Minimally Invasive Management of Distal Metaphyseal Tibial Fractures and Pilon Fractures

Gehr, J.; Hilsenbeck, F.; Arnold, Timothy; Friedl, W.

doi:10.1007/s00068-004-1414-9

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…Retrograde intramedullary nailing of tibial fractures has not been introduced in routine clinical practice and only a few selected cases have been reported in literature [ 12 - 15 ]. This is mainly due to the lack of an adequately designed implant.…”

Section: Introductionmentioning

confidence: 99%

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

et al. 2014

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BackgroundCurrently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures. However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus with stab incisions sufficient for interlocking. During this project, we investigated the feasibility of retrograde tibial nailing in a cadaver model and conducted biomechanical testing.MethodsAnatomical implantations of the RTN were carried out in AO/OTA 43 A1-3 fracture types in three cadaveric lower limbs. Biomechanical testing was conducted in an AO/OTA 43 A3 fracture model for extra-axial compression, torsion, and destructive extra-axial compression. Sixteen composite tibiae were used to compare the RTN against an angle-stable plate osteosynthesis (Medial Distal Tibial Plate, Synthes®). Statistical analysis was performed by Student's t test.ResultsRetrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps, while in highly comminuted fractures, the use of a large distractor can aid the reduction. Biomechanical testing shows a statistically superior stability (p < 0.001) of the RTN during non-destructive axial loading and torsion. Destructive extra-axial compression testing resulted in failure of all plate constructs, while all RTN specimens survived the maximal load of 1,200 N.ConclusionsThe prototype retrograde tibial nail meets the requirements of maximum soft tissue protection by a minimally invasive surgical approach with the ability of secure fracture fixation by multiple locking options. Retrograde tibial nailing with the RTN is a promising concept in the treatment of distal tibia fractures.

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Section: Introductionmentioning

confidence: 99%

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

et al. 2014

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“…The XS nail can additionally be used in percutaneous technique for concomitant fractures of the fibula in distal metaphyseal fractures of the lower leg, pilon fractures and for fixation of the tibia following joint reconstruction [28,32,33]. A perfect anatomical reduction of the fibula is not needed, so no additional damage will compromise the thin soft tissue and impaired blood supply (Figure 13).…”

Section: Locked Intramedullary Xs Nail For Ankle and Pilon Fractures:mentioning

confidence: 99%

“…The percutaneous osteosynthesis with an XS nail is first performed for the fibular fracture and then tibia is fixed with one XS nail introduced from the medial malleolus to the proximal lateral cortical bone; if it is necessary, a second XS nail is inserted from the distal lateral tibia aiming at the proximal medial cortical bone [28,32,33].…”

Section: Locked Intramedullary Xs Nail For Ankle and Pilon Fractures:mentioning

confidence: 99%

Clinical and Experimental Biomechanical Studies Regarding Innovative Implants in Traumatology

Sîrbu¹,

Friedl²,

Mihăilescu³

et al. 2020

Recent Advances in Biomechanics

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Fracture treatment has experienced a fascinating evolution in the last years. The aim of this chapter is to reveal some clinical and biomechanical studies regarding innovative implants. After a short introduction (1), we intend to present our results regarding (2) dynamic condylar screw versus condylar blade plate in complex supracondylar femoral fractures; (3) biomechanical analysis of four types of implants in humeral fractures; (4) clinical and experimental studies for optimal stabilization of trochanteric fractures: the gliding nail; (5) intramedullary XS nail for pilon and ankle fractures: design, biomechanics, and clinical results; (6) the XS nail for the treatment of patella and olecranon fractures; and (7) plates with polyaxial stability for fractures of distal radius and proximal humerus. In conclusion, the authors highlight the advantages of these innovative implants in difficult trauma cases. Biomechanics 2 DCS versus CBP in complex supracondylar femoral fractures: a biomechanical studyDistal femoral fractures represent a challenge for orthopedic surgeons, and despite numerous biomechanical studies, the optimal implant is still controversial [1][2][3][4]. However, while plates with angular stability and retrograde interlocking nails are nowadays the best choice for treatment, CBP and DCS were the most used implants until the development of these innovative implants [5].In a biomechanical study from 2009, the authors compared the mechanical rigidity of the bone/implant (DCS or CBP) construct in complex supracondylar femoral fractures [5,6].Twelve synthetic composite femoral bones were fixed in the distal part with six DCS and six CBP, and then, the authors performed by osteotomy a bone defect of 1.5 cm to simulate a complex supracondylar fracture type A3/AO (Figure 1).The femurs were sectioned in the midshaft, and the proximal part of the distal fragments was fixed in a metallic adapter sleeve. The bone-implant constructs were tested for seven types of loading: (1) internal compression; (2) external compression; (3) anterior compression; (4) posterior compression; (5) axial compression; (6) external torsion; and (7) internal torsion.The compression tests were realized up to 350 N, and the applied torsion attended 25 Nm. The tests were repeated six times in order to establish the statistic dispersion. All the measurements for DCS were realized with or without compaction screw.The compression force and loading force were measured by a M221B04 (PCB Piezotronics force transducer), while linear deformation values for the compression were measured using two inductive transducers applied in frontal axis (TD1) and sagittal axis (TD2) (Figure 2). Data acquisition was realized by a six-channel admittance bridge, an interface board, and a digital data acquisition system DAQ1200 connected to a laptop.According to study measurements, by reporting the loading/unloading force to the transducer (TD1 and TD2) displacement, we represented hysteresis cycles as diagrams for the femur/DCS (with and without compaction screw)...

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Weichteilschonende stabile Versorgung nach Fraktur bei Ellbogenankylose

Gehr

Friedl

2005

Unfallchirurg

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The two cases presented are fractures of ankylosed elbow joints with severe soft tissue damage. Closed reduction and percutaneous osteosynthesis were performed using the IP-XS-nail system to prevent further soft tissue damage. By implanting two parallel XS-nails between the humerus and ulna and humerus and radius, we achieved a situation allowing early functional treatment of the weight bearing joints. There were no complications.

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Minimally Invasive Management of Distal Metaphyseal Tibial Fractures and Pilon Fractures

Cited by 7 publications

References 13 publications

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

Clinical and Experimental Biomechanical Studies Regarding Innovative Implants in Traumatology

Weichteilschonende stabile Versorgung nach Fraktur bei Ellbogenankylose

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