Intramedullary Nail Fixation of Tibial Shaft Fractures

Cereijo, Cesar; Attum, Basem; Rodriguez-Buitrago, Andres; Jahangir, A. Alex; Obremskey, William T.

doi:10.2106/jbjs.st.17.00063

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…Initially, most of the weight-bearing load passes through the nail, but, eventually, the load is gradually transferred to the bone as the fracture heals, allowing for early weight bearing [8,9]. This fixation method requires minimal surgical dissection, which allows for preservation of periosteal and soft tissue blood supply by minimizing tissue disruption surrounding the fracture site [10]. In addition to small incisions and minimal soft tissue disruption, this form of fracture stabilization allows for immediate weight-bearing, which has benefits that appeal to both providers and patients [11].…”

Section: Intramedullary Nail 21 Indicationsmentioning

confidence: 99%

A Review of Tibial Shaft Fracture Fixation Methods

Tamburini,

Zeng,

Neumann

et al. 2023

Trauma Care

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Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures.

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Section: Intramedullary Nail 21 Indicationsmentioning

confidence: 99%

A Review of Tibial Shaft Fracture Fixation Methods

Tamburini,

Zeng,

Neumann

et al. 2023

Trauma Care

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“…Intramedullary (IM) nails are used widely for the management of diaphyseal fractures of the tibia and femur. 1 Whilst these can be retained indefinitely after successful fracture union, some may require removal in cases of non-union, infection, deformity, implant prominence causing soft tissue irritation and, occasionally, at a patient's request. The majority are easy to remove but, at times, the surgeon is faced with a situation where the nail is firmly integrated.…”

Section: B Ackgroundmentioning

confidence: 99%

A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail

Lahoti¹,

Somerville²,

Hanschell³

et al. 2022

Strategies in Trauma and Limb Reconstruction

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A bstract Aim To present a novel technique developed in our institution to remove incarcerated and broken intramedullary (IM) tibial and femoral nails. Background IM nails are commonly used to treat diaphyseal fractures in both the tibia and femur. These nails can become problematic for the orthopaedic surgeon when they need to be removed, especially in the rare event that the nail has failed and broken. This can leave part of the nail deep in the bone and incarcerated. Multiple techniques have been described to remove a broken nail but we present a novel technique developed based on our experience. Technique After all other methods to remove the broken nail have failed, a window technique can be employed. This requires a small window of bone to be removed from the cortex overlying the remaining IM nail. A carbide drill is then used to drill a hole into the nail to gain purchase. The edge of an osteotome is placed in the hole in the nail through the window and gently hammered upwards to push the nail towards the over-reamed nail entry point. The nail is repeatedly drilled and pushed until the nail can be removed. The bone window is then replaced. Conclusion This is a novel technique that works when all other options including hooks, wire stacks and specialist nail removal techniques have failed. It is simple, efficient and effective for both the tibial and femoral nails. How to cite this article Somerville CMB, Hanschell H, Tofighi M, et al. A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail. Strategies Trauma Limb Reconstr 2022;17(1):55–58.

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“…This soft-tissue preserving fracture fixation method uses a load-sharing device to achieve biomechanical stability of the fracture, allowing patients to weight-bear early after surgery. 8 Nevertheless, these two fixation methods may lead to certain complications. For example, IMN fixation may cause malunion of the fracture site and anterior knee pain.…”

Section: Introductionmentioning

confidence: 99%

Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

Ren

Sun

et al. 2021

J Orthop Surg (Hong Kong)

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Objective: This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. Methods: We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Results: Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Conclusions: Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.

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Intramedullary Nail Fixation of Tibial Shaft Fractures

Abstract: Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A223).

Cited by 12 publications

References 18 publications

A Review of Tibial Shaft Fracture Fixation Methods

A Review of Tibial Shaft Fracture Fixation Methods

A Novel Surgical Technique for Extraction of a Firmly Integrated Broken Intramedullary Nail

Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

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