Radiologic Outcome and Patient-Reported Function After Intramedullary Nailing

Jones, Mark; Parry, Michael; Whitehouse, Michael R; Mitchell, S E

doi:10.1097/bot.0000000000000070

Cited by 81 publications

(110 citation statements)

References 41 publications

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“…Since then there have been multiple reports of functional outcomes following intramedullary fixation of tibia fractures 33,34 , however cohorts have often been small and assessments were limited to questions regarding knee pain or activity and employment 35,36 . Court-Brown et al, evaluated the functional recovery of 100 patients with closed tibia fractures who were enrolled in a prospective trial of reamed versus unreamed tibial nails and found that the average time to return to work and jumping activities was approximately 11 weeks, though they did not report the proportion of those who had returned to full activity at one year.…”

Section: Discussionmentioning

confidence: 99%

Reaming Does Not Affect Functional Outcomes After Open and Closed Tibial Shaft Fractures

Lin

Swiontkowski

Bhandari

et al. 2016

Journal of Orthopaedic Trauma

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Objectives We sought to determine the effect of reaming on 1-year SF-36 and SMFA scores from the Study to Prospectively Evaluate Reamed Intramedullary Nails in patients with Tibial Fractures (SPRINT). Design Prospective randomized controlled trial. 1,319 patients were randomized to reamed or unreamed nails. Fractures were categorized as open or closed. Setting 29 academic and community health centers across the US, Canada, and the Netherlands Patients/Participants 1,319 skeletally mature patients with closed and open diaphyseal tibia fractures. Intervention Reamed versus unreamed tibial nails Main Outcome Measurements SF-36 and the SMFA. Outcomes were obtained during the initial hospitalization to reflect preinjury status, and again at the 2-week, 3-month, 6-month, and 1-year follow-up. Repeated measures analyses were performed with P <0.05 considered significant. Results There were no differences between the reamed and unreamed groups at 12 months for either the SF-36 Physical Component Score (PCS) (42.9 v 43.4, p = 0.54, 95% Confidence Interval for the difference [CI] −2.1 to 1.1) or the SMFA Dysfunction Index (DI) (18.0 v 17.6, p=0.79. 95% CI −2.2 to 2.9). At one year, functional outcomes were significantly below baseline for the SF-36 PCS, SMFA DI, and SMFA Bothersome Index (p < 0.001). Time and fracture type were significantly associated with functional outcome. Conclusions Reaming does not affect functional outcomes following intramedullary nailing for tibial shaft fractures. Patients with open fractures have worse functional outcomes than those with a closed injury. Patients do not reach their baseline function by one year after surgery.

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Section: Discussionmentioning

confidence: 99%

Reaming Does Not Affect Functional Outcomes After Open and Closed Tibial Shaft Fractures

Lin

Swiontkowski

Bhandari

et al. 2016

Journal of Orthopaedic Trauma

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“…It is unclear if suprapatellar intramedullary nailing has a lower incidence of knee pain after stabilization of a tibia fracture with an intramedullary rod versus an infrapatellar approach. A retrospective analysis of consecutive patients treated with either a suprapatellar approach or an infrapatellar approach was completed by Jones et al 24 . No differences were seen in knee pain score using the Kujala score as measure of anterior knee pain.…”

Section: Discussionmentioning

confidence: 99%

Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

Obremskey

Agel

Archer

et al. 2016

Journal of Orthopaedic Trauma

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Objective To study the activity and incidence of knee pain after sustaining a isolated tibia fracture treated with an infrapatellar intramedullary nail at one year. Design Retrospective review of prospective cohort Setting Multicenter Academic and Community hospitals Patients 437 patients with an isolated tibia fracture completed a 12 month assessment on pain and self-reported activity. Intervention Infrapatellar Intramedullary Nail Outcomes Demographic information co-morbid conditions, injury characteristics, and surgical technique were recorded. Knee pain was defined on a 1-7 scale with 1 being “no pain” and 7 being a “very great deal of pain.” Knee pain > 4 was considered clinically significant. Patients reported if they were “able”, “able with difficulty” or “unable” to perform the following activities: kneel, run, climb stairs, and walk prolonged. Variables were tested in multilevel multivariable regression analyses. Results Knee Pain: 11% percent of patients reported a “good deal” to a “very great deal” of pain (> 4). 52% of patients reported “no” or “very little” pain at 12 months. Activity at 12 months: 26% and 29% of patients were unable to kneel or run, respectively. 31% and 35% of patients respectively stated they were able with difficulty or unable to use stairs or walk. Conclusion Clinically significant knee pain (>4/7) was present in 11% of patients one year after a tibia fracture. 31%-71% of patients had difficulty performing or were unable to perform routine daily activities of kneeling, running, and stair climbing or walking prolonged distances.

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“…9 Furthermore Jones et al showed significantly better reductions and more accurate starting points in the suprapatellar approach. 10 Concluding that the suprapatellar approach offers facilitated reduction in particular in proximal third tibia fractures, decreased postoperative anterior knee pain, excellent tibial alignment and union. Caregivers may remain reluctant to implement this novel, innovative technique due to concerns regarding iatrogenic damage to the patellofemoral joint especially in young patients.…”

Section: Discussionmentioning

confidence: 99%

Use of the suprapatellar approach in intramedullary nailing of a multi-fragmentary dislocated tibia fracture with a hypermobile intermediate fragment in a young patient

2016

Orthop Rev

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A case of an adolescent female patient who suffered from first grade open multi-fragment fracture of the tibia (AO42-C2) with a large hypermobile intermediate fragment is presented in this case report. Intramedullary nailing of the tibia remains the treatment of choice despite a high risk of malformation and anterior knee pain especially in multi-fragment fractures. Here the suprapatellar approach as a semiextended nailing technique seems favorable. The specialty in our case was an early change of procedures necessary due to persistent swelling during external fixation based on the hypermobile intermediate fragment. Decision in favor of this surgical technique was conducted in order to achieve beneficial alignment and union while protecting the soft-tissue despite the hypermobile intermediate fragment and decrease the risk of anterior knee pain. In our case we achieved successful alignment and proper bone healing without any signs of anterior knee pain or limitations in the range of motion of the knee. With this report we would like to recommend the suprapatellar approach as a favorable alternative in intramedullary nailing in this type of fracture also in young patients.

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Radiologic Outcome and Patient-Reported Function After Intramedullary Nailing

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 81 publications

References 41 publications

Reaming Does Not Affect Functional Outcomes After Open and Closed Tibial Shaft Fractures

Reaming Does Not Affect Functional Outcomes After Open and Closed Tibial Shaft Fractures

Character, Incidence, and Predictors of Knee Pain and Activity After Infrapatellar Intramedullary Nailing of an Isolated Tibia Fracture

Use of the suprapatellar approach in intramedullary nailing of a multi-fragmentary dislocated tibia fracture with a hypermobile intermediate fragment in a young patient

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