1
|
Lin X, Zhang C, Yang Y, Yang W, Wang X, Lu H, Liu Q. Comparative experimental study of the biomechanical properties of retrograde tibial nailing and distal tibia plate in distal tibia fracture. Front Bioeng Biotechnol 2024; 12:1322043. [PMID: 38444646 PMCID: PMC10912641 DOI: 10.3389/fbioe.2024.1322043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
Objective: A biomechanical comparative analysis was conducted to evaluate the retrograde tibial nailing (RTN) and distal tibia plate techniques for the treatment of distal tibia fractures. Methods: Fourteen fresh adult tibia specimens were selected, consisting of seven males and seven females aged 34-55 years. The specimens were randomly divided into two groups (Group A and Group B) using a numerical table method, with seven specimens in each group. Group A underwent internal fixation of distal tibial fractures using RTN, while Group B received internal fixation using a plate. The axial compression properties of the specimens were tested in the neutral positions under pressures of 100, 200, 300, 400, and 500 N. Additionally, the torsional resistance of the two groups was assessed by subjecting the specimens to torques of 1.0, 2.0, 3.0, 4.0, and 5.0 N m. Results: At pressures of 400 and 500 N, the axial compression displacement in Group A (1.11 ± 0.06, 1.24 ± 0.05) mm was significantly smaller than that in Group B (1.21 ± 0.08, 1.37 ± 0.11) mm (p = 0.023, 0.019). Moreover, at a pressure of 500 N, the axial compression stiffness in Group A (389.24 ± 17.79) N/mm was significantly higher than that of the control group (362.37 ± 14.44) N/mm (p = 0.010). When subjected to torques of 4 and 5 N m, the torsion angle in Group A (2.97° ± 0.23°, 3.41° ± 0.17°) was significantly smaller compared to Group B (3.31° ± 0.28°, 3.76° ± 0.20°) (p = 0.035, 0.004). Furthermore, at a torque of 5 N m, the torsional stiffness in Group A (1.48 ± 0.07) N m/° was significantly higher than that in Group B (1.36 ± 0.06) N·m/° (p = 0.003). Conclusion: The results obtained from the study demonstrate that the biomechanical performance of RTN outperforms that of the distal tibial plate, providing valuable biomechanical data to support the clinical implementation of RTN.
Collapse
Affiliation(s)
- Xuping Lin
- Department of Spinal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- Department of Orthopedic Surgery, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, China
| | - Cong Zhang
- Department of Orthopedic Surgery, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, China
| | - Yanfang Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wencheng Yang
- Department of Spinal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Xiaomeng Wang
- Department of Spinal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Haichuan Lu
- Department of Spinal Surgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Qingjun Liu
- Department of Orthopedic Surgery, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, China
| |
Collapse
|
2
|
Lu Y, Zhao J, Huang Q, Ren C, Sun L, Wang Q, Li M, Zhang C, Xue H, Li Z, Zhang K, Xu Y, Ma T. Combined Medial Plate and Intramedullary Nailing for the Fixation of Extra-Articular Proximal Tibial Fractures: a Biomechanics Study. Front Bioeng Biotechnol 2022; 10:859512. [PMID: 35845415 PMCID: PMC9280979 DOI: 10.3389/fbioe.2022.859512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: The extra-articular proximal tibial fractures continue to have high malunion rates despite development in intramedullary nailing (IMN) technology. Combined plate and IMN fixation can increase mechanical stability. The purpose of this study was to investigate combined plate and IMN for the treatment of extra-articular proximal tibial fracture using a biomechanical model. Methods: A 10-mm defective osteotomy was created in the fourth-generation composite tibia to simulate extra-articular proximal tibial fractures (AO/OTA 41A2). The fractures were stabilized with IMN alone (IMN group), IMN with supplementary medial plate (M-IMN group), and IMN with supplementary lateral plate (L-IMN group). The biomechanical properties of each specimen were tested under axial compression loading, bending stress, and cyclic loading. The maximum displacement of the fragments and implant-bone construct failure was recorded. Results: The maximum displacement of the M-IMN group was significantly less than either the L-IMN or IMN group in both axial compression loading and bending stress (p < 0.05 for both comparisons). All specimens in the three groups survived in 10,000 cyclic loading without hardware deformation. The maximum stiffness of failure was similar between the M-IMN and L-IMN groups, but the IMN group was statistically lower than either the L-IMN or the IMN group (p < 0.05). Conclusion: The results indicated that combined medial plate and IMN fixation could effectively increase the mechanical stability of proximal tibial fractures.
