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Heck BE, Poucke LV, Heck VC, Heck BE. Double Squeeze Reduction Clamp Technique for Fracture Stabilization: A Case Report. J Orthop Case Rep 2024; 14:22-27. [PMID: 38784862 PMCID: PMC11111237 DOI: 10.13107/jocr.2024.v14.i05.4420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/02/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction The double squeeze technique for fracture stabilization is a technique in which the surgeon uses a second reduction clamp to hold and stabilize a smaller reduction clamp that reduces a fracture or plate yet is too small to hold by itself. This technique greatly assists anatomic fracture reduction and stabilization and allows the surgeon to complete the operation when there is limited reduction instrumentation available, or the surgeon needs more excursion on a small clamp holding a fracture and does not want to change instruments and possibly lose a reduction. We present a case of the double squeeze clamp technique, which to our knowledge has not been reported, to facilitate limited open reduction percutaneous plate stabilization in a distal tibia fracture. Case Report This case report presents an 18-year-old male with a closed, oblique, displaced right distal tibia fracture following a crush injury to the extremity with a tree while using a chainsaw. He was initially seen in the emergency room and was discharged home in a splint to follow-up with the orthopedic surgeon on call. The family requested follow-up with our practice 3 days later and requested surgery at their rural local hospital secondary to insurance reasons. Patient requested plate fixation to treat his fracture. Due to limited reduction instrumentation in the facility, a double squeeze reduction clamp technique using a pointed reduction clamp on a serrated reduction clamp that was too small to hold the plate on the reduced fracture accomplished stabilization of the plate on the fracture while screws were placed. Conclusion The double squeeze reduction clamp technique using one reduction clamp on a smaller reduction clamp greatly increases the ability to successfully reduce and stabilize multiple variations of different fractures whether secondary to differences in sizes of the bones, different types of bones, or in our case limited fracture reduction tools available.
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Affiliation(s)
- Benjamin E Heck
- Department of Medicine and Life Sciences, College of Medicine, University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Logan Van Poucke
- Department of Medicine, College of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Vanessa C Heck
- Department of Health and Human Services, College of Health and Human Services, The University of Toledo, Ohio, USA
| | - Bruce E Heck
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
- Northwest Ohio Orthopedics and Sports Medicine, Findlay, Ohio, USA
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Gouveia K, Hache P, Johal H. Plating as a reduction aid prior to intramedullary nailing of tibia fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1259-1267. [PMID: 38145978 DOI: 10.1007/s00590-023-03801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE The purpose of this meta-analysis is to analyse the literature on plate-assisted reduction during intramedullary nailing of tibial shaft fractures and to compare the rates of infection and nonunion. METHODS The databases Medline, Embase, and Web of Science were searched from inception to February 2022 for literature comparing plate-assisted reduction during intramedullary nailing of extra-articular tibia fractures to standard, closed means of reduction. Data were extracted and pooled in a random effects meta-analysis for the primary outcomes of nonunion and infection risk. RESULTS Five comparative studies were identified including 520 total patients, of which 151 underwent tibial nailing with the use of plate-assisted reduction with an average follow-up time of 17.9 months. Approximately two-thirds of patients retained the plate used to assist reduction during intramedullary nailing (102 of 151). Pooled analysis of the infection rates found no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.90, 95% CI 0.49-1.65, p = 0.72), and for nonunion rates, there was also no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.80, 95% CI 0.40-1.60, p = 0.53). CONCLUSIONS Plate-assisted reduction during intramedullary nailing of tibia shaft fractures was not associated with an increased risk for nonunion or infection, and can be safely applied as an adjunct for reduction in challenging fracture patterns, without the need for later removal. However, evidence is quite limited and further investigation into the use of provisional plating as a technique is needed as its use in intramedullary nailing continues to expand.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Philip Hache
