for the unreamed group 43 min (SD 18) compared to 55 (SD 27), but the main determinants were the fracture type and the surgeon's experience. We conclude that reamed nailing proved beneficial, but the impact on overall outcome is not superior to unreamed nailing.

Freehand ‘Figure 4’ technique for tibial intramedullary nailing: introduction of technique and review of 87 cases

Intramedullary nailing of tibial fractures is commonplace, and freehand operative techniques are increasingly popular. The standard freehand method has the knee of the injured leg flexed over a radiolucent bolster. This requires the theatre fluoroscope to swing from antero-posterior to lateral position several times. Furthermore, guide wire placement, reaming and nail insertion are all performed well above most surgeons' shoulder height. Alternatively the leg is hung over the edge of the table, and the assistant must crouch and hold the leg until the nail is passed beyond the fracture. We describe a freehand figure 4 position technique for tibial nailing which is easier both for the surgeons and the radiographer, and present a series of 87 consecutive cases utilising this method.

Su2.7 Is usage of elastic stable intramedullary nailing for tibial fractures in children still an effective method?

malaligment, follow-up time, functional outcomes (Flynn outcome scoring) were recorded. Results: Mean age was 9.6 years for all cases. Nail removal was at a mean24.4weeks. Eighteenpatients had complications, six insufficent reduction, two refracture, four deep infection, one delayed union which needs revision, two lower extremity lenght discrepancy more than 15mm, three skin impingements. Unexpected surgical revision was required in seven cases.Mean admision timewas 14 hours,mean number of X-rays from the diagnosis time to removed time of nail/s was 24. All patients showed excellent or satisfactory results of Flynn’s criteria. The time to full-weight bearing was 51.3 days (p <0.05). More the nail diameter/medullary canal diameter ratio over than 0.4 more sufficent results; short union time, less lower extremity lenght discrepancy, less mallaligment were recorded (p<0.05). Conclusion: According to our experience and opinion, elastic intramedullary nailing is the best of choice for diaphyseal fractures in children with skeletal immaturity, especially for the long bones.

Anterior knee pain after T2 intramedullary nailing of tibial fracture: An international multicenter prospective clinical study

Anterior knee pain after T2 intramedullary nailing of tibial fracture: An international multicenter prospective clinical study

Study to prospectively evaluate reamed intramedually nails in patients with tibial fractures (S.P.R.I.N.T.): study rationale and design.

BackgroundSurgeons agree on the benefits of operative treatment of tibial fractures – the most common of long bone fractures – with an intramedullary rod or nail. Rates of re-operation remain high – between 23% and 60% in prior trials – and the two alternative nailing approaches, reamed or non-reamed, each have a compelling biological rationale and strong proponents, resulting in ongoing controversy regarding which is better.Methods/DesignThe objective of this trial was to assess the impact of reamed versus non-reamed intramedullary nailing on rates of re-operation in patients with open and closed fractures of the tibial shaft. The study to prospectively evaluate reamed intramedullary nails in tibial fractures (S.P.R.I.N.T) was a multi-center, randomized trial including 29 clinical sites in Canada, the United States and the Netherlands which enrolled 1200 skeletally mature patients with open (Gustilo Types I-IIIB) or closed (Tscherne Types 0–3) fractures of the tibial shaft amenable to surgical treatment with an intramedullary nail. Patients received a statically locked intramedullary nail with either reamed or non-reamed insertion. The first strategy involved fixation of the fracture with an intramedullary nail following reaming to enlarge the intramedullary canal (Reamed Group). The second treatment strategy involved fixation of the fracture with an intramedullary nail without prior reaming of the intramedullary canal (Non-Reamed Group). Patients, outcome assessors, and data analysts were blinded to treatment allocation. Peri-operative care was standardized, and re-operations before 6 months were proscribed. Patients were followed at discharge, 2 weeks post-discharge, and at 6 weeks, 3, 6, 9, and 12 months post surgery. A committee, blinded to allocation, adjudicated all outcomes.DiscussionThe primary outcome was re-operation to promote healing, treat infection, or preserve the limb (fasciotomy for compartment syndrome after nailing). The primary outcome was a composite comprising the following re-operations: bone grafts, implant exchanges, and dynamizations, in patients with fracture gaps less than 1 cm post intramedullary nail insertion. Infections and fasciotomies were considered events irrespective of the fracture gap. We planned a priori to conduct a subgroup analysis of outcomes in patients with open and closed fractures. S.P.R.I.N.T is the largest collaborative trial evaluating alternative orthopaedic surgical interventions in patients with tibial shaft fractures. The methodological rigor will set new benchmarks for future trials in the field and its results will have important impact on patient care. The S.P.R.I.N.T trial was registered [ID NCT00038129] and received research ethics approval (REB#99-077).

