1
|
Chandak R, Kekatpure AL, Agrawal R, Kekatpure A. Tibia Nailing Using Modular Stand: A Technical Note. Cureus 2022; 14:e24801. [PMID: 35686274 PMCID: PMC9170429 DOI: 10.7759/cureus.24801] [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] [Accepted: 05/07/2022] [Indexed: 11/15/2022] Open
Abstract
Interlocking nailing is a well-established procedure for managing unstable tibial shaft fractures. Closed reduction and internal fixation of the tibial shaft fractures require ease of intraoperative positioning, maneuvering, and biplane imaging.
We describe the use of an innovative modular tibia-nailing stand, which greatly enhances the ergonomics of the tibia nailing procedure.
Collapse
|
2
|
Displaced diaphyseal tibia fractures managed by elastic stable intramedullary nailing with or without the use of intraoperative traction table during nail insertion: a comparative analysis of 160 patients. J Pediatr Orthop B 2021; 30:431-437. [PMID: 32732800 DOI: 10.1097/bpb.0000000000000788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of an orthopedic traction table (OTT) during elastic stable intramedullary nailing (ESIN) in the management of displaced diaphyseal tibia fractures (DTFs) is controversial. The aim of this study was to evaluate the clinical and radiological outcome of children with displaced DTF managed by ESIN with and without the use of an OTT. Medical records were retrospectively reviewed for all pediatric patients sustaining DTF managed by ESIN from 2011 to 2019 at two different institutions. In all, 160 consecutive children with displaced DTF were recorded, of whom 80 underwent operative treatment by ESIN without OTT (group A), and 80 by ESIN with the use of an OTT and skeletal traction (group B). ESIN outcome measure scale, Beaty radiologic criteria and Radiographic Union Scale for Tibia fractures (RUST) score were used to evaluate the results. Average patient age at time of injury was 10.8 years (range 7-15). The mean follow-up was 55.8 months (range 12-96). All complications (2.5%) and poorer results according to ESIN outcome measure scale and Beaty radiological criteria were recorded among children managed with OTT. No complications related to pin insertion for skeletal traction were observed. Mean RUST score, length of surgery and cumulative time of radiation exposure were comparable between the two groups. Children with a displaced DTF treated by ESIN without the use of OTT showed superior results as there are no additional procedures (traction wire insertion and removal) decreased theater time and no complications with similar radiation dose.
Collapse
|
3
|
Holler JT, Kandemir U. Intraoperative Fluoroscopy for Correcting Rotational Malalignment After Fixation of Tibial Shaft Fracture: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00087. [PMID: 34398844 DOI: 10.2106/jbjs.cc.21.00234] [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: 11/14/2022]
Abstract
CASE A 29-year-old man previously treated with closed reduction and intramedullary nail (IMN) fixation for a right tibial shaft fracture presented with complaint of the foot pointing outward compared with uninjured side. He was diagnosed with tibial malrotation, and a novel intraoperative imaging technique was used for correction. CONCLUSION Literature suggests that the prevalence of tibial malrotation after IMN fixation is greater than previously thought. This case highlights the need for a simple and reliable intraoperative approach to guide and confirm correction of tibial malrotation after IMN fixation, and it demonstrates a technique that can be implemented with immediate results.
Collapse
Affiliation(s)
- Jordan T Holler
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
- UCSF School of Medicine, University of California, San Francisco, San Francisco, California
| | - Utku Kandemir
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| |
Collapse
|
4
|
Pozzi A, Lewis DD, Scheuermann LM, Castelli E, Longo F. A review of minimally invasive fracture stabilization in dogs and cats. Vet Surg 2021; 50 Suppl 1:O5-O16. [PMID: 34309048 PMCID: PMC9292778 DOI: 10.1111/vsu.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/20/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To summarize and discuss peer-reviewed studies on minimally invasive osteosynthesis (MIO) of long bone, physeal, and articular fractures in dogs and cats. STUDY DESIGN Invited review. METHODS A critique of literature was performed to assess MIO feasibility, outcomes, and complications through PubMed, Scopus, and CAB abstracts research databases (2000-2020). RESULTS More than 40 MIO articles have been published in the last 15 years, but most studies had small numbers, lacked control groups, and used limited outcome measures. Studies generally showed that MIO was feasible in dogs and cats with low complication rates. The current evidence does not demonstrate superior bone healing or functional outcomes with MIO when compared to standard methods. Although treatment principles, case selection, and techniques varied depending on the anatomical location, there were no salient differences in complication rates among long bones, physeal, and articular fractures treated by MIO. CONCLUSION The current available evidence and the personal experience of the authors support MIO as a promising fracture management modality. MIO can yield excellent outcomes when applied in carefully selected cases, performed by surgeons experienced in the technique. We cannot, however, conclude that MIO is superior to open fracture stabilization based on the available evidence in veterinary literature. Randomized controlled studies are warranted to prospectively compare MIO with other osteosynthesis techniques and thereby validate its role in fracture management for dogs and cats.
