Treatment Of Tibial Shaft Fractures Research Articles

Predictors of reoperation following operative management of fractures of the tibial shaft.

Accurate prediction of likelihood of reoperation in patients with tibial shaft fractures would facilitate optimal management. Previous studies were limited by small sample sizes and noncomprehensive examination of possible risk factors. We conducted an observational study to determine which prognostic factors were associated with an increased risk of reoperation following operative treatment in a heterogeneous population of patients with tibial shaft fractures. Retrospective observational study. Level 1 trauma center. We identified 200 patients with tibial shaft fractures from two university-affiliated centers. Two reviewers independently abstracted data regarding 20 possible prognostic variables, reviewed preoperative and postoperative radiographs, and documented reoperations (defined as any surgical procedure </=1 year after the initial surgery that was aimed specifically at achieving bony union of the fracture, including bone grafts, implant exchanges, or débridement for infections). We chose a Cox proportion hazards model to conduct a survival analysis for time to reoperation and constructed a multivariable model to estimate the relative risk of reoperation and associated 95%confidence interval (CI) for each predictor variable. Time to reoperation following the initial surgery. Complete follow-up information was available for 192 of 200 (96%) patients. Three variables predicted reoperation: the presence of an open fracture wound (relative risk 4.32, 95% CI 1.76 to 11.26), lack of cortical continuity between the fracture ends following fixation (relative risk 8.33, 95% CI 3.03 to 25.0), and the presence of a transverse fracture (relative risk 20.0, 95% CI 4.34 to 142.86). We identified a set of three simple prognostic variables (open fracture, transverse fracture, and postoperative fracture gap) that can assist surgeons in predicting reoperation following operative treatment of tibial shaft fractures.

Current practice in the intramedullary nailing of tibial shaft fractures: an international survey.

Tibial fractures are the most common of all long bone fractures. Although many tibial fractures may be managed conservatively, a certain subset, including unstable fractures and open fractures, require operative stabilization. Intramedullary nails have become the popular choice of implant in the treatment of tibial shaft fractures. The variability in outcomes with tibial shaft fractures may reflect technical aspects of the surgical procedure and perioperative care regimens among surgeons. Identifying the distribution of surgeons' preferences in nailing technique, and the rationale for their choices, will aid in focusing educational activities for the orthopedic community and planning future clinical trials. Our objectives were to clarify surgeons' opinions regarding technical aspects of surgery and perioperative care after intramedullary nailing of closed and open tibial shaft fractures, and to identify predictors of surgeons' preferences in technique and perioperative care. This study was a cross-sectional survey using focus groups, key informants, and sampling to redundancy strategies to develop a survey to examine surgeons' preferences in the treatment of tibial shaft fractures. The survey was pilot tested for clarity and content validity. We mailed this survey in July 2000 to 577 orthopedic surgeons who have an interest in trauma care. These were members of the Orthopaedic Trauma Association, American Academy of Orthopaedic Surgeons, or European AO International affiliated trauma centers. We used several strategies to improve response rates including personalized cover letters, stamped return envelopes, follow-up telephone calls, and repeat mailing of questionnaires. Main outcome measures included technical issues such as reduction, exposure, intramedullary reaming, and interlocking screws; and factors associated with surgeons' preferences such as age, fellowship, academic practice, and geographic location. Four hundred forty-four surgeons (77%) responded. Sixty percent of respondents had an academic practice, 84% supervised residents, and 65.1% had fellowship training in trauma. Approximately half (51.5%) of surgeons used a tourniquet. The odds that a surgeon in Asia or Africa used tourniquets was 10 times that of a North American surgeon (p = 0.004 and p = 0.002, respectively). Patellar tendon retraction and an inferior-based entry portal was the popular choice among surgeons (70.1% and 70.8%, respectively). Surgeons from Australia (odds ratio [OR] = 50, p < 0.001), South America (OR = 9.0, p < 0.001), Europe (OR = 3.7, p = 0.001), and Asia (OR = 3.8, p = 0.006) were significantly more likely to use a patellar splitting approach compared with North American surgeons. In the perioperative care of open tibial shaft fractures, there was consensus in the use of intravenous antibiotics and wound irrigation (96.5% and 95.6%, respectively). However, we found considerable variability in surgeons' preference in wound irrigation pressures (high, 38.7%; low, 45.4%). Surgeons in South America were 10 times more likely to use low-pressure irrigation than North American surgeons (p = 0.0005). In grade IIIB open tibial shaft fractures, 94% of surgeons believed wound closure should be obtained within the first 7 days after the injury. A surgeon's geographic location was a significant predictor of the timing of soft tissue coverage (p = 0.001). Consensus in the use of irrigation and intravenous antibiotics in open fractures was achieved among surgeons. However, there remains considerable variability in the surgical technique of intramedullary nailing, the duration of antibiotic use, and the timing of wound closure in open tibial fracture care. Continued education and large multicenter trials are needed to establish best practice in the operative treatment of tibial shaft fracture.

