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Journal Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES
Year 2014
BACKGROUND: In this study, we aimed to compare the functional and radiological results of intramedullary nailing and plate fixation techniques in the surgical treatment of distal tibia diaphyseal fractures close to the ankle joint. METHODS: Between 2005 and 2011, 55 patients (32 males, 23 females; mean age 42 years; range 15 to 72 years) who were treated with intramedullary nailing (21 patients) or plate fixation (34 patients) due to distal tibia diaphyseal fracture were included in the study. The average follow-up period was 27.6 months (range, 12-82 months). The patients were evaluated with regard to nonunion, malunion, infection, and implant irritation. The AOFAS (American Orthopaedic Foot and Ankle Society) scale was used for the clinical evaluation. RESULTS: No statistically significant difference was found between the two surgical methods with respect to unification time, AOFAS score, accompanying fibula fracture, material irritation, and malunion. Nine patients had open fractures, and these patients were treated with plate fixation (p=0.100). Nonunion developed in three patients who were treated with plates. Infection occurred in one patient. Anterior knee pain was significantly higher in patients who were treated with intramedullary nails. There was no malunion in any patient. CONCLUSION: As the distal fragment is not long enough, plate fixation technique is usually preferred in the treatment of distal tibia diaphyseal fractures. In this study, we observed that if the surgical guidelines are followed carefully, intramedullary nailing is an appropriate technique in this kind of fracture. The malunion rates are not significantly increased, and it also has the advantages of being a minimally invasive surgery with fewer wound problems.

Primary study

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Authors Guo, YQ , Li, GW , Luo, JH , Chen, T , Huang, CX , Li, JX
Journal 广东医学 (Guangdong Medical Journal)
Year 2014
Abstract: Objective To compare, the lateral minimally invasive percutaneous plate osteosynthesis (MIPPO) and intramedullary nail fixation for AO / ASIF-43 A type distal tibial fractures clinical effect will undergo surgery in 90 cases of AO / ASIF- 43 A type distal tibial fractures were randomly divided into three groups, each group with 30 cases .A MIPPO medial treatment, group B outer MIPPO therapy, group C using intramedullary nail fixation. using the corresponding measurement parameters and radiographic clinical score to assess the effect of the surgery. Results The operation time, blood loss, hospital stay and fracture healing time difference was not statistically significant (P> 0.05) .3 group were healed fracture in all patients. Postoperative 18 After months of follow-up, three groups Lowa ankle malunion rates and incidence differences were statistically significant (P <0.05), group C was significantly higher than A, group B (P <0.05), A, group B of There was no significant difference between (P> 0.05) .A, B, C group of soft tissue complication rates were 13.3%, 10.0% and 0, between the two groups was statistically significant (P = 0.047) difference between group C significantly lower than A, group B (P <0.05), not between A, B group difference was statistically significant (P> 0.05). Conclusion MIPPO treatment AO / ASIF-43A type distal tibial fractures and soft tissue complication rate intramedullary nailing, and the high incidence of intramedullary nailing malunion in MIPPO; inside, outside of clinical treatment MIPPO rather, when the distal medial tibia poor skin condition, choose the outside MIPPO implementation fracture fixation .

Primary study

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Authors Li Y , Jiang X , Guo Q , Zhu L , Ye T , Chen A
Journal International orthopaedics
Year 2014
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PURPOSE: A few studies focused on the methods of treatment for displaced distal tibial shaft fractures have been published, all of which compared two different methods. In this randomized, prospective study, we aimed to compare minimally invasive plate osteosynthesis, locking intramedullary nail stabilization and external fixation combined with limited open reduction and absorbable internal fixation for distal tibial shaft fractures by assessing complications and secondary procedures. METHODS: From November 2002 to June 2012, 137 skeletally mature patients with displaced distal tibial shaft fractures with or without fibula fracture were randomized to be treated by minimally invasive plate osteosynthesis (group A, n = 46), locking intramedullary nail (group B, n = 46) or external fixation combined with limited open reduction and absorbable internal fixation (group C, n = 45). Age, gender, mechanism of injury, fracture pattern and presence of open fracture were equally distributed among the three groups. Indexes for evaluation included hospital stay, operative time, time to radiographic union, union status, infection and the incidence of re-operation. Mazur ankle score was introduced for functional evaluation. Statistics Analysis System (SAS) 9.2 was used for analysis. RESULTS: A total of 121 patients were included in the final analysis (group A 42, group B 40 and group C 39) and evaluated after a mean of 14.8 months follow-up. There was no significant difference (P > 0.05) in hospital stay, time to radiographic union and the incidence of union status among the three groups. Although group C was associated with less secondary procedures versus groups A and B, it was related with more pin tract infections (15.4 %). Anterior knee pain occurred frequently after locking intramedullary nailing (37.5 %) and the irritation symptoms were more frequently encountered in group A (59.5 %). There was no difference in ankle function between the three methods after operation (P > 0.05). CONCLUSIONS: We consider that the minimally invasive plate osteosynthesis, locking intramedullary nail stabilization and external fixation combined with limited open reduction and absorbable internal fixation techniques are all efficient methods for treating distal tibia fractures. With its wide indications, external fixation combined with limited open reduction and absorbable internal fixation leads to minimal soft tissue complication, good functional result and no local soft tissue irritation or implant removal.