Collapse
Affiliation(s)
- Antonio Pozzi
- Department of Small Animal SurgeryVetsuisse Faculty, University of ZurichZurichSwitzerland
| | - Daniel D. Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Logan M. Scheuermann
- Department of Small Animal Clinical Sciences, College of Veterinary MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Emanuele Castelli
- Department of Small Animal SurgeryVetsuisse Faculty, University of ZurichZurichSwitzerland
| | - Federico Longo
- Department of Small Animal SurgeryVetsuisse Faculty, University of ZurichZurichSwitzerland
| |
Collapse
|
5
|
Patel R, Rhee PC. Team Approach: Multidisciplinary Perioperative Care in Upper-Extremity Reconstruction for Adults with Spasticity and Contractures. JBJS Rev 2020; 8:e0164. [DOI: 10.2106/jbjs.rvw.19.00164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
6
|
Shih YC, Chau MM, Arendt EA, Novacheck TF. Measuring Lower Extremity Rotational Alignment: A Review of Methods and Case Studies of Clinical Applications. J Bone Joint Surg Am 2020; 102:343-356. [PMID: 31743239 DOI: 10.2106/jbjs.18.01115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yushane C Shih
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Michael M Chau
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth A Arendt
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Tom F Novacheck
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.,Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| |
Collapse
|
7
|
Schmutz B, Rathnayaka K, Albrecht T. Anatomical fitting of a plate shape directly derived from a 3D statistical bone model of the tibia. J Clin Orthop Trauma 2019; 10:S236-S241. [PMID: 31700213 PMCID: PMC6823809 DOI: 10.1016/j.jcot.2019.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Intra- and inter-population variations of bone morphology have made the process of designing an anatomically well-fitting fracture fixation plate challenging. Although statistical bone models have recently been used for analysing morphological variabilities, it is not known to what extent they would also provide the basis for the design of a new plate shape. This would be particularly valuable in the case where no existing plate shape is available to start the process of fit optimisation. Therefore, this study investigated the anatomical fitting of a plate shape (statistical plate) derived from the mean shape of a statistical 3D tibia bone model in comparison to results available from two other plate shapes. METHODS Forty-five 3D bone models of tibiae from Japanese cadaver specimens, as well as 3D models of the plate undersurface of both a commercial and shape optimised Medial Distal Tibia Plate, were utilised from earlier studies. The mean shape of the 3D statistical bone model was generated from the tibia models utilising the Statismo framework. With reverse engineering software, the plate undersurface of the statistical plate shape was derived directly from the mean surface of the statistical 3D bone model. Through an iterative process, the statistical plate model was placed at the correct surgical position on each bone model for fit assessment. RESULTS The statistical plate was fitting for 20% of the tibiae compared to 13% for the commercial and 67% for the optimised plate, respectively. CONCLUSIONS The plate shape derived directly from a statistical bone model was fitting better than the commercial plate, but considerably inferior to that of an optimised plate. However, the results do clearly indicate that this approach provides an appropriate and solid basis for commencing shape optimisation of the statistical plate. Studies of other anatomical regions are required to confirm whether these findings can be generalised.