Chapter 6: The Treatment of Tibial Shaft Fractures with Ilizarov Fixators

Chapter 6: The Treatment of Tibial Shaft Fractures with Ilizarov Fixators

Postural control and torque of the knee joint after healed tibial shaft fracture

Muscular atrophy occurs as a consequence of trauma and immobilisation. This cohort comparison study was conducted to evaluate the limb function after healed tibial shaft fractures, which were treated by casting versus nailing. Balance (as centre of pressure) and muscle strength (as torque of the knee joint during knee extension) have been measured in 27 patients with tibial shaft fractures with a mean age of 39 (19–73) years, 1 year after fracture healing. Fourteen patients were treated by intramedullary nailing ‘nailed group’ and 13 by plaster cast with or without minimal internal fixation ‘casted group’. Centre of pressure was measured on a force platform. Knee extension torque was measured during isometric and concentric muscle actions by an isokinetic dynamometer. Centre of pressure tended to be more towards the uninjured leg in patients who had been treated by plaster cast ( P<0.05). Side-to-side differences for isometric torque were significantly higher within the casted group ( P<0.05). Patients with tibial shaft fractures treated by intramedullary nailing showed better postural control, one-leg standing test, and side-to-side differences for isometric muscle strength compared with patients treated by cast. Therefore, we recommend intramedullary nailing as a better method of treatment for tibial shaft fractures, with regard to recovery of muscle function.

Preparation and properties of flame retardant acrylate rubber : Yin, Hong, Jiao, Shuke, Li, Xiaoyu, Xia, Yuzheng, Beijing University of Chemical Technology, Beijing, China in Hecheng Xiangjiao Gongye/China synthetic rubber industry, vol. 23, issue 2, 2000

