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Boff MS, Paolucci PHDO, de Oliveira GM, Zanesco L, Andrade-Silva FB, Leonhardt MDC, dos Reis PR, Silva JDS, Kojima KE. WEDGE FRAGMENT VARIATIONS OF TIBIAL SHAFT FRACTURES WITH INTRAMEDULLARY NAILING. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268124. [PMID: 37720813 PMCID: PMC10502966 DOI: 10.1590/1413-785220233103e268124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/17/2023] [Indexed: 09/19/2023]
Abstract
Introduction Tibial shaft fracture is the most common long-bone fracture, and the standard treatment is intramedullary (IM) nail fixation. Regardless of the development of this technique pseudoarthrosis remains prevalent. Objectives Evaluate the correlation between wedge fragment size and displacement, displacement of the main fragments of the 42B2 type, and pseudoarthrosis incidence. Methods We retrospectively assessed all patients with 42B2 type fracture treated with IM nailing between January, 2015 and December, 2019. Six radiographic parameters were defined for preoperative radiographs in the anteroposterior (AP) and lateral views. Another six parameters were defined for postoperative radiographs at three, six, and 12 months. The Radiographic Union Score for Tibial Fractures score was used to assess bone healing. Results Of 355 patients with tibial shaft fractures, 51 were included in the study. There were 41 (82.0%) male patients, with a mean age of 36.7 years, 37 (72.5%) had open fractures, and 28 (54.9%) had associated injuries. After statistical analysis, the factors that correlated significantly with nonunion were wedge height > 18 mm, preoperative translational displacement of the fracture in the AP view > 18 mm, and final distance of the wedge in relation to its original anatomical position after IM nailing > 5 mm. Conclusion Risk factors for nonunion related to the wedge and42B2 fracture are wedge height > 18 mm, initial translation in the AP view of the fracture > 18 mm, and distance > 5 mm of the wedge from its anatomical position after IM nailing. Evidence level III; Retrospective comparative study .
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Affiliation(s)
- Mario Sergio Boff
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Pedro Henrique de Oliveira Paolucci
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Gabriel Machado de Oliveira
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Leonardo Zanesco
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Fernando Brandao Andrade-Silva
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Marcos de Camargo Leonhardt
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Paulo Roberto dos Reis
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Jorge dos Santos Silva
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
| | - Kodi Edson Kojima
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, Instituto de Ortopedia e Traumatologia IOT, Grupo de Trauma, Sao Paulo, SP, Brazil
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Patel AH, Wilder JH, Lee OC, Ross AJ, Vemulapalli KC, Gladden PB, Martin MP, Sherman WF. A Review of Proximal Tibia Entry Points for Intramedullary Nailing and Validation of The Lateral Parapatellar Approach as Extra-articular. Orthop Rev (Pavia) 2022; 14:31909. [PMID: 35106131 PMCID: PMC8801390 DOI: 10.52965/001c.31909] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Tibial shaft fractures are the most common long bone injury and are often treated surgically in an attempt to minimize complications. Although treatment options for tibial shaft fractures vary based on factors including open injury, severity of fracture, and soft tissue status, intramedullary nailing in adults has emerged as the preferred definitive option for stabilization. Therefore, the primary purposes of this review and cadaveric study were to evaluate the entry points for reamed tibial nails and the risks, benefits, and advantages of each approach. Due to concerns of violating the joint capsule and the generalized applicability to everyday practice of the extra-articular lateral parapatellar semi-extended technique, the secondary goal of this manuscript was to evaluate whether an intramedullary tibial nail can be consistently placed extra-articularly using the lateral parapatellar technique described by Kubiak et al. and generalizability to surgeons of varying experience.
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Affiliation(s)
- Akshar H Patel
- Orthopaedic Surgery, Tulane University School of Medicine
| | - J Heath Wilder
- Orthopaedic Surgery, Tulane University School of Medicine
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Tulane University School of Medicine; Department of Orthopaedic Surgery, Louisiana State University School of Medicine and Southeast Louisiana Veterans Health Care System
| | - Austin J Ross
- Orthopaedic Surgery, Tulane University School of Medicine
| | | | - Paul B Gladden
- Orthopaedic Surgery, Tulane University School of Medicine
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von Rüden C, Dietz SO, Schmittenbecher P, Fernandez FF, Lieber J, Wilkens B, Rüger M, Schneidmueller D. Pediatric aseptic lower leg fracture nonunion. Eur J Trauma Emerg Surg 2020; 47:303-311. [PMID: 33263815 PMCID: PMC8016764 DOI: 10.1007/s00068-020-01556-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/10/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Lower leg nonunion in pediatric patients is a rarity. Therefore, eight European pediatric trauma units retrospectively analyzed all patients younger than 18 years suffering lower leg fractures resulting in aseptic nonunion. METHODS Thirteen children and adolescents less than 18 years old (2 girls and 11 boys) diagnosed with aseptic nonunion of the tibia and/or fibula were evaluated. In all patients, epidemiological data, mechanism of injury, fracture configuration, and the initial treatment concept were assessed, and the entire medical case documentation was observed. Furthermore, potential causes of nonunion development were evaluated. RESULTS The mean age of patients was 12.3 years with the youngest patient being seven and the oldest being 17 years old. Open fractures were found in six out of thirteen patients (46%). Nonunion was hypertrophic in ten and oligotrophic in three patients. Mean range of time to nonunion occurrence was 7.3 ± 4.6 months. Nonunion healing resulting in complete metal removal was found in 12 out of 13 patients (92%), only in one case of a misinterpreted CPT type II osseous consolidation could not be found during the observation period. Mean range of time between surgical nonunion revision and osseous healing was 7.3 months as well. CONCLUSION If treatment principles of the growing skeleton are followed consistently, aseptic nonunion of the lower leg remains a rare complication in children and adolescents. Factors influencing the risk of fracture nonunion development include patient's age, extended soft tissue damage, relevant bone loss, and inadequate initial treatment.
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Affiliation(s)
- Christian von Rüden
- Department of Trauma Surgery, BG Unfallklinik Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
- Department of Trauma Surgery, Sports Orthopaedics and Pediatric Traumatology, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany.
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria.
| | - Sven-Oliver Dietz
- Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | | | - Francisco F Fernandez
- Department of Orthopaedic Surgery, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Justus Lieber
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Björn Wilkens
- Department of Pediatric Surgery and Pediatric Urology, Krankenhaus St. Elisabeth und St. Barbara, Halle/Saale, Germany
| | - Matthias Rüger
- Pediatric Orthopaedics and Traumatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Dorien Schneidmueller
- Department of Trauma Surgery, BG Unfallklinik Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany
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