Traction methods in the retrograde intramedullary nailing of femur shaft fractures: the double reverse traction repositor or manual traction

Double reverse traction repositor assisted closed reduction and internal fixation versus open reduction and internal fixation for treatment of lateral tibial plateau fractures among the elderly

BACKGROUND

In elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs.

METHODS

From January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications.

RESULTS

The DRTR assisted CRIF group experienced a 43.6 mL decrease in intraoperative blood loss (161.3 ml vs 204.9 ml, p = 0.033), and the operation duration was 32.1 min shorter than the ORIF group (83.8 min vs 115.9 min, p < 0.001). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) immediately after surgery and at the last follow-up. No differences in malreduction (p = 0.566) or reduction loss (p = 0.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 ± 15.8 vs 83.4 ± 5.1, p = 0.934; 89.3 ± 7.8 vs 86.9 ± 6.2, p = 0.172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, p = 0.008).

CONCLUSION

Both types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs.

A new surgical strategy for the treatment of tibial pilon fractures with MIPO facilitated by double reverse traction repositor

The present study aims to introduce a technique combining double reverse traction repositor (DRTR) with minimally invasive plate osteosynthesis (MIPO) in the surgical treatment of pilon fractures and to observe the efficiency of this approach during a short-term follow-up period. From January to December 2018, patients with pilon fractures who were treated by MIPO with DRTR were reviewed. The demographic and fracture characteristics, surgical data, and prognostic data of 24 patients were extracted. In all 24 patients, closed reduction was achieved with the MIPO technique, and excellent functional and radiological outcomes were observed. The average duration of surgery and intraoperative blood loss were 95.0 ± 14.2 min and 152.1 ± 52.1 ml, respectively. A mean of 16.0 ± 1.9 intraoperative fluoroscopies were conducted. At the 12-month follow-up evaluation, the average AOFAS score was 85.2 ± 5.1. Anatomic or good reduction was observed in 23 (95.8%) patients. The mean ranges of motion of dorsiflexion and plantarflexion were 11.0 ± 2.7 and 32.7 ± 11.1, respectively. Two patients with deep venous thrombosis and one patient with wound non-purulent exudate were noted. Additionally, the wounds healed after routine dressing change. No other complications, including skin necrosis or delayed, non-union or malunion, were observed. The new strategy combining DRTR with MIPO in the treatment of pilon fractures allowed excellent radiological and clinical outcomes and a low postoperative complication rate to be achieved in a short-term follow-up period. Further large sample and comparative studies should be conducted to validate our results.