1
|
Liu J, Dai S, Liu L, Kuang H, Yan L, Cai Q, Shao Z, Wei W, Min Z, Tang W. A novel assisted reduction method in extra-articular fractures of the distal tibia treated with intramedullary nail. Front Med (Lausanne) 2024; 11:1444434. [PMID: 39131089 PMCID: PMC11310112 DOI: 10.3389/fmed.2024.1444434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Background To explore the clinical efficacy and safety of Kirschner wires (KWs) as a blocking screw technique for extra-articular fractures of the distal tibia treated with intramedullary nails (IMNs). Methods Fifty-three patients were treated with KW-assisted IMN for extra-articular fractures of the distal tibia via the blocking screw technique or Poller screw (PS) technique. The operation time, number of fluoroscopies, number of blocking screws used, blood loss and time to union were compared between the two groups. Additionally, the functional outcomes of the two groups were compared using range of motion (ROM), visual analog scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), and Lysholm scores. Results Compared with those in the PS group, the operation time in the KW group was significantly shorter, and the number of fluoroscopy procedures and amount of blood loss during KW surgery were also significantly lower (p = 0.014, 0.001, and 0.036, respectively). Regarding the functional outcomes, there were no significant differences in the ROM, VAS score, AOFAS score or Lysholm score between the two groups (p > 0.05). Conclusion In the treatment of extra-articular fractures of the distal tibia with nails, the use of KW as a blocking screw technique is safe and reliable.
Collapse
Affiliation(s)
- Jun Liu
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Simin Dai
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lijin Liu
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Hailin Kuang
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Liang Yan
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Qiangqiang Cai
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Zongzuan Shao
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Wenbo Wei
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Zhihai Min
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| | - Wubing Tang
- Department of Orthopaedic Surgery, The Third Hospital of Nanchang, Nanchang People's Hospital, Nanchang, Jiangxi, China
| |
Collapse
|
2
|
Force A, Tarpada S, Follett L, Dedhia N, Dimitroulias A, Sen MK. Fixation of Proximal Tibial Fractures with Intramedullary Nail and Immediate Weightbearing: A Beneficial Alternative. Injury 2024; 55:111530. [PMID: 38637188 DOI: 10.1016/j.injury.2024.111530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/10/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
Newer intramedullary (IM) nails have become another option in the fixation of proximal tibia fractures. There is limited data on the successful use of these implants in intra-articular and extra-articular fractures of the proximal tibia, and no studies assessing the ability of these implants to maintain alignment with early weight bearing. Our objective was to determine whether immediate weight bearing after IM fixation, with or without supplemental plate or screw fixation, of proximal third tibial fractures (OTA/AO 41A-C) results in a change in alignment prior to union. 35 patients with 39 proximal tibia fractures from 2015 to 2020, all treated with IM nailing with or without supplemental plate or screw fixation, all made weight-bearing as tolerated following surgery, were included. The main outcomes were change in medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA) from initial post-operative films to final follow up. 12 fractures were OTA/AO 41 type A, 14 were type B, and 13 were type C. Mean initial MPTA was 87.0 +/-2.53 degrees, while mean initial PPTA was 79.6 +/- 3.50 degrees. The mean change in MPTA was 0.048 +/- 2.8 degrees (P=0.92), and mean change in PPTA was 0.264 +/- 3.67 degrees. 92.3% of fractures had normal final coronal plane alignment, with MPTA between 85.0 and 90.0 degrees. 89.7% of fractures had normal final sagittal plane alignment, with PPTA between 77.0 and 84.0 degrees. No patients required reoperation for malalignment. In OTA/AO type 41 fractures, immediate weight bearing after IM nail fixation, with or without supplemental plate or screw fixation when indicated, leads to minimal change in final coronal or sagittal alignment, and was well tolerated in most patients. [authors blinded for review].