Primary study

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Authors Yao Q , Ni J , Peng LB , Yu DX , Yuan XM
Journal Zhonghua yi xue za zhi
Year 2013
OBJECTIVE: To compare the efficacies of minimally invasive plate osteosynthesis (MIPPO) and interlocking intramedullary nailing (IMN) in the treatment of extra-articular fractures of distal tibia. METHODS: Retrospective reviews were conducted for 126 patients with extra-articular distal tibia fractures. Treatment was either MIPPO (n = 61) or IMN (n = 65). The outcomes were assessed by comparing operating duration, time to union, the last follow-up American Orthopedic Foot and Ankle Society (AOFAS) score and complication rate. RESULTS: The average follow-up period was 23.7 (12-53) months. In the minimally invasive plate osteosynthesis group, there were deep infections (n = 2), superficial infections (n = 5), delayed union (n = 2), malunion (n = 2) and knee joint pain (n = 10) were observed. In addition, the average operating duration (85.9 ± 18.9 min), average time to union (17.3 ± 3.8 weeks) and average AOFAS (83.2 ± 11.9) were analyzed. In the interlocking intramedullary nailing group, there were delayed union (n = 3), malunion (n = 12) and knee joint pain (n = 22). And the average operating duration (83.3 ± 15.7 min), average time to union (16.5 ± 3.1 weeks) and average AOFAS (84.9 ± 12.0) were analyzed. No statistical significance existed in operating duration, time to union and the last follow-up AOFAS between two groups (P > 0.05). However, the rates of malformation and knee joint pain were higher in the intramedullary nail group than those in the plate group. And the difference was statistically significant (P = 0.015, P = 0.025). CONCLUSION: Both MIPPO and IMN are effective for extra-articular fractures of distal tibia. However, the former has the advantage of lowers rate of malformation and knee joint pain. Therefore a surgeon should consider the degree of injury while managing extra-articular fracture of distal tibia.

Primary study

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Authors Seyhan M , Unay K , Sener N
Journal European journal of orthopaedic surgery & traumatology : orthopédie traumatologie
Year 2013
The aim of this study is to compare distal tibial fractures (4-10 cm proximal to the plafond) treated by intramedullary nailing with those treated by percutaneous locked plating and to assess the clinical and radiographic results, complication rates, and the need for secondary procedures. Thirty-six patients received percutaneous locked plate treatment and 25 patients received intramedullary nail treatment. The results obtained from these two treatment methods were assessed by comparing infection rates, starting time for wight-bearing, local implant irritation, union and malunion rates and along with secondary procedures. In the percutaneous locked plate group, two deep infections, four superficial infections, two nonunions, one malunion and 10 local implant irritations were observed. In the intramedullary nail group, one nonunion, four malunions and two local implant irritations were observed. The incidence of deep and superficial infections, local implant irritations and secondary procedures in the percutaneous locked plate group was greater than those in the intramedullary nail group. The time to full weight bearing was shorter in the intramedullary nail group. There was no significant statistical difference in malunion and nonunion rates between the two groups. The need for secondary procedures was more common in group receiving the percutaneous locked plate treatment and the time to full weight bearing was shorter in the intramedullary nail group.

