Management of Extra-articular Fractures of the Distal Tibia: Intramedullary Nailing Versus Plate Fixation

Casstevens, Chris; Le, Toan; Archdeacon, Michael T.; Wyrick, John D.

doi:10.5435/00124635-201211000-00001

Cited by 38 publications

(36 citation statements)

References 32 publications

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“…In general, stability at the fracture site is better with a plating system compared with an intramedullary nailing system [19,20]. Therefore, we considered that this biomechanical factor contributed to the nonunion at the host-graft junction, and we have since adopted the plating system for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Pedicle versus free frozen autograft for reconstruction in malignant bone and soft tissue tumors of the lower extremities

Shimozaki¹,

Yamamoto²,

Shirai³

et al. 2014

Journal of Orthopaedic Science

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Background Of the biological reconstruction methods for malignant bone and soft tissue tumors, reconstruction with liquid nitrogen has the advantage of maintaining continuity on the distal side of the tumor bone site (pedicle freezing procedure; PFP). This method is expected to result in early blood flow recovery, with early union and low complication rate. The purpose of this study was to compare the outcomes of the PFP and free freezing procedure (FFP) in the lower extremities. Methods The study included 20 patients (12 men and 8 women) with frozen autografts (FFP, 13 cases; PFP, 7 cases). The mean age of the subjects was 36.3 years (range 11-79 years), and the mean follow-up period was 56.4 months (range 12-142 months). Results Final bone union occurred in 11 patients in the FFP group (84.6 %) and in 7 patients in the PFP group (100 %). The mean union period in patients who did not need additional surgery was 9.8 months (range 4-21 months) in the FFP group and 4.8 months (range 2-7 months) in the PFP group. Postoperative complications occurred in 8 cases: infection in 3 cases, fracture in 3 cases, and joint destruction in 2 cases. Six FFP patients, and 2 PFP patients (two cases of fracture), developed postoperative complications. Conclusions The union period was shorter and the rate of postoperative complications was lower with the PFP than with the FFP. We considered that early blood flow recovery might have led to the above results in the PFP.

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Section: Discussionmentioning

confidence: 99%

Pedicle versus free frozen autograft for reconstruction in malignant bone and soft tissue tumors of the lower extremities

Shimozaki¹,

Yamamoto²,

Shirai³

et al. 2014

Journal of Orthopaedic Science

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“…Both treatment methods have advantages and disadvantages. [5][6][7][8][9][10][11][12][13][14][15] One of the major findings of our study is the significantly higher rate of valgus malunion. This situation may be due to technical problems during the implementation of IMN, or due to the small number of fibular fixation in our study.…”

Section: Discussionmentioning

confidence: 89%

“…[3,8] Although the fixing method with plate has the advantage of providing better mechanical support, there are publications reporting more complaints with this method, such as soft tissue problems and implant irritation. [9][10][11][12] In the intramedullary nailing method, although soft tissue problems and complaints such as irritation connected to the implant are less frequent, mechanical problems and symptoms such as anterior knee pain are reported more frequently. [10,13] But there are also some literature information which states that intramedullary fixation is stiffer.…”

mentioning

confidence: 99%

“…[9][10][11][12] In the intramedullary nailing method, although soft tissue problems and complaints such as irritation connected to the implant are less frequent, mechanical problems and symptoms such as anterior knee pain are reported more frequently. [10,13] But there are also some literature information which states that intramedullary fixation is stiffer. [14] Although treatment of distal tibial fractures that do not extend to the ankle joint is controversial, the general procedure for distal tibial fractures extending to the ankle joint is anatomical reduction with osteosynthesis by plate.…”

mentioning

confidence: 99%

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Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension?

Beytemür¹

2016

Eklem Hastalik Cerrahisi

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ÖZ Amaç : We retrospectively evaluated 35 AO/OTA type 43C1 and C2 patients (26 males, 9 females; mean age 39.8±16.9 years; range 19 to 82 years) treated with intramedullary nailing. Two interfragmentary screws out of nail were applied in 10 patients (29%), while one interfragmentary screw out of nail was applied in 17 patients (49%). Intramedullary nailing was applied in eight patients (23%) without external screws. Fracture union, union time, alignment problems, and complications were evaluated. Clinical evaluation of patients was conducted using the Olerud and Molander score and by measuring the ankle joint range of motion. Results: Union was achieved in all 35 patients. Mean union time was 16.5±2.8 weeks (range 12 to 24 weeks) and mean Olerud and Molander score was 88±8.24. Varus deformity was detected in one patient, valgus deformity was detected in two patients, and rotation deformity was detected in one patient. Superficial infection was detected in three patients (9%). Deep infection was not detected in any patient. Conclusion: Intramedullary nailing is not contraindicated for simple intra-articular distal tibial fractures. In these fractures, intramedullary nailing performed in accordance with its technique, with an additional percutaneous screw if necessary, is a successful treatment option with high fracture union rates, high functional results, and low complication rates.

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“…Fibular fixation must be done if syndesmosis tear is present, [1,34] and it is suggested that it may facilitate indirect reduction of the tibia fracture. However, in some studies, [3,34,35] fibular fixation is said to delay bone healing. We did not use fibular fixation except for displaced distal fibular fractures, which may cause valgus deformity.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intramedullary nail or plate fixation in distal tibial diaphyseal fractures at close to mortis

Yavuz¹,

Sökücü²,

Demir³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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Management of Extra-articular Fractures of the Distal Tibia: Intramedullary Nailing Versus Plate Fixation

Cited by 38 publications

References 32 publications

Pedicle versus free frozen autograft for reconstruction in malignant bone and soft tissue tumors of the lower extremities

Pedicle versus free frozen autograft for reconstruction in malignant bone and soft tissue tumors of the lower extremities

Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension?

Comparison of intramedullary nail or plate fixation in distal tibial diaphyseal fractures at close to mortis

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