Collapse
Affiliation(s)
- Beat Schmutz
- Institute of Health and Biomedical Innovation Queensland University of Technology 60 Musk Avenue, Kelvin Grove QLD, 4059, Australia,Corresponding author.
| | - Kanchana Rathnayaka
- Accident and Orthopaedic Service The National Hospital of Sri Lanka Colombo 10, Sri Lanka
| | - Thomas Albrecht
- Department of Mathematics and Computer Science University of Basel Spiegelstrasse 1, 4051, Basel, Switzerland
| |
Collapse
|
8
|
Abstract
Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities, the spectrum of nailing has significantly increased. Nailing of fractures beyond the isthmus is technically challenging because fractures need to be reduced before the nailing procedure starts. Indirect techniques of reduction include the use of an extension table, a large distractor or an external fixator. Direct reduction with pointed reduction forceps, lag screws, a cerclage wire or a short plate can optimize indirect reduction. The choice of the correct entry portal is of utmost importance for an optimal operative result. The location of the entry portal is dependent on the local anatomy and the bend of the nail. The optimal entry portal at the proximal tibia is directly behind the patellar tendon and accessible with the knee in more than 90° of flexion, alternatively through a suprapatellar approach with a slightly flexed knee joint. Insertion of the nail through the suprapatellar approach is possible without stress on the reduced fracture fragments. Blocking screws create an artificial isthmus in the metaphyseal area and force the guide wire in the desired direction. Blocking screws help to avoid axial malalignment during nail insertion. Interlocking of the nail with screws coming from different directions prevents secondary dislocation.
Collapse
|
9
|
|
10
|
Radzi S, Dlaska CE, Cowin G, Robinson M, Pratap J, Schuetz MA, Mishra S, Schmutz B. Can MRI accurately detect pilon articular malreduction? A quantitative comparison between CT and 3T MRI bone models. Quant Imaging Med Surg 2017; 6:634-647. [PMID: 28090442 DOI: 10.21037/qims.2016.07.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pilon fracture reduction is a challenging surgery. Radiographs are commonly used to assess the quality of reduction, but are limited in revealing the remaining bone incongruities. The study aimed to develop a method in quantifying articular malreductions using 3D computed tomography (CT) and magnetic resonance imaging (MRI) models. METHODS CT and MRI data were acquired using three pairs of human cadaveric ankle specimens. Common tibial pilon fractures were simulated by performing osteotomies to the ankle specimens. Five of the created fractures [three AO type-B (43-B1), and two AO type-C (43-C1) fractures] were then reduced and stabilised using titanium implants, then rescanned. All datasets were reconstructed into CT and MRI models, and were analysed in regards to intra-articular steps and gaps, surface deviations, malrotations and maltranslations of the bone fragments. RESULTS Initial results reveal that type B fracture CT and MRI models differed by ~0.2 (step), ~0.18 (surface deviations), ~0.56° (rotation) and ~0.4 mm (translation). Type C fracture MRI models showed metal artefacts extending to the articular surface, thus unsuitable for analysis. Type C fracture CT models differed from their CT and MRI contralateral models by ~0.15 (surface deviation), ~1.63° (rotation) and ~0.4 mm (translation). CONCLUSIONS Type B fracture MRI models were comparable to CT and may potentially be used for the postoperative assessment of articular reduction on a case-to-case basis.
Collapse
Affiliation(s)
- Shairah Radzi
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Constantin Edmond Dlaska
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia;; Trauma Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Gary Cowin
- Centre of Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Mark Robinson
- Orthopaedics Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jit Pratap
- Radiology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Michael Andreas Schuetz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia;; Trauma Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Sanjay Mishra
- Department of Science & Technology, Government of India, New Delhi, India
| | - Beat Schmutz
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
11
|
Dong WW, Shi ZY, Liu ZX, Mao HJ. Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures. Chin J Traumatol 2016; 19:348-352. [PMID: 28088940 PMCID: PMC5198924 DOI: 10.1016/j.cjtee.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support. METHODS Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images. RESULTS Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. CONCLUSIONS This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.
Collapse
|
12
|
Chen W, Tang DZ, Guo ZM, Shi B, Lin B, Ding ZQ, Lian KJ. Use a simple lower limb outrigger frame in intramedullary nailing fixation of a floating knee. Orthop Traumatol Surg Res 2014; 100:561-4. [PMID: 25082776 DOI: 10.1016/j.otsr.2014.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 05/14/2014] [Accepted: 05/26/2014] [Indexed: 02/02/2023]
Abstract
Closed intramedullary nailing is a classical therapeutic approach for floating knee injuries. An appropriate positioning is critical for a successful surgery. However, there is a lack of an ideal auxiliary device to facilitate the implantation of intramedullary nail. The authors developed a simple lower limb outrigger frame (SLLOF), which is made of nylon, to facilitate the nail implementation process. The SLLOF could be radiolucent and autoclavable. A total of 31 patients with floating knee injury underwent the closed intramedullary nailing assisted by SLLOF. The average operative duration was 91.0 min, and all tibial and femur fractures reached bony union. The SLLOF could assist well insertion of intramedullary nail for the treatment of floating knee injuries, with the advantages of simple operation, less manpower, easy imaging access but less radiation exposure, and more cost-effectiveness.
