MIPO vs. intra-medullary nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients

Bleeker, Nils Jan; Veelen, Nicole M. van; Wall, Bryan Joost Marinus van de; Sierevelt, Inger N.; Link, Björn‐Christian; Babst, Reto; Knobe, Matthias; Beeres, Frank J. P.

doi:10.1007/s00068-021-01836-4

Cited by 7 publications

(5 citation statements)

References 46 publications

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“…Unfortunately, treating DTFs remains a challenge to this day. An inadequate soft-tissue envelope, adjoining ankle joint, and underlying trauma mechanisms induce complications following fractures [ 2 ]. Given these challenges, minimally invasive treatment procedures such as minimally invasive plating (MIPO) and intramedullary nailing (IMN) are preferred, despite certain drawbacks.…”

Section: Introductionmentioning

confidence: 99%

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

Lü

Wang

et al. 2022

J Orthop Traumatol

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Background Malalignment is a common event during the intramedullary nailing (IMN) of distal tibia fractures (DTFs). Although it is reported that the semi-extended IMN techniques such as suprapatellar (SP) and parapatellar (PP) approaches may be superior in preventing malalignment, the application of these techniques is concerning owing to the intra-articular involvement. We thus developed an extra-articular semi-extended infrapatellar (SEIP) approach which utilizes the infrapatellar (IP) space while maintaining the knee in a semi-extended position. However, there are no studies on the safety and efficacy of SEIP in treating DTFs. Therefore, in this study, the SEIP technique was examined, particularly in terms of the potential alignment improvement of DTFs, and this technique was compared with the traditional hyperflexed infrapatellar (HFIP) procedure. Materials and methods This randomized clinical trial (RCT) compared IMN malalignment while correcting extraarticular and nondisplaced intra-articular DTFs between April 2018 and June 2021 using the HFIP and SEIP techniques at a level I trauma center in China. The study participants were clinically and radiographically examined for at least 12 months of follow-ups. Intraoperative fluoroscopy time, operation time, blood loss, hospitalization duration, functional ankle score, and complications were assessed as well. Results Among the 88 recruited participants, 45 (51%) underwent traditional HFIP IMN and 43 (49%) underwent SEIP IMN. Malalignment occurred in 9 patients (20.0%) from the HFIP cohort and in 2 patients (4.7%) from the SEIP cohort (P value = 0.030). In addition, the SEIP IMN technique significantly reduced the intraoperative fluoroscopy time, operation time, and improved the postoperative ankle function compared to the HFIP IMN technique. However, the intraoperative blood loss, hospitalization duration, infection, delay union, and nonunion remained the same between the two cohorts. Conclusions In summary, we demonstrated that the SEIP IMN provides markedly enhanced alignment of extraarticular and nondisplaced intra-articular DTFs compared to the traditional HFIP IMN procedure. The described technique represents an effective option for IMN of DTFs. Level of evidence Level 2. Trial registration The Chinese Clinical Trial Registry, ChiCTR2100043673. Registered 26 February 2021, retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=122263

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Section: Introductionmentioning

confidence: 99%

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

Lü

Wang

et al. 2022

J Orthop Traumatol

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“…As with SSI, the influence of implant type on the nonunion rate has been investigated in the context of largely EADTF. 13,[27][28][29][30] In a randomized trial of PF versus IMN, Vallier et al 13 showed no difference in nonunion rates, and similar findings were seen in study by Barcak and Collinge. 30 In a retrospective review of open distal tibia shaft fractures, however, Avilucea et al 28 found a higher rate of nonunion in fractures treated with PF versus IMN.…”

Section: Discussionmentioning

confidence: 57%

Plating versus Intramedullary Nailing of OTA/AO 43C1 and C2 Intra-articular Distal Tibia Fractures: A Propensity Score and Multivariate Analysis

