Which is superior in the treatment of AO type 42A tibial shaft fracture? A comparison of talon intramedullary nailing and conventional locked intramedullary nailing

Abstract

BACKGROUND: This study aimed to compare the clinical and radiological outcomes of conventional locked intramedullary nailing (IMN) and talon IMN in AO Type 42A tibial fractures. METHODS: A total of 93 patients with AO Type 42A fracture were retrospectively analyzed. The patients were divided into two groups: Those treated with conventional IMN (Group 1), and those treated with talon distal locked nailing (Group 2). The patients were statistically compared in terms of age, sex, mechanism of injury, follow-up time, time to union, smoking status, presence of open fracture, presence of concomitant fibula fracture, development of malunion and nonunion, and the number of intraoperative fluoroscopy shots captured. All patients were evaluated with American Orthopaedic Foot and Ankle Society and Tegner Lysholm scores for clinical outcomes. RESULTS: A total of 93 patients (68 men and 35 women) participated in the study. Group 1 consisted of 35 (71.4%) men and 14 (28.6%) women, a total of 49 patients, while Group 2 consisted of 33 (75%) men and 11 (25%) women, a total of 44 patients. There were no significant differences between the two groups in terms of age, sex, mechanism of injury, follow-up times, smoking status, concomitant fibula fracture, presence of malunion, and presence of open fracture (p>0.05). However, there were significant differences between both groups in terms of time to union, nonunion rate, and the number of fluoroscopy shots captured (p<0.05). American Orthopaedic Foot and Ankle Society and Tegner Lysholm score were analyzed and compared, no statistically differences were found (p=0.786 and p=0.764). CONCLUSION: Although talon IMN reduces radiation exposure, locked conventional IMN has lower nonunion rates and achieves union faster.

Evolution of a traditional technique: Comparison of a 4-mm lag screw and Kirschner wire technique versus a 4-mm lag screw and Kirschner technique with anti-gliding miniplate fixation for the treatment of medial malleolar fractures

“…Furthermore, there are studies in the literature com-paring implants related to tibial fractures and investigating the effects of implant designs in fracture healing. [18] In the present study, early AOFAS clinical scores appeared to be significantly higher. For patients treated with a cannulated cancellous screw, K-wire, and mini-plates, our leading concerns following surgery were the development of irritation, necrosis, and skin pathologies at the implant site where the miniplate was applied due to the thinness of the subcutaneous tissue and skin in the medial malleolus region; however, none of the patients experienced such complications in our study.…”

Does the distance of the fixation points to the fracture affect healing in tibial shaft fractures treated with openable distal claw intramedullary nail?

“…Shorter operating times, less radiation exposure and stable fracture fixation have been obtained with different IMN designs used in tibia fractures. However good the stability is in locking IMN's, there are the disadvantages of difficulties in application (6)(7)(8)(9). The ease of application of expandable nail designs or nails with retractable claws for distal fixation is a great advantage for orthopaedic surgeons (6,7,10,11).…”

“…However good the stability is in locking IMN's, there are the disadvantages of difficulties in application (6)(7)(8)(9). The ease of application of expandable nail designs or nails with retractable claws for distal fixation is a great advantage for orthopaedic surgeons (6,7,10,11). Nails designed to be completely expandable without locking screws eliminate the complications that can develop during…”

“…In this design, while proximal fixation is made with classic locking screws, distal fixation is provided by the retractable claws attaching to the inner surface of the bone cortex. Distal retractable claws eliminate the problems of distal screw application (6,7). However, there is no study in the literature related to what the distance should be of the distal claws from the fracture region, even though these measurements are known to affect fracture healing.…”