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Centre for Evidence-Based Orthopaedics, Hamilton, ON, Canada
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Teixidor-Serra J, Andrés-Peiró JV, García-Sanchez Y, Selga-Marsa J, Garcia-Martínez MC, Carbonell-Rosell C, García-Albó E, Tomás-Hernández J. Outcomes and their predictors in suprapatellar nailing for tibia fractures. Multivariable analysis of 293 consecutive cases. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02476-0. [PMID: 38472386 DOI: 10.1007/s00068-024-02476-0] [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: 09/30/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Intramedullary nailing of tibial fractures is one of the most common procedures in orthopedic surgery. It can be technically demanding in proximal or distal fractures, which may be facilitated using semi-extended approaches. The aim of this study is to identify outcomes and their predictors using a semi-extended suprapatellar approach for tibial fracture nailing. METHODS This is a retrospective cohort of 293 patients who underwent intramedullary nail fixation of a tibial fracture through a suprapatellar approach, considering a postoperative follow-up of 1 year. Data on patient's baseline characteristics, injuries, treatments, and outcomes regarding alignment, fracture union, and complications were recorded. For multivariable analysis, hierarchical binary (logistic) regression analysis was performed. RESULTS The mean patient age was 47.7 years (SD 18.9), with 42A1 the most frequent fracture pattern (n = 98, 33.5%). Correct or anatomical alignment (≤ 5º in both planes) was achieved in 272 (92.8%) of the patients. On multivariate analysis, surgical delay ≥ 7 days (OR = 1.3, 95% CI = 1.3-8.1) and age over 50 years (OR = 3.2, 95% CI = 1.2-8.3) were found as predictors of fracture malalignment. Fracture healing was achieved in 97.6%, and reoperation rate was 6.14%. Overall complication's predictors were proximal fracture (OR = 2.8, 95% CI = 1.1-7.2), temporary external fixation (OR = 2.4, 95% CI = 1.2-4.9), and fracture malalignment (OR = 2.9, 95% CI = 1.1-7.9). CONCLUSION The suprapatellar approach is a safe and useful technique for treating tibial fractures, leading to no less than correct reduction in almost all patients and achieving a high fracture healing rate, at very low rates of complications. Pre- and postoperative predictors identified must be taken into account to improve outcomes while treating these fractures.
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Affiliation(s)
- Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Yaiza García-Sanchez
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsa
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Carla Carbonell-Rosell
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Enrique García-Albó
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Jayaraju U, Rammohan R, Awad F, Kaur K, Brock J, Singhal A, Clewer G. Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer? Cureus 2022; 14:e29915. [PMID: 36348901 PMCID: PMC9633433 DOI: 10.7759/cureus.29915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background With the increasingly accepted method of suprapatellar tibial nailing for tibial shaft fractures, we aimed to compare intraoperative and postoperative outcomes of infrapatellar (IP) vs suprapatellar (SP) tibial nails. Methods This is a retrospective cohort analysis of 34 SP tibial nails over three years vs 24 IP tibial nails over a similar time frame. We compared total radiation dose (TRD), patient positioning time (PPT), fracture healing and follow up time. Knee pain in the SP group was evaluated utilising the Hospital for Special Surgery (HSS) Knee Injury and Osteoarthritis Outcome Score (KOOS). Results Fifty-eight patients with a mean age of 43 years were included. Mean intraoperative radiation dose for SP nails was 61.78 cGy (range: 11.60-156.01 cGy) vs 121.09 cGy (range: 58.01-18.03 cGy) for IP nails (p < 0.05). Mean PPT for SP nails was 10 minutes vs 18 minutes for IP nails (p < 0.05). All fractures united in the SP group vs one non-union in the IP group. Mean follow up was 5.5 months vs 11 months in the IP and SP groups, respectively. Mean KOOS was 7 (range: 0-22) at six months for the SP group. Conclusion The semi-extended position (SP group) leads to reduced TRD because of ease of imaging. Patients showed improved outcomes with shorter follow up and fracture union in all patients (SP group). The KOOS revealed that SP nail patients had minimal pain and good knee function. This study establishes a management and patient-reported outcome measures (PROMs) baseline for ongoing evaluation of SP nails.