Collapse
Affiliation(s)
- W Chen
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
| | - D-Z Tang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 200032 Shanghai, PR China
| | - Z-M Guo
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China.
| | - B Shi
- Zhengzhou University School of Medicine, 450001 Zhengzhou, Henan, PR China
| | - B Lin
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
| | - Z-Q Ding
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
| | - K-J Lian
- Department of Orthopaedic Surgery, the Affiliated Dongnan Hospital of Xiamen University, 269 Huazhong Road, 363000 Zhangzhou, Fujian, PR China; Orthopaedic Trauma Center of the 175th Hospital of PLA, 363000 Zhangzhou, Fujian, PR China
| |
Collapse
|
13
|
Bonnaig N, Dailey S, Archdeacon M. Proper Patient Positioning and Complication Prevention in Orthopaedic Surgery. J Bone Joint Surg Am 2014; 96:1135-1140. [PMID: 24990979 DOI: 10.2106/jbjs.m.01267] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ The consequences of improper intraoperative positioning can be profound: it not only may cause substantial morbidity but also may be a major area of litigation, particularly when peripheral nerve injury occurs.➤ The ulnar nerve is most likely to be injured secondary to improper positioning. The elbow should be flexed ≤90° and the forearm placed in a neutral or slightly supinated position intraoperatively to minimize pressure in the cubital tunnel.➤ Pressure-related complications, such as pressure ulcers and alopecia, are best avoided by the use of adequate padding. Cushions on the operating-room table and armrest should be emphasized under osseous prominences.➤ Positioning the head in a non-neutral alignment or arm abduction of ≥90° may result in injury to the brachial plexus.➤ The hemilithotomy position increases intracompartmental pressure in the leg on the uninjured side. The risk of well-leg compartment syndrome can be minimized by avoiding this position if possible.
Collapse
Affiliation(s)
| | - Steven Dailey
- UC Health Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212. E-mail address for S. Dailey:
| | - Michael Archdeacon
- UC Health Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0212, Cincinnati, OH 45267-0212. E-mail address for S. Dailey:
| |
Collapse
|
14
|
Abstract
Nailing of metaphyseal fractures demands thorough preoperative planning. The trauma surgeon has to take the specific morphology of the fracture, the individual anatomy of the broken bone, and the design and characteristics of the selected implant into consideration. The fracture has to be precisely reduced and the reduction controlled during nail insertion. The reduction technique and reduction aids must be chosen preoperatively. The nail has to be introduced with care and brought to its correct and ideal position. Only after successful proximal and distal interlocking can the nail become the central weight bearing implant, which holds the fracture stable and reduced. In the following contribution, the specific problems of reduction and nail fixation of metaphyseal fractures of the proximal humerus, proximal and distal femur, and proximal and distal tibia together with the needed reduction and fixation aids are presented.
Collapse
|
15
|
Hosalkar HS, Parikh G, Bittersohl B. Surgical fixation of displaced clavicle fracture in adolescents: a review of literature. Orthop Rev (Pavia) 2013; 5:e29. [PMID: 24191189 PMCID: PMC3808804 DOI: 10.4081/or.2013.e29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 05/12/2013] [Indexed: 11/23/2022] Open
Abstract
The literature available on patient-orientated outcomes of operative management for clavicle fractures in adolescents is fairly limited. Open surgical treatment of displaced midshaft fractures of the clavicle continues to be a topic of controversy. Traditional treatment of clavicle fractures has been via non-operative methods in both children and adults. Management in adolescent patients remains controversial, and rightly so, as the traditional experience from non-operative methods has been regarded as satisfactory, while the literature on the more recent approach towards fixing some of these fractures is evolving. We present a review of relevant literature.
