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Palm VF, Hoogendoorn JM, Verhage SM. The role of fibula fixation in combined distal-third tibia and fibula fractures: a systematic literature review. Arch Orthop Trauma Surg 2024; 144:219-228. [PMID: 37831196 DOI: 10.1007/s00402-023-05092-6] [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: 08/11/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE The role of concomitant fibula fracture fixation in distal-third tibia fractures regarding alignment, union, and functional outcome is still a topic of debate. In this review, we summarize the available comparative literature regarding fibula fixation in distal third lower leg fractures. MATERIALS AND METHODS A systematic literature review of articles published between January 2000 and January 2022 in the PubMed, Cochrane, and EMBASE databases about this topic was performed. RESULTS 746 unique studies were identified of which four randomized-controlled trials and six retrospective studies were included. Nine studies compared alignment after tibia fixation with or without fibula fixation, six studies reported on tibial union, and three studies reported on functional outcome between groups. Pooling of data was not possible due to varying outcome measures and inclusion criteria. Fibula fixation was associated with less rotational malalignment, while there does not seem to be consensus regarding the effect on sagittal and coronal alignment. Six studies reported on the effect of fibula fixation on tibial union. None of these studies found a significant difference between treatment modalities. Furthermore, one out of three studies reporting functional outcome described a marginal beneficial functional outcome after fibula fixation. Ultimately, no differences in complication rates between treatment modalities were described. CONCLUSION Fixation of the fibula in distal-third lower leg fractures does not seem to have a significant effect on coronal and sagittal tibial alignment. Furthermore, fibula fixation is associated with significantly less rotational malalignment, although the clinical importance of this finding is questionable as true differences in rotational alignment between treatment modalities are small. Finally, fibula fixation does not affect union, functional outcome, or complication rate as adjuvant to tibia fixation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Victor Franciscus Palm
- Department of Surgery, Haaglanden Medical Center, Secretariaat Heelkunde F1.31, Lijnbaan 12, 2512VA, The Hague, The Netherlands.
| | - Jochem Maarten Hoogendoorn
- Department of Surgery, Haaglanden Medical Center, Secretariaat Heelkunde F1.31, Lijnbaan 12, 2512VA, The Hague, The Netherlands
| | - Samuel Marinus Verhage
- Department of Surgery, Haaglanden Medical Center, Secretariaat Heelkunde F1.31, Lijnbaan 12, 2512VA, The Hague, The Netherlands
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Ma X, Wang Z, Wang J. Clinical analysis of accelerated rehabilitation surgery for Gustilo type IIIA/B open tibio fibular fracture. Eur J Trauma Emerg Surg 2023; 49:2355-2362. [PMID: 36370184 DOI: 10.1007/s00068-022-02164-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the clinical efficacy of accelerated rehabilitation surgery for the treatment of Gustilo type IIIA/B open tibiofibular fracture with emergency stage I debridement, internal fracture fixation, bone grafting, coverage of the wound surface with a muscle flap combined with vacuum sealing drainage (VSD), and internal and lateral leg reduction. METHODS A retrospective analysis was performed on the clinical data of 15 patients with Gustilo type IIIA/B open tibiofibular fracture who were admitted to the Affiliated Zhongshan Hospital of Dalian University from January 2015 to December 2018. There were 12 males and 3 females. The patients ranged in age from 20 to 62 years, with an average of 39.5 years. After admission, the patients underwent stage I emergency debridement (including exploration and repair of nerves and tendons), open reduction and internal fixation of the tibia and fibula, iliac bone grafting, muscle flap and VSD coverage of the bone defect, complete tensioning of the calf inside and outside, tibia-sparing incision before healing, and stage II free skin grafting. Patients were followed up periodically to observe muscle flap survival, fracture healing time, length of hospitalization, wound healing time, delayed