Collapse
Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Jiasong Zhao
- Department of International Ward (Orthopedic), Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Congming Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yibo Xu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yibo Xu, ; Teng Ma,
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yibo Xu, ; Teng Ma,
| |
Collapse
|
3
|
Greenfield J, Appelmann P, Wunderlich F, Mehler D, Rommens PM, Kuhn S. Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking. Eur J Trauma Emerg Surg 2021; 48:3693-3700. [PMID: 34859267 PMCID: PMC9532294 DOI: 10.1007/s00068-021-01843-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/14/2021] [Indexed: 01/08/2023]
Abstract
Objectives Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology. Methods Six Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations. Results The removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading. Conclusions The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.
Collapse
Affiliation(s)
- Julia Greenfield
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Philipp Appelmann
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Felix Wunderlich
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Dorothea Mehler
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sebastian Kuhn
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany. .,Department of Digital Medicine, Medical School OWL, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| |
Collapse
|
4
|
Liang H, Li L, Yang J, Du Y, Peng W. Treatment of open and comminuted mid-distal tibial fractures by bilateral external fixation combined with limited-internal fixation. Acta Orthop Belg 2021; 87:745-750. [PMID: 35172442 DOI: 10.52628/87.4.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Open and comminuted mid-distal fractures often result from high-energy trauma, and a concomitant poor blood supply often leads to skin necrosis, infection, and bone union. To circumvent such complications, we used limited-reduction and bilateral-external fixators to treat open and comminuted mid-distal tibial fractures with compromised soft tissue. A retrospective series of 34 patients who had open and comminuted mid-distal tibial fractures and treated by bilateral-external fixators with limited-internal fixation were analyzed. Patients were followed for 10-25 months (mean: 12 months) post-treatment and osseous union was achieved in each case. The average union time was 16.3 weeks. Based on the Johner- Wruhs criteria, the retrospective series consisted of 21 'excellent' cases, 8 'good' cases, 4 'fair' cases, and a 'poor' case. The total percentage of 'excellent' and 'good' cases of fracture recovery was 85.29%. Bilateral-external and limited-internal fixators pro- vided high bone union rate and excellent ankle-joint motion. Hence, it is an appropriate surgical approach for treating open and comminuted mid-distal tibial fractures with compromised soft tissue.
Collapse
|
5
|
Greenfield J, Appelmann P, Lafon Y, Bruyère-Garnier K, Rommens PM, Kuhn S. A comparative biomechanical study of the Distal Tibia Nail against compression plating for the osteosynthesis of supramalleolar corrective osteotomies. Sci Rep 2021; 11:18834. [PMID: 34552116 PMCID: PMC8458440 DOI: 10.1038/s41598-021-97968-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/21/2021] [Indexed: 11/09/2022] Open
Abstract
The Distal Tibia Nail (DTN; Mizuho, Japan) has demonstrated higher biomechanical stiffness to locking plates in previous research for A3 distal tibia fractures. It is here investigated as a fixation option for supramalleolar corrective osteotomies (SMOT). Sixteen Sawbones tibiae were implanted with either a DTN (n = 8) or Medial Distal Tibia Plate (MDTP; n = 8) and a SMOT simulated. Two surgical outcome scenarios were envisaged: "best-case" representing an intact lateral cortex, and "worst-case" representing a fractured lateral cortex. All samples were subjected to compressive (350 N, 700 N) and torsional (± 4 Nm, ± 8 Nm) testing. Samples were evaluated using calculated construct stiffness from force-displacement data, interfragmentary movement and Von Mises' strain distribution. The DTN demonstrated a greater compressive stiffness for the best-case surgical scenario, whereas the MDTP showed higher stiffness (p < 0.05) for the worst-case surgical scenario. In torsional testing, the DTN proved more resistant to torsion in the worst-case surgical setup (p < 0.05) for both ± 4 Nm and ± 8 Nm. The equivalent stiffness of the DTN against the MDTP supports the use of this implant for SMOT fixation and should be considered as a treatment option particularly in patients presenting vascularisation problems where the MDTP is an inappropriate choice.