Collapse
Affiliation(s)
- Harish S Hosalkar
- Center for Hip Preservation and Children's Orthopedics , San Diego, CA, USA
| | | | | |
Collapse
|
16
|
Next generation distal locking for intramedullary nails using an electromagnetic X-ray-radiation-free real-time navigation system. J Trauma Acute Care Surg 2012; 73:243-8. [DOI: 10.1097/ta.0b013e31824b0088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
El Attal R, Hansen M, Rosenberger R, Smekal V, Rommens PM, Blauth M. [Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2012; 23:397-410. [PMID: 22159844 DOI: 10.1007/s00064-011-0071-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. INDICATIONS Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) CONTRAINDICATIONS Patient in reduced general condition (e.g., bed ridden), flexion of the knee of less than 90°, patients with knee arthroplasty of the affected leg, infection in the area of the nail's insertion, infection of the tibial cavity, complex articular fractures of the proximal or distal tibia with joint depression. SURGICAL TECHNIQUE Closed reduction of the fracture preferably on a fracture table or using a distractor or an external fixation frame. If necessary, use pointed reduction clamps or sterile drapery. In some cases, additional implants like percutaneous small fragment screws, poller screws or k-wires are helpful. Open reduction is rarely necessary and must be avoided. Opening of the proximal tibia in line with the medullary canal. Canulated insertion of the Expert(TM) tibia nail (ETN; Synthes GmbH, Oberdorf, Switzerland) with reaming of the medullary canal. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. POSTOPERATIVE MANAGEMENT Immediate mobilization of ankle and knee joint. Mobilization with 20 kg weight-bearing with crutches. X-ray control 6 weeks postoperatively and increased weight-bearing depending on the fracture status. In cases with simple fractures, good bony contact, or transverse fracture pattern, full weight-bearing at the end of week 6 is targeted. RESULTS Between July 2004 and May 2005, 180 patients were included in a multicenter study. The follow-up rate was 81% after 1 year. Of these, 91 fractures (50.6%) were located in the distal third of the tibia. In this segment, the rate of delayed union was 10.6%. Malalignment of > 5° was observed in 5.4%. A secondary malalignment after initial good reduction was detected in only 1.1% of all cases. The implant-specific risk for screw breakage was 3.2%. One patient sustained a deep infection. If additional fibula plating was performed an 8-fold higher risk for delayed bone healing was observed (95%CI: 2.9-21.2, p< 0.001). If the fracture of the fibula was at the same height as on the tibia, the risk for delayed healing was even 14-fold (95% CI: 3.4-62.5, p< 0.001). Biomechanically plating of the fibula does not increase stability in suprasyndesmal distal tibia-fibular fractures treated with an intramedullary nail. Using the ETN with its optimized locking options, fibula plating is not recommended, thus, avoiding soft tissue problems and potentially delayed bone healing.
Collapse
Affiliation(s)
- R El Attal
- Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
| | | | | | | | | | | |
Collapse
|
18
|
Hosalkar HS, Parikh G, Bomar JD, Bittersohl B. Open reduction and internal fixation of displaced clavicle fractures in adolescents. Orthop Rev (Pavia) 2011; 4:e1. [PMID: 22577497 PMCID: PMC3348684 DOI: 10.4081/or.2012.e1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 10/10/2011] [Indexed: 12/14/2022] Open
Abstract
The literature available on patient oriented outcomes of operative management for clavicle fractures in adolescents is fairly limited. The purpose of this study was to analyze the potential of open reduction and internal fixation for displaced mid-shaft clavicle fractures in adolescent patients. We reviewed our series of surgical cases performed in 19 adolescents (mean age: 14.6 years) with displaced unilateral clavicle fractures. Baseline data acquisition included demographic and radiographic variables. A Synthes(®) LCP clavicular plate was utilized for fixation in all cases. Follow-up data included functional outcome assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (DASH), the simple shoulder test (SST) and additional binary questions. At a mean follow-up of 16 months, quick DASH scores were 4.0 (range: 0-35.5) and mean number of positive yes responses on the SST for all operative patients was 11 (range: 9-12). All cases proved complete radiological union at the 3-month follow-up. All patients returned to full athletics at a mean time of 14 weeks (range: 12-17 weeks). Two patients had minimal hypertrophic scars while no patient was noted with keloid formation or neurovascular deficit. One patient complained of implant prominence and occasional symptoms of discomfort at the 15 month follow-up and opted for implant removal. This was successfully performed with uneventful full recovery. All patients were fully satisfied with their choice for surgical intervention. Anatomical reduction with internal fixation and early mobilization of adolescent displaced clavicle fractures remains a viable treatment option with predictable results and no major complications in reliable hands.
