Intramedullary Nailing of Periarticular Fractures

Plate fixation has historically been the preferred surgical treatment method for periarticular fractures of the lower extremity. This trend has stemmed from difficulties with fracture reduction and concerns of inadequate fixation with intramedullary implants. However, the body of literature on management of periarticular fractures of the lower extremities has expanded in recent years, indicating that intramedullary nailing of distal femur, proximal tibia, and distal tibia fractures may be the preferred method of treatment in some cases. Intramedullary nailing reliably leads to excellent outcomes when performed for appropriate indications and when potential difficulties are recognized and addressed

Fluoroscopic freehand and electromagnetic-guided targeting system for distal locking screws of humeral intramedullary nail

Purpose The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation. Materials and methods The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure. Results Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″). Conclusion The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient

Far Proximal and Far Distal Tibial Fractures: Management with Intramedullary Nails

Operative treatment of tibial fractures located at the proximal metaphyseal-epiphyseal and distal metaphyseal-epiphyseal areas, including those with articular extensions, is a technical challenge. Common methods for surgical management include plates (locking and nonlocking), external fixation devices, and intramedullary nails. All these methods have shown satisfactory results in terms of quality of reduction and clinical and radiological outcomes. The authors present some technical methods and strategies that have been useful for the surgical approach, reduction, and fixation of these lesions with the use of locked nails

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

Background: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.Methods: This was the prospective comparative study of 50 patients with distal third tibia fractures divided into two groups. First group of patients were treated with MIPPO technique while second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, non-union, superficial and deep infection between the two groups.Results: Average time taken by patients for full weight bearing in group A was 17.6 weeks as compared to 16.7 weeks in group B. All patients were able to bear weight prior to complete union of fracture. By the process of weight bearing, we believed that it would promote secondary bone healing. On taking X-rays during follow up of included patients starting of radiological union was observed carefully by looking for bridging callus, haziness of fracture line. Appearance of callus was taken average time of 12.5 weeks in group A and 12.1 weeks in group B.Conclusions: Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique

Role of tibia interlocking nail in treating distal tibial metadiaphyseal fractures: study of 46 cases

Background: Distal tibial diaphyseal fractures are known for its various challenges that orthopaedicians face while treating. While performing surgery, many principles of fixations are needed to be properly addressed. This study was undertaken to know the efficiency of closed reduction, polar screws and tibia interlocking nail fixation at our Institute.Methods: The data, which were collected from the medical records and Department digitalised storage system and from the HMIS patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and AO classification of distal tibial fracture admitted in Orthopaedics Department from 2007 to 2013. Analyses of 46 cases, 34 males and 12 females, were made to find out the functional, radiological outcome, associated complications in treating distal tibia with ILN. During Analysis, association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P value of <0.05 was considered significant.Results: The average time to union of the closed fracture was 15.4 weeks (range: 12–28 weeks). The healing times for the primarily nailed compound Grade I averaged 17.8 weeks (range: 15-34 weeks). Complications of delayed union occurred in 3 cases, and two cases of non-union. Infection in 6 cases (5 superficial, 1 deep), screw breakage in 4 cases and 3 cases of significant malalignment. The final functional outcome of 33 patients had excellent results, 11 had good results and 2 had fair results as determined by criteria of Johner and Wruh. Conclusions: The dynamic osteosynthesis of distal tibia by interlocking nail and judicious use of poller screws is an effective alternative for the treatment of distal metaphyseal tibial fractures.

Interlocking nailing in fractures of distal tibia

Background: The complex biomechanics of distal tibial fractures, lack of robust soft tissue coverage and a wide metaphysis makes their treatment a challenging prospect even for experienced surgeons.Methods: A total of 42 patients of distal tibia fracture were treated with reamed intramedullary nailing. Fibula was fixed in selected cases either with nailing or a low profile plate. Outcome was measured with Klemm and Borner criteria.Results: In this study 42 patients treated with reamed IM nailing were included. Fractures were classified according to AO classification. In present study, we got 22 patients (53.38 %) of fracture 43A1, 11 patients (26.19%) 43A2 and 9 patients (21.42%) 43A3 type. Fibular fracture was fixed with plate in 16 patients and intramedullary device in 15 patients. In the study all the fractures united. Mean time for union was 21 weeks. Time range for union was from 12-34 weeks. Four patients had mal-alignment. One patient had superficial infection which was treated with oral antibiotics. In the present study, 35 (83.33%) patients had no loss of ankle motion, while 5 (11.90 %) had loss of <25 degrees and 2 had loss of 25 degrees. Out of 42 patients, 33 (78.58%) patients had excellent results while 5 (11.90%) patients had good results, 4 (9.52%) patients had fair results.Conclusions: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. A proper patient selection, adjuvant fixation of fibula and use of at least two distal interlocking screws is suggested for better outcome.