Collapse
Affiliation(s)
- Julia Greenfield
- Univ Gustave Eiffel, IFSTTAR, LBMC, UMR_T9406, Univ Lyon, 25 Avenue François Mitterrand, 69500, Bron, France.,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Philipp Appelmann
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Yoann Lafon
- Univ Gustave Eiffel, IFSTTAR, LBMC, UMR_T9406, Univ Lyon, 25 Avenue François Mitterrand, 69500, Bron, France
| | - Karine Bruyère-Garnier
- Univ Gustave Eiffel, IFSTTAR, LBMC, UMR_T9406, Univ Lyon, 25 Avenue François Mitterrand, 69500, Bron, France
| | - Pol Maria Rommens
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sebastian Kuhn
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany. .,Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| |
Collapse
|
6
|
Kang H, Song JK, Rho JY, Lee J, Choi J, Choi S. Minimally invasive plate osteosynthesis (MIPO) for mid-shaft fracture of the tibia (AO/OTA classification 42): A retrospective study. Ann Med Surg (Lond) 2020; 60:408-412. [PMID: 33250999 PMCID: PMC7677665 DOI: 10.1016/j.amsu.2020.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is abundance of literature regarding the treatment of tibial mid-shaft fracture, and intramedullary nailing (IMN) is described as the treatment of choice. However, problems such as malunion and knee pain are known disadvantages of this approach. Minimally invasive plate osteosynthesis (MIPO) technique is another treatment option for tibial mid-shaft fracture.The purpose of this study is to evaluate the clinical, radiological results, and complication rates of tibial mid-shaft fractures treated with MIPO technique. MATERIALS AND METHOD Thirty-seven skeletally mature patients who underwent MIPO for a mid-shaft fracture of tibia (AO/OTA classification 42) from June 2016 to May 2018 were retrospectively reviewed. A total of 37 patients (12 females, 25 males) with a mean age of 52.7 years (range 28-78 years) were included. The clinical and radiological outcomes, such as the Jeju Lower Extremity Trauma Scale (JLETS), time to callus formation, time to bony union, and complications such as delayed union, malunion, nonunion, and infection were assessed. RESULTS Bony union was achieved in all cases but one (36 cases). Average callus formation was observed in 10.7 (6.5-14.5) weeks. The average time to union was 19.8 (11.5-26.5) weeks. The average JLETS score was 46.9 (40-53) point. Malunion deformities were observed in 3 cases (8.1%). Two superficial infection cases all resolved spontaneously. There was no statistically significant difference in clinical and radiographic outcomes by different AO/OTA fracture types. CONCLUSION The MIPO technique with locking compression plate provides stable fixation and satisfactory clinical and radiological results for mid-shaft fractures of tibia irrespective of the fracture type. Future study should aim to compare MIPO and IMN cases directly to clarify the differences and similarities between the two treatment modalities.
Collapse
Affiliation(s)
- Hyunseong Kang
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, South Korea
| | - Jung-Kook Song
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, South Korea
| | - Joseph Y. Rho
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, South Korea
| | - Jaehwang Lee
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, South Korea
| | - Jaewon Choi
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, South Korea
| | - Sungwook Choi
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, South Korea
| |
Collapse
|
7
|
Santolini E, Stella M, Divano S, Ceccarelli M, Vicenti G, Bizzoca D, Santolini F. Optimum timing of conversion from DCO to definitive fixation in closed fractures of the lower limb: When and how? Injury 2020; 54 Suppl 1:S63-S69. [PMID: 32958344 DOI: 10.1016/j.injury.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/18/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In damage control orthopaedics (DCO), fractures are initially stabilised with external fixation followed by delayed conversion to definitive internal fixation. The aim of this study is to determine whether the timing of the conversion influences the development of deep infection and fracture healing in a cohort of patients treated by DCO after a closed fracture of the lower limb. Furthermore, we wanted to evaluate whether the one-stage conversion procedure is always safe. MATERIALS AND METHODS A retrospective cohort study was conducted at a single level 1 trauma centre. Ninety-four cases of closed fractures of lower limb treated by DCO subsequently converted to internal fixation from 2012 to 2019 were included. Development of deep infection, superficial infection, non-union and time to union were recorded. Patients were then divided into three groups according to the timing of conversion: Group A (<7 days), Group B (7-13 days), Group C (> 14 days). Comparison between groups was performed to assess intergroup variabilty. RESULTS The mean number of days between DCO and conversion was 6.7±4.52 (range 1-22). We observed one case of deep infection (1.1%), one case of non-union (1.1%), four cases of superficial infection (4.3%) and mean time to union was ±1.38 months. Comparison between groups demonstrated no significant correlation between timing of conversion and development of superficial or deep infection and non-union, while it highlighted that complexity of the fracture and longer surgical time of conversion procedure were significantly higher in Group C. CONCLUSIONS One-stage conversion to definitive internal fixation within 22 days from DCO is a safe and feasible procedure, which does not influence the incidence of infection or non-union.