union, bone nonunion, osteomyelitis and other complications. At the last follow-up, the Johner-Wruhs criteria were used to evaluate the rate of good functional recovery from tibial shaft fracture, fracture healing quality was evaluated by the Merchant score, and limb function was evaluated by the LEFS. RESULTS All 15 cases were followed up for 12-32 months, with an average of 22.8 months. All the fractures healed; the range of healing time was 14-30 weeks (mean 18.5 weeks). The length of hospitalization was 25.1 ± 7.6 days, and wound healing took 12.2 ± 2.0 days. None of the patients had complications such as osteomyelitis infection. When the Johner-Wruhs evaluation criteria for functional recovery from tibial shaft fracture were applied at the last follow-up, the outcomes were as follows: excellent in 13 cases, good in 1 case and fair in 1 case, for an excellent and good rate of 93.3%. When fracture healing was evaluated according to the Merchant scoring standard, the outcomes were as follows: excellent in 12 cases, good in 1 case, fair in 1 case, and poor in 1 case, for an excellent and good rate of 86.7%. The mean LEFS score of the affected limb at the last follow-up was 70 (59-80). CONCLUSION For Gustilo type IIIA/B open tibiofibular fractures, emergency stage I debridement, internal fixation of the fracture, bone grafting, coverage of the wound with a muscle flap, complete tensioning of the calf inside and outside, and application of VSD can improve the repair of leg soft-tissue defects, shorten hospitalization time, promote fracture healing, and effectively reduce infection and complications related to bone exposure. More importantly, this treatment protocol provides effective wound repair, guarantees the recovery of limb function, significantly speeds up recovery, and improve patients' quality of life.
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Affiliation(s)
- Xiaowei Ma
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Zongpu Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jianchuan Wang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Lee JW, Byun SE, Kim YW, Byun YS, Yoon YC, Sohn HS. Fibular Fixation in Same-Level Distal Third Tibiofibular Fractures: Is Fibular Fracture Regarded as a Secondary Importance? Clin Orthop Surg 2023; 15:704-710. [PMID: 37811504 PMCID: PMC10551684 DOI: 10.4055/cios23036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 10/10/2023] Open
Abstract
Background Although most studies focused on the alignment or union of the tibia in same-level distal third tibiofibular fractures, the outcome of a concomitant fibular fracture is generally regarded as being of secondary importance in the literature. This study aimed to assess the outcomes of fibular fractures in same-level distal third tibiofibular fractures. Methods In this retrospective study, we enrolled 111 patients with same-level distal third tibiofibular fractures treated at our institute between January 2016 and August 2020. Tibial fractures were stabilized with intramedullary nailing, and the cases were divided into two groups based on whether they additionally underwent fibular fixation (group 1, 57 cases) or not (group 2, 54 cases). Clinical and radiographic outcomes were used for the evaluation of tibial and fibular alignments, union of the tibia and fibula, number of interlocking screws in the distal tibial fragment, range of motion of the ankle joint, and complications. Results No statistically significant differences in the tibial union rate or mean tibial alignment were observed between the two groups on either the immediate postoperative or final radiographs. The fibular union rate in group 1 was significantly higher than that in group 2 (fibular nonunion, 0 vs. 15; p < 0.001). Statistically significant differences in fibular displacement were observed on immediate postoperative radiographs between patients with fibular union and those without it. At the final follow-up, the mean range of ankle motion and lower extremity functional scale scores did not differ between the two groups. Conclusions Regardless of whether fibular fixation was performed, the overall tibial alignment with intramedullary nailing was well restored and the union rate of the tibia was comparable in the two groups. Fibular nonunion is not uncommon in unfixed fibula fractures. Displacement of the fibula as seen on immediate postoperative radiographs was related to fibular nonunion.
