Comparison of plate and intramedullary nail fixation of extra-articular tibial fractures: A retrospective study exploring hidden blood loss

Wang, Ji-Qi; Chen, Zexin; Guo, Weihua; Zhao, You-Ming; Luo, Peng

doi:10.1016/j.injury.2018.12.016

Cited by 17 publications

(16 citation statements)

References 40 publications

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“…In addition, MIPPO had a significantly higher mean of blood loss than IMN (175 ml vs. 81.19 ml) respectively. However, Wang et al ( 45 ) reported higher amount of hidden blood loss with nail than plates, and they suggested the use of plates in anemic patients or patients with multiple injuries.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Treating Tibial Shaft Fractures Using Intramedullary Nailing (IMN) versus Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO)

et al. 2022

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Background: Tibia shaft fractures are one of the most common long-bone fractures, second most common open sport-related injuries and they are estimated to occur in 4 percent of the senior population. Objective: Management of tibial fractures has been updating to achieve the best outcomes and avoid complications especially when talking about most common long bone fractures. Less invasive fixation techniques are the preferred ones to reduce surrounding soft tissue injury, improve healing process and decrease complications. Minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intramedullary nailing (IMN) are the least invasive and most popular modalities used nowadays. This study compares outcomes and complications of both modalities. Methods: This is a retrospective cohort study conducted in orthopedics department at KAUH-Jordan. Patients were followed up for a mean of 15.3 months. Only MIPPO and IMN were used, and exclusively tibial shaft fractures were included. Open fractures were classified according to the Gustilo-Anderson classification. Results: Ninety patients with a mean age of 36.9 years (range, 9-79) were observed. Fifty nine of them were treated with IMN; nine of them had complications. Thirty one patients were treated with MIPPO and only three developed complications. Three patients treated with IMN had non-union, whereas none of MIPPO patients developed non-union. Only perioperative blood loss was more when MIPPO was used taking into consideration the amount in the suction tube, amount of fluid irrigation and soaked gauze. Conclusion: In treating tibial shaft fractures, MIPPO appears to cause fewer complications and provides better healing environment therefore attributes to lower non-union rates than IMN. Larger sample size might be needed to provide better results.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Treating Tibial Shaft Fractures Using Intramedullary Nailing (IMN) versus Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO)

et al. 2022

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“…In this article Group LCP had signi cantly higher total surgical duration and intraoperative bleeding loss than did Group IMN, which was decided by the unique operative techniques of the two different implant options, the mainly affecting factors for prolonged surgical duration of Group LCP were longer duration of fracture reduction and wound closure [1,19,20]. Meanwhile the intraoperative bleeding loss was signi cantly higher in Group LCP than in Group IMN when a tourniquet was performed for both groups, whereas Wang et al found that the Hb loss, Hct loss and surgical duration were signi cantly lower in Group LCP than in Group IMN after taking the hidden blood loss into account [21]. We assumed that the blood loss issue depends on the surgical duration, the experience and operation skills of orthopedic surgeon.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

Xu¹,

Ren²,

Zhong³

et al. 2020

Preprint

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Background To analyze the clinical characteristic and economic of intramedullary nailing versus locking compression plate for the treatment of open distal tibial fractures.Methods A retrospective analysis was conducted by enrolling patients with open distal tibial fractures who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department，Xi’an Honghui Hospital from January 2016 to January 2019. The collected clinical materials and data included gender, age, injury mechanism, smoke and alcohol, comorbidity disease, Gustilo classification, days before operation, final treatment option, surgical duration, intraoperative bleeding loss, length of stay, complications, Johner-Wruhs criteria, total cost within 1 year after surgery (including hospitalization expenses and postoperative rehabilitation or follow-up expenses). All the patients were divided into two groups based on the final treatment options: Group IMN(intramedullary nailing) and Group LCP(locking compression plate). Cost data for each case within 1 year after surgery were analyzed for the cost-effectiveness ratio (CER)and incremental cost-effectiveness ratio (ICER) of IMN versus LCP.Results 49 consecutive cases were enrolled including 28 cases of Group IMN and 21 cases of Group LCP with the excellent and good rate of 82.1% (23 cases) and 85.7% (18 cases) respectively based on Johner-Wruhs criteria. The surgical duration (p=0.017) and intraoperative bleeding loss(p=0.046) were significantly lower in Group IMN than in Group LCP. Total cost within 1 year after surgery(p=0.048) was also less in Group IMN（126435.90±39093.98 CNY）than in Group LCP（147834.60±56821.12 CNY）. No statistically significant difference was discovered on the excellent and good rate of Johner-Wruhs criteria between the two groups(p＞0.05). The average cost for every 1% of excellent and good rate was 1540.02 CNY in Group IMN and 1725.02 CNY in Group LCP. Each 1% increasing of excellent and good rate cost 5944.08 CNY more in Group LCP compared with Group IMN.Conclusions Both the IMN and LCP could provide a satisfactory outcome for open distal tibial fractures. However the IMN was a more cost-effective management than LCP when the economic analysis was included.

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“…However, these procedures lead to longer surgical time, more blood loss, and more fluoroscopy time. [ 1 , 26 ] Reaming could provide better stability, but it is also possible that reamed IMN results in delayed healing because of damage to the medullary blood supply. [ 3 ] Malalignment was also associated with ankle pain related to the close anatomic neighboring to the ankle.…”

Section: Discussionmentioning

confidence: 99%

“…Intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) are two commonly used surgical techniques that are superior to other available options (external fixation and conventional plate fixation) for the treatment of tibia shaft fractures. [ 1 ] In a survey study among orthopedic surgeons, 90% of orthopedic trauma surgeons preferred IMN as their first choice for tibial shaft fracture fixation. [ 2 ] Intramedullary nailing has several advantages over conventional open reduction and plating.…”

Section: Introductionmentioning

confidence: 99%

May minimally invasive plate osteosynthesis be an alternative to intramedullary nailing in selected spiral oblique and spiral wedge tibial shaft fractures?

et al. 2020

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Comparison of plate and intramedullary nail fixation of extra-articular tibial fractures: A retrospective study exploring hidden blood loss

Cited by 17 publications

References 40 publications

Outcomes of Treating Tibial Shaft Fractures Using Intramedullary Nailing (IMN) versus Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO)

Outcomes of Treating Tibial Shaft Fractures Using Intramedullary Nailing (IMN) versus Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO)

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

May minimally invasive plate osteosynthesis be an alternative to intramedullary nailing in selected spiral oblique and spiral wedge tibial shaft fractures?

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