Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of...Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.展开更多
A study was performed in adults to determine the efficacy of closed reduction and intramedullary nailing in dynamic mode on union, implant failure and incidence of malalignment in patients who sustained an extra-artic...A study was performed in adults to determine the efficacy of closed reduction and intramedullary nailing in dynamic mode on union, implant failure and incidence of malalignment in patients who sustained an extra-articular fracture of the distal tibia. Methods: Between January 2007 and December 2013, one hundred and twelve patients of distal tibia that involved the distal 6 cm of the tibia were treated at our hospital with reamed intramedullary nailing with use of two distal interlocking screws and one proximal screw in dynamic mode. The augmentation was done with poller screws whenever it was necessary. The nailing of fibular fractures was done in 27 cases. There were 85 males and 27 females with a mean age of 30.9 (range: 20 to 72). Eighty fractures were closed whereas 32 were grade 1 open fractures. 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 (range: 15 - 34 weeks). After minimum follow-up of one year, rate of primary union was in 97.32%. One case of broken nail required revision surgery. There were three cases of delayed union and two cases of non union. In one case there was deep infection which required exchange nailing with antibiotic impregnated nail. There was breakage of interlocking screws in three cases but fracture had united. In twenty two cases acceptable malalignment of the tibia was observed after union. The outcome was determined at a minimum of one year in our study based on the criteria of Johner and Wruhs. Out of 112 patients, 79 patients had excellent results, 29 had good results and 4 had fair results. 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.展开更多
Objective:To study the effect of different surgical methods on trauma response degree and osteoblast-osteoclast balance in patients with distal tibial fracture.Methods:58 cases of patients with distal tibial fracture ...Objective:To study the effect of different surgical methods on trauma response degree and osteoblast-osteoclast balance in patients with distal tibial fracture.Methods:58 cases of patients with distal tibial fracture who received open reduction and internal fixation in Orthopedics Department of our hospital from May 2013 to October 2015 were selected as research subjects and divided into delayed group (n = 29) and routine group (n = 29) according to different timing of surgery. Delayed group received open reduction and internal fixation 7–15 d after trauma and routine group received open reduction and internal fixation within 24 h after trauma. Levels of serum stress response indicators and osteoblast-osteoclast markers were compared between two groups.Results:On the day after operation, serum adrenocorticotropic hormone, cortisol, renin, angiotensin II, epinephrine and norepinephrine levels of delayed group were significantly lower than those of control group (P<0.05);on the 7th day after operation, serum osteocalcin, procollagen type I carboxyl-terminal peptide and bone alkaline phosphatase of delayed group were significantly higher than those of control group (P<0.05) while cross-linked carboxyl-terminal telopeptide of type I collagen and tartrate-resistant acid phosphatase isoform 5b levels were significantly lower than those of control group (P<0.05). Conclusions: Delayed open reduction and internal fixation treatment of distal tibial fracture can reduce the trauma caused by surgical procedures, increase osteoblast viability and inhibit osteoclast viability, which are conducive to fracture healing.展开更多
文摘Purpose:Distal tibia fractures comprise about 7%-10% of lower extremity trauma.Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures.Plating is fraught with complications of wound dehiscence and infection.There are limited studies which document outcomes in such cases using intramedullary interlocking nail.We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India.There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study.Only cases with fresh injury (less than 1 week),fracture below the isthmus,closed and open Gustilo Anderson type 1 and 2 fractures were included in the study.Patients were reviewed at 3,6,12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing,any complications,time to union and functional outcome.Results:There were 102 males and 45 females (male/female ratio is 2.3∶1) with a mean age of 38.96 (range 23-65) years.According to AO classification,there were 78 cases (53.06%) of 43-A1,39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%.The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks),none of the patient in our series had a delayed or non-union.Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°).The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score,there were no cases with poor score.Conclusion:Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome.Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.
文摘A study was performed in adults to determine the efficacy of closed reduction and intramedullary nailing in dynamic mode on union, implant failure and incidence of malalignment in patients who sustained an extra-articular fracture of the distal tibia. Methods: Between January 2007 and December 2013, one hundred and twelve patients of distal tibia that involved the distal 6 cm of the tibia were treated at our hospital with reamed intramedullary nailing with use of two distal interlocking screws and one proximal screw in dynamic mode. The augmentation was done with poller screws whenever it was necessary. The nailing of fibular fractures was done in 27 cases. There were 85 males and 27 females with a mean age of 30.9 (range: 20 to 72). Eighty fractures were closed whereas 32 were grade 1 open fractures. 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 (range: 15 - 34 weeks). After minimum follow-up of one year, rate of primary union was in 97.32%. One case of broken nail required revision surgery. There were three cases of delayed union and two cases of non union. In one case there was deep infection which required exchange nailing with antibiotic impregnated nail. There was breakage of interlocking screws in three cases but fracture had united. In twenty two cases acceptable malalignment of the tibia was observed after union. The outcome was determined at a minimum of one year in our study based on the criteria of Johner and Wruhs. Out of 112 patients, 79 patients had excellent results, 29 had good results and 4 had fair results. 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.
文摘Objective:To study the effect of different surgical methods on trauma response degree and osteoblast-osteoclast balance in patients with distal tibial fracture.Methods:58 cases of patients with distal tibial fracture who received open reduction and internal fixation in Orthopedics Department of our hospital from May 2013 to October 2015 were selected as research subjects and divided into delayed group (n = 29) and routine group (n = 29) according to different timing of surgery. Delayed group received open reduction and internal fixation 7–15 d after trauma and routine group received open reduction and internal fixation within 24 h after trauma. Levels of serum stress response indicators and osteoblast-osteoclast markers were compared between two groups.Results:On the day after operation, serum adrenocorticotropic hormone, cortisol, renin, angiotensin II, epinephrine and norepinephrine levels of delayed group were significantly lower than those of control group (P<0.05);on the 7th day after operation, serum osteocalcin, procollagen type I carboxyl-terminal peptide and bone alkaline phosphatase of delayed group were significantly higher than those of control group (P<0.05) while cross-linked carboxyl-terminal telopeptide of type I collagen and tartrate-resistant acid phosphatase isoform 5b levels were significantly lower than those of control group (P<0.05). Conclusions: Delayed open reduction and internal fixation treatment of distal tibial fracture can reduce the trauma caused by surgical procedures, increase osteoblast viability and inhibit osteoclast viability, which are conducive to fracture healing.