Collapse
|
19
|
Schmutz B, Wullschleger ME, Noser H, Barry M, Meek J, Schütz MA. Fit optimisation of a distal medial tibia plate. Comput Methods Biomech Biomed Engin 2011; 14:359-64. [DOI: 10.1080/10255842.2010.482044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
20
|
Buckley R, Mohanty K, Malish D. Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures. Injury 2011; 42:194-9. [PMID: 20869056 DOI: 10.1016/j.injury.2010.08.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/26/2010] [Accepted: 08/18/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence of rotational malalignment in distal femoral and proximal tibial fractures using computed tomography (CT) scanograms following indirect reduction and internal fixation with the minimally invasive percutaneous osteosynthesis (MIPO) technique. DESIGN Prospective Cohort. SETTING Level I Trauma Centre. PATIENTS/PARTICIPANTS A total of 27 consecutive subjects, and 14 proximal tibia and distal femur fractures. INTERVENTION All patients underwent indirect reduction and internal fixation with a MIPO plating system. A CT scanogram to measure rotational malalignment between the injured and non-injured extremity was then undertaken. MAIN OUTCOME MEASURE(S) Femoral anteversion angles and tibial rotation angles between the injured and non-injured extremities were compared. Malrotation was defined as a side-to-side difference of >108. RESULTS A total of 14 postoperative tibias and 13 femurs underwent CT scanograms. Three females and 11 males with an average age of 38.1 years sustained proximal tibia fractures and six females and seven males with an average age of 55.8 years sustained distal femur fractures. The difference between tibial rotation in the injured and the non-injured limbs ranged from 2.7 to 40.08 with a mean difference of 16.28(p = 0.656, paired T-test). Fifty percent of the tibias fixed with MIPO plates were malrotated >108 from the uninjured limbs. The difference between femoral anteversion in the injured and non-injured limbs ranged from 2.0 to 31.38 with a mean difference of 11.58 (p = 0.005, paired T-test). A total of 38.5% of the distal femurs fixed with MIPO plates were malrotated >108 from the uninjured limb. CONCLUSIONS Following fixation of distal femoral and proximal tibial fractures, the incidence of malrotation was 38.5% and 50%, respectively. The difference of the mean measures was significant for femoral malrotation; however, statistical significance could not be demonstrated for tibial malrotation.The incidence of malrotation following MIPO plating in this study is much higher than that quoted in previous studies.
Collapse
Affiliation(s)
- R Buckley
- Foothills Medical Centre, AC144A, 1403 – 29th Street NW, Calgary, AB, Canada T2N 2T9.
| | | | | |
Collapse
|
21
|
Beazley JC, Hull P. Temporary intra-operative reduction techniques for tibial fracture fixation: A review of the literature. Injury 2010; 41:1228-33. [PMID: 20691444 DOI: 10.1016/j.injury.2010.07.250] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 06/29/2010] [Accepted: 07/12/2010] [Indexed: 02/02/2023]
Abstract
Accurate intra-operative reduction and maintenance of reduction is essential for successful fixation of tibial fractures. Although many tibial fractures can be reduced with minimal manipulation, numerous techniques have been described to facilitate fixation of more difficult fractures. These include use of a traction table, manual traction techniques, temporary distracters, reduction clamps and temporary unicortical plating. This article reviews the literature and assesses the options available for the temporary reduction and maintenance of reduction of tibial fractures prior to definitive fixation.
Collapse
Affiliation(s)
- J C Beazley
- Department of Trauma and Orthopaedics, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
| | | |
Collapse
|
22
|
Abstract
Traction tables are used in numerous procedures about the hip and femur, including fracture fixation, hip arthroscopy, and less invasive arthroplasty. The use of a traction table is not without risks, however, and significant complications have been described, including injury to the perineal integument and soft tissues, neurologic impairment, and iatrogenic compartment syndrome of the well leg. The orthopaedic surgeon who uses a traction table for the surgical management of femur fracture must be familiar with the associated potential dangers and risks and must develop a plan to avoid traction table-associated complications, such as use of a radiolucent flat-top operating table for obese patients, adequate patient positioning, and the minimum possible surgical time.
