Risk factors for infection in fixation of distal tibia fractures

Ideal entry point and direction of retrograde intramedullary nailing of the tibia

PURPOSE

To determine the ideal entry point and direction of retrograde intramedullary nailing of the tibia.

METHODS

The imaging data of patients with distal tibial fractures from June 2020 to December 2021 in our hospital were collected, and computer-aided design was performed. The relevant data were imported into the software for processing, so as to obtain a distal tibial fracture model and simulate the retrograde intramedullary nail placement in the tibia. The entry points and angles at which the intramedullary nail could be inserted successfully and the fracture could be maintained in good alignment were overlapped and counted to obtain the safe entry range and angle. The center of this safe range is the ideal entry point for retrograde intramedullary nailing of the tibia, and the mean value of the angle is the ideal direction of entry.

RESULTS

The ideal entry point of the retrograde intramedullary nailing was located at the midpoint of the medial malleolus in the C-arm fluoroscopic anteroposterior (AP) and lateral view. The ideal nail entry direction was located at the anatomic axis of the medial malleolus in the AP position and at the anatomic axis of the distal tibial metaphysis in the lateral position.

CONCLUSION

The ideal point and direction of nail insertion for retrograde tibial intramedullary nailing is a "double midpoint, double axis" approach.

Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges

The uses of implantable medical devices are safer and more common since sterilization methods and techniques were established a century ago; however, device-associated infections (DAIs) are still frequent and becoming a leading complication as the number of medical device implantations keeps increasing. This urges the world to develop instructive prevention and treatment strategies for DAIs, boosting the studies on the design of antibacterial surfaces. Every year, studies associated with DAIs yield thousands of publications, which here are categorized into four groups, i.e., antibacterial surfaces with long-term efficacy, cell-selective capability, tailored responsiveness, and immune-instructive actions. These innovations are promising in advancing the solution to DAIs; whereas most of these are normally quite preliminary “proof of concept” studies lacking exact clinical scopes. To help identify the flaws of our current antibacterial designs, clinical features of DAIs are highlighted. These include unpredictable onset, site-specific incidence, and possibly involving multiple and resistant pathogenic strains. The key point we delivered is antibacterial designs should meet the specific requirements of the primary functions defined by the “intended use” of an implantable medical device. This review intends to help comprehend the complex relationship between the device, pathogens, and the host, and figure out future directions for improving the quality of antibacterial designs and promoting clinical translations.

Comparison of Open Reduction and Internal Fixation With Minimally Invasive Plating in the Treatment of Distal Tibial Fractures: A Retrospective Study

Introduction

Treatment of distal tibial fractures may be problematic due to their close proximity to the ankle joint and poor skin coverage, resulting in skin problems, deep infection, and malunion. To address these problems, minimally invasive plating methods have been described. In this study, we aimed to compare the clinical findings, radiological findings, and complication rates of patients treated with open reduction or minimally invasive plating.

Methods

A total of 44 patients with distal tibial fractures with a mean follow-up period of 20.73 (12-50) months were included in this study retrospectively. The patients were divided into two groups, those who underwent open reduction and internal fixation and those treated with minimally invasive plates. The two groups were statistically compared in terms of radiological and clinical scores and complication rates (p=0.05). Comparative analysis was also performed for three fracture types in both groups.

Results

Twenty patients were treated with a minimally invasive approach and 24 patients were treated with the open reduction method. Age, gender, fracture type, and follow-up times were similar between the two groups (p>0.05). There was no statistically significant difference between postop American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), anterior distal tibial angle (ADTA), or lateral distal tibial angle (LDTA) values between both groups. There was also no difference in union times or nonunion rates (p>0.05). There was no statistically significant difference in rates of superficial skin problems or deep infections between the two groups (p>0.05). In comparison regarding fracture types, patients with type C fractures seemed to have better outcomes with minimal invasive plating.

Conclusion

Minimally invasive plating is a good approach in the treatment of distal tibial fractures. The technique seems to be advisable, especially for patients with type C fractures. However, the rates of skin problems and deep infections are similar to those seen with the open reduction method.