1
|
Yang X, Zhang X, Liu C, Zhang L, Wu F, Shen Q, Yu Y. Treatment of Distal Third Tibial Fractures with Anterior Soft Tissue Compromise through the Posterolateral Approach: Distal Third Tibial Fractures via the Posterolateral Approach. J Foot Ankle Surg 2024:S1067-2516(24)00215-1. [PMID: 39245431 DOI: 10.1053/j.jfas.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/27/2024] [Accepted: 09/01/2024] [Indexed: 09/10/2024]
Abstract
Distal third tibial fractures associated with anterior soft tissue compromise are a predictor of more complications and poor prognosis. The study aimed to introduce the treatment of such fractures through the posterolateral approach. From March 2020 and January 2022, 32 patients with distal third tibial fractures were plated through the posterolateral approach due to concurrent closed anterior soft tissue compromise. There were 30 male and 2 female patients with the mean age of 33 years (range, 20-53 years). The reduction quality of diaphyseal fractures was good (n=30) and acceptable (n=2). The reduction quality of articular fragments was anatomic (n=21), good (n=6), and fair (n=1). All anterior soft tissue injuries healed without surgical intervention. Follow-ups lasted 28 months (range, 25-34 months). The mean dorsiflexion of the injured and uninjured ankles were 17.8°±5.4° and 24.5°±6.6°, respectively (P<0.05). The mean plantar flexion of the ankles were 42°±8.8° and 46°±12.9°, respectively (P>0.05). The mean inversion of the injured and uninjured ankles were 15°±13.3° and 19°±12.4°, respectively (P<0.05). The mean eversion of the injured and uninjured ankles were 27.8°±16.9° and 32.9°±14.3°, respectively (P>0.05). The mean American Orthopaedic Foot and Ankle score was 90 (range, 68-100). Distal third tibial fractures with anterior soft tissue compromise can be plated through the posterolateral approach, resulting in good functional outcomes and minimum complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV.
Collapse
Affiliation(s)
- Xiaoliang Yang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xu Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Caixia Liu
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Liming Zhang
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Fan Wu
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Qiang Shen
- Department of Hand and Foot Surgery, Armed Police Corps Hospital of Hebei, Shijiazhuang, Hebei, China.
| | - Yadong Yu
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| |
Collapse
|
2
|
Nie W, Wang Z, Xu S, Guo S, Yue Y, Sun K. A retrospective investigation on clinical and radiographic outcomes of distal tibial fractures after intramedullary nailing using the lateral parapatellar extra-articular approach. Arch Orthop Trauma Surg 2024; 144:2101-2108. [PMID: 38653838 PMCID: PMC11093779 DOI: 10.1007/s00402-024-05344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION According to reports, the modified extra-articular parapatellar approach allows the performance of tibial nailing in the semi-extended position without the concern of joint violation. However, there remains no special study that has provided a detailed assessment of the benefits and risks of this approach for treating distal tibial fractures (DTFs). The aim of this retrospective study was to investigate the clinical and radiological outcomes of patients with DTFs after intramedullary nailing using a lateral parapatellar extra-articular (LPE) approach in comparison to using the suprapatellar (SP) and transpatellar (TP) approaches. METHODS Data were collected from 99 patients with a minimum follow-up period of 12 months. Comparisons were conducted between the groups regarding the number of intraoperative fluoroscopies, complications, knee pain, knee range of motion (ROM), the Lysholm Knee Scale (LKS), the Olerud-Molander Ankle Score (OMAS) and radiological findings. RESULTS The demographic characteristics were comparable between the groups. Fewer intraoperative fluoroscopies were performed in the LPE (27.47 ± 4.98) and SP (26.03 ± 5.12) groups than in the TP group (30.20 ± 7.42; P<0.001). When compared with the other two approaches, the LPE approach was associated with less knee pain (P<0.001) and better knee ROM (P<0.001) at one week postoperative. No significant intergroup differences were detected in the incidence of complications, LKS scores (P = 0.687) and OMAS (P = 0.926). Radiological findings demonstrated that postoperative tibial alignment (P = 0.853), the time of bony union and rate of non-union were similar between the groups. CONCLUSION The LPE approach can serve as a safe and effective option for tibial nailing, as it offers favourable outcomes in knee pain relief and knee ROM in the early postoperative period and is equivalent to the other two approaches in terms of the incidence of complications, fracture healing, functional recovery and postoperative alignment for patients with DTFs.