Anterior knee pain after T2 intramedullary nailing of tibial fracture: A multicentre prospective clinical study

Anterior knee pain after T2 intramedullary nailing of tibial fracture: A multicentre prospective clinical study

Is the patellar tendon responsible for anterior knee pain after intramedullary nailing of tibial fractures?

Is the patellar tendon responsible for anterior knee pain after intramedullary nailing of tibial fractures?

A Technique for Nailing Severely Shortened and Displaced Tibia Fractures

Previously described techniques using external fixators or large distractors can simplify the closed nailing of tibia fractures and nonunions. However, delayed intramedullary nailing can be especially challenging when significant shortening or translation has occurred. We present a modification of an old technique for external fixator-assisted closed tibial nailing in these difficult cases.

Robot-assisted and computer-guided intramedullary nailing for tibial fractures: design and clinical application

目的 以胫骨骨折闭合复位、带锁髓内钉手术为研究对象,开发医用机器人及计算机辅助导航手术系统,总结该系统的临床应用经验,优化系统的结构设计,评价系统的临床 应用效果.方法应用机器人双目视觉空间定位技术,进行医用机器人的模块化、小型化、实 用化结构设计,开发医用机器人及计算机辅助导航手术系统;对胫骨骨折进行机器人辅助复位、计算机辅助导航定位髓内钉置入;临床应用于 30例闭合胫、腓骨骨折(胫骨中 1/3骨折 8例、胫骨中下 1/3骨折 17例、胫骨远 1/3骨折 5例 ;其中斜螺旋骨折 16例,蝶形骨折 5例,粉碎、多段骨折 9例).受伤至手术的平均时间为 36 h.记录总手术时间、系统连接建立时间、骨折闭合复位所需 X线透视时间 (C型臂透视次数 )、每个远端锁定螺钉置入所需要的透视时间( C型臂透视次数).髓内钉型号大小 8/310～ 11/330.结果 30例手术均按照机器人及计算机导 航系统的预定程序,规划完成,但关键的操作(髓内钉入点置入、远端锁钉锁孔)是在机械臂精确定位的辅助下,由术者亲自完成.总手术时间平均为 77 min(46～ 110 min);系统连接建立时间 5 min(3～ 7 min);骨折闭合复位所需 X线透视时间 10.1 s(7.0～ 18.0 s), C型臂透视次数 12次( 9～ 21次);每个远端锁定螺钉置入所需的透视时间 2.9 s(2.2～ 6.9 s) , C型臂透视次数 7次( 5～ 16次),并且所有远端锁孔均一次锁定成功.结论医用机器人及计算机辅助导航手术系统设计合理,系统的基本功能可满足胫骨带锁髓内钉手术中骨折闭合复位、 锁钉准确置入、患肢牢靠固定的要求;系统结构安装简便、易于掌握,人机接口方便、安全 ,对于未来在创伤骨科发展智能化、微创化、数字化手术具有重要意义。

Ankle distraction device in IM nailing of tibial fracture

Ankle distraction device in IM nailing of tibial fracture

External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients

We performed a prospective, randomised study to compare the Ex-fi-re external fixator (EF) with locked intramedullary (IM) nailing in tibial fractures. Only fractures without soft-tissue problems of importance were included. Ex-fi-re is a unilateral, dynamic axial fixator with fracture reduction capabilities. The Grosse-Kempf nail was used for nailing. A total of 78 patients with 79 fractures were entered in the study (41 Ex-fi-re, 38 IM nails). Time to radiographic union and full weight-bearing did not differ significantly, but unprotected weight-bearing was achieved earlier in the IM group (12 vs 20 weeks; p<0.001). There were more reoperations due to secondary dislocation in the EF group. There were no differences in final angulation or shortening. After 6 months and 1 year there were no differences in knee motion, ankle motion, fracture site pain or ankle pain. Some 64% of the nailed patients complained of anterior knee pain after 1 year. The results were comparable in most respects. Unprotected weight-bearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.

Patellar tendon rupture post reamed intra-medullary tibial nail in a patient with Ehlers-Danlos syndrome. A case report

Patellar tendon rupture is a rare complication of intra-medullary nailing in tibial fractures. We report such a case in a patient with type III Ehlers-Danlos syndrome. We recommend the use of unreamed nails and a parapatellar entry point for tibial nailing in patients with connective tissue disorders.

Primary Reamed Intramedullary Nailing for Tibial Fractures with Bone Loss

Primary Reamed Intramedullary Nailing for Tibial Fractures with Bone Loss