Retrospective analysis of minimal invasive plating versus intramedullary nailing for the treatment of extra-articular distal tibia fracture

Background: The volume of cases of distal tibia fractures at the trauma care centre are quite high in the Indian scenario. This type of fracture often creates a dilemma for the orthopaedic surgeons over the choice of the implant for the management. The aim of our study was to compare intramedullary interlocking nail (IMILN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) based on various parameters.Methods: We collected data of 40 patients with extra-articular distal tibial fractures (within 2 muller square from tibial plafond). Patients were divided into two groups: IMILN and MIPPO. We compared the 2 groups for demographic variables, union time, complication rate and functional score.Results: There was no statistical difference in union time, complication rate, functional outcome and other demographic variables among the groups. Only 2 patients developed non-union and two patients had an infection. Overall 38 patients obtained excellent or good results (95%) and two patient had fair outcomes (5%).Conclusions: The overall analysis suggested that both MIPPO and IMILN treatment options are comparable with consideration of all the parameters. Detailed results indicate a superiority of MIPPO over IMILN in terms of better anatomical reductions of the fracture with less incidence of malalignment while IMILN is better in terms of having lower rates of infections

Effect of minimally invasive percutaneous plates versus interlocking intramedullary nailing in tibial shaft treatment for fractures in adults: A meta-analysis

OBJECTIVE: The aim of this article was to determine the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults. METHOD: Literature searches of the Cochrane Library, PubMed, EMBASE, the Chinese Biomedical Literature database, the CNKI database, Wanfang Data, and the Weipu Journal database were performed up to August 2013. Only randomized and quasi-randomized controlled clinical trials comparing the use of percutaneous plates and interlocking intramedullary nails for tibial shaft fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. RESULTS: Eleven trials were included. Compared with interlocking intramedullary nailing, minimally invasive percutaneous plates shortened fracture healing time and resulted in lower rates of postoperative delayed union and pain. There was no significant difference between the two methods with regard to the rates of excellent and good Johner-Wruh scoring, the rate of reoperation, and other complications. CONCLUSIONS: Overall, insufficient evidence exists regarding the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults. Low-quality evidence suggests that minimally invasive percutaneous plates could shorten fracture healing time, decrease the rate of postoperative delayed union, and decrease pain levels compared with interlocking intramedullary nailing. There is no significant difference between the two groups in terms of functional recovery scores, reoperation, and other complications. Further research that includes high-quality randomized controlled, multicenter trials is required to compare the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults

Distal tibial metaphyseal fractures: the role of fibular fixation

Distal tibial extra-articular fractures are often a result of complex high-energy trauma, which commonly involves associated fibular fractures and soft tissue injury. The goal of tibial fixation is to maximise fracture stability without increasing soft tissue morbidity from surgical intervention. The role of adjunctive fibular fixation in distal tibial metaphyseal fractures has been controversial; although fibular fixation has been shown to improve stability of distal tibial fractures, there has been increased potential for soft tissue-related complications and a delay to tibial fracture healing. Adjunctive fixation of concomitant fibular fractures without associated syndesmotic or ankle pathology is not necessary in surgically stabilised extra-articular metaphyseal fractures of the distal tibia

Prospective and Retrospective analysis of Functional Outcome of Distal both bone Leg Fracture treated with Tibial Interlocking Nailing with and without Fibular plating: Comparative study

AIM AND OBJECTIVE: To analyse the functional outcome of distal both bone leg fractures treated with Tibial Interlocking nail with and without supplementary fibular plating. MATERIALS AND METHODS: This is a prospective and retrospective study of 20 patients distal both bone leg fractures– 10 patients treated with interlocking nailing alone and 10 patients treated with interlocking nailing with supplementary fibular plating. The study was done after getting clearance from Hospital ethical committee. Those who fulfilled the inclusion criteria given below, were invited to participate in the study. Informed consent was obtained from all the patients willing to take part in the study. OUTCOME: Alignment and reduction preoperatively, postoperatively and at healing was the main outcome measured with an emphasis on loss of initial reduction on follow up. Fibular plating Fibular plating was selected for the following reasons, 1. correction of alignment before insertion of nail. 2. Maintaining the alignment or to improve the stability of bone implant complex. 3. For achieving rotational stability. Kalstrom-Olerud score was used to assess the functional outcome. It is an independent measurement, not influenced by other co-morbid conditions and associated injuries. RESULTS: All the relevant data were analysed. The Fractures treated with tibial interlocking nailing without fibular plating were analysed and 5 (50%) cases were malunited and deformed. Karlstrom- Olerud scoring was excellent in one (10%) patient, good in 5 Patients (50%), fair in 3 (30%) patients and poor in 1 (10 %) patients. The mean delay in surgery for this group is 2.2 weeks. Radiologically the mean post operative varus/valgus alignment was 8.6 degrees. The mean duration of time of union is 12.70 weeks. 4 patients needed cast support. The average follow up is 8 months( lowest – 4 months , longest – 18 months). All the fractures treated with supplementary fibular plating in addition to tibial interlocking nailing eventullay united in a mean period of 11.60 weeks Karlstrom-Olerud score was excellent in 6 fractures (60%), good in 3 patients (30%) and fair in 1 patient (10%) The mean delay between the injury and the surgery was 1.8 weeks. Radiologically the mean post operative varus/valgus alignment was 2.10 degrees. The alignment was maintained till union with the mean remaining the same in the coronal plane. The average follow up is 10.3 months (lowest- 6 months, longest – 24 months). The p value for varus/ valgus angulation with equal variances assumed is 0.0016 and with equal variances not assumed is 0.0064. Thus it is statistically significant that the p- value is < 0.05. The p- value for time of union is 0.3425( p value >0.05), so it is statistically insignificant. CONCLUSION: We conclude that fibular plating, when supplemented the intramedullary nailing of distal both bone fractures of leg, 1. Were effective in achieving the fracture alignment especially in fresh fractures. 2. Improves not only angular stability but also rotational stability. 3. Maintained the fracture alignment till union, preventing loss of initial Reduction