Collapse
Affiliation(s)
- Ashley Force
- Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Sandip Tarpada
- Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; NYC Health + Hospitals/ Jacobi, 1400 Pelham Parkway S, Building 1, Bronx, NY 10461, USA
| | - Lisa Follett
- Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; NYC Health + Hospitals/ Jacobi, 1400 Pelham Parkway S, Building 1, Bronx, NY 10461, USA
| | - Nicket Dedhia
- Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; NYC Health + Hospitals/ Jacobi, 1400 Pelham Parkway S, Building 1, Bronx, NY 10461, USA
| | - Apostolos Dimitroulias
- Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; NYC Health + Hospitals/ Jacobi, 1400 Pelham Parkway S, Building 1, Bronx, NY 10461, USA
| | - Milan Kumar Sen
- Albert Einstein College of Medicine/Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY 10461, USA; NYC Health + Hospitals/ Jacobi, 1400 Pelham Parkway S, Building 1, Bronx, NY 10461, USA
| |
Collapse
|
3
|
Lee C, Brodke D, Hogue M. Recurvatum Deformity in Proximal Tibial Fractures Treated With the Synthes Tibial Nail. Orthopedics 2023; 46:e129-e131. [PMID: 36067047 DOI: 10.3928/01477447-20220831-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sagittal malalignment after intramedullary fixation of proximal third tibial shaft fractures has been described frequently, but almost every reported case involves a procurvatum deformity. We report 2 cases of recurvatum deformity of proximal third tibial shaft fractures where the Synthes EX tibial nail was used. The recurvatum deformity may have been induced by the shape of the nail, with its more distal Herzog curve relative to designs from other manufacturers. In proximal third tibial shaft fractures, tibial nails with distal Herzog curves may induce a recurvatum deformity that is not easily correctable. [Orthopedics. 2023;46(2):e129-e131.].
Collapse
|
5
|
Fixation of Extra-articular Proximal Tibia Fractures: Biomechanical Comparison of Single and Dual Implant Constructs. J Am Acad Orthop Surg 2022; 30:629-635. [PMID: 35442912 DOI: 10.5435/jaaos-d-21-01089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/17/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES This biomechanical study seeks to define the relative effectiveness of contemporary single and dual implant constructs for fixation of an extra-articular proximal tibia fracture model. METHODS An extra-articular proximal tibia fracture model was created using synthetic tibias. Four constructs were tested. Constructs included (1) lateral locked plate (LLP), (2) intramedullary nail (IMN), (3) combined LLP and IMN (PN), and (4) LLP and medial locked plate. Specimens were axially loaded through the medial plateau to evaluate construct stiffness and the ability to resist varus collapse. RESULTS Dual implant constructs were stiffer than single implant constructs in this model. Although DP and PN were stiffer than IMN at all loads tested, the difference was notable only for DP at higher loads. Isolated LLP provided insufficient stability to be tested at higher loads. CONCLUSION Dual plate fixation provides the greatest resistance to varus collapse. In the clinical setting, consideration must be given to the fracture morphology, desired construct stiffness, and soft-tissue envelope in selecting the optimal construct to be used.
Collapse
|
6
|
Erdal OA, Gorgun B, Sarikaya IA, Inan M. Retro-patellar approach in telescopic nailing of the tibia in children with osteogenesis imperfecta. J Child Orthop 2021; 15:388-394. [PMID: 34476029 PMCID: PMC8381389 DOI: 10.1302/1863-2548.15.200263] [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] [Received: 12/21/2020] [Accepted: 05/17/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Telescopic intramedullary nailing (TN) has become the main choice of treatment in children with osteogenesis imperfecta (OI). The classical parapatellar tibial nailing technique poses difficulties in maintaining reduction, insertion of the nail and fluoroscopic imaging. Also, deformities of the proximal tibia in relatively small children with OI can be problematic for tibial nailing. In this report, we present the retro-patellar approach in tibial TN of children with OI as an alternative to the classical approach and report the early radiographic and clinical results of our patients. METHODS The nail is inserted through a skin incision proximal to the patella, passing inside the patellofemoral joint while the knee is positioned to 15° to 20° of flexion. In total, 30 tibiae of 15 patients had been operated and were reviewed after at least one year of follow-up. Any complications, such as implant failure, joint damage or instability, malunion, nonunion or refracture, were recorded. RESULTS The mean age of our patients was 8.5 years, and the mean follow-up period was 27 months. There were no complaints involving the knee. All patients showed complete union without any implant failure or refracture. We did not observe any nail protrusion, bending or loss of correction during the procedure. CONCLUSION The retro-patellar approach for tibial TN appears to be safe and effective in patients with OI. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Ozan A. Erdal
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Baris Gorgun
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Ilker A. Sarikaya
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| | - Muharrem Inan
- Ortopediatri Istanbul, Academy of Pediatric Orthopaedics, Istanbul, Turkey
| |
Collapse
|