Collapse
|
23
|
A Positioning Technique for Closed Intramedullar Nailing of Tibia Fractures. ACTA ACUST UNITED AC 2008; 64:1408-11. [DOI: 10.1097/ta.0b013e31814dadda] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Abstract
The Taylor Spatial Frame has become an important part of the trauma and reconstruction surgeon's armamentarium. We describe a technique to assist in the application of this device that does not hinder the use of the image intensifier or rely on an assistant to hold a constant position and aids provisional fracture reduction.
Collapse
|
25
|
Abstract
OBJECTIVES With the development and popularization of minimally invasive surgical methods and implants for fracture fixation, it is increasingly important that the available implants are precontoured to the specific anatomic location for which they are designed. The objective of this study was to develop a noninvasive method and criteria for quantifying the fit of a distal periarticular medial tibia plate and to test the method on a small set of tibia models. METHODS The undersurface of the plate was extracted from a digital model of the plate. The surface of the plate was fitted to 21 computer tomography (CT)-based 3-dimensional (3-D) models of human tibiae. Four criteria were defined that constitute an anatomic plate fit and subsequently were applied for the quantitative fit assessment. The fitting of the plate undersurface to the bone was entirely conducted in a virtual environment. RESULTS An anatomic fit of the plate was achieved for 4 of the models (19%). The individual categories generated fits of 62% (n = 13) for the proximal end; 43% (n = 9) for the proximal angle; 57% (n = 12) for the middle distance; and 57% (n = 12) for a distal fit. CONCLUSIONS Although for the 4 individual criteria plate fits of 43%-62% were achieved, a global/anatomic fit only occurred for 19% of the bone models. This outcome is likely a result of bone morphology variations, which exist in a random population sample combined with the effects of a nonoptimized plate shape. Recommendations for optimizing the fit of the plate are discussed.
Collapse
|
26
|
Labronici PJ, Franco JS, Lourenço PRBDT, Tevês ADV, Saturnino USDO, Hoffmann R, Reis FBD. Estudo do desvio rotacional da tíbia. ACTA ORTOPEDICA BRASILEIRA 2008. [DOI: 10.1590/s1413-78522008000500007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: avaliar o desvio rotacional pós-operatório das fraturas diafisárias da tíbia de pacientes tratadas com haste intramedular bloqueada não-fresada e placa em ponte, utilizando a tomografia computadorizada. MÉTODOS: foram tratados 113 pacientes com fraturas diafisárias da tíbia, sendo que em 42 fraturas os autores utilizaram haste intramedular bloqueada e em 71 foram utilizadas placa em ponte. O método tomográfico utilizado ara se obter as medidas da rotação tibial. Foi empregada a classificação AO das fraturas; à exposição: fechadas e expostas e a percentagem de desvios em rotação interna e externa. RESULTADOS: foi demonstrado não haver diferença significativa de rotação tibial nos seguintes parâmetros analisados: localização, rotação interna ou externa e nos tipos A e B da classificação AO. Porém, nas fraturas do tipo C e nas fraturas expostas, a haste intramedular bloqueada apresentou diferença rotacional significativamente menor (p = 0,028) e (p = 0,05), quando comparada à placa em ponte. CONCLUSÃO: independente da localização das fraturas diafisárias da tíbia, os desvios rotacionais estão relacionados à energia do trauma, apresentando uma maior dificuldade de controle com a técnica placa em ponte.
Collapse
|
27
|
Clint SA, Rossouw DJ. The use of the Acufex Ankle Distractor during intramedullary tibial nailing--the best of both worlds? Injury 2006; 37:570-2. [PMID: 16504191 DOI: 10.1016/j.injury.2005.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 12/20/2005] [Indexed: 02/02/2023]
Affiliation(s)
- S A Clint
- Department of Trauma and Orthopaedics, Barnet General Hospital, Wellhouse Lane, Barnet, Herts EN5 3DJ, United Kingdom.
