A multicentre case series of tibia fractures treated with the Expert Tibia Nail (ETN)

Attal, R.; Hansen, Matthias; Kirjavainen, Mikko; Bail, Hermann Josef; Hammer, Thorsten; Rosenberger, Ralf; Höntzsch, Dankward; Rommens, Pol Maria

doi:10.1007/s00402-012-1502-y

Cited by 50 publications

(40 citation statements)

References 39 publications

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“…Metaphyseal fractures will not be corrected by introducing the nail, whether it be antegrade or retrograde. If malalignment is present during nail insertion, the fracture will most likely be stabilized in a non-anatomical position [24,25]. Therefore, prior reduction and careful control of the fragments while introducing the nail across the fracture line are crucial.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

et al. 2014

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BackgroundCurrently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures. However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus with stab incisions sufficient for interlocking. During this project, we investigated the feasibility of retrograde tibial nailing in a cadaver model and conducted biomechanical testing.MethodsAnatomical implantations of the RTN were carried out in AO/OTA 43 A1-3 fracture types in three cadaveric lower limbs. Biomechanical testing was conducted in an AO/OTA 43 A3 fracture model for extra-axial compression, torsion, and destructive extra-axial compression. Sixteen composite tibiae were used to compare the RTN against an angle-stable plate osteosynthesis (Medial Distal Tibial Plate, Synthes®). Statistical analysis was performed by Student's t test.ResultsRetrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps, while in highly comminuted fractures, the use of a large distractor can aid the reduction. Biomechanical testing shows a statistically superior stability (p < 0.001) of the RTN during non-destructive axial loading and torsion. Destructive extra-axial compression testing resulted in failure of all plate constructs, while all RTN specimens survived the maximal load of 1,200 N.ConclusionsThe prototype retrograde tibial nail meets the requirements of maximum soft tissue protection by a minimally invasive surgical approach with the ability of secure fracture fixation by multiple locking options. Retrograde tibial nailing with the RTN is a promising concept in the treatment of distal tibia fractures.

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Section: Discussionmentioning

confidence: 99%

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

et al. 2014

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“…Furthermore, the reported average time to union was approximately 20 weeks for simple fractures that had been caused by a low-energy mechanism and over 30 weeks for comminuted fractures that had been caused by a high-energy mechanism. Different authors also reported that fractures of the middle third of the tibia usually healed in an average of 12 weeks, and little variation in healing time relative to the type of fracture was noted [20][21][22][23][24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults

El-Sayed

Atef

2012

International Orthopaedics (SICOT)

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Purpose Although intramedullary fixation of closed simple (type A or B) diaphyseal tibial fractures in adults is well tolerated by patients, providing lower morbidity rates and better mobility, it is associated with some complications. This study evaluated the results of managing these fractures using percutaneous minimal internal fixation using one or more lag screws, and Ilizarov external fixation. Methods This method was tested to evaluate its efficacy in immediate weight bearing, fracture healing and prevention of any post-immobilisation stiffness of the ankle and knee joints. This randomised blinded study was performed at a referral, academically supervised, level III trauma centre.

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“…As such, unreamed nailing is associated with an increased rate of delayed and nonunion [ 31 , 35 , 54 ]. Attal et al found that tibia fractures within the mid-diaphysis, followed by the distal third had a higher rate of delayed union versus proximal third fractures (16.7 & 10.5 % versus 5.9 %) [ 5 ]. Again, this would logically seem to be related toward the issue of available soft tissue coverage and blood supply.…”

Section: Delayed Union and Nonunionmentioning

confidence: 93%

Complications of Intramedullary Nailing

Berkes

Little

Lorich

2014

Intramedullary Nailing

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Intramedullary nailing offers a safe and reliable means of osteosynthesis. Complications encountered when performing intramedullary fi xation are malalignment, infection, hardware failure, impaired bony healing and neurovascular injuries. Primary malalignment is largely a consequence of either an inappropriate entry point or fracture site malreduction. Secondary malalignment refers to a change in fracture reduction and alignment at some point during the postoperative period. Hardware failure is seen when the implant sustains more load than intended, either due to early excessive weight bearing or prolonged cyclical loading, as in a non-united fracture. Infection can result in secondary operations, increased risk of secondary complications, delayed/nonunion and worse clinical outcome for the patient.

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A multicentre case series of tibia fractures treated with the Expert Tibia Nail (ETN)

Cited by 50 publications

References 39 publications

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults

Complications of Intramedullary Nailing

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