Treatment Of Tibial Shaft Fractures Research Articles

External Fixation of Tibial Shaft Fractures in Cameroon-Central Africa

<i>Introduction: </i>Open Tibial Shaft Fractures (TSF) are the most commonly encountered injury type in Cameroon. External fixation, relatively unfamiliar in Cameroon, helps prevent its complications. <i>Objectives:</i> The objective of this study was to evaluate the outcomes of the treatment of TSF using external fixation in Cameroon. <i>Materials and Methods:</i> Patients operated at Laquintinie and Edea Regional Hospital (ERH) with an external fixator (EF) for TSF were followed up from 2018 to 2022. Circumstances of the trauma, anatomo-clinical lesions, types of management, complications, and duration of fixator maintenance were assessed. <i>Results:</i> 161 EFs were placed on 144 patients. Of these, 93 (64.6%) were aged between 20 and 49 years with a sex ratio of 2.5/1. Motorcycle crashes were involved in 68.2% of patients. The fracture involved the middle third in 61 patients (37.9%). It was oblique in 57 patients (35.4%). The injuries were open in 126 (78.3%) cases. The average length of hospital stay was 36.2 days. 122 fractures (75.8%) healed within the expected time, and 21 cases (13.0%) of delayed union were observed. Bone infection was noted in 24 patients (14.9%). The outcome was deemed excellent and good in 122 cases (84.8%). <i>Conclusion:</i> External fixation is effective in managing TSF and is recommended for wider use in Cameroon.

Persistent racial disparities in postoperative management after tibia fracture fixation: A matched analysis of US medicaid beneficiaries

IntroductionRacial and ethnic disparities in orthopaedic surgery are well documented. However, the extent to which these persist in fracture care is unknown. This study sought to assess racial disparities in the postoperative surgical and medical management of patients after diaphyseal tibia fracture fixation. MethodsPatients with surgically treated tibial shaft fractures from October 1, 2015, to December 31, 2020, were identified in the MarketScan® Medicaid Database. Exclusion criteria included concurrent fractures or amputation. Outcomes included 2-year postoperative complications, reoperation rates, and filled prescriptions. Surgically-treated Black and White cohorts were propensity-score matched using nearest-neighbor matching on patient demographics, comorbidities, fracture pattern and severity, and fixation type. Chi-square tests and survival analyses (Kaplan-Meier and Cox proportional hazard models) were conducted. Results5,472 patients were included, 2,209 Black and 3,263 White patients. After matching, 2,209 were retained in each cohort. No significant differences in complication rates were observed in the matched Black vs White cohorts. Rates of reoperation, however, were significantly lower in Black as compared to White patients (28.5 % vs. 35.5 % rate, risk difference = 7.0 % (95 % confidence interval (CI): 4.2 % to 9.7 %)). Implant removal was also significantly lower in Black (17.9 %) vs. White (25.1 %) patients (Risk difference = 7.2 %, (95 %CI: 4.8 % to 9.6 %)). The adjusted hazard ratio comparing the reoperation rate in Black versus White patients was 0.77 (95 %CI: 0.69-0.82, p < 0.0001). Significantly lower proportions of Black vs White patients filled at least one prescription for benzodiazepine, antidepressants, strong opiates, or antibiotics at every time point post-index. DiscussionFewer resources were used in post-operative management after surgical treatment of tibial shaft fractures for Black versus White Medicaid-insured patients. These results may be reflective of the undertreatment of complications after tibia fracture surgery for Black patients and highlight the need for further interventions to address racial disparities in trauma care.

Suprapatellar tibial fracture nailing is associated with lower rate for acute compartment syndrome and the need for fasciotomy compared with the infrapatellar approach