Collapse
Affiliation(s)
- Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy.
| | - Marco Stella
- Orthopedics and Trauma Unit, Ente Ospedaliero Ospedali Galliera, Mura delle Cappuccine 14 - 16148, Genoa, Italy
| | - Stefano Divano
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy
| | - Michele Ceccarelli
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy
| | - Giovanni Vicenti
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Davide Bizzoca
- Department of Neuroscience and Sense Organs, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy
| | - Federico Santolini
- Orthopedics and Trauma Unit, Emergency Department, Ospedale Policlinico San Martino, Largo R. Benzi 10 - 16132, Genoa, Italy
| |
Collapse
|
8
|
Cramer C, Frosch KH. [External fixator for temporary stabilization of complex periarticular knee fractures]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:410-420. [PMID: 32876757 DOI: 10.1007/s00064-020-00674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/03/2020] [Accepted: 02/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Temporary stabilization of the knee joint in order to minimize soft tissue strain until definitive surgery is possible. INDICATIONS Bicondylar distal femoral and tibial plateau fractures, additional vascular injury, open fractures (second or third degree), severe soft tissue damage, unicondylar fracture with contralateral ligament tear, (open) knee dislocation, polytrauma. CONTRAINDICATIONS Unsafe pin placement, severe osteoporosis. SURGICAL TECHNIQUE Two femoral and tibial pins are connected by two rods and are spanned over the knee with two additional longitudinal rods via a tube-to-tube clamp. Alternatively, this can be facilitated by a direct connection of two rods in case of anteriorly placed femoral pins. A reasonable distance should be kept to open wounds, the fracture, and later operative approaches. The knee is fixed in 5-15° of flexion. POSTOPERATIVE MANAGEMENT Definitive treatment depending on patient well-being and amenable soft tissue.
Collapse
Affiliation(s)
- C Cramer
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland.
| | - K-H Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland
| |
Collapse
|
9
|
Microbiological diagnosis of intramedullary nailing infection: comparison of bacterial growth between tissue sampling and sonication fluid cultures. INTERNATIONAL ORTHOPAEDICS 2020; 45:565-573. [PMID: 32783073 DOI: 10.1007/s00264-020-04771-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intramedullary nailing (IMN) has been frequently indicated to treat long bone open and closed fractures, but IMN infection (IMNI) may have devastating consequences. Sonication has been regarded as an important add-on for microbial identification on a variety of orthopaedic implant-associated infections, but its role in the IMNI is poorly studied. We aim at evaluating the accuracy obtained by conventional peri-implant tissue culture (TC) samples with sonication fluid cultures (SCs) of IMNI. METHODS Longitudinal prospective cohort study ongoing since June 2014, which included patients with indication for IMN removal due to any reason. Clinical diagnosis of INMI was defined according to publication addressing fracture-related infections. Minimal of two samples from TC were cultured. SCs followed the protocol previously published. Statistical analysis was performed using McNemar's test for related proportions. RESULTS We included 54 patients submitted to IMN retrieval, of whom 47 presenting clinical signs of IMNI. Sensitivity for detecting microorganisms using TC and SC was 89.4% (42/47) and 97.6% (40/41), and specificity was 71.4% (5/7) for both TC and SC (p = 1.00). Positive and negative predictive values for TC and SC were 95.5% (42/44), 95.2% (40/42), 50% (5/10), and 83.3% (5/6), respectively. The most frequent organisms isolated in both TC and SC were Staphylococcus aureus, S. epidermidis, and Enterococcus sp. Polymicrobial infection was diagnosed in 14.8% (8/54) and 25% (12/48) by TC and SC, respectively (p = 0.19). CONCLUSION Sonication fluid and tissue samples presented similar accuracy on the diagnosis of IMNI, but SC was advantageous of detecting polymicrobial infection.