Intramedullary nails are considered the gold standard for the treatment of tibial shaft fractures. Thereby, the screw-bone interface is considered the weakest link. For biomechanical evaluation of osteosyntheses synthetic bones are often used to overcome the disadvantages of human specimens. However, commercially available synthetic bones cannot adequately mimic the local mechanical properties of human bone. Thus, the aim of this study was to develop and evaluate novel cortical bone surrogate materials that mimic human tibial shafts in the screw-loosening mechanisms of intramedullary nails.Bone surrogates, based on two different polyurethanes, were developed and shaped as simple tubes with varying cortical thicknesses to simulate the diaphyseal cortex of human tibiae. Fresh frozen human tibiae and commercially available synthetic bones with similar cortical thickness were used as references. All specimens were treated with a nail dummy and bicortical locking screws to simulate treatment of a distal tibia shaft fracture. The nail-bone construct was loaded in a combined axial-torsional-sinusoidal loading protocol to simulate the physiological load during human gait. The loads to failure as well as the number of load cycles were evaluated. Furthermore, the cut-through length of the screws was analysed by additional micro computed -tomography images of the tested specimens.The failure load of custom made synthetic bone tubes with 6 mm cortical thickness (3242 ± 136 N) was in accordance with the failure load of human samples (3300 ± 307 N, p = 0.418) with a similar cortical thickness of 4.9 ± 1.4 mm. Commercially available synthetic bones with similar cortical thickness of 4.5 ± 0.7 mm were significantly stronger (4575 ± 795 N, p = 0.008). Oval-shaped migration patterns were “cut” into the cortices by the screws due to the cyclical loading. The cut-through length of the self-developed synthetic bones with 6 mm cortices (0.8 ± 0.6 mm, p = 0.516) matched the cut-through of the human tibiae (0.7 ± 0.6 mm). The cut-through of commercially available epoxy-based synthetic bones deviated from the human reference (0.2 ± 0.1 mm, p < 0.001).The results of this study indicate that the novel bone surrogates realistically mimic the failure and screw migration behaviour in human tibiae. Thus, they offer a new possibility to serve as substrate for biomechanical testing. The use of commercially available surrogates is discouraged for biomechanical testing as there is a risk of drawing incorrect conclusions.

Ender nailing for tibial shaft fractures

During the period from December 1980, when we began using Ender nails for the treatment of tibial shaft fractures, to December 1995, 274 unions of 280 fractures in 275 patients treated by Ender nailing were successfully achieved. Ender nailing for tibial shaft fractures can be classified into three methods A, B, and C, according to the insertion points of the nails. In method A, which is used for the proximal one-third fractures of the tibia, the nails are inserted from the distal tibia medially and laterally towards the proximal tibia. In method B, which is for middle or distal one-third fractures of the tibia, the nails are inserted from the proximal tibia medially and laterally directed distally. In method C, which is for long oblique or double fractures, one nail is inserted from a proximal site, and the other is inserted distally; these two nails must form an X-shape. Ender nailing is an excellent semiconservative treatment for tibial shaft fractures, maintaining adequate elasticity at the fracture sites where much callus is formed, leading to a good union.

Closed reduction of tibial shaft fractures using a sling

We wish to report a simple technique for closed reduction of tibial shaft fractures. The patient is put in the supine position. Longitudinal traction is applied through a plaster boot on the corresponding foot and ankle. A gauze sling ( Fig. 1) placed behind the calf at the fracture site allows suspension of the limb whilst controlling posterior angulation and displacement. This allows control of the limb whilst alignment is checked with the image intensifier in two planes. When satisfactory reduction is obtained, a long leg plaster can be applied to immobilise the fracture. The technique was applied to 21 closed tibial shaft fractures in 21 patients. Satisfactory results were obtained in 20 patients. Analysis of the initial post-manipulation X-rays showed an average of 5.2 mm shortening (range 0–15 mm). The average coronal angulation was 1.9° (range 0–5°), and sagittal angulation was 2.0° (range 0–8°). Average percentage overlap of the fracture fragments was 79% in the coronal plane (range 40–100%) and 82% in the saggital plane (range 50–100%). We found this technique to be simple and reliable. It is particularly useful as the first phase of non-operative treatment of tibial shaft fractures by functional bracing.

Treatment of Tibial Shaft Fractures with Ender Nailing and Postoperative Functional Bracing

Treatment of Tibial Shaft Fractures with Ender Nailing and Postoperative Functional Bracing

Treatment of Tibial Shaft Fractures Using Interlocking Intramedullary Comparison of Reamed and Unlearned Methods

Treatment of Tibial Shaft Fractures Using Interlocking Intramedullary Comparison of Reamed and Unlearned Methods

けい骨骨幹部骨折に対するＲｕｓｓｅｌｌ‐Ｔａｙｌｏｒ Ｉｎｔｅｒｌｏｃｋｉｎｇ Ｎａｉｌ Ｓｙｓｔｅｍによる治療経験

Fifteen tibial fractures were treated by the Russell-Taylor interlocking nail system. Ages of patients ranged from 14 to 77 years with an average of 39 years. Fractures were classified according to AO as A2 in 5 cases, A3 in 3 cases, B2 in 4 cases, B3 in 1 case and C3 in 2 cases. The average time to union was 107.3 days (range: 59-225 days). The average time to full weight bearing gait was 46.9 days (range: 21-92 days). The R-T nail was found to function well in these patients.There were no infections, no malunions and no cases of nonunion.The present study suggested that the R-T nail is suitable for surgical treatment of tibial shaft fractures.