BackgroundIntramedullary tibial nailing (IMN) is the gold standard for stabilizing tibial shaft fractures. IMN can be performed through an infra- or suprapatellar approach.PurposeThe aim of this study is to compare the rate of fasciotomies for acute compartment syndrome between infra- and suprapatellar approaches.MethodsA total of 614 consecutive patients who were treated with IMN for tibial fracture between October 2007 and February 2020 were included in the study. The approach used for IMN was determined by the operating surgeon. Infrapatellar IMN was performed with the knee in deep flexion position, with or without calcaneal traction. Suprapatellar IMN was performed in straight or semiflexed position. The diagnosis of compartment syndrome was based on clinical analysis, but for some patients, a continuous compartment pressure measurement was used. The primary outcome was the rate of peri- and postoperative compartment syndrome treated with fasciotomies.ResultsThe study sample included 513 patients treated with infrapatellar IMN and 101 patients treated with suprapatellar IMN technique. The mean age of the patients was 44.7 years (infrapatellar technique) and 48.4 years (suprapatellar technique). High energy trauma was seen in 138 (27%) patients treated with infrapatellar technique and in 39 (39%) patients treated with suprapatellar technique. In the suprapatellar group (n = 101), there were no cases of peri- or postoperative compartment syndrome treated with fasciotomies. In the infrapatellar group (n = 513), the need for fasciotomies was stated in 67 patients, 31 patients (6.0%) perioperatively and in 36 patients (7.0%) postoperatively. The rate of fasciotomies (0/101 versus 67/513 cases) differed significantly (p < 0.001). There were no significant differences in the fracture morphology or patient demographics between the study groups.ConclusionsThe suprapatellar technique is recommended over the infrapatellar approach in the treatment of tibial shaft fractures. The rate of peri- and postoperative compartment syndrome and the need for fasciotomies was significantly lower with the suprapatellar technique. The major cause of increased rate of peri- or postoperative acute compartment syndrome with infrapatellar IMN technique is presumably associated with the positioning of the patient during the operation.Level of evidence3.

Higher Modified Frailty Index Score is Associated with Increased 30-Day Postoperative Complications Following Surgical Treatment of Tibial Shaft Fractures.

This study was conducted to determine if factors comprising the mFI were correlated with adverse outcomes following surgical intervention of tibial shaft fractures. We identified patients 50 years or older with tibial shaft fractures that were managed surgically from a national database from 2007-2019. The 5-item mFI score, which comprised of diabetes, hypertension, congestive heart failure, dependent functional status, and chronic obstructive pulmonary disease, was calculated for each patient. Regression analysis was used to evaluate the association of different mFI scores with thirty-day postoperative outcomes. 1,159 total patients (mean age of 65 years) were included in this study. After controlling for confounding variables on multivariate analysis, compared to patients with a mFI of 0, those with a score of 1 had an increased risk of major complications (OR 5.11; p=0.038), minor complications (OR 3.11; p=0.004), readmission (OR 2.75; p=0.020), postoperative transfusion (OR 2.22; p=0.037), prolonged hospital stay (OR 1.88; p<0.001), and non-home discharge (OR 1.52; p=0.014). Similar increased risk of complications was seen for patients with a mFI of 2 compared to those with a score of 0: major complications (OR 9.49; p=0.004), readmission (OR 3.73; p=0.003), postoperative transfusion (OR 4.07; p<0.001), prolonged hospital stay (OR 2.50; p<0.001), and non-home discharge (OR 2.32; p<0.001). Higher scores on the mFI were associated with higher complication rates in patients following surgical treatment of tibial shaft fractures. The modified frailty index is a useful tool for surgeons to assess risk before operation.

Use of external fixator combined with titanium elastic nails in the treatment of tibia shaft fractures in children

Tibia shaft fractures are common in all age groups. For these fractures; Conservative and surgical treatment methods are available. In surgical treatment, numerous surgical methods such as plate screw fixation, external fixator, and titanium elastic nail and K-wire fixation have been defined. The aim of the present study was to present the results of patients for whom external fixator combined with titanium elastic nails or titanium elastic nails alone were applied due to tibia shaft fractures. The study included 40 patients treated for tibia shaft fracture in our clinic between January 2016 and January 2019. Combined external fixator (EF) fixation was applied to patients who were found to be instable after Titanium elastic nail (TEN) application during the surgery. In clinical evaluation, Flynn classification, time to fracture union, fluoroscopy count, reoperation and time to full weight bearing were used. The results of patients for whom EF combined with TEN were applied were compared with the patients who had only TEN. Thirty patients were treated using TEN and 10 patients using EF combined with TEN. After 12 months of follow-ups, fracture union was achieved in all patients. There were 5% sagittal and 2.5% coronal plane angulation. Patients developed angular deformity of an average of 2.43 ± 1.9 degrees in the coronal plane and 2.65 ± 1.9 degrees in sagittal plane. Lower percentages of angular and rotational deformity were observed compared to the literature. Despite the disadvantages of using a greater number of fluoroscopy and longer operation periods in patients who underwent TEN+EF, these patients were mobilized earlier. It was concluded that combined EF application is a more feasible method in patients with pediatric tibia shaft fracture for whom stable fixation cannot be achieved with TEN.