Jang,

Wilson,

Jones

et al. 2023

Journal of Orthopaedic Trauma

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Objective: To compare rates of loss of reduction, nonunion, and infection in intra-articular distal tibia fractures (IADTF) treated with limited open reduction internal fixation and intramedullary nailing (IMN) as compared to open reduction internal fixation with plate and screws (PF). Design: Retrospective Review Setting: Level-I academic trauma center Patients: 110 patients, age ≥ 18 with operatively treated OTA/AO 43C1 and C2 IADTF between 2013-2021 Primary outcome measurement: Loss of reduction, surgical site infection (SSI), nonunion, and patient-reported outcomes (PROs) Results: 110 patients met the inclusion criteria (IMN 33, PF 77). There was no loss of reduction reported. 17 nonunions (15% overall; IMN 4/33, PF 13/77) and 13 SSIs (12% overall; IMN 2/33, PF11/77) were identified. Despite several risk factors being identified for nonunion and SSI in bivariate analysis, only open fracture remained significant as a risk factor for both nonunion (OR 0.09 for closed fracture, 95% CI 0.02-0.56, p=0.009) and SSI (OR 0.07 for closed fracture, 95% CI 0.06-0.26, p=0.012) in the multivariate model. Propensity scoring based on presurgical variables was significantly different between patients that received IMN vs PF (p=0.03); however, logistic regression incorporating the propensity score revealed no significant association with nonunion and SSI. Adjusting for the propensity score, there remained no association comparing IMN versus PF with nonunion and SSI (p=0.54 and p=0.17, respectively). There was also no difference in PROs between IMN and PF (Physical function: p=0.25, Pain interference: p=0.21). Conclusion: Overall nonunion and SSI prevalence in our cohort was 15% and 12%, respectively, in operatively treated OTA/AO 43C1 and C2 IADTF. An open fracture is a significant risk factor for nonunion and SSI. Metaphyseal fixation via IMN or PF in IADTF did not affect the loss of reduction, nonunion, SSI, and PROs. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…[4,14] Numerous studies compare minimally invasive plate osteosynthesis (MIPO) and IMN for distal metaphyseal tibial fractures. [15][16][17] Clinically, IMN may preferable to MIPO because it has a smaller impact on the surrounding soft tissues and vascularization, reducing the risk of related complications such as infection. [18,19] Koksal et al concluded that IMN is a cost-effective and superior option in terms of union time and return to the market compared to MIPO in the treatment of extra-articular distal tibia fractures.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary nailing at different distal tibial fracture levels: A biomechanical study

Guran,

Ozmanevra,

Husemoglu

et al. 2024

Medicine

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Background: Distal tibial fractures remains a significant challenge in orthopedic trauma surgery. As the fracture level approaches the joint, alternative fixation options instead of intramedullary nailing (IMN) come to the fore. The present study aimed to assess the biomechanical stability of IMN at different distal tibial fracture levels and the number of locking screws required. Methods: Using a total of 21 sawbone models, 3 different tibial fracture levels (3, 4.5, and 6 cm proximally to the talocrural joint) were created and the fractures were fixed using 2, 3, or 4 distal locking screws. A single compression force at a speed of 30 mm/min with a maximum force of 800 Newton and a cyclic compression force of 60 cycles at a speed of 60 mm/min was applied to all tibia models. The applied weight and displacements from the fracture lines were recorded and evaluated. Results: There was no statistically significant difference in fixation with 2 distal locking screws in groups 1, 2, and 3 (single test P =.9689) (cyclic test P =.8050). Therefore, if 2 distal screws are used, the fracture level does not affect the strength of fixation. In fractures located 6 cm proximal to the talocrural joint, all 4 holes of the nail can be used to insert screws, which provides a stronger fixation. When 2 screws are used, a statistically weaker fixation is obtained than with 3 or 4 screws. However, there is no significant difference between using 3 or 4 screws. Conclusion: Our findings support the use of IMN with 2 distal locking screws as a viable option for the management of distal tibial fractures. We found that it provides sufficient fixation regardless of the fracture level, suggesting that there is no need to choose an alternative fixation technique due to concerns of inadequate fixation as the fracture line moves distally. In cases where more stable fixation is desired, an additional locking screw can be used, but the potential increase in procedure and fluoroscopy time should be considered.

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MIPO vs. intra-medullary nailing for extra-articular distal tibia fractures and the efficacy of intra-operative alignment control: a retrospective cohort of 135 patients

Cited by 7 publications

References 46 publications

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

The semi-extended infrapatellar intramedullary nailing of distal tibia fractures: a randomized clinical trial

Plating versus Intramedullary Nailing of OTA/AO 43C1 and C2 Intra-articular Distal Tibia Fractures: A Propensity Score and Multivariate Analysis

Intramedullary nailing at different distal tibial fracture levels: A biomechanical study

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