Tensioned Wire–Assisted Intramedullary Nail Treatment of Proximal Tibia Shaft Fractures: A Technical Trick

Abstract

Summary: Proximal tibia shaft fractures are often challenging to manage because of their intrinsic tendency toward valgus and apex anterior deformity. In recent years, intramedullary nailing (IMN) has become more frequently used to treat these injuries, allowing for biologic advantages such as load-sharing, immediate weight-bearing, and avoidance of disruption of periosteal blood supply. Several adjunctive techniques, such as semiextended positioning, blocking screws, and external fixation, have been developed to assist with fracture reduction during IMN. We describe a new adjunctive reduction technique—tensioned wire–assisted IMN—for the treatment of proximal tibia shaft fractures. We have found that tensioned wire assistance facilitates fracture reduction during IMN, does not interfere with intraoperative image intensification, and is compatible with both standard nailing instrumentation and additional adjunctive techniques. We present tensioned wire nailing as a technical trick for anatomic and stable reduction of proximal tibia fractures and compare a cohort of proximal tibia shaft fractures managed with and without tensioned wire assistance.

Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

“…(4) The follow-up time varied greatly among the included studies and it might affect the results of heterogeneity and lead to publication bias. (5) The combined results of infection were unstable, and larger sample studies needed to be included to verify our findings. (6) Fracture type is relatively single.…”

“…Among these, percutaneous locked plating (PLP) and intramedullary nail (IMN) are two most frequently used surgical fixation methods for the treatment of extra-articular proximal tibial fractures. 5,6 In clinical application, proximal tibial fractures treated with IMN fixation sometimes require additional surgical techniques, such as percutaneous anterior plate assisted fracture reduction, which could be left or removed after IMN fixation. As two different fixation methods, each has its advantages.…”

Treatment of segmental tibial defects by bone transport with circular external fixation and a locking plate

“…In this way, the locking plates not only move the disassembly time earlier, but also allow a large space for the insertion of the external fixation needle, which does not frequently contact the locking steel plates, thereby reducing the occurrence of deep infection. 22,24 We treated segmental tibial bone defects using locking plates combined with external fixation with an average EFI of 15.1 days/1 cm. A similar observation was made by Gupta et al 21 We attributed the reduced EFI to the locking plate's ability to provide sufficient stability, such that the external fixator was able to be removed after the distraction was completed.…”

Application of the Distraction Support in Intramedullary Nailing Treatment for Tibial Shaft Fracture: A Randomized Controlled Study

“…This can also signi cantly reduce the amount of blood loss during the operation. Meanwhile, ne-tuning operation can be adjusted to precise reduction, avoiding secondary neurovascular injury caused by excessive traction 18 . Iatrogenic injuries are associated with delayed union and nonunion of tibial shaft fractures 19 .…”