2007, Number 4
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Acta Ortop Mex 2007; 21 (4)
Use of the orthofix intramedullary nail in tibial shaft fractures. A review of 22 cases
García JJD, Aguilera ZJM, Tohen BA, Encalada DMI, Dávila SO
Language: Spanish
References: 21
Page: 212-216
PDF size: 102.26 Kb.
ABSTRACT
Introduction: Tibial shaft fractures are common since they account for 9% of all fractures. Intramedullary nailing is described in the literature as the gold standard for their treatment and the most recent research emphasizes minimum exposure.
Objective: To present the clinical and radiological course of closed, unreamed intramedullary fixation for tibial shaft fractures in a group of patients seen at Medica Sur Hospital.
Material and methods: Twenty-two male patients with a diagnosis of tibial shaft fracture were analyzed retrospectively; mean age was 28 years. In all of them the Orthofix nail was inserted through the patellar tendon, with a closed approach and without reaming the medullary cavity.
Results: Twenty patients had closed fractures (90.90%) and 2 patients had open fractures (9.09%). The mean time to starting ambulation with protected weight bearing was two weeks in 18 patients (81.81%); with full weight bearing, six weeks in 13 patients (91%). The mean time to full weight bearing without crutches was 10 weeks in 21 patients (95.45%). Mean radiographic grade III-IV healing time was 16 weeks. Complications were: delayed union in two patients (9.09%), compartmental syndrome, in one patient (4.45%).
Conclusion: The Orthofix interlocking intramedullary nail placed with a closed approach provides immediate stability due to the proximal and distal locking. Patient rehabilitation is quicker, with total mobility, providing an early stimulation for callus formation and the added benefit of sparing the endosteal blood supply.
REFERENCES
Vidyadhara S, Sharath KR: Prospective study of the clinical-radiological outcome of interlocked nailing in proximal third tibial fractures. Injury 2006; 37(6): 536-42.
Braten M, Helland P, Grontvedt T: External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomized study of 78 patients. Arch Orthop Trauma Surg 2005; 125(1): 21-6.
Toivanen JA, Honkonen SE: Treatment of low-energy tibial shaft fractures: plaster cast compared with intramedullary nailing. Int Orthop 2001; 25(2): 110-3.
Obremskey WT, Medina M: Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists. Orthopedics 2004; 27(11): 1180-4.
Burgos FJ: Cirugía ortopédica y traumatología. Fracturas diafisiarias de la tibia, primera edición. España, Editorial Médica Panamericana, 1999: 633-48.
Schmidt AH, Finkemeier CG. Treatment of closed tibial fractures. Instr Course Lect 2003; 52: 607-22.
Müller ME, Allgower, Schneider R, Willenegger H: Manual de osteosíntesis, fracturas de la diafisis de la tibia, octava edición, Alemania, Springer-Verlag Ibérica, 1998: 442-6.
Kutty S, Farooq M, Murphy D: Tibial shaft fractures treated with the AO undreamed tibial nail. Ir J Med Sci 2003; 172(3): 141-2.
Müller M: Intramedullary pressure, strain on the diaphysis and evaluation of temperature when reaming. Injury 1993; 24: 22-30.
Nassif JM, Gorczyca JT, Cole JK: Effect of acute reamed versus unreamed intramedullary nailing compartment pressure when treating closed tibial shaft fracture a randomized prospective study. J Orthop Trauma 2000; 14(8): 554-8.
Ruedi TP, Murphy WM: Principios de la AO en el tratamiento de las fracturas. Primera edición, Barcelona, Ed. Masson, 2003: 523-35.
Frankhauser F, Seibert FJ, Boldin C: The unreamed intramedullary tibial nail in tibial shaft fractures soccer players: a prospective study. Knee Surg Sports Traumatol Arthrosc 2004; 12(3): 254-8.
Crenshaw AH: Campbell cirugía ortopédica, fracturas de la extremidad inferior. Octava edición, Argentina, Editorial Médica Panamericana 1993: 751-75.
Giannoudis PV, Snowden S, Matthews SJ: Temperature rise during reamed tibial nailing. Clin Orthop Relat Res 2002; (395): 255-61.
Schatzker J, Tile M: Tratamiento quirúrgico de las fracturas, fracturas de la tibia. Segunda edición, Argentina, Editorial Médica Panamericana, 1998: 402-49.
Babis GC, Benetos IS, Karachalios T: Eight years clinical experience with Orthofix Tibial nailing system in the treatment of tibial shaft fractures. Injury 2007; 38(2): 227-34.
Vaisto O, Toivanen J, Kannus P: Anterior knee pain and thigh muscle strength after intramedullary nailing of shaft fractures: a report of 40 consecutive cases. J Orthop Trauma 2004; 18(1): 18-23.
Gugala Z, Nana A, Lindsey RW: Tibial intramedullary nail distal interlocking screw Placement: comparison of the free-hand versus distally-based targeting device techniques. Injury 2001; 32 Suppl 4: SD21-5.
Althausen PL, Neiman R: Incision placement for intramedullary tibial nailing: an anatomical study. J Orthop Trauma 2002; 16(10): 687-90.
Ben-Galim P, Rosemblatt Y, Parnes N: Intramedullary fixation of tibial fractures Using and expandable nail. Clin Orthop Relat Res 2007; 455: 234-40.
Steinberg EL, Geller DS, Yacoubian SV: Intramedullary fixation of tibial fractures Using an expandable nail: early results of 54 acute tibial shaft fractures. J Orthop Trauma 2006; 20(5): 303-9.