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Affiliation(s)
- Jin-Woo Lee
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young-Woo Kim
- Department of Orthopaedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Young-Soo Byun
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Yong-Cheol Yoon
- Department of Orthopaedic Surgery, Gachon University Gil Hospital, Incheon, Korea
| | - Hoon-Sang Sohn
- Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
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Duramaz A, Koluman AC, Bayrak A, Ziroğlu N, Bilgili MG, Kural C. Fibular fixation improves ankle functional outcomes and alignment in the intramedullary nailing of distal third tibiofibular diaphyseal fractures. Eur J Trauma Emerg Surg 2022; 48:4019-4029. [PMID: 35275243 DOI: 10.1007/s00068-022-01934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aims to determine the effect of fibular fixation on alignment and fracture healing of tibia, and ankle functional outcomes in the treatment of distal third tibiofibular diaphyseal fractures. METHODS Consecutive 111 patients (33 females and 78 males) with distal third tibiofibular diaphyseal fracture who met the inclusion criteria were included in the study. Patients were divided into two groups as those who underwent fibular fixation with tibia intramedullary nailing (study group) and those who did not (control group). Groups were compared in terms of demographic features, trauma and fracture characteristics, functional and radiological outcomes. RESULTS No significant difference was observed between the groups in terms of demographic features, trauma characteristics, complications, and follow-up time (p > 0.05). Surgery time was significantly lower in the control group (p = 0.001). Ankle joint range of motion, AOFAS score, OMAS score, and full weight-bearing time were significantly better in the fibular fixation group (p = 0.023, p = 0.001, p = 0.001 and p = 0.039, respectively). Significantly better coronal alignment and sagittal alignment were found in the fibular fixation group (p = 0.001 and p = 0.001, respectively). Patients who underwent fibular fixation had significantly better radiological outcomes in terms of fibular rotation angle and ankle arthrosis (p = 0.000 and p = 0.022, respectively). CONCLUSION Fibular fixation not only contributes to fracture union, early full weight-bearing, and alignment but also improves ankle functional outcomes in the distal third tibiofibular fractures treated with intramedullary nailing for tibia. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
- Altuğ Duramaz
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St., Number 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Ali Can Koluman
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St., Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Alkan Bayrak
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St., Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Nezih Ziroğlu
- Department of Orthopedics and Traumatology, Beylikdüzü State Hospital, Pınartepe Ave, 253 St, Number 8, 34500, Büyükçekmece, Istanbul, Turkey
| | - Mustafa Gökhan Bilgili
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St., Number 11, 34147, Bakırköy, Istanbul, Turkey
| | - Cemal Kural
- Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St., Number 11, 34147, Bakırköy, Istanbul, Turkey
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van Veelen NM, van de Wall BJM, Bleeker NJ, Buenter IR, Link BC, Babst R, Knobe M, Beeres FJP. The value of fibular fixation in patients with stabilized distal tibia fractures. Eur J Trauma Emerg Surg 2022; 48:3257-3263. [PMID: 35122103 DOI: 10.1007/s00068-022-01888-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE There is currently no consensus regarding the need for fixation of concomitant fibula fractures in patients with surgically treated distal tibia fracture. Although studies have shown it to be beneficial for fractures involving the syndesmosis, it remains unclear for suprasyndesmotic fractures. This study evaluates what effect the fixation of such suprasyndesmotic fibula fractures had on patients who underwent fixation of distal tibia fractures. METHODS This retrospective cohort study included all consecutive adult patients who received surgical treatment for an extra-articular or simple intraarticular distal tibia fracture between 2012 and 2020 and had a concomitant fibula fracture proximal to the syndesmosis. Two groups were formed depending on whether the fibula was stabilized. The need for revision surgery, the occurrence of complications, fracture healing, rotational and angular malalignment were evaluated for both groups. RESULTS This study included 120 patients, of which 40 (33.3%) had operative treatment of the fibula fracture. Of those with stabilized fibula fractures, 28 (70%) were treated with a plate and 12 (30%) with a titanium elastic nail. The group of patients with surgically treated fibula fractures had significantly more angular malalignments (10% vs 1.2%, p = 0.042), while there was no difference regarding rotational malalignment or fracture healing. Further, infections of the fibular surgical site occurred in 15% of surgically treated patients leading to significantly more revision surgeries in this group (40% vs 20%, p = 0.03). All infections occurred when a plate was used. CONCLUSION This study was unable to show any benefit from stabilizing concomitant, suprasyndesmotic fibula fractures in surgically treated distal tibia fractures. On the contrary, infection, revision surgery and angular malalignment were more frequent when the fibula was fixed. Therefore, such concomitant fibula fractures should not routinely be fixed and if stabilization is deemed necessary, the implant should be chosen carefully.