Collapse
|
10
|
Mathieu L, Tossou-Odjo L, de l'Escalopier N, Demoures T, Baus A, Brachet M, Masquelet AC. Induced membrane technique with sequential internal fixation: use of a reinforced spacer for reconstruction of infected bone defects. INTERNATIONAL ORTHOPAEDICS 2020; 44:1647-1653. [PMID: 32696330 DOI: 10.1007/s00264-020-04735-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate a novel sequential internal fixation strategy using a reinforced spacer for infected bone defect reconstruction by the induced membrane technique (IMT). METHODS A retrospective case study was performed among patients treated for infected bone defects by applying this strategy. Following radical debridement, temporary stabilization was provided by a massive cement spacer combined with minimal intramedullary fixation during step 1. Definitive internal fixation was performed together with bone grafting at step 2. RESULTS Eight patients with a mean age of 58 years were reviewed. The mean bone defect length was 8.8 cm. The spacer armature mostly consisted of elastic nails and Steinmann pins. Iterative debridement was required in one case after step 1. The mean interval between steps was 12 weeks. Definitive internal fixation was performed by intramedullary nailing (n = 4) or plating (n = 4). At a mean follow-up of 21 months, bone union was achieved in seven cases without additional bone grafting or infection recurrence. CONCLUSIONS Sequential internal fixation using a reinforced cement spacer seems to be a valuable option for avoiding external fixation between IMT steps and limiting the recurrence of infection.
Collapse
Affiliation(s)
- Laurent Mathieu
- Clinic of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. .,Department of surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75005, Paris, France.
| | - Léon Tossou-Odjo
- Clinic of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France
| | - Nicolas de l'Escalopier
- Clinic of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France
| | - Thomas Demoures
- Clinic of Orthopedics and Traumatology, Bégin Military Hospital, 69 avenue de Paris, 94160, Saint-Mandé, France
| | - Arnaud Baus
- Clinic of Esthetic and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France
| | - Michel Brachet
- Clinic of Esthetic and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France
| | - Alain Charles Masquelet
- Clinic of Orthopedics, Trauma and Hand Surgery, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| |
Collapse
|
11
|
Liu XK, Xu WN, Xue QY, Liang QW. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 11:954-965. [PMID: 31823496 PMCID: PMC6904655 DOI: 10.1111/os.12575] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/14/2022] Open
Abstract
To evaluate the application, safety and efficacy of the patients treated with intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal tibia fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, we searched databases PubMed, Cochrane library, EMBASE and Web of Science from inception of the database up to 10 October 2018, using the keywords "distal tibia fractures", "plate", "intramedullary nailing" and "RCT" to identify randomized clinical trials about distal tibia fractures. The included studies were assessed by two researchers according to the Cochrane risk-of-bias criteria. The primary outcome of measurement included operation time, malunion rate, nonunion/delayed union rate, and wound complication. Data analysis was conducted with Review Manager 5.3 software. A total of 10 RCTs involving 911 patients fulfilled the inclusion criteria with 455 patients in the IMN group and 456 patients in the MIPO group. There were no significant differences in radiation time, nonunion or delayed union rate, union time and operation time between the two groups. Patients treated with MIPO had lower incidence of malunion compared with IMN (RR = 1.85, 95%CI: 1.21 to 2.83, P = 1.00), while IMN seemed to have lower surgical incision complications whether in closed or opening fractures (RR = 0.49, 95%CI 0.33 to 0.73, P = 0.43). But in patients classified as 43A, the result of subgroup analysis suggested that there was no significant inwound complication between the two groups. MIPO was superior in preventing malunion compared with IMN, and intramedullary nailing appeared to have lower wound complications. However, in patients with 43A distal tibial fractures, MIPO was more recommended for its prevention of malunion. No matter which method we choose, we should notice and prevent the associated complications.
