"Clothesline technique" for proximal tibial shaft fracture fixation using conventional intramedullary nail: a simple, useful, and inexpensive technique to prevent fracture malalignment

Intramedullary nail versus minimally invasive plate osteosynthesis for displaced extraarticular proximal tibia fractures: a prospective comparative cohort study

PURPOSE

The treatment of extraarticular proximal tibial fractures is challenging. As the optimal fixation technique is still debated, the purpose of this study was to compare minimally invasive plate osteosynthesis (MIPO) and intramedullary nail (IMN) fixation.

METHODS

A prospective matched comparative study was conducted on patients with displaced extraarticular proximal tibia fractures treated with MIPO (n = 29) versus IMN (n = 30) fixation. Outcomes collected were the Johner-Wruhs grading, range of motion (ROM), union rate, time to union, malunion, coronal and sagittal alignment, and post-operative complications.

RESULTS

Union rates were similar between the MIPO and IMN groups (93% vs. 97%, P = 1.0). The IMN group had an earlier time to union (15 vs. 18 weeks, P < 0.001) and superior functional outcomes at one year (effective Johner-Wruhs score: 80% vs. 55%, P = 0.04). There was a significantly higher incidence of anterior knee pain in the IMN group (23% vs. 0%, P = 0.02) and there was a trend for more infections in the MIPO group (21% vs. 13%, P = 0.73).

CONCLUSION

IMN fixation of extraarticular proximal tibia fractures was associated with a shorter union time and better functional scores compared to MIPO.

Avoiding deformity in proximal tibial nailing: risk factors, deformity rules, tips, and tricks

Malalignment is one of the most common problems linked to nailing of proximal tibial fractures. This review will cover technical aspects of intramedullary nailing and will help explain the various risk factors. Deformity rules aid in identifying the likely deformity and help to develop management strategies. Various tools and techniques are discussed which can help optimize the outcome.

Level of Evidence

Therapeutic Level V.

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.