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Affiliation(s)
- Nicole Maria van Veelen
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, Lucerne, Switzerland.
| | | | - Nils Jan Bleeker
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, Lucerne, Switzerland
| | - Isabelle Ruth Buenter
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, Lucerne, Switzerland.,Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, Lucerne, Switzerland
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Mathematical Modelling of Destabilization Stress Factors of Stable-Elastic Fixation of Distal Trans- and Suprasyndesmotic Fibular Fractures. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6607364. [PMID: 34795885 PMCID: PMC8594993 DOI: 10.1155/2021/6607364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/21/2021] [Indexed: 11/17/2022]
Abstract
Introduction Specification of possible stress factors destabilizing the fibula stable osteosynthesis by the intramedullary nail with distal blocking and elastic fixation of distal syndesmosis by the thread with endobuttons by mathematical modelling of distal unstable ankle injuries. Material and Methods. We studied the thread tension during the combined stable-elastic fixation of unstable injuries of the ankle joint in cross-syndesmosis fractures of the fibula (B, C Danis–Weber classification), which includes a one-time stable minimally invasive fixation with the intramedullary nail and elastic fixation by the thread with endobuttons. We used a titanium alloy for the intramedullary nail and polyester for the thread. The deformed state was studied using the methods of mechanics. Results A model of a fractured fibula blocked with the intramedullary nail and fixed with the elastic thread was developed. A formulation to specify the rational tension forces of the elastic thread depending on the parameters of the fibula and intramedullary blocking nail and on the location of the bone injury was obtained. The effect of foot rotation on the thread tension was investigated. The results of theoretical research should be implemented in medical practice. Conclusions A mathematical model of the damaged fibula blocked by the intramedullary nail and fixed with the elastic thread was developed. Dependences for calculation of tension of the fixing thread were obtained. A slight increase in thread tension during foot rotation was found.
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Peng J, Long X, Fan J, Chen S, Li Y, Wang W. Concomitant Distal Tibia-Fibula Fractures Treated with Intramedullary Nailing, With or Without Fibular Fixation: A Meta-Analysis. J Foot Ankle Surg 2021; 60:109-113. [PMID: 33218862 DOI: 10.1053/j.jfas.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
There is no consensus on whether a fibular fracture should be fixed when a concurrent extra-articular distal tibia fracture is managed with intramedullary nails. We evaluated the use of fibular fixation in a meta-analysis of randomized trials and observational studies. Two researchers independently assessed the quality of eligible studies and extracted the data. We analyzed 4 trials with a pooled sample of 283 patients (mean age, 24 to 43 years; 141 men), 94 who had undergone fibular fixation and 189 who had not. Two randomized trials assessed on the Cochrane risk-assessment criteria were determined to have a moderate risk of bias, and 2 retrospective cohort studies evaluated with the Newcastle-Ottawa Scale were considered to be high quality. Tibia malalignment at follow-up times ranging from 12 to 72 weeks was reported in 20% (19/94) of patients in the fibular-fixation group and 67% (126/189) of patients in the nonfixation group, indicating that fibular fixation was significantly associated with a lower risk of malalignment (risk ratio, 0.34; 95% confidence interval [CI] 0.13 to 0.92; p = .03). The groups did not differ in the proportion of patients with malalignment immediately after surgery, delayed union, nonunion, or infection. When distal extra-articular tibia-fibular fractures are treated with intramedullary nails, fibular fixation may decrease the risk of late malalignment. Further randomized controlled trials with higher quality are required to verify the result.
