Results of angular-stable locked intramedullary nails in the treatment of distal tibia fractures

Boyer, Patrick; Charles, Philippe; Loriaut, Patrick; Alkhaili, J.; Mylle, G.; Pélissier, A.; Massin, P.

doi:10.1016/j.otsr.2014.09.012

Cited by 6 publications

(10 citation statements)

References 21 publications

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“…One increasingly prevalent novel device that could be used to address this concern is angular stable fibular nails, which could address problems related to increased surgical dissection over thin skin and the lack of good soft tissue coverage over the fibula. 34 Our results should be interpreted for their limitations. Despite inclusion of 3 high-volume Level 1 trauma centers, the number of patients is still limited so as not to allow greater stratification of the patient population.…”

Section: Discussionmentioning

confidence: 83%

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Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters

Shafiq

Zhang

Zhu

et al. 2023

Journal of Orthopaedic Trauma

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Objective: To correlate patient-specific and surgeon-specific factors with outcomes after operative management of distal intra-articular tibia fractures. Design: Retrospective cohort study. Setting: 3 Level 1 tertiary academic trauma centers. Patients/Participants: The study included a consecutive series of 175 patients with OTA/AO 43-C pilon fractures. Main Outcome Measurements: Primary outcomes included superficial and deep infection. Secondary outcomes included nonunion, loss of articular reduction, and implant removal. Results: The following patient-specific factors correlated with poor surgical outcomes: increased age with superficial infection rate (P < 0.05), smoking with rate of nonunion (P < 0.05), and Charlson Comorbidity Index with loss of articular reduction (P < 0.05). Each additional 10 minutes of operative time over 120 minutes was associated with increased odds of requiring I&D and any treatment for infection. The same linear effect was seen with the addition of each fibular plate. The number of approaches, type of approach, use of bone graft, and staging were not associated with infection outcomes. Each additional 10 minutes of operative time over 120 minutes was associated with an increased rate of implant removal, as did fibular plating. Conclusions: While many of the patient-specific factors that negatively affect surgical outcomes for pilon fractures may not be modifiable, surgeon-specific factors need to be carefully examined because these may be addressed. Pilon fracture fixation has evolved to increasingly use fragment-specific approaches applied with a staged approach. Although the number and type of approaches did not affect outcomes, longer operative time was associated with increased odds of infection, while additional fibular plate fixation was associated with higher odds of both infection and implant removal. Potential benefits of additional fixation should be weighed against operative time and associated risk of complications. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters

Shafiq

Zhang

Zhu

et al. 2023

Journal of Orthopaedic Trauma

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“…26 However, clinical studies in which the effectiveness of angular stable nailing were assessed failed to show any benefit in healing time or reduction in complications potentially related to improved mechanical performance. 32,33 Finally, it has been suggested that angular stable locking might have advantages in preventing fatigue failure. 13,25,28 However, while all studies including this one using cadaveric bones failed to demonstrate a beneficial effect of angular stable locking, 13,28 only one study using plastic bone surrogate material reported the prevention of screw breakage.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Biomechanical effects of angular stable locking in intramedullary nails for the fixation of distal tibia fractures

Augat

Hoegel

Stephan

et al. 2016

Proc Inst Mech Eng H

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Treatment of distal tibia shaft fractures using intramedullary nailing requires stable fixation of the distal fragment to prevent malunion. Angular stable locking for intramedullary nails pledge to provide increased mechanical stability. This study tested the hypothesis that intramedullary nails with angular stable interlocking screws would have increased construct stiffness, reduced fracture gap movement and enhanced fatigue failure compared to nails with conventional locking having the same diameter. Biomechanical experiments were performed on 24 human cadaveric tibiae which obtained a distal fracture and were fixed by three different techniques: conventional locking with 8- and 10-mm-diameter nails and angular stable locking with 8-mm nails. Stiffness of the implant-bone construct and movement of the fragments were tested under axial loading and torsion. The constructs were tested to failure under cyclic fatigue loading. Analysis of variance and Kaplan-Meier survival analysis were used for statistical assessment. Axial stiffness of the 10-mm nail was about 50% larger compared to both 8-mm nail constructs independent of the type of locking mode (p < 0.01). No differences were found in axial performance between angular stable and conventional locking neither under static nor under cyclic testing conditions (p > 0.5). Angular stability significantly decreased the clearance under torsional load by more than 50% compared to both conventionally locked constructs (p = 0.03). However, due to the larger nail diameter, the total interfragmentary motion was still smallest for the 10-mm nail construct (p < 0.01). Although the 10-mm nail constructs survived slightly longer, differences between groups were minor and not statistically significant (p = 0.4). Our hypothesis that angular stable interlocking of intramedullary nails would improve mechanical performance of distal tibia fracture fixation was not confirmed in a physiologically realistic loading scenario. Whether minor mechanical advantages provided by angular stability of the locking screws would improve biological tissue response cannot be concluded from this biomechanical study.

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“…This has the potential benefit of increasing stability using fewer screws and avoiding supplemental fibula fixation resulting in less soft-tissue damage. [11][12][13], though never shown in a randomized setting [14], there are several studies indicating that angular stable locking screws has the potential ability of achieving higher stability and increased bone healing, reducing the risk of mal-or nonunion, malalignment and loss of reduction [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Good results using angular stable locking system with distal tibia fracture nail osteosynthesis

Schønnemann¹

2012

Prog Orthop Sci

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Objectives: The treatment of unstable tibia fractures has always been challenging. In recent years the treatment of choice has been intramedullary nailing. Intramedullary nails have been shown to have a risk of non-union and the need for secondary procedures is substantial. Studies has shown that angular stable locking screws has the ability of achieving higher stability and increased bone healing. The study describes the results of tibial nailing with angular stable locking screws in patients with tibia fractures. Methods: Designed as a prospective case series with inclusion from accident and emergency department at a level 1 trauma center, recruiting a consecutive cohort of all skeletally mature patients with tibia fracture in the distal half of the crus where intramedullary nail was indicated and osteosynthesis with a Tibia Expert Nail supplemented with the Angular Stable Locking System was performed. Main outcome measurement was bone healing. Results: Fifty-one patients were included and eligible for one-year follow-up and all fractures healed in an average of 4.8 months, though two patients had secondary procedures performed to facilitate healing, and two patients healed in valgus malunion, 6° and 18° respectively. Conclusions: The osteosynthesis method showed a high rate of healing and a low rate of complications.

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Results of angular-stable locked intramedullary nails in the treatment of distal tibia fractures

Abstract: level IV.

Cited by 6 publications

References 21 publications

Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters

Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters

Biomechanical effects of angular stable locking in intramedullary nails for the fixation of distal tibia fractures

Good results using angular stable locking system with distal tibia fracture nail osteosynthesis

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