Primary study

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Authors ZHU Weiguo
Journal 组织工程与重建外科杂志 (Journal of Tissue Engineering and Reconstructive Surgery )
Year 2013
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OBJECTIVE:To investigate the clinical effects of expert tibial nail in treating distal tibial fracture. METHODS:From January 2010 to December 2012, 74 patients with distal tibial fracture were randomly divided into 2 groups, experimental group (n=37) and control group (n=37). Patients in experimental group were treated with expert tibial nail fixation while patients in control group were treated with anatomical plate fixation. The surgical information and postoperative recovery of the two groups were compared.RESULTS: There was no significant differences of operative time, blood loss, times of X-ray exam, postoperative hospital stay and incidence of major complications between the two groups ( P>0.05);Preoperative hospital time, total hospitalization time, full weight bearing time and bone healing time of experimental group were shorter than that of control group (P<0.05); There was no significant differences of post-operative rehabilitation and function score between the two groups according to Ankle Symptom and Function Score and Johner&Wruhs Score ( P>0.05).CONCLUSION:Expert tibial nail is effective in treating tibial fracture, which is conducive to the patient's early recovery, and is worthy of promotion.

Primary study

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Journal 中国骨与关节损伤杂志 (Chinese Journal of Bone and Joint Injury)
Year 2013
Objective To compare the intramedullary nail and locking plate fixation of distal tibial metaphyseal fractures. Methods 102 cases of distal tibial metaphyseal fracture of the fibula fractures were treated with closed reduction and intramedullary nail (nail group, 50 cases) and locking plate (plate group, 52 cases) and internal fixation, open reduction and fibula fracture reduction and plate fixation. results intramedullary nail group and steel group, shorter operative time, less wound complications and the incidence of pain irritation , fracture healing time shorter, AOFAS score higher, the differences were statistically significant (P <0.05). Conclusion with fibula fracture treatment for distal metaphyseal fractures of the tibia, ultra-distal interlocking intramedullary nailIt is the better choice.

Primary study

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Authors KE Difeng , ZENG Qiutao
Journal 中外医疗 (China Foreign Medical Treatment)
Year 2013
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Objective To evaluate the clinical efficacy of tibial interlocking intramedullary nail and percutaneous plate fixation of distal tibial fractures. Methods A retrospective analysis of the hospital in January 2010 - September 2012 adopted by interlocking intramedullary nail or percutaneous plate solid 62 cases of surgical treatment of distal tibial fracture patients with clinical data, divided according to the surgical intramedullary nail group (n = 32) and the plate group (n = 30), general information and treatment of two groups were compared. Results All patients receive 12 months or more of follow-up, both groups surgery time, maximum ankle dorsiflexion degree perspective often no significant difference (P0.05). Intramedullary nail group blood loss was less in the plate group (P0.05). All patients were healing well, intramedullary nail group, the average healing time was 21.3 weeks, steel group was 19.1 weeks. Intramedullary nail group, two cases of angular deformity healing, steel group, 4 cases of soft tissue complications. Effective internal fixation Conclusion Interlocking intramedullary nail and percutaneous plate is distal tibial fractures, and interlocking intramedullary nail for local soft tissue injury associated with fracture more favorable.

Primary study

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Authors Li Y , Liu L , Tang X , Pei F , Wang G , Fang Y , Zhang H , Crook N
Journal International orthopaedics
Year 2012
PURPOSE: The aim of this study was to compare the results of a new technique for low, multidirectional locked nailing with closed reduction and minimally invasive plating in the treatment of distal tibial metadiaphyseal fractures. METHODS: Forty-six matched patients were divided according to age, gender, Injury Severity Score, and fracture pattern into group A (expert tibial nailing) and group B (minimally invasive plating). Then, the patients were followed up, and the clinical and radiographic results were retrospectively analysed. RESULTS: The mean followed-up was 24.7±2.7 months in group A and 25.8±2.8 months in group B. No patient had nonunion, shortening, hardware breakdown, or deep-seated infection. Patients in group A had a significantly shorter mean operating time, hospital stay, full weight-bearing time and union time (76±16.6 vs. 90±20.3 minutes, p=0.000; 5.8±2.1 vs. 8.9±3.1 days, p=0.000; 9.0±1.4 vs. 11.1±1.7 weeks, p=0.000; and 21.3±3.5 vs. 23.1±3.6 weeks, p=0.047, respectively). Three patients in group A and one patient in group B presented with malalignment (p=0.608). The mean Olerud-Molander Ankle score was 89.0±7.1 in group A and 87.6±8.4 in group B (p=0.478). CONCLUSIONS: Distal tibia metadiaphyseal fractures may be treated successfully with low, multidirectional locked nails or plates. However, low, multidirectional locked nailing may represent a superior surgical option, since it offers advantages in terms of mean operating time, hospital stay, full weight-bearing time and union time.