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Affiliation(s)
- Jing Peng
- Surgeon, Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, China
| | - Xiaotao Long
- Surgeon, Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, China
| | - Jun Fan
- Surgeon, Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, China.
| | - Shiyang Chen
- Surgeon, Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, China
| | - Yang Li
- Surgeon, Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, China
| | - Wei Wang
- Surgeon, Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, China
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The Role of Fibular Fixation in Distal Tibia-Fibula Fractures: A Meta-Analysis. Adv Orthop 2021; 2021:6668467. [PMID: 33708447 PMCID: PMC7932767 DOI: 10.1155/2021/6668467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/09/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The necessity of fibular fixation in distal tibia-fibula fractures remains controversial. This study aimed to assess its impact on radiographic outcomes as well as rates of nonunion and infection. METHODS A systematic search of the electronic databases of PubMed, Embase, and Cochrane library was performed to identify studies comparing the outcomes of reduction and internal fixation of the tibia with or without fibular fixation. Radiographic outcomes included malalignment and malrotation of the tibial shaft. Data regarding varus/valgus angulation, anterior/posterior angulation, internal/external rotation deformity, and the rates of nonunion and infection were extracted and then polled. A meta-analysis was performed using the random-effects model for heterogeneity. RESULTS Additional fibular fixation was statistically associated with a decreased rate of rotation deformity (OR = 0.13; 95% CI 0.02-0.82, p=0.03). However, there was no difference in the rate of malreduction between the trial group and the control group (OR = 0.86; 95% CI 0.27-2.74, p=0.80). There was also no difference in radiographic outcomes of varus-valgus deformity rate (OR = 0.17; 95% CI 0.03-1.00, p=0.05) or anterior-posterior deformity rate (OR = 0.76; 95% CI 0.02-36.91, p=0.89) between the two groups. Meanwhile, statistical analysis showed no significant difference in the nonunion rate (OR = 0.62; 95% CI 0.37-1.02, p=0.06) or the infection rate (OR = 0.81; 95% CI 0.18-3.67, p=0.78) between the two groups. CONCLUSIONS Additional fibular fixation does not appear to reduce the rate of varus-valgus deformity, anterior-posterior deformity, or malreduction. Meanwhile, it does not appear to impair the union process or increase the odds of infection. However, additional fibular fixation was associated with decreased odds of rotation deformity compared to controls.
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Sun DD, Lv D, Zhou K, Chen J, Gao LL, Sun ML. External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study. BMC Musculoskelet Disord 2021; 22:1. [PMID: 33397351 PMCID: PMC7780413 DOI: 10.1186/s12891-020-03840-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/26/2020] [Indexed: 12/02/2022] Open
Abstract
Background To compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula. Methods From January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups. Results Four patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05). Conclusion Compared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.
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Affiliation(s)
- Dong-Dong Sun
- Department of Orthopedic, Characteristic Medical center of Chinese People's Armed Police Force, No. 220 Cheng Lin Road, Tianjin, 300171, China.,Logistics University of People's Armed Police, Tianjin, 300300, China
| | - Dan Lv
- Department of Orthopedic, Characteristic Medical center of Chinese People's Armed Police Force, No. 220 Cheng Lin Road, Tianjin, 300171, China
| | - Kun Zhou
- Logistics University of People's Armed Police, Tianjin, 300300, China
| | - Jian Chen
- Logistics University of People's Armed Police, Tianjin, 300300, China
| | - Li-Lan Gao
- School of Mechanical Engineering, Tianjin University of Technology, No. 391 Bin Shui West Road, Tianjin, 300384, China.
| | - Ming-Lin Sun
- Department of Orthopedic, Characteristic Medical center of Chinese People's Armed Police Force, No. 220 Cheng Lin Road, Tianjin, 300171, China.
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Tian R, Zheng F, Zhao W, Zhang Y, Yuan J, Zhang B, Li L. Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis. J Orthop Surg Res 2020; 15:377. [PMID: 32883313 PMCID: PMC7469357 DOI: 10.1186/s13018-020-01904-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study is to assess the prevalence of nonunion in patients with tibia fracture and the association between influencing factors and tibia fracture nonunion. METHOD A database searches of PubMed, the Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Weipu database, and Wanfang database from inception until June 2019 was conducted. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata software. RESULTS In this study, 111 studies involving 41,429 subjects were included. In the study of the relationship between influencing factors and tibia fracture nonunion, 15 factors significantly influenced the fracture union, including > 60 years old, male, tobacco smoker, body mass index > 40, diabetes, nonsteroidal anti-inflammatory drugs (NSAIDs) user, opioids user, fracture of middle and distal tibia, high-energy fracture, open fracture, Gustilo-Anderson grade IIIB or IIIC, Müller AO Classification of Fractures C, open reduction, fixation model, and infection. CONCLUSION The prevalence of nonunion in patients with tibia fracture was 0.068 and 15 potential factors were associated with the prevalence. Closed reduction and minimally invasive percutaneous plate osteosynthesis (MIPPO) have the low risks of nonunion for the treatment of tibial fractures.