Collapse
Affiliation(s)
- Xiao-Kai Liu
- Joint Surgery Department, Chaoyang Central Hospital, Chaoyang City, Liaoning Province, China
| | - Wen-Nan Xu
- Department of Orthopaedic, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qing-Yun Xue
- Department of Orthopaedic, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qing-Wei Liang
- Department of Orthopaedic, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| |
Collapse
|
12
|
Park S, Moon SW, Lee J, Kim JW. Intramedullary tibia nailing with external fixation. Eur J Trauma Emerg Surg 2020; 47:1947-1955. [PMID: 32221638 DOI: 10.1007/s00068-020-01351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study introduces an intramedullary nailing technique with external fixation and aims to determine the safest position of Schanz screws for this technique. METHODS 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. RESULTS The safe area for inserting Schanz screws in the medial to lateral direction in the proximal tibia was found to be 1.5-4.5 cm distal to the knee joint line on the AP view, 1 cm anterior to the posterior cortex at the distal 4.5 cm level, and ≤ 24 mm from the posterior cortex on the lateral view. In males, the area 1.5-3.0 cm proximal to the tibial plafond and 0.5 cm 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 1.5 cm proximal to the tibial plafond and just anterior to the posterior cortex. CONCLUSION 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.
Collapse
Affiliation(s)
- Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang Won Moon
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jaehyung Lee
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
13
|
Russo AP, Caubere A, Ghabi A, Grosset A, Mangin P, Rigal S, Mathieu L. Sequential management of tibial fractures using a temporary unicortical external fixator. SICOT J 2018; 4:39. [PMID: 30192226 PMCID: PMC6128168 DOI: 10.1051/sicotj/2018035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction: The development of damage control orthopedics (DCO) procedures has led to the development of temporary unicortical external fixators (TUEFs) intended to limit deep infectious complications and facilitate early conversion to internal fixation. Methods: A retrospective study was conducted in two French military trauma centers, including on patients being treated for tibial fractures with a TUEF (UNYCO® − Orthofix®) followed by an early conversion to intramedullary nailing. Results: Eleven patients with an average age of 41 were included between September 2015 and June 2017. A total of 12 TUEFs were implanted for one closed fracture and 11 open fractures, including one type I, eight types II, and two Gustilo types IIIB. The indication of DCO was related to hemodynamic instability in three cases, to the severity of soft tissue lesions in eight cases, and to the context of treatment in one case. The conversion to IM nailing was made after an average of 7.6 days. No significant loss of reduction was observed until internal osteosynthesis, which was performed with “fixator in place” in ten cases. The coverage of Gustilo type III injuries was performed by free flap transfers at the same time as IM nailing. All the patients were reviewed with an average follow-up of 16.5 months. Bone union was achieved in all cases. Two IM nailing dynamizations were carried out, but no bone grafting was required. Two cases of pandiaphysitis were observed and treated without functional complications. Discussion: Despite a limited number of patients, this study demonstrates the reliability of the TUEF to maintain the reduction of tibial fractures and facilitate early conversion to IM nailing. Unicortical fixation does not prevent septic complications related to the severity of soft tissue injuries.
Collapse
Affiliation(s)
- Anne-Pauline Russo
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Alexandre Caubere
- Department of Orthopedic Surgery and Traumatology, Sainte-Anne Military Hospital, Toulon, France
| | - Ammar Ghabi
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Antoine Grosset
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Philippe Mangin
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France
| | - Sylvain Rigal
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France - Department of Surgery, French Military Health Service Academy, École du Val-de-Grâce, Paris, France
| | - Laurent Mathieu
- Department of Orthopedic Surgery, Traumatology and Reconstructive Surgery, Percy Military Hospital, Clamart, France - Department of Surgery, French Military Health Service Academy, École du Val-de-Grâce, Paris, France
| |
Collapse
|
14
|
Wang Z, Cheng Y, Xin D, Liu T, Qu W, Wang D, Zhao Y, Zhao J. Expert Tibial Nails for Treating Distal Tibial Fractures With Soft Tissue Damage: A Patient Series. J Foot Ankle Surg 2018; 56:1232-1235. [PMID: 28888404 DOI: 10.1053/j.jfas.2017.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Indexed: 02/03/2023]
Abstract
Distal tibial fractures with soft tissue damage are relatively difficult to treat. We assessed the outcomes of patients with these fractures treated with the Expert Tibial Nail® (DePuy Synthes, Raynham, MA) from March 2012 to December 2014. At 6 months postoperatively, the general health quality of patients was assessed using operative time, interval to return to work, American Orthopaedic Foot and Ankle Society ankle scale score, pain measured using a visual analog scale, and short-form health outcomes 36-item survey physical functioning and mental health dimension scores. Of 11 cases, 7 (63.6%) were open fractures (3 [27.3%] Gustilo-Anderson type II, 3 [27.3%] type IIIA, and 1 [9.1%] type IIIB) and 4 (36.4%) were closed fractures with Tscherne-Oestern type II tissue damage. Their mean age was 52.2 (range 28 to 66) years. The mean operative time was 83 (range 65 to 105) minutes. The mean follow-up period was 16.3 (range 14 to 18) months. The median short-form 36-item survey scores were 79.1 (range 68.9 to 89.0) for the physical function dimension and 77.0 (range 64.3 to 90.0) for the mental health dimension. The mean postoperative ankle score was 88.6 (range 84 to 94). The mean pain score was 1.6 (range 0 to 4) mm. The mean interval to return to work was 14 (range 11 to 17) months. No patient showed evidence of neurovascular damage, malunion, nonunion, or shortening of the tibia. Taken together, we have confirmed that Expert Tibial Nails can effectively treat distal tibial fractures with soft tissue damage.
