Semi-Extended Nailing of Metaphyseal Tibia Fractures

Ryan, Scott P.; Steen, Brandon; Tornetta, Paul

doi:10.1097/bot.0000000000000083

Cited by 43 publications

(20 citation statements)

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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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“…A retrospective study comparing SPN with standard nailing found no differences in the level pain. 6 In a study of 37 patients operated with SPN there were no patients with anterior knee pain at 1-year follow-up. 7 Rothberg et al 10 compared 18 patients with semi-extended tibial nailing with a control group of uninjured patients, and at 1 yr there was no increased incidence of anterior knee pain in the fracture group.…”

Section: Discussionmentioning

confidence: 96%

“…3 In Tornetta and Collins’ 1 original series of 25 patients, one patient developed postoperative hemarthrosis, and two patients had minor cartilage abrasion. 1 Later Ryan and Tornetta 6 modified the method by nailing with the knee joint in 20-30 degrees flexion, changing the surgical entry to a smaller incision of 3-5 cm from the middle to the upper part of the patella, and performing the medial arthrotomy covering only the upper part of the retinaculum and 1-2 cm into the quadriceps tendon. 6 Several manufacturers have now developed equipment for SPN in which protection sleeves protect against intraarticular damage.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Later Ryan and Tornetta 6 modified the method by nailing with the knee joint in 20-30 degrees flexion, changing the surgical entry to a smaller incision of 3-5 cm from the middle to the upper part of the patella, and performing the medial arthrotomy covering only the upper part of the retinaculum and 1-2 cm into the quadriceps tendon. 6 Several manufacturers have now developed equipment for SPN in which protection sleeves protect against intraarticular damage. Sanders et al 7 operated on 55 patients with T2 (Stryker, Kalamazoo, MI) and Trigen (Smith and Nephew, Memphis, TN) nails with the suprapatellar approach.…”

Section: Discussionmentioning

confidence: 99%

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Suprapatellar nailing of tibial fractures

Brink

2016

Current Orthopaedic Practice

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Intramedullary nailing of the tibia with suprapatellar entry and semi-extended positioning makes it technically easier to nail the proximal and distal fractures. The purpose of this article was to describe a simple method for suprapatellar nailing (SPN). A stepby-step run through of the surgical technique is described, including positioning of the patient. There are as yet only a few clinical studies that illustrate the complications with this method, and there has been no increased frequency of intraarticular damage. Within the body of the manuscript, information is included about intraarticular damage and comments with references about anterior knee pain.

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“…Así mismo, evaluaron el dolor posoperatorio de rodilla y no hallaron diferencias significativas a los 2.3 años con respecto a la técnica infrarrotuliana. 14 En 2019, Kubiak y cols. presentaron un estudio comparativo aleatorizado sobre el dolor de rodilla posoperatorio con la técnica pararrotuliana lateral en semiextensión y con la técnica infrarrotuliana clásica.…”

Section: Discussionunclassified

Tratamiento con clavo endomedular de las fracturas metafisarias proximales y distales de tibia. Abordaje pararrotuliano medial en posición de semiextensión

Pereira¹,

Vindver²,

Bidolegui³

2020

Rev. Asoc. Arg. Ort. y Traumatol

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El enclavado endomedular de las fracturas metafisarias de tibia se asocia con algunas complicaciones relacionadas con la necesidad de flexionar la rodilla durante la introducción del clavo endomedular con la técnica infrarrotuliana clásica. Es por ello, que se han diseñado diferentes abordajes para la colocación del clavo en una posición de semiextensión de rodilla. El objetivo fue evaluar nuestros resultados, de forma retrospectiva, con el abordaje pararrotuliano medial en semiextensión, para el tratamiento de las fracturas metafisarias proximales y distales de tibia con clavo endomedular. Materiales y Métodos: Se incluyó a 23 pacientes con un seguimiento posoperatorio mínimo de un año. Doce eran fracturas distales de tibia; 9, proximales y 2, segmentarias. Se evaluaron el rango de movilidad de la rodilla, el dolor posoperatorio con la escala de Lysholm, el eje posoperatorio y la tasa de consolidación. Resultados: El arco de movilidad de la rodilla fue de 125° (rango 110-140). Al año de la cirugía, 16 de 23 pacientes no tenían dolor, 5 de 23 refirieron un leve dolor durante la actividad física y 2, dolores intensos durante la actividad física. En todos los casos, se consiguió un eje posoperatorio aceptable y la consolidación ósea. Un paciente requirió un aumento con una placa e injerto óseo. Conclusión: La colocación de un clavo de tibia a través de un abordaje pararrotuliano medial con la rodilla en semiextensión es una técnica segura y simple para el tratamiento de las fracturas metafisarias de tibia.

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Semi-Extended Nailing of Metaphyseal Tibia Fractures

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

Cited by 43 publications

References 32 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

Suprapatellar nailing of tibial fractures

Tratamiento con clavo endomedular de las fracturas metafisarias proximales y distales de tibia. Abordaje pararrotuliano medial en posición de semiextensión

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