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Affiliation(s)
- Ruifeng Tian
- Department of Orthopaedics, No.1 Hospital of China Medical University, Shenyang, China
| | - Fang Zheng
- Department of Orthopaedics, No.1 Hospital of China Medical University, Shenyang, China
- Department of Orthopaedics, Shenyang Orthopaedic Hospital, Shenyang, China
| | - Wei Zhao
- Department of Orthopaedics, No.1 Hospital of China Medical University, Shenyang, China
- Department of Orthopaedics, No.4 Hospital of China Medical University, Guangzhou, China
| | - Yuhui Zhang
- Department of Dermatology, No.1 Hospital of China Medical University, Guangzhou, China
| | - Jinping Yuan
- Department of Dermatology, No.1 Hospital of China Medical University, Guangzhou, China
| | - Bowen Zhang
- Department of Orthopaedics, No.1 Hospital of China Medical University, Shenyang, China
| | - Liangman Li
- Department of Orthopaedics, No.1 Hospital of China Medical University, Shenyang, China.
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Liu XK, Xu WN, Xue QY, Liang QW. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis. Orthop Surg 2020; 11:954-965. [PMID: 31823496 PMCID: PMC6904655 DOI: 10.1111/os.12575] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/14/2022] Open
Abstract
To evaluate the application, safety and efficacy of the patients treated with intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal tibia fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, we searched databases PubMed, Cochrane library, EMBASE and Web of Science from inception of the database up to 10 October 2018, using the keywords "distal tibia fractures", "plate", "intramedullary nailing" and "RCT" to identify randomized clinical trials about distal tibia fractures. The included studies were assessed by two researchers according to the Cochrane risk-of-bias criteria. The primary outcome of measurement included operation time, malunion rate, nonunion/delayed union rate, and wound complication. Data analysis was conducted with Review Manager 5.3 software. A total of 10 RCTs involving 911 patients fulfilled the inclusion criteria with 455 patients in the IMN group and 456 patients in the MIPO group. There were no significant differences in radiation time, nonunion or delayed union rate, union time and operation time between the two groups. Patients treated with MIPO had lower incidence of malunion compared with IMN (RR = 1.85, 95%CI: 1.21 to 2.83, P = 1.00), while IMN seemed to have lower surgical incision complications whether in closed or opening fractures (RR = 0.49, 95%CI 0.33 to 0.73, P = 0.43). But in patients classified as 43A, the result of subgroup analysis suggested that there was no significant inwound complication between the two groups. MIPO was superior in preventing malunion compared with IMN, and intramedullary nailing appeared to have lower wound complications. However, in patients with 43A distal tibial fractures, MIPO was more recommended for its prevention of malunion. No matter which method we choose, we should notice and prevent the associated complications.
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Affiliation(s)
- Xiao-Kai Liu
- Joint Surgery Department, Chaoyang Central Hospital, Chaoyang City, Liaoning Province, China
| | - Wen-Nan Xu
- Department of Orthopaedic, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qing-Yun Xue
- Department of Orthopaedic, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Qing-Wei Liang
- Department of Orthopaedic, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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Immediate weightbearing after intramedullary fixation of extra-articular distal tibial fractures reduces the nonunion rate compared with traditional weight-bearing protocol: A cohort study. Int J Surg 2020; 76:132-135. [DOI: 10.1016/j.ijsu.2020.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/02/2020] [Accepted: 02/28/2020] [Indexed: 01/01/2023]
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