Comparison of Reamed and Unlearned type Intramedullary Interlocking Nail in Treatment of Tibia Shaft Fracture

Comparison of Reamed and Unlearned type Intramedullary Interlocking Nail in Treatment of Tibia Shaft Fracture

Treatment of Tibial Shaft Fractures by Intramedullary Nailing

Treatment of Tibial Shaft Fractures by Intramedullary Nailing

A Clinical Comparison between DCP Fixation and Brooker-Wills IM Nailing in the Treatment of Tibial Shaft Fracture

A Clinical Comparison between DCP Fixation and Brooker-Wills IM Nailing in the Treatment of Tibial Shaft Fracture

A clinical comparison between plate fixation and intramedullary nailing in the treatment of tibial shaft fractures

A clinical comparison between plate fixation and intramedullary nailing in the treatment of tibial shaft fractures

Orthotic Design and Application for Functional Treatment of Tibial Shaft Fractures

Zagorski, Joseph B. MD; Zych, Gregory A. DO; Latta, Loren L. PE, PhD; Finnieston, Alan R. CPO Author Information

The Use of Ender Nails in the Treatment of Tibial Shaft Fractures

The Use of Ender Nails in the Treatment of Tibial Shaft Fractures

Ender nailing in the Treatment of Tibial Shaft Fracture

Ender nailing in the Treatment of Tibial Shaft Fracture

The Treatment of Tibial Shaft Fractures by Closed Kuntscher I - M Nailing

The Treatment of Tibial Shaft Fractures by Closed Kuntscher I - M Nailing

Displaced Malleolar Fractures Associated with Spiral Fractures of the Tibial Shaft

A displaced fracture of the lateral malleolus, of the posterior tibial margin (posterior malleolus), or of both requiring open reduction and internal fixation was observed in association with ipsilateral spiral tibial shaft fracture in five patients. The malleolus fracture components all were managed using AO (ASIF) instrumentation. The tibial shaft fracture was treated nonoperatively in three patients and with interfragmentary screw fixation in two with more severe initial displacement. The bony healing of all fractures was uneventful. These combined injuries amounted to 0.9% of all admitted tibial shaft fractures and 3.9% of those with spiral configuration. An associated displaced malleolar fracture in tibial shaft fractures, sometimes even indiscernible in the anteroposterior view, may be overlooked unless roentgenograms are focused on the ankle joint. Examination of the joints above and below the fracture is of particular importance in clinics advocating functional treatment of tibial shaft fractures.

The Treatment of Tibial Shaft Fractures by Interlocking Nailing

The treatment of tibial shaft fracture has become one of the most controversial subjects in orthopedic surgery. Comminuted, segmental and rotationally unstable fractures or bone defect at fracture site have problems of the fixation. The interlocking nail solve these problems. We have experienced 8 cases of the tibial shaft fractures treated with interlocking nail from 1986 to 1988. Authors analysed these cases and our own clinical study. The results were as follows. 1. The average bone union rate was about 15 weeks. 2. The interval between operation and crutch walking was 4:3 weeks. 3. The merits of this operation were the short hospitalization and early adaptation of social activity. 4. The advantage is be able to do early ambulation without following muscular atrophy or joint stiffness. 5. The results were assessed on clinical examination and radiographic appearance by Hamza et al. An excellent results were 7 cases and good result was 1 case.