Collapse
Affiliation(s)
- Zhenhai Wang
- Surgeon, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China; Professor, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China
| | - Yiheng Cheng
- Surgeon, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China; Professor, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China
| | - Dajiang Xin
- Surgeon, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China; Professor, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China
| | - Tong Liu
- Surgeon, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China
| | - Wenqing Qu
- Surgeon, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China
| | - Dan Wang
- Surgeon, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China
| | - Yong Zhao
- Surgeon, Department of Orthopaedic and Trauma, Yantaishan Hospital, Yantai, People's Republic of China
| | - Jingjing Zhao
- Surgeon and Professor, Department of Orthopaedic and Trauma, Wuhan Pu Ai Hospital, Wuhan, People's Republic of China.
| |
Collapse
|
15
|
Kim TH, Chung JY, Kim KS, Song HK. Is external fixation needed for the treatment of tibial fractures with acute compartment syndrome? Injury 2018; 49:376-381. [PMID: 29153450 DOI: 10.1016/j.injury.2017.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/10/2017] [Accepted: 11/15/2017] [Indexed: 02/02/2023]
Abstract
Acute compartment syndrome (ACS) after tibial fracture carries a risk of various complications, including infection, delayed union, nonunion, nerve damage, and poor prognosis. For the treatment of fractures with ACS, fasciotomy is conducted, and the method to stabilise the fracture has to be considered. Thirty-five patients who underwent surgery for ACS with tibial shaft fractures were evaluated, and the results of initial internal fixation (Group I, 20 patients) and initial external fixation (Group II, 15 patients) were analysed. The mean age was 41 years. Five patients needed additional surgery for bone union. Complications occurred in 4 cases, but no deep infection was reported. The time to bone union, the need for additional surgery, and the incidence of complications in Group I and Group II were not statistically different. For the treatment of ACS with tibial fracture, immediate internal fixation and changing from external fixation to internal fixation did not affect the clinical course.
Collapse
Affiliation(s)
- Tae Hun Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jun Young Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Keun Su Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyung Keun Song
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
| |
Collapse
|
16
|
Testa G, Aloj D, Ghirri A, Petruccelli E, Pavone V, Massé A. Treatment of femoral shaft fractures with monoaxial external fixation in polytrauma patients. F1000Res 2017; 6:1333. [PMID: 28928953 PMCID: PMC5580418 DOI: 10.12688/f1000research.11893.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 12/23/2022] Open
Abstract
Background: Femoral shaft fractures, typical in younger people, are often associated with polytrauma followed by traumatic shock. In these situations, despite intramedullary nailing being the treatment of choice, external fixation could be used as the definitive treatment. The aim of this study is to report evidence regarding definitive treatment of femoral shaft fractures with monoaxial external fixation. Methods: Between January 2006 and December 2015, 83 patients with 87 fractures were treated at the Department of Orthopaedics and Traumatology CTO of Turin, with a monoaxial external fixation device. Mean age at surgery, type of fracture, mean follow-up, time and modalities of treatment, non-weight bearing period, average healing, external fixation removal time, and complications were reported. Results: The average patient age was 31.43±15.19 years. In 37 cases (42.53%) the right femur was involved. 73 (83.91%) fractures were closed, and 14 (16.09%) were open. The average follow-up time was 61.07±21.86 weeks. In 68 (78.16%) fractures the fixation was carried out in the first 24 hours, using a monoaxial external fixator. In the remaining 19 cases, the average delay was 6.80±4.54 days. Mean non-weight bearing time was 25.82±27.66 days (ranging from 0 to 120). The 87 fractures united at an average of 23.60±11.37 weeks (ranging from 13 to 102). The external fixator was removed after an average of 33.99±14.33 weeks (ranging from 20 to 120). Reported complications included 9.19% of delayed union, 1.15% of septic non-union, 5.75% of malunion, and 8.05% cases of loss of reduction. Conclusions: External fixation of femoral shaft fractures in polytrauma is an ideal method for definitive fracture stabilization, with minimal additional operative trauma and an acceptable complication rate.
