Intramedullary Nailing and Plate Osteosynthesis for Fractures of the Distal Metaphyseal Tibia and Fibula

Krishan, Ajay; Peshin, Chetan; Singh, Dara

doi:10.1177/230949900901700315

Cited by 17 publications

(12 citation statements)

References 11 publications

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“…Nonunion occurred in 8 % of the fractures in this study. This compares favourably to the reports by Im and Tae [6] and Vallier et al [32] nailing groups, whereby the rate of delayed and non-union after nailing distal tibial fractures vary between 0 and 23 % in the literature [3,6,8,13,14,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Screw failure remains a common problem with small diameter nails [2,15,16].…”

Section: Discussionsupporting

confidence: 65%

“…Egol et al recommended fibular plating whenever nailing is contemplated in distal tibial fractures [23]. Krischan et al reported good results with this treatment, even if a single distal locking screw was used [35]. Ehlinger et al reported that the absence of supplemental fibular fixation was the only statistically identifiable risk factor for malalignment and recommended primary fixation of all distal third fibular fractures [24].…”

Section: Discussionmentioning

confidence: 99%

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Unreamed intramedullary nailing in distal tibial fractures

Salem

2013

International Orthopaedics (SICOT)

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Purpose Unreamed nailing has gained acceptance in the treatment of diaphyseal long bone fractures, especially in cases with polytrauma or high-energy injuries. Its application in distal tibial fractures, however, remains controversial. Methods In this study, 101 distal tibial fractures treated using closed unreamed nailing were reviewed after a mean followup of 32 months. There were 59 type A und 42 type B fractures. The most common fracture pattern was the A1 spiral fracture (n = 40) followed by the B2 wedge fracture (n = 18). Intra-articular extension was encountered in 14 cases. One-fourth of the patients (n = 24) had open injuries. Forty-seven patients had additional injuries, and nearly onethird of them were polytraumatised. Results Union occurred after a mean time of 23.9 (range, 11-134) weeks. There were 13 cases of delayed union and seven non-unions; all healed eventually with additional surgery in only six fractures. Malunion was seen in 12 cases (five valgus, two varus and five external torsion), ten of which were associated with unplated fibular fractures. Three fractures (two open) were treated for deep infection. The most common complication seen was fatigue failure of the locking screws (27 cases). Conclusions Unreamed nailing of distal tibial fractures is associated with a rather high rate of bone healing complications and locking screw failure. The decision for its use in the notoriously challenging fractures of this segment should be critically considered.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Unreamed intramedullary nailing in distal tibial fractures

Salem

2013

International Orthopaedics (SICOT)

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“…defined rotational malalignment as a difference greater than 15° between normal and injured tibiae, and reported two cases with malrotation after IM nailing of 93 tibial fractures 21. Williams et al .,22 Krishan et al .,23 Freedman and Johnson,24 O’Dwyer et al .,25 Pintore et al .,26 Lambiris et al .,27 and Tu et al 28. also reported similar findings.…”

Section: Discussionmentioning

confidence: 77%

Malrotation following reamed intramedullary nailing of closed tibial fractures

Ebrahimpour

Bakhshi

Haghnegahdar

et al. 2012

IJOO

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Background:Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially >10°)of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures.Materials and Methods:Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4±13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10° between two tibiae was defined as malrotation.Results:Eighteen (30%) patients had malrotation of more than 10°. Malrotation was greater than 15° in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°.Conclusions:Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem.

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“…Various authors have published on the treatment of the nonarticular metaphyseal tibial fractures with the application of the intramedullary nailing. [5][6][7] However, little evidence exists regarding the management of distal tibia fractures with articular extension of the fracture into the joint with intramedullary nailing. 8,9 The purpose of the current study was to analyze the clinical, functional, and the radiographic results and to determine the impact of these injuries on the ankle joint.…”

Section: Introductionmentioning

confidence: 99%