External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients

Bråten, Martinus; Helland, Per; Grøntvedt, Torbjørn; Aamodt, Arild; Benum, Pål; Mølster, Anders

doi:10.1007/s00402-004-0768-0

Cited by 47 publications

(53 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A higher soft tissue infection rate has been seen in patients treated with minimally invasive plate osteosynthesis, which may be explained by the extended operation time. Moreover, pin tract infection is an inherent problem in external fixation [6,35]. Our results are in line with previous reports, and pin tract infection occurred frequently in the external fixation combined with limited open reduction and absorbable internal fixation group.…”

Section: Discussionsupporting

confidence: 92%

“…No patients showed signs of persistent pin tract infection after six months or one year. We observed a high frequency of anterior knee pain after intramedullary nailing, which is consistent with early studies [6,14,37]. A tendon-splitting approach was used in our study.…”

Section: Discussionsupporting

confidence: 91%

“…The highest infection rate is seen in patients treated with open reduction and internal fixation. MIPO, intramedullary nail and external fixation lead to a serious decrease in the infection rates [5,6,15,31,35,36]. Results from this present study show that deep infection does not have a significant difference between the three groups.…”

Section: Discussionmentioning

confidence: 45%

“…In the past few years, several studies focussing on the methods of treatment for displaced distal tibial shaft fractures have been published [1][2][3][4][5][6][7]. Plates, intramedullary nails and external fixations are three well-accepted and effective methods, but each has been historically related to complications.…”

Section: Introductionmentioning

confidence: 99%

“…Although previous studies have compared plates with intramedullary nails [1][2][3][4][5]10], plates with external fixation [7] and intramedullary nails with external fixation [6], few data are available on the three methods above. The minimally invasive plate osteosynthesis (MIPO) technique has gained prevalence in recent years.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

Jiang

Guo

et al. 2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

Jiang

Guo

et al. 2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Disadvantages of interfragmentary shear on fracture healing—mechanical insights through numerical simulation

Steiner

Claes

Ignatius

et al. 2014

Journal Orthopaedic Research

View full text Add to dashboard Cite

The outcome of secondary fracture healing processes is strongly influenced by interfragmentary motion. Shear movement is assumed to be more disadvantageous than axial movement, however, experimental results are contradictory. Numerical fracture healing models allow simulation of the fracture healing process with variation of single input parameters and under comparable, normalized mechanical conditions. Thus, a comparison of the influence of different loading directions on the healing process is possible. In this study we simulated fracture healing under several axial compressive, and translational and torsional shear movement scenarios, and compared their respective healing times. Therefore, we used a calibrated numerical model for fracture healing in sheep. Numerous variations of movement amplitudes and musculoskeletal loads were simulated for the three loading directions. Our results show that isolated axial compression was more beneficial for the fracture healing success than both isolated shearing conditions for load and displacement magnitudes which were identical as well as physiological different, and even for strain-based normalized comparable conditions. Additionally, torsional shear movements had less impeding effects than translational shear movements. Therefore, our findings suggest that osteosynthesis implants can be optimized, in particular, to limit translational interfragmentary shear under musculoskeletal loading. With the use of numerical models, distinct effects of different loading modes on fracture healing can be simulated. [17][18][19] Recently, we developed a numerical fracture healing algorithm, 20-22 which allows us to investigate the influence of single input parameters on the change in IFM and tissue distribution over the healing time. This enables a direct comparison between different mechanical conditions. Thus, according to experimental data, we identified more cartilage formation under axial compression than under shear loading conditions. 22The present study compares healing outcomes of different loading directions (i.e., axial compression, and translational and torsional shear) under normalized mechanical conditions using our calibrated sheep fracture healing algorithm. The aims were to identify adverse conditions and to explain them based on the predicted tissue development over time.From a mechanical point of view, translational shear and axial compressive loading lead to regions of compressive hydrostatic pressure (negative dilatational strain) which stimulate cartilage development, and therefore promote endochondral ossification. 2,[23][24][25] In contrast, torsional shear loading leads only to distortional strains without compressive hydrostatic pressure generation, which suppresses cartilage development.Thus, we hypothesize that differences in healing outcomes are because of differences in cartilage formation resulting from mechanical tissue strain conditions. METHODS Numerical Fracture Healing ModelWe used a numerical fracture healing simulation algorithm that w...

show abstract

Anterior knee pain and functional outcome following different surgical techniques for tibial nailing: a systematic review

Leliveld

Verhofstad

Bodegraven

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose The aim of this systematic review was to compare knee pain and function after tibial nail insertion through an infrapatellar, semi-extended and suprapatellar technique. Methods A search was carried out to identify articles with an exact description of the method used for insertion of the tibial nail and description of the outcome parameters (knee pain or function). Data on study design, population, rate and severity of anterior knee pain and function scores were extracted. Pooled rates and scores were calculated. Results 67 studies with 3,499 patients were included. The pooled rate of patients with anterior knee pain was 38% (95% CI 32–44) after nail insertion through an infrapatellar approach and 10% (95% CI 1–26) after insertion through a suprapatellar approach. Pooled analysis was not possible for the semi-extended technique. Knee pain scores as measured by visual analogue score (0–10) ranged from 0.2 (95% CI − 0.1–0.5) for general knee pain to 3.7 (95% CI 1.3–6.1) for pain during kneeling. Pooled estimates for the Lysholm score were 87 points (range 77–97) for the infrapatellar technique and 85 points (range 82–85) for the suprapatellar technique. Iowa Knee scores were 94 (range 86–96) and Anterior Knee Pain Scale scores were 76 (range 75–80) after infrapatellar nail insertion. Discussion Depending on the technique used, the proportion of patients with knee pain after tibial nailing varied between 10 and 38%. The actual measured knee pain scores were, however, surprisingly low. Knee function was good for both the infra- and suprapatellar technique.

show abstract

External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients

Abstract: The results were comparable in most respects. Unprotected weight-bearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.

Cited by 47 publications

References 28 publications

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study

Disadvantages of interfragmentary shear on fracture healing—mechanical insights through numerical simulation

Anterior knee pain and functional outcome following different surgical techniques for tibial nailing: a systematic review

Contact Info

Product

Resources

About