| | | |
Collapse
|
28
|
Puloski S, Romano C, Buckley R, Powell J. Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 2004; 18:397-402. [PMID: 15289683 DOI: 10.1097/00005131-200408000-00001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence and severity of tibial malrotation following reamed intramedullary nail fixation as measured by computerized tomography and to determine the repeatability of computed tomography measurement in the assessment of rotational malreduction. DESIGN Prospective cohort. SETTINGS Level 1 trauma center. PARTICIPANTS Twenty-five consecutive patients with 25 tibial shaft fractures. INTERVENTION All patients were treated with reamed intramedullary nailing. Appropriate radiographs and a postoperative lower extremity computed tomography scan were obtained for each patient who consented to the study. MAIN OUTCOME MEASURE Rotational alignment of affected tibia as compared to a version of the normal contralateral limb. Malrotation was defined as an internal/external rotation deformity greater than 10degrees. RESULTS Malrotation, comparing the fractured limb to normal limb, was determined using a similar measurement method previously described in the literature. Two patients declined inclusion, and in one case, the computed tomography was not acceptable for analysis. Malrotation, comparing the fractured limb to the normal limb, was determined using the measurements from axial computed tomography images. Results revealed a mean absolute rotational difference of 6.7degrees (SD +/-6.3degrees). Rotational malreduction ranged from 15degrees of internal rotation to 22degrees of external rotation. Five of the 22 tibia (22%) were malrotated greater than 10degrees. A larger degree of deformity was seen with certain injury patterns. The intraobserver and interobserver repeatability testing revealed a mean absolute difference between paired malrotation calculations of 3.4degrees and 3.9degrees, respectively, and a repeatability coefficient of 8degrees for both. CONCLUSION Computed tomography measurement is a repeatable method of assessing tibial torsion and in this study revealed a significantly higher incidence of rotational malreduction than that previously reported in the literature.
Collapse
Affiliation(s)
- S Puloski
- Foothills Medical Centre, University of Calgary, Alberta, Canada.
| | | | | | | |
Collapse
|
29
|
Stephen DJG, Kreder HJ, Schemitsch EH, Conlan LB, Wild L, McKee MD. Femoral intramedullary nailing: comparison of fracture-table and manual traction. a prospective, randomized study. J Bone Joint Surg Am 2002; 84:1514-21. [PMID: 12208906 DOI: 10.2106/00004623-200209000-00002] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare manual traction and fracture-table traction for the reduction and nailing of femoral shaft fractures. We evaluated the quality of the reduction, operative time, complications, and functional status of the patient. METHODS Eighty-seven consecutive adult patients with a unilateral fracture of the femoral diaphysis that did not extend into the knee joint or proximal to the lesser trochanter were enrolled in the study. Patients who were transferred to our institution more than forty-eight hours after injury; those with multiple-system injuries, injury to the ipsilateral lower extremity, or pathological fracture; and those who were unable or unwilling to provide consent or to return for follow-up were excluded. Forty-five patients were randomized to manual traction and forty-two, to fracture-table traction; all were treated in the supine position. The number of surgical assistants, operative and fluoroscopy time, complications, functional scores, and other outcomes were recorded. RESULTS There were no significant differences between the groups with respect to age, gender, Glasgow Coma Score, Injury Severity Score, side or mechanism of injury, fracture type, or time from injury to treatment. Internal malrotation was significantly more common when the fracture table had been used: twelve (29%) of the forty-two femora were internally rotated by >10 compared with three (7%) of the forty-five treated with manual traction (p = 0.007). Total operative time, from the beginning of the patient positioning to the completion of the skin closure, was decreased from a mean of 139 minutes (range, 100 to 212 minutes) when the fracture table was used to a mean of 119 minutes (range, sixty-five to 180 minutes) when manual traction was used (p = 0.033). There was no significant difference between the two treatment groups with regard to the number of assistants per case (mean two; range, zero to three), fluoroscopy time, other complications including femoral shortening or lengthening, or functional status of the patient at one year. CONCLUSIONS Compared with fracture-table traction with the patient in a supine position, manual traction for intramedullary nailing of isolated fractures of the femoral shaft is an effective technique that decreases operative time and improves the quality of the reduction.
Collapse
Affiliation(s)
- David J G Stephen
- University of Toronto Orthopaedic Trauma Research Group, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
High-energy tibial fractures are common injuries that are managed by most practicing orthopaedic surgeons. Many methods of treatment are available. This article reviews the options for skeletal stabilization, the risks and benefits of each, and the necessary concepts that effect outcome.
Collapse
Affiliation(s)
- Bruce French
- Orthopaedic Trauma and Reconstructive Surgery, 340 East Town Street, Suite 10-200, Columbus, Ohio 43215, USA
| | | |
Collapse
|