Collapse
Affiliation(s)
- Wei Nie
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No.41 East Hailian Road, Haizhou District, Lianyungang, Jiangsu Province, China
| | - Zhaojun Wang
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No.41 East Hailian Road, Haizhou District, Lianyungang, Jiangsu Province, China
| | - Shizhuang Xu
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No.41 East Hailian Road, Haizhou District, Lianyungang, Jiangsu Province, China
| | - Sutong Guo
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No.41 East Hailian Road, Haizhou District, Lianyungang, Jiangsu Province, China
| | - Yang Yue
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No.41 East Hailian Road, Haizhou District, Lianyungang, Jiangsu Province, China
| | - Kefu Sun
- Department of Orthopedic Surgery, Lianyungang 2nd People's Hospital, No.41 East Hailian Road, Haizhou District, Lianyungang, Jiangsu Province, China.
| |
Collapse
|
3
|
Makaram NS, Sheppard J, Leow JM, Oliver WM, Keating JF. Outcome Following Intramedullary Nailing of Tibial Diaphyseal Fractures: Suprapatellar Nail Insertion Results in Superior Radiographic Parameters But No Difference in Mid-Term Function. J Bone Joint Surg Am 2024; 106:397-406. [PMID: 38100599 DOI: 10.2106/jbjs.23.00421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND The primary aim of this study was to compare the radiographic parameters (nail insertion-point accuracy [NIPA] and fracture malalignment) of patients who had undergone tibial intramedullary nailing via the suprapatellar (SP) and infrapatellar (IP) approaches. The secondary aims were to compare clinical outcomes and patient-reported outcomes (PROs) between these approaches. METHODS All adult patients with an acute tibial diaphyseal fracture who underwent intramedullary nailing at a single level-I trauma center over a 4-year period (2017 to 2020) were retrospectively identified. The nailing approach (SP or IP) was at the treating surgeon's discretion. Intraoperative and immediate postoperative radiographs were reviewed to assess NIPA (mean distance from the optimal insertion point) and malalignment (≥5°). Medical records and radiographs were reviewed to evaluate the rates of malunion, nonunion, and other postoperative complications. The Oxford and Lysholm Knee Scores (OKS and LKS) and patient satisfaction (0 = completely dissatisfied, 100 = completely satisfied) were obtained via a postal survey at a minimum of 1 year postoperatively. RESULTS The cohort consisted of 219 consecutive patients (mean age, 48 years [range, 16 to 90 years], 51% [112] male). There were 61 patients (27.9%) in the SP group and 158 (72.1%) in the IP group. The groups did not differ in baseline demographic or injury-related variables. SP nailing was associated with superior coronal NIPA (p < 0.001; 95% confidence interval [CI] for IP versus SP, 1.17 to 3.60 mm) and sagittal NIPA (p < 0.001; 95% CI, 0.23 to 0.97 mm) and with a reduced rate of malalignment (3% [2 of 61] versus 11% [18 of 158] for IP; p = 0.030). PROs were available for 118 of 211 patients (56%; 32 of 58 in the SP group and 86 of 153 in the IP group) at a mean of 3 years (range, 1.2 to 6.5 years). There was no difference between the SP and IP groups in mean OKS (36.5 versus 39.6; p = 0.246), LKS (71.2 versus 73.5; p = 0.696), or satisfaction scores (81.4 versus 79.9; p = 0.725). CONCLUSIONS Compared with IP nailing, SP nailing of tibial shaft fractures was associated with superior NIPA and a reduced rate of intraoperative malalignment but not of malunion at healing. However, the superior NIPA may not be clinically important. Furthermore, there were no differences in PROs at mid-term follow-up. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Navnit S Makaram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - James Sheppard
- University of Edinburgh Medical School, Edinburgh, Scotland, United Kingdom
| | - Jun M Leow
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - William M Oliver
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - John F Keating
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| |
Collapse
|
4
|
Pires RE, Bidolegui F, Xicará JA, Altamirano-Cruz MA, Carabelli GS, Valderrama-Molina CO, Gómez A, Velarde JE, Azi ML, Belangero WD, Giordano V. Is there a trend towards semi-extended knee positioning during intramedullary tibial nailing in Latin America? A survey among 990 orthopaedic surgeons. Injury 2023; 54 Suppl 6:110774. [PMID: 38143123 DOI: 10.1016/j.injury.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the Latin American orthopaedic trauma surgeons preference regarding knee positioning and entry portals for IM nailing and identify the reasons of these preferences. METHODS Using the AO Trauma database, 22.285 surveys were distributed by email to Latin American orthopaedic surgeons. Demographic data and practice patterns, especially regarding knee positioning and approach for tibial nailing, were then evaluated and statistically treated. RESULTS amongst one thousand five hundred fourteen responses, 990 orthopaedic surgeons (4.4% of response rate) fully responded to the survey. Transpatellar tendon approach (613 / 61.9%,) with the knee in flexion (518 / 52.3%) on a radiolucent table remains the standard practice for intramedullary tibial nailing. Even for proximal and distal tibial nailing, the transpatellar tendon approach (455 / 46%) with the knee in flexion (562 / 56.8%) hold on the most used method. Only 55 (9.36%) orthopaedic surgeons reported that they have migrated to the supra-patellar tibial nailing in the recent years. The main reasons for a low rate of migration were lack of knowledge about the technique and unavailability of specific gigs and cartilage protectors for a safe suprapatellar nailing. CONCLUSION Even with the potential benefits of the semi-extended knee positioning for tibial nailing, the Latin American orthopaedic community remains using the transpatellar tendon approach with the knee in flexion as the standard technique. Lack of surgical training for suprapatellar and parapatellar approaches with the knee in semi-extension, added by the unavailability of suprapatellar jigs and soft outer protection sleeves contribute to counter the trend towards the semi-extended techniques.