Regional anesthesia improves inpatient but not outpatient opioid demand in tibial shaft fracture surgery.

Patients undergoing operative treatment of tibial shaft fractures have considerable pain largely managed with opioids. Regional anesthesia (RA) has been increasingly used to reduce perioperative opioid use. This was a retrospective study of 426 patients that underwent operative treatment of tibial shaft fractures with and without RA. Inpatient opioid consumption and 90-day outpatient opioid demand were measured. RA significantly decreased inpatient opioid consumption for 48h post-operatively (p = 0.008). Neither inpatient use after 48h nor outpatient opioid demand differed in patients with RA (p > 0.05). RA may help with inpatient pain control and reduce opioid use in tibial shaft fracture. Level III, retrospective, therapeutic cohort study.

A study of supra patellar versus infra patellar intramedullary interlocking nailing in tibial diaphyseal fractures

Introduction: Tibial shaft fractures are a common traumatic injury. Traditional infra patellar intra medullary nailing is a popular surgical procedure used in the treatment of tibia shaft fractures. Recently, the supra patellar approach has attracted the attention of orthopedic surgeons, as it seems to offer fewer complications and re-operations. Material and methods: The total of 30 patients with tibial diaphyseal fractures and underwent Intra medullary interlocking nailing, in which 15 with supra patellar approach and 15 patients with infra patellar approach. Results: There was a statistically significant difference in the final outcome in patients undergoing Intra medullary interlocking nailing through Supra Patellar and infrapatellar approach with better functional outcome in the former. Conclusion: we conclude that supra patellar approach had a better clinical outcome compared to Infra patellar approach for tibial diaphyseal fractures with relation to duration of surgery, Intra operative bleeding, Fluoroscopy time, Post-operative anterior knee pain and Knee functional outcome.

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.

Prospective study on functional and radiological outcome of suprapatellar approach for intramedullary nailing using semi extended knee position in tibial shaft fractures

Fractures of the tibia are one of the most common orthopedic injuries occurring most often in younger patients. Tibial fractures are frequently associated with high energy trauma mechanisms. Intramedullary nailing is one amongst the preferred treatment modalities for mid shaft tibial fractures. Standard Tibial nailing entry portals used are the infrapatellar and parapatellar approaches. Suprapatellar tibial nailing is a recent advance in the surgical technique for treatment of tibial shaft fractures. This method has shown reduced operative and fluoroscopy time and lesser pain incidence in previous studies. The semi extended position of the knee also allows for countering the deforming effect of the musculature pull of the quadriceps mechanism and also easier fluoroscopy imaging. The suprapatellar technique decreases the risk of perforation of posterior cortex by placing the starting point in line with the medullary canal. This technique also helps to reduce Varus and Valgus deformity by using the femoral trochlear groove as a guide to the starting point which maintains the mechanical axis of the lower extremity.Objectives of the study: To assess Functional outcomes of suprapatellar approach in mid shaft tibial fractures by Lower extremity functional score (LEFS).To assess Radiological outcomes of suprapatellar approach in mid shaft tibial fractures by the Radiological Union in Tibia Score (RUST).Study design: Prospective interventional studyStudy period: October 2019 to May 2021Source of data: Patients admitted with closed mid shaft tibial fractures as an inpatient in the Department of Orthopaedics, Victoria hospital and Bowring and Lady Curzon hospitals attached to BMCRI were included in the study satisfying the inclusion and exclusion criteriaMethodology: 20 patients with closed or open (type 1 and 2) mid shaft tibial fractures were treated using the suprapatellar approach. Functional outcome was measured using the Lower extremity functional score and radiological outcome was measured using the Radiological union in tibia score at immediate and last follow up intervals.Results: Our study group comprised of 20 patients between the ages 20 to 60 years. LEFS showed a statistically significant improvement from 23.35 at 6 weeks to 69.25 at 12 months. In our study analysis out of 20 patients, 11 patients had excellent LEFS score, 7 patients had good LEFS score and 2 patients had fair LEFS score. Also in our study 100% patients achieved union by 20 weeks with a mean RUST score of 7.4 at 6 weeks compared to a mean RUST score of 14.15 at 12 months.Conclusion: Suprapatellar nailing has shown shorter fluoroscopy less manoeuvrability and operative time, excellent to fair functional outcome of lower limb and reduced incidence of valgus and varus malalignment postoperatively. Suprapatellar nailing is a promising technique of tibial fracture fixation with satisfactory radiological and functional outcomes postoperatively.