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Yasuda T, Sato K, Yamazaki K, Arai M, Shinohara D, Taisuke Y, Minagawa Y, Samejima Y, Okamoto K, Irie Y, Shiobara K, Kusaba A, Kawasaki K, Hayashi J, Obara S, Kanzaki K, Inagaki K. Nail insertion points in semi-extended nailing of tibial fractures and their influence on alignment: A retrospective cohort study comparing two nail insertion techniques. Injury 2022; 53:3508-3516. [PMID: 35803744 DOI: 10.1016/j.injury.2022.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Semi-extended tibial nailing techniques include the extra-articular technique (EAT) and the patellar eversion technique (PET). These approaches differ regarding the exposure of the patellar retinaculum and the size of the surgical field. This study compared the postoperative alignment and intramedullary nailing entry points between the EAT and PET for tibial fractures. PATIENTS AND METHODS A total of 54 patients (aged ≥18 years) who had undergone intramedullary nailing by the EAT (n = 29) or PET (n = 25) for a tibial shaft fracture were evaluated. The intramedullary nailing entry point and postoperative alignment were measured, and the 1-year postoperative follow-up results were compared. RESULTS For the EAT and PET, the intramedullary nailing entry point was located at a mean distance of 4.04 mm medial to the optimal entry point and 0.27 mm lateral to the optimal entry point, respectively. The mean angular deformation observed in anteroposterior radiographs following surgery using the EAT and PET were 2.49° and 0.32° valgus, respectively. CONCLUSION The intramedullary nailing entry point affected postoperative alignment. Intramedullary nailing may result in malalignment while performing the EAT due to the interference of the patella at the time of nailing.
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Affiliation(s)
- Tomohiro Yasuda
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Kaoru Sato
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Ken Yamazaki
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Masayuki Arai
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Daichi Shinohara
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Yoneya Taisuke
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuuto Minagawa
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yuki Samejima
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Keiji Okamoto
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Yuko Irie
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Kyosuke Shiobara
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Atsushi Kusaba
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Keikichi Kawasaki
- Department of Orthopedic Surgery, Showa University Northern Yokohama Hospital, Yokohama, Japan.
| | - Junji Hayashi
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Shu Obara
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Koji Kanzaki
- Department of Orthopedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.
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Baker HP, Strelzow J, Dillman D. Tibial alignment following intramedullary nailing via three approaches. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1247-1255. [PMID: 34420095 DOI: 10.1007/s00590-021-03101-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the incidence of malalignment in patients undergoing IMN for tibial shaft fractures treated with the extra-articular lateral parapatellar, suprapatellar, and infrapatellar approaches. METHODS A retrospective review of an institutional trauma database was completed at a single level 1 trauma academic medical centre. Quality of reduction was assessed using the following three parameters: (1) < 10°of angulation in orthogonal radiographic views (2) < 5 mm of displacement between the major fracture fragments (3) < 5 mm of gap between the major fracture fragments. A good reduction was one that met all 3 criteria, an acceptable reduction met 2 criteria, and a bad reduction met one or none of the criteria. All patients treated consecutively for tibial shaft fractures between June 1, 2019 and June 1, 2020 were identified. The final cohort included 57 tibia fractures in 56 patients. Of the 57 tibia fractures, 8 (14%) were proximal third, 32 (56%) were middle third, and 17 (30%) were distal third fractures. RESULTS We found no significant difference in angulation, displacement, or gapping with respect to surgical approach utilized or location of fracture (proximal or distal tibia fractures) on one-way ANOVA. Quality of reduction was rated as "good" in 48 (84%) of the cases (19 supra, 13 infra, and 16 lateral). Nine reductions (16%) met only two of the three reduction quality criteria and were considered acceptable reductions. These included 2 suprapatellar (1 > 5 mm displacement, 1 > 5 mm gapping), 4 infrapatellar (4 > 5 mm displacement), and 3 lateral extra-articular parapatellar (2 > 5 mm displacement and 1 > 5 mm gapping). No reductions were determined to be bad according the Baumgaertner et al. criteria. There was no significant difference in the rate of combined fibula fractures or the rate of fibular fixation between the three cohorts. CONCLUSIONS In conclusion, no significant difference was found in fracture reduction angulation, displacement, and gapping in patients treated with an IMN with respect to approach for diaphyseal or metadiaphyseal tibial shaft fractures.
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Affiliation(s)
- Hayden P Baker
- Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL, 60637, USA.
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