Collapse
Affiliation(s)
- Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil.
| | - Fernando Bidolegui
- Servicio de Ortopedia y Traumatología, Hospital Sirio Libanés, Buenos Aires (BA), Argentina
| | - José Arturo Xicará
- Servicio de Ortopedia y Traumatología, Universidad San Carlos, Quetzaltenango, Guatemala
| | | | | | | | - Amparo Gómez
- Hospital Universitario de la Samaritana, Colombia
| | | | | | | | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro (RJ), Brazil
| |
Collapse
|
5
|
Li T, Wu Z, Wang J, Xu X. Application of a self-made novel fracture reduction forceps in refractory distal tibial fracture. Asian J Surg 2023; 46:5312-5313. [PMID: 37537036 DOI: 10.1016/j.asjsur.2023.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/09/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Tao Li
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Zhonghan Wu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Jingkun Wang
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Xinzhong Xu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China.
| |
Collapse
|
6
|
Lu Y, Zhao J, Huang Q, Ren C, Sun L, Wang Q, Li M, Zhang C, Xue H, Li Z, Zhang K, Xu Y, Ma T. Combined Medial Plate and Intramedullary Nailing for the Fixation of Extra-Articular Proximal Tibial Fractures: a Biomechanics Study. Front Bioeng Biotechnol 2022; 10:859512. [PMID: 35845415 PMCID: PMC9280979 DOI: 10.3389/fbioe.2022.859512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: The extra-articular proximal tibial fractures continue to have high malunion rates despite development in intramedullary nailing (IMN) technology. Combined plate and IMN fixation can increase mechanical stability. The purpose of this study was to investigate combined plate and IMN for the treatment of extra-articular proximal tibial fracture using a biomechanical model. Methods: A 10-mm defective osteotomy was created in the fourth-generation composite tibia to simulate extra-articular proximal tibial fractures (AO/OTA 41A2). The fractures were stabilized with IMN alone (IMN group), IMN with supplementary medial plate (M-IMN group), and IMN with supplementary lateral plate (L-IMN group). The biomechanical properties of each specimen were tested under axial compression loading, bending stress, and cyclic loading. The maximum displacement of the fragments and implant-bone construct failure was recorded. Results: The maximum displacement of the M-IMN group was significantly less than either the L-IMN or IMN group in both axial compression loading and bending stress (p < 0.05 for both comparisons). All specimens in the three groups survived in 10,000 cyclic loading without hardware deformation. The maximum stiffness of failure was similar between the M-IMN and L-IMN groups, but the IMN group was statistically lower than either the L-IMN or the IMN group (p < 0.05). Conclusion: The results indicated that combined medial plate and IMN fixation could effectively increase the mechanical stability of proximal tibial fractures.
Collapse
Affiliation(s)
- Yao Lu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Jiasong Zhao
- Department of International Ward (Orthopedic), Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
| | - Liang Sun
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Ming Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Congming Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Hanzhong Xue
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yibo Xu
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yibo Xu, ; Teng Ma,
| | - Teng Ma
- Department of Orthopaedic Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Bioinspired Engineering and Biomechanics Center (BEBC), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yibo Xu, ; Teng Ma,
| |
Collapse
|