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;

Suprapatellar intramedullary nailing of tibial shaft fractures in pregnancy. A report of two cases

BackgroundTreatment of closed tibial shaft fractures in the 3rd trimester of pregnancy is controversial. Since there are few case reports published in literature, there is no consensus on the appropriate management of these fractures. This case report proposes intramedullary nailing throught the suprapatellar approach for the treatment of tibial shaft fracture in pregnant women, never described before in literature.Case presentationWe report 2 cases of a tibial diaphyseal fracture treated by intramedullary nailing in women at the 3rd trimester of pregnancy.ConclusionSurgical treatment of tibial shaft fracture of pregnant women in the 3rd trimester of pregnancy with intramedullary nailing seems to be safe. The use of the specific suprapatellar approach helps in the intra-operative management of the pregnant patients.

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.

Functional Outcomes in Suprapatellar Nailing for the Treatment of Tibial Shaft Fractures

Introduction: The purpose of this study was to evaluate the functional outcomes of suprapatellar intramedullary nailing for the treatment of tibial shaft fractures.Material and Methods: The present retrospective study included 10 cases aged more than 20 years, who were operated for tibial shaft fractures over last 3 years with suprapatellar tibial nailing. Patients were retrospectively followed up with all their previous surgical records and radiographs.Results: The mean age was 41.57±16.51 with a range of 20-72 years. Mean operating time was 81±10.15 minutes. Mean blood loss was 110±20.5 ml. Mean time for union was 15.15±1.35 weeks. No deep infection was noted. 1 patient had anterior knee pain. The mean Lysholm knee score was 87.91 ± 5.75.Conclusion: The suprapatellar approach is good and safe technique for nailing in the tibial fractures.

Prophylactic use of antibiotic-coated intramedullary nails in the treatment of open fractures of the tibia: A clinical observational assessment

Aim: To evaluate the efficacy of antibiotic-coated intramedullary locking nail in the open tibia fractures. Materials and Methods: It was a one-year clinical observational research at the Department of Orthopaedics, BIMS Medical college, Belagavi, which was conducted in a clinical setting. An interlocking tibia nail was used to treat 70 patients. Those with open fractures of the gustillo type 1, 2, and 3A, 3B were included in this research. There were excellent, good, fair and bad grades for RUST Scores and clinical evaluation scores. Result: Of the 70 patients, 44.28 percent belonged to 30-40 years age group, 28.57 percent were in the age group 40-50, and 20 percent were above 50. Males (72.86%) outnumbered females. The most prevalent cause of injury was a car collision, accounting for 55 (78.57%) of cases. 92.86 percent of patients had a femur fracture. Wounds healed in less than 6 weeks in 50% of patients, 6-8 weeks in 31.43%, 8-10 weeks in 10%. At six months, 40 patients (57.14%) had RUST score 9, 15 patients (21.43%) had RUSH score 11, and 6 patients (8.57%) had RUSH score 6. Out of 70 patients, 8 (11.14%) had great outcomes, 15 (21.43%) good, 41 (58.57%) fair, and only 6 (8.57%) had bad outcomes. Conclusion: Implant-related infection is a major stumbling block in the surgical treatment of tibia shaft fracture, according to the present study. Local administration of antibiotics might minimize the risk of infection.

Rates and timing of short-term complications following operative treatment of tibial shaft fractures.

