Locked intramedullary nailing of open tibial fractures

Court-Brown, C. M.; McQueen, M. M.; Quaba, A.A.; Christie, James H.

doi:10.1302/0301-620x.73b6.1955445

Cited by 184 publications

(101 citation statements)

References 15 publications

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“…Nonoperative management has been recommended for treatment of spiral tibial shaft fractures and associated ankle fractures [7,17]. The current treatment recommendations are predominantly operative [4,10,13,14]. This makes preoperative diagnosis of the associated posterior malleolus fracture imperative.…”

Section: Discussionmentioning

confidence: 99%

High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

Boraiah

Gardner

Helfet

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Associations between fracture patterns are important and can ensure proper diagnosis and guide treatment. Occult posterior malleolus fractures associated with distal spiral tibia fractures often are underrecognized and the morbidity of a missed posterior malleolus injury can be substantial. We determined the association between the two injuries and evaluated the ability of a new protocol to improve management of these associated fractures. Of 62 consecutive patients with fractures of the distal third of the tibia, we retrospectively evaluated the first 39 patients and prospectively used a diagnostic protocol including computed tomography of the ankle in the subsequent 23 patients. The minimum followup was 3 months (mean, 25 months; range, 3-68 months). Twenty-four patients (39%) had fractures of the posterior malleolus. Before initiation of the protocol, intraarticular fractures were recognized in 33% (with one delayed diagnosis and one missed diagnosis), and after institution of the protocol, the detection rate was 48% with no known missed injuries and complete followup; however, with the limited power the detection rates were similar without and with the protocol. A spiral distal tibial shaft fracture with a proximal fibula fracture should alert the surgeon to investigate an occult ankle injury, particularly of the posterior malleolus. A protocol including computed tomography of the ankle may detect more injuries in a larger study.

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Section: Discussionmentioning

confidence: 99%

High Association of Posterior Malleolus Fractures with Spiral Distal Tibial Fractures

Boraiah

Gardner

Helfet

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…Earlier methods of unreamed intramedullary fixation using Ender's nails and Lotte's nails produced good results when compared with external fixation but with problems of axial control [5,9,10]. Recent reports of the unreamed locked nailing technique have drawn attention to the fact that rigid fixation may be obtained without damage to the periosteum and with maintenance of intramedullary blood flow [3,6]. The mean time to union in this series, excluding the case of delayed union, was 21.9 weeks, which is similar to that in other series [7].…”

Section: Discussionmentioning

confidence: 99%

Primary unreamed intramedullary nailing for open fractures of the tibia

Park

Ihn

et al. 2001

International Orthopaedics

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Forty-six open tibial fractures (42 patients) were treated by primary unreamed intramedullary nailing, with debridement of open wounds and treatment of soft tissue. According to Gustilo-Anderson classification there were 18 grade I cases, 18 grade II cases and 10 grade III cases. The incidence of infection was low with two cases of superficial infection and one of deep infection. The mean time for union was 21.9 weeks and the rate of nonunion was 10.8%. There was no significant difference in the mean time to union, infection rate and rate of nonunion with different site and grade of fracture, but there was a longer union time and a higher rate of nonunion in complex and comminuted fractures. Unreamed intramedullary nailing, with appropriate soft tissue treatment, gives good results in the treatment of open tibial fractures including grade III.Résumé Quarante-six fractures ouvertes du tibia (18 grades I, 18 grades II et 10 grades III d'après GustiloAnderson) ont été traitées avec enclouage centro médul-laire non verrouillé après parage de la plaie et traitement des parties molles. Il y avait deux cas d'infection superficielle et un cas d'infection profonde après un minimum d'observation de 12 mois. Le temps de consolidation moyen était 21.9 semaines, et cinq fractures n'ont pas consolidé. Un délai plus long de consolidation et un taux supérieur de pseudarthrose a été observé dans les fractures complexes et comminutives. Avec un traitement adapté des parties molles, l'enclouage centro medullaire non verrouillé peut être un traitement satisfaisant des fractures ouvertes du tibia, même pour celles de grade III.

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“…This is the reason why many authors dislike using this technique for open fractures and attribute a high infection rate to it [3,24]. Nevertheless, good results have been reported in grade I and II open fractures [5, 9,15], and there are reports of a good outcome with its use in grade III cases [7,15]. Some authors have used delayed intramedullary nailing after initial external fixation in order to avoid the disadvantages, and report good results [1,2].…”

Section: Discussionmentioning

confidence: 99%