Open distal tibial shaft fractures: a retrospective comparison of medial plate versus nail fixation

Avilucea, Frank R.; Sathiyakumar, Vasanth; Greenberg, Sarah E.; Ghiam, Michael K.; Thakore, Rachel V.; Francois, Elvis L.; Benvenuti, Michael A.; Siuta, Michael; Smith, A. K.; Ehrenfeld, Jesse M.; Evans, Jason M.; Obremskey, William T.; Sethi, Manish K.

doi:10.1007/s00068-015-0519-7

Cited by 28 publications

(24 citation statements)

References 20 publications

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“…The patient was treated with surgical debridement and hardware removal to decrease biofilm burden. In this case, initial treatment with medial plate may have increased the risk for non-union and wound-healing complications, but previous literature has not demonstrated an increased patient risk for infection 12–14. Biofilm formation, particularly with regards to orthopaedic devices, has been proposed in the literature as an important feature in the maintenance of infection, which also contributes to the difficult nature of eradication in these reported infections 8 15.…”

Section: Discussionmentioning

confidence: 83%

Escherichia hermanniias the sole cause of osteomyelitis in a patient with an open tibial shaft fracture

et al. 2019

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Escherichia hermannii is a rare monomicrobial cause of infection in humans. E. hermannii has never before been reported as the sole isolate from an infected open tibia fracture. We present a case of E. hermannii infection after a type III open tibia fracture. The patient was initially treated with irrigation and debridement, open reduction internal fixation and primary wound closure. However, after 8 weeks, he developed a draining wound and infection at the fracture site. He required a repeat debridement, hardware removal, external fixation and 6 weeks of intravenous ceftriaxone for treatment. At 2-year follow-up, he remains infection free, asymptomatic and continues to work with excellent functional outcomes. This case adds to the growing literature that evidences E. hermannii as an organism that can be pathogenic, virulent and cause monomicrobial infection.

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Section: Discussionmentioning

confidence: 83%

Escherichia hermanniias the sole cause of osteomyelitis in a patient with an open tibial shaft fracture

et al. 2019

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“…The advantages of applying open reduction and internal xation were that the fracture site could be exposed su ciently and the reduction could be ful lled anatomically under direct vision. Researchers [3,[15][16][17] reported that the deformed union rate of fractures after plate xation was less than 10%, but the risk of postoperative complications with soft tissues was higher, including super cial infections, deep infections, delayed wound healing, and necrosis of soft tissues. In the early 1940s, the intramedullary nail system was introduced to treat tibial shaft fractures, which can reduce the deformity union for tibial fracture and decrease the formation of pseudo-articular joints after the surgery, meanwhile promote the ossi cation of fractured callus.…”

Section: Discussionmentioning

confidence: 99%

An approach to determine the coronal plane deformity of the distal tibia intraoperatively in the treatment of tibial fracture with intramedullary nail fixation

Lu¹,

Yang²,

Xu³

et al. 2020

Preprint

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Background To develop a new approach to determine the existence of coronal plane deformity (valgus and varus) intraoperatively in the treatment of tibial fracture with closed reduction and intramedullary nail fixation. Methods A retrospective analysis was conducted by enrolling 33 consecutive patients with tibial fracture who underwent closed reduction and intramedullary nail fixation from January 2018 to January 2019 in our trauma center. There were 23 males and 10 females aged from 22 to 69 years old with an average of 41.3. The standard anteroposterior and lateral preoperative radiographs were performed routinely. After insertion of the tibial intramedullary nail through the standard entry point intraoperatively, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the anteroposterior fluoroscopy was used to determine the occurrence of valgus or varus deformity of the distal tibial fragment. Results 33 patients were postoperatively followed up for 13 to 25 months (mean 18.7 months). The fractures achieved bone union in 4.3 months by average (ranging from 3 to 6 months). The lateral distal tibial angle (LDTA) of the unaffected side which is measured postoperatively was 87.3°-89.6 ° (average 88.7 °± 0.8°), and the LDTA of the affected side was 87.5°-90.4°(average 88.9°± 1.1°). There was no statistically significant difference between the unaffected side and the affected side (t=-1.865, p=0.068). The intraoperative measurement indicated 6 cases of valgus angulation and 3 cases of varus angulation deformities, and all the deformities were corrected accordingly during the surgery. According to the Olerud-Molander Ankle Score, the clinical outcomes demonstrated 22 excellent cases, 8 good cases, 2 fair cases, and 1 poor case of all the fractures at 12 months after surgery. Conclusion During closed reduction and intramedullary nail fixation for tibial fractures, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the intraoperative anteroposterior films showed the better discriminative ability to determine the onset of valgus or varus deformity of the distal tibial fragment after the tibial intramedullary nail inserted through the standard entry point.Level of Evidence: Level IV, case series study.

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“…With the increase in high energy trauma and osteoporosis, the incidence of open fractures as well as complex fracture patterns involving a large segment of distal tibia has increased. 1,13 The soft tissue envelope over the distal tibia is thin with limited vascularity and is prone to complications like wound dehiscence and infection. The management of these fractures is dictated by the condition of the soft tissues and a two staged approach with initial spanning external fixation is often necessary.…”

Section: Discussionmentioning

confidence: 99%

Soft tissue complications in distal tibial fractures managed with medial locking plates: A myth or reality?

Jain

Selhi

Yamin

et al. 2017

Journal of Clinical Orthopaedics and Trauma

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Open distal tibial shaft fractures: a retrospective comparison of medial plate versus nail fixation

Cited by 28 publications

References 20 publications

Escherichia hermanniias the sole cause of osteomyelitis in a patient with an open tibial shaft fracture

Escherichia hermanniias the sole cause of osteomyelitis in a patient with an open tibial shaft fracture

An approach to determine the coronal plane deformity of the distal tibia intraoperatively in the treatment of tibial fracture with intramedullary nail fixation

Soft tissue complications in distal tibial fractures managed with medial locking plates: A myth or reality?

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