Introduction:Tibial shaft fractures are a relatively common injury in orthopaedic surgery, with management options including intramedullary nail (IMN) fixation or open reduction internal fixation (ORIF) with plate osteosynthesis. Using a large national database, we sought to compare the prevalence and timing of short-term complications following either IMN or ORIF for tibial shaft fractures.Methods:The American College of Surgeons National Surgical Quality Improvement Program was used to identify patients undergoing IMN or ORIF for the treatment of tibial shaft fracture between 2012 and 2018. Multivariate Poisson hurdle regression models were utilized to determine predictors of postoperative complications as well as the timing of postoperative complications.Results:A total of 4963 tibial shaft fracture were identified, with 3601 patients undergoing IMN (72.6%) and 1362 undergoing ORIF (27.4%). Patients undergoing IMN had a lower mean age of 48.8 compared with 53.9 for plate osteosynthesis (P < .001). IMN patients were also more likely to be male (53.5%) compared with ORIF patients (44.2%, P < .001). In multivariate analysis, ORIF patients were significantly more likely to experience surgical site complications, including dehiscence, superficial, and deep infections (OR 2.04, P = .003). There was no difference in probability of VTE between constructs; however, patients who underwent ORIF were diagnosed with VTE earlier than those who underwent IMN (relative rate 0.50, P < .001). There was no difference between ORIF and IMN with regard to probability or timing of subsequent blood transfusion, major complications, or return to the operating room. Many patient factors, such as higher American Society of Anesthesiologists score, congestive heart failure, and hypertension, were independently associated with an increased risk of postoperative complications.Conclusions:Postoperative complications within 30 days are common after the surgical treatment of tibial shaft fractures. The risk of developing specific complications and the timing of these complications vary depending on numerous factors, including potentially modifiable risk factors such as the method of fixation or operative time, as well as nonmodifiable risk factors such as medical comorbidities.

High Value Tibial Nail Utilization Improves Cost Without Compromising Outcomes: Experience at a Level II Trauma Center

Introduction In today’s opportunistic healthcare climate, value based care has moved to the forefront of cost containment. With respect to orthopaedic trauma, it has become increasingly important to factor cost into the treatment of an often underinsured patient population. As patents expire on many commonly used trauma implants, high value alternatives represent an excellent opportunity for trauma surgeons to provide value-based care so long as it does not compromise outcomes. The objective of this study was to appraise the clinical and economic impact of the use of high quality, low-cost tibial nails in the treatment of tibial shaft fractures. Methods Two hundred patients treated with high value tibial nail implants were compared to two hundred patients treated with conventional implants at a busy community level II trauma center between January 2011 and December 2019. Operative records were reviewed to identify intraoperative complications, operative time, and estimated blood loss. Cases of infection, malunion, nonunion, or need for repeat surgery were recorded. Hospital financial records were analyzed to determine implant cost. Results There was no appreciable difference in age, sex, diabetes, smoking, or American Society of Anesthesiologist (ASA) physical status score between the high value and conventional groups. A significant difference in operative time was observed. No differences were observed in intraoperative or postoperative complications. There was no significant difference found in return to the operating room or interlocking screw removal. Analysis found an average of $735 per case in implant savings. This represented a 38% reduction in implant cost with an overall realization of $147,000 in savings across the study period. Conclusion The use of high value tibial nails at our institution resulted in significantly reduced implant expenditures with equivalent radiographic and clinical outcomes. Based on this data, the use of high value tibial nail implants has potential to markedly reduce operative costs without compromising patient care as long as quality products are utilized.

Multiplanar fracture reducer versus manual traction in the treatment of tibial shaft fractures with intramedullary nails.

The purpose of this study was to propose a new traction device, a multiplanar fracture reducer (MFR), for the treatment of tibial shaft fractures with intramedullary nails (IMN). The efficiencies of the multiplanar fracture reducer and manual traction (MT) in the treatment of tibial shaft fractures with IMN were compared. From January 2019 to January 2020, a total of 79 patients were enrolled in this study, among whom 38 were treated with MFR while 41 were treated with MT. Their demographics and fracture characteristics, surgical data, and prognostic data between the two groups were compared. The mean number of intra-operative fluoroscopies in the MFR group was less than that in the MT group (19.4 vs 21.2, p < 0.001); surgical procedures involving open reduction were more in the MT group than in MFR group (0 vs 5, p = 0.026); there were less assistants in the MFR group than in the MT group (1 vs 1.9, p < 0.001), while the average Lysholm Knee Function Score and knee flexion were 92.7 ± 2.0 and 128.8 ± 1.4 in the MFR group, and 91.9 ± 2.1 and 127.5 ± 1.8 in the MT group, respectively. Both LKFS and knee flexion in the MFR group were significantly better than those in the MT group (p = 0.032 and p < 0.001). The remaining data between the two groups were comparable. MFR is a safe and effective device for the minimal invasive treatment of tibial shaft fractures fixed with IMN.