Collapse
Affiliation(s)
- Gianluca Testa
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Domenico Aloj
- Department of Traumatology, PO Sant'Andrea, Vercelli, Italy
| | - Alessandro Ghirri
- Department of Orthopaedics Surgery, Division of Muscular-Skeletal Traumatology, AOU Città della Salute, CTO Hospital, Turin, Italy
| | - Eraclite Petruccelli
- Department of Orthopaedics Surgery, Division of Muscular-Skeletal Traumatology, AOU Città della Salute, CTO Hospital, Turin, Italy
| | - Vito Pavone
- Department of Orthopaedics and Traumatologic Surgery, AOU Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Alessandro Massé
- Department of Orthopaedics Surgery, Division of Muscular-Skeletal Traumatology, AOU Città della Salute, CTO Hospital, Turin, Italy
| |
Collapse
|
17
|
Omar M, Zeller AN, Gellrich NC, Rana M, Krettek C, Liodakis E. Application of a customized 3D printed reduction aid after external fixation of the femur and tibia: Technical note. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1803] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/15/2016] [Accepted: 12/07/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Mohamed Omar
- Trauma Department; Hannover Medical School; Hannover Germany
| | | | | | - Majeed Rana
- Department of Craniomaxillofacial Surgery; Hannover Medical School; Hannover Germany
| | | | | |
Collapse
|
18
|
Tu KK, Zhou XT, Tao ZS, Chen WK, Huang ZL, Sun T, Zhou Q, Yang L. Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures. Injury 2015; 46:2428-32. [PMID: 26472198 DOI: 10.1016/j.injury.2015.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/27/2015] [Accepted: 09/29/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Several techniques have been described to treat tibial fractures, which respectively remains defects. This article presents a novel intra- and extramedullary fixation technique: percutaneous external fixator combined with titanium elastic nails (EF-TENs system). The purpose of this study is to introduce this new minimally invasive surgical technique and selective treatment of tibial fractures, particularly in segmental fractures, diaphysis fractures accompanied with distal or proximal bone subfissure, or fractures with poor soft-tissue problems. METHODS Following ethical approval, thirty-two patients with tibial fractures were treated by the EF-TENs system between January 2010 and December 2012. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up. RESULTS All thirty-two patients were achieved follow-ups. According to the AO classification, 3 Type A, 9 Type B and 20 Type C fractures were included respectively. According to the Anderson-Gustilo classification, there were 5 Type Grade II, 3 Type Grade IIIA and 2 Type Grade IIIB. Among 32 patients, 8 of them were segmental fractures. 12 fractures accompanied with bone subfissure. Results showed no nonunion case, with an average time of 23.7 weeks (range, 14-32 weeks). Among them, there were 3/32 delayed union patients and 0/32 malunion case. 4/32 patients developed a pin track infection and no patient suffered deep infection. The external fixator was removed with a mean time of 16.7 weeks (range, 10-26 weeks). Moreover, only 1/32 patient suffered with the restricted ROM of ankle, none with the restricted ROM of knee. CONCLUSION This preliminary study indicated that the EF-TENs system, as a novel intra- and extramedullary fixation technique, had substantial effects on selective treatment of tibial fractures.
Collapse
Affiliation(s)
- Kai-Kai Tu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Xian-Ting Zhou
- Department of Orthopaedic Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China.
| | - Zhou-Shan Tao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Wei-Kai Chen
- Department of Orthopaedic Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou, Wenzhou, Zhejiang, China.
| | - Zheng-Liang Huang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Tao Sun
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Qiang Zhou
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| | - Lei Yang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China.
| |
Collapse
|
19
|
Affiliation(s)
- S Rajasekaran
- Department of Orthopaedic and Spine Surgery, Ganaga Hospital, 331 Mettpalayam Road, Coimbatore, 641043, India
| | | |
Collapse
|