Purpose： To compare the outcomes of closed reduction and expert tibial nailing （ETN） versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods： This study included 53 c...Purpose： To compare the outcomes of closed reduction and expert tibial nailing （ETN） versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods： This study included 53 cases of two segmental fractures of the tihial shaft. They were admitted to our department between March 2010 and June 2013 and treated respectively by closed reduction and ETN （ETN group, n = 31 ） or open reduction fixation with plate and screws （PS group, n = 22）. The general data of two groups including gender, age, injury cause, fracture type, etc showed no significant difference （p 〉 0.05）. To compare the therapeutic effects between two groups, the intraoperative condition, post- operative function and related complications were investigated. Results： All the patients were successfully followed up. The period was 19.2 months for ETN group and 20.5 months for PS group. All the fractures in ETN group had union without complications such as malunion, infection, or osteofascial compartment syndrome; whereas there were 3 cases of superficial infection cured by repeated dressing change and 2 cases of delayed union in PS group. The total incidence of complication in PS group was 22.7% （5/22）, much higher than that in ETN group （p 〈 0.05）. Moreover, ETN group showed a better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. In ETN group, at one-year follow-up, Johner-Wruhs＇ criteria was adopted to assess the postoperative function, which was reported as excellent in 18 cases, good in 10 cases and fair in 3 cases in ETN group （100% excellent-good rate）. While in PS group, the result was excellent in 10 cases, good in 7 cases, fair in 3 cases and poor in 2 cases （77.3% excellent-good rate）. The comparison was insignificant （p 〉 0.05）. Conclusion： Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat two segmental tibial fractures.展开更多
Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecr...Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecranon to 5th metacarpal head"(O-MH)measurement can be used to reliably predict the tibial nail length.Methods:This was a cross sectional study involving 100 volunteers.Measurements were done and recorded by two observers on two separate occasions.Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus(TT-MM).O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched.Statistical analysis was done to find out correlation between two measurements and influence of age,gender and body mass index on them.Results:Paired t-test showed no systematic error between the readings.Intraclass correlation coefficient showed strong agreement in inter and intra observer settings.Strong correlation was found between the TT-MM&O-MH measurements using Pearson's correlation coefficient test(r=0.966).Hierarchical regression analysis showed age,gender and BMI have no statistically significant bearings on these measurements and their correlations.Conclusion:O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.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
文摘Purpose： To compare the outcomes of closed reduction and expert tibial nailing （ETN） versus open reduction and plate and screw fixation in treating two segmental tibial fractures. Methods： This study included 53 cases of two segmental fractures of the tihial shaft. They were admitted to our department between March 2010 and June 2013 and treated respectively by closed reduction and ETN （ETN group, n = 31 ） or open reduction fixation with plate and screws （PS group, n = 22）. The general data of two groups including gender, age, injury cause, fracture type, etc showed no significant difference （p 〉 0.05）. To compare the therapeutic effects between two groups, the intraoperative condition, post- operative function and related complications were investigated. Results： All the patients were successfully followed up. The period was 19.2 months for ETN group and 20.5 months for PS group. All the fractures in ETN group had union without complications such as malunion, infection, or osteofascial compartment syndrome; whereas there were 3 cases of superficial infection cured by repeated dressing change and 2 cases of delayed union in PS group. The total incidence of complication in PS group was 22.7% （5/22）, much higher than that in ETN group （p 〈 0.05）. Moreover, ETN group showed a better result in terms of intraoperative blood loss, operation time, postoperative weight bearing time and fracture union time. In ETN group, at one-year follow-up, Johner-Wruhs＇ criteria was adopted to assess the postoperative function, which was reported as excellent in 18 cases, good in 10 cases and fair in 3 cases in ETN group （100% excellent-good rate）. While in PS group, the result was excellent in 10 cases, good in 7 cases, fair in 3 cases and poor in 2 cases （77.3% excellent-good rate）. The comparison was insignificant （p 〉 0.05）. Conclusion： Compared with plate and screw fixation, ETN fixation has the advantages of fewer complications, shorter operation time, being less invasive, earlier postoperative rehabilitation and weight bearing, quicker fracture union and better functional recovery, thus being an effective way to treat two segmental tibial fractures.
文摘Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecranon to 5th metacarpal head"(O-MH)measurement can be used to reliably predict the tibial nail length.Methods:This was a cross sectional study involving 100 volunteers.Measurements were done and recorded by two observers on two separate occasions.Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus(TT-MM).O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched.Statistical analysis was done to find out correlation between two measurements and influence of age,gender and body mass index on them.Results:Paired t-test showed no systematic error between the readings.Intraclass correlation coefficient showed strong agreement in inter and intra observer settings.Strong correlation was found between the TT-MM&O-MH measurements using Pearson's correlation coefficient test(r=0.966).Hierarchical regression analysis showed age,gender and BMI have no statistically significant bearings on these measurements and their correlations.Conclusion:O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.
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.