Efficacy of intramedullary nail fixation for the tretament of tibial shaft fracture with difference approachs

To compare clinical effect of intramedullary nailing through suprapatellar, infrapatellar and paracpatellar approach in treating tibial shaft fracture. From June 2012 to June 2018, 36 patients with tibial shaft fracture were treated with intramedullary nails, and were divided into three groups according to surgical approach. Twleve patients were through suprapatellar approach, including 7 males and 5 females aged from 25 to 53 years old with an average of (37.8±11.4) years old;and 4 patients were type A, 4 patients were type B, and 4 patients were type C according to AO classification. Ten patients were through infrapatellar approach, including 6 males and 4 females aged from 19 to 56 years old with an average of (35.6±10.0) years old;and 3 patients were type A, 4 patients were type B, and 3 patients were type C according to AO classification. Forteen patients were through paracpatellar approach, including 8 males and 6 females aged from 21 to 58 years old with an average of (36.6±10.0) years old;and 4 patients were type A, 6 patients were type B, and 4 patients were type C according to AO classification. Operation time, intraoperative blood loss, fluoroscopy times, fracture healing time and complications among three groups were observed, and knee joint functions were evaluated by Lysholm score. All patients were followed up from 12 to 18 months with an average of (15.0±3.0) months. There were no difference in intraoperative blood loss and fracture healing time among three groups (P>0.05). There were statistical difference in operation time, fluoroscopy times and complications compared with suprapatellar approach and infrapatellar approach, paracpatellar approach (P<0.05). While there were no difference in operation time, fluoroscopy times and complications between infrapatellar approach and paracpatellar approach (P>0.05). Lysholm score among suprapatellar approach, infrapatellar approach and paracpatellar approach were (87.5±7.5), (78.2±6.7) and (77.4±6.3) respectively, and had differences among three groups (P<0.05). Compared with suprapatellar approach and infrapatellar approach, paracpatellar approach, there were difference in squatting, climbing stairs, pain and total scores (P<0.05);while there were no difference between infrapatellar and paracpatellar group (P>0.05). intramedullary nailing through suprapatellar for the treatment of tibial shaft fracture is benefit for fracture healing and recovery of knee joint function, while infrapatellar and paracpatellar approach have advantages in exposure of insertion point. We should select approach reasonably according to our experience.

Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury?

IntroductionThe present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury. HypothesisPatients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF. Material and methodsThe study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months). ResultsNo statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05). DiscussionAlthough AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures. Level of evidenceIV; retrospective, case-control study.

Application of the multiplanar fracture redactor in the treatment of tibial shaft fractures with intramedullary nails

This prospective study aimed to introduce the application of the multiplanar fracture redactor (MFR) in the treatment of tibial shaft fractures with intramedullary nails (IMNs). From February to June 2018, a total of 18 patients with tibial shaft fractures were recruited. MFR was used to help achieve the reduction of tibial shaft fractures with IMN in all patients. The demographic and fracture characteristics, surgical data, postoperative complications and prognostic indicators of 16 patients were recorded. All operations were performed under closed reduction, excellent radiological and functional outcomes were observed. The average duration of surgery, intraoperative blood loss, intraoperative fluoroscopy times, number of intraoperative assistants, and duration of postoperative hospital stay were 91.2 ± 26.1 min, 95.0 ± 58.3 ml, 19.2 ± 2.3 times, 1 (1–2), and 7.8 ± 2.6 days, respectively. The mean Lysholm Knee Function Score (LKFS), American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores at one year after surgery were 96.8 ± 2.1, 94.8 ± 2.9, and 1 (0–3), respectively. Wound infection, non-union, malunion or complications associated with MFR were not observed in this study. Thus, MFR was a safe and neater method to achieve and maintain the reduction of tibial shaft fractures with IMN.