Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study

Abstract

Objectives: To assess the impact of various reduction techniques on postoperative alignment following intramedullary nail (IMN) fixation of tibial shaft fractures. Design: Retrospective comparative study. Setting: Level I trauma center. Patients: Four hundred twenty-eight adult patients who underwent IMN fixation of a tibial shaft fracture between 2008 and 2017. Intervention: IMN fixation with use of one or more of the following reduction techniques: manual reduction, traveling traction, percutaneous clamps, provisional plating, or blocking screws. Main outcome measures: Immediate postoperative coronal and sagittal plane alignment, measured as deviation from anatomic axis (DFAA); coronal and sagittal plane malalignment (defined as DFAA >5° in either plane). Results: Four hundred twenty-eight patients met inclusion criteria. Manual reduction (MR) alone was used in 11% of fractures, and adjunctive reduction aids were used for the remaining 89%. After controlling for age, BMI, and fracture location, the use of traveling traction (TT) with or without percutaneous clamping (PC) resulted in significantly improved coronal plane alignment compared to MR alone (TT: 3.4°, TT+PC: 3.2°, MR: 4.5°, P = .007 and P = .01, respectively). Using TT+PC resulted in the lowest rate of coronal plane malalignment (13% vs 39% with MR alone, P = .01), and using any adjunctive reduction technique resulted in decreased malalignment rates compared to MR (24% vs 39%, P = .02). No difference was observed in sagittal plane alignment between reduction techniques. Intraclass correlation coefficient (ICC) results indicated excellent intraobserver reliability on both planes (both ICC>0.85), good inter-observer reliability in the coronal plane (ICC = 0.7), and poor inter-observer reliability in the sagittal plane (ICC = 0.05). Conclusions: The use of adjunctive reduction techniques during IMN fixation of tibia fractures is associated with a lower incidence of coronal plane malalignment when compared to manual reduction alone. Level of evidence: Therapeutic Level III.

Comparison of Open versus Closed Reduction and Intramedullary Nailing in cases of Closed Tibial Shaft Fractures

“…15 We studied the two commonly followed surgical techniques i-e closed percutaneous intramedullary nailing an open technique for the management of closed tibial shaft fractures. 16,17 In our study, we found out that both operative techniques do not increase the risk of post-operative complications. Two similar studies were conducted by Auston DA et al 10 and Grundnes O.…”

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

“…The semi-extended position of the knee in the suprapatellar approach allows for quicker PPT and is not demanding in maintaining fracture reduction/position. In comparison, the infrapatellar approach requires at least 90° of knee flexion or hyperflexion to introduce the entry guide-wire and subsequent tibial nail [ 7 ]. Various techniques are adopted by surgeons to maintain the flexed position of the knee, which involve additional attachments, supports and manual fracture reduction, optimal patient positioning for the infrapatellar approach can be time-consuming [ 7 ].…”

“…In comparison, the infrapatellar approach requires at least 90° of knee flexion or hyperflexion to introduce the entry guide-wire and subsequent tibial nail [ 7 ]. Various techniques are adopted by surgeons to maintain the flexed position of the knee, which involve additional attachments, supports and manual fracture reduction, optimal patient positioning for the infrapatellar approach can be time-consuming [ 7 ]. Whereas the semi-extended position required for suprapatellar approach is less demanding with a simple set-up [ 8 ].…”

Nail insertion points in semi-extended nailing of tibial fractures and their influence on alignment: A retrospective cohort study comparing two nail insertion techniques

“…In the present study, the intramedullary nail was inserted with reaming in all patients. Reduction with the use of a clamp during surgery via intramedullary nailing of tibial shaft fractures results in a low incidence of malalignment in the coronal plane compared with that using manipulative reduction alone [29] .…”