Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions

Ebraheim, Nabil A.; Evans, Brad; Liu, Xiaochen; Tanios, Mina; Gillette, Marshall; Liu, Jiayong

doi:10.1007/s00264-017-3432-3

Cited by 12 publications

(8 citation statements)

References 32 publications

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“…No significant difference was found between external fixation and ORIF. Ebraheim NA et al reported that IMN can achieve better healing effect in the treatment of tibial fractures, comparing to ORIF and external fixation [149]. MIPPO had the lowest nonunion rate of all fixation modes.…”

Section: Discussionmentioning

confidence: 97%

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

et al. 2020

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Objective The aim of this study is to assess the prevalence of nonunion in patients with tibia fracture and the association between influencing factors and tibia fracture nonunion. Method A database searches of PubMed, the Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Weipu database, and Wanfang database from inception until June 2019 was conducted. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata software. Results In this study, 111 studies involving 41,429 subjects were included. In the study of the relationship between influencing factors and tibia fracture nonunion, 15 factors significantly influenced the fracture union, including > 60 years old, male, tobacco smoker, body mass index > 40, diabetes, nonsteroidal anti-inflammatory drugs (NSAIDs) user, opioids user, fracture of middle and distal tibia, high-energy fracture, open fracture, Gustilo-Anderson grade IIIB or IIIC, Müller AO Classification of Fractures C, open reduction, fixation model, and infection. Conclusion The prevalence of nonunion in patients with tibia fracture was 0.068 and 15 potential factors were associated with the prevalence. Closed reduction and minimally invasive percutaneous plate osteosynthesis (MIPPO) have the low risks of nonunion for the treatment of tibial fractures.

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Section: Discussionmentioning

confidence: 97%

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

et al. 2020

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“…This prospective study extends the indications for this novel SEIP technique from tibial shaft fracture to DTF. Currently, the primary interventions for treating DTF are IMN, locked plate, and external fixation [19,20]. The usage of the above surgical procedures depends on the fracture site, related fracture, ankle joint component, soft-tissue status, and patient's general health.…”

Section: Discussionmentioning

confidence: 99%

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

Lü

Wang

et al. 2022

J Orthop Traumatol

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Background Malalignment is a common event during the intramedullary nailing (IMN) of distal tibia fractures (DTFs). Although it is reported that the semi-extended IMN techniques such as suprapatellar (SP) and parapatellar (PP) approaches may be superior in preventing malalignment, the application of these techniques is concerning owing to the intra-articular involvement. We thus developed an extra-articular semi-extended infrapatellar (SEIP) approach which utilizes the infrapatellar (IP) space while maintaining the knee in a semi-extended position. However, there are no studies on the safety and efficacy of SEIP in treating DTFs. Therefore, in this study, the SEIP technique was examined, particularly in terms of the potential alignment improvement of DTFs, and this technique was compared with the traditional hyperflexed infrapatellar (HFIP) procedure. Materials and methods This randomized clinical trial (RCT) compared IMN malalignment while correcting extraarticular and nondisplaced intra-articular DTFs between April 2018 and June 2021 using the HFIP and SEIP techniques at a level I trauma center in China. The study participants were clinically and radiographically examined for at least 12 months of follow-ups. Intraoperative fluoroscopy time, operation time, blood loss, hospitalization duration, functional ankle score, and complications were assessed as well. Results Among the 88 recruited participants, 45 (51%) underwent traditional HFIP IMN and 43 (49%) underwent SEIP IMN. Malalignment occurred in 9 patients (20.0%) from the HFIP cohort and in 2 patients (4.7%) from the SEIP cohort (P value = 0.030). In addition, the SEIP IMN technique significantly reduced the intraoperative fluoroscopy time, operation time, and improved the postoperative ankle function compared to the HFIP IMN technique. However, the intraoperative blood loss, hospitalization duration, infection, delay union, and nonunion remained the same between the two cohorts. Conclusions In summary, we demonstrated that the SEIP IMN provides markedly enhanced alignment of extraarticular and nondisplaced intra-articular DTFs compared to the traditional HFIP IMN procedure. The described technique represents an effective option for IMN of DTFs. Level of evidence Level 2. Trial registration The Chinese Clinical Trial Registry, ChiCTR2100043673. Registered 26 February 2021, retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=122263

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“…After the intramedullary nail is implanted, the surrounding bone tissue is compressed to form an elastic xation between the nail and the bone. At the same time, this procedure does not damage the blood supply in the fracture end [14][15][16][17][18][19] and help to accelerate the healing process [20,21]. This method becomes especially important for severe comminuted fractures due to its incomparable advantages over steel plates [16,18,[22][23][24][25] .…”

Section: Discussionmentioning

confidence: 99%

“…At the same time, this procedure does not damage the blood supply in the fracture end [14][15][16][17][18][19] and help to accelerate the healing process [20,21]. This method becomes especially important for severe comminuted fractures due to its incomparable advantages over steel plates [16,18,[22][23][24][25] . Due to the above merits, interlocking intramedullary nails have become the rst-line treatment for unstable tibial fractures [26,27].…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of small incision open reduction and intramedullary nail fixation surgery in the treatment of simple tibial shaft fracture

shi

hai

Zhang

et al. 2021

Preprint

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Objective: To explore the clinical efficacy and safety of small incision open reduction and intramedullary nail internal fixation surgery in the treatment of simple tibial shaft fracture compared to the closed reduction surgery. Methods: A total of fifty patients with simple tibial shaft fractures admitted to our hospital were randomly and equally assigned into the observation group and the control group. Patients in the observation group received small incision open reduction surgery with intramedullary nail while patients in the control group received the closed reduction surgery. The clinical efficacy, prognosis as well as safety profile were compared between the two groups. Results: Our data indicated that the average bleeding volume of patients in the observation group was increased while the operation time was decreased compared to the control group. No significant difference of postoperative complications, fracture healing time, and Johner-Wruhs scores was identified between the two groups. Conclusion: The small incision open reduction surgery can significantly shorten the operation time while achieved a similar clinical efficacy compared to the closed reduction surgery in simple tibial shaft fracture.

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Comparison of intramedullary nail, plate, and external fixation in the treatment of distal tibia nonunions

Cited by 12 publications

References 32 publications

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

The efficacy and safety of small incision open reduction and intramedullary nail fixation surgery in the treatment of simple tibial shaft fracture

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