Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Analysis of Radiological and Clinical Results in Treatment of Open Segmented Tibia Fractures: A Comparison between Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis

  • Kim, Ji Wan (Department of Orthopaedic Surgery, Haeundae Paik Hospital, Inje University) ;
  • Song, Hyung Keun (Department of Orthopaedic Surgery, Ajou University School of Medicine)
  • Received : 2016.08.18
  • Accepted : 2016.09.12
  • Published : 2016.09.30
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Abstract

Purpose: The purpose of this study was to compare the data comprehensively including not only the clinical and radiographic outcomes but some parameters related to operation between the minimally invasive plate osteosynthesis (MIPO) technique and intramedullary nailing (IMN) for treatment of segmental tibia shaft fractures. Methods: We conducted a retrospective study of 31 patients (mean age, 49.3 years, range, 27-74 years), with a mean follow-up of 14.1 months (range, 12-19 months) with acute segmental tibial fractures (AO 42-C2) who underwent either surgical treatment of MIPO or IMN. In accordance with the Gustilo-Anderson classification, 11 were type I, 5 were type II, and 15 were type III. Initial compartment syndrome was confirmed in 2 cases. Results: There were no statistically significant differences in terms of the patient demographic data between the two groups. The time to definitive fixation was longer in the MIPO group (mean $13.7{\pm}10.9days$; range, 2-27) than in the intramedullary group (mean $5.4{\pm}9.6days$; range, 0-35) with statistically significant difference (p=0.002). Bony union was observed in most of cases but except 5 cases of nonunion were diagnosed (3 in the MIPO vs 2 in IMN, p=0.188). The average bone healing time was 27.1 weeks (10 to 56 weeks) in MIPO group and 23.2 weeks (13 to 66 weeks) in IMN group, respectively (p=0.056). Overall complications were 5 cases in MIPO group and 2 cases in the IMN group. Difference in LEFS was not statistically significant between both groups (p=0.824). Conclusion: This study showed that segmental tibia shaft fractures treated with both MIPO and intramadullary nailing was challenging with relatively high complication rate. A well planned sequential strategy with keeping the soft tissue and personality of fracture in mind is utmost significant as much as the choice of surgical modalities.

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References

  1. Arastu MH, Sheehan B, Paolucci EO, Buckley RE. Does it really spin? Intra-medullary nailing of segmental tibial fractures--a cadaveric study. Injury 2015; 46: 643-8. https://doi.org/10.1016/j.injury.2015.01.014
  2. Foster PA, Barton SB, Jones SC, Morrison RJ, Britten S. The treatment of complex tibial shaft fractures by the Ilizarov method. J Bone Joint Surg Br 2012; 94: 1678-83.
  3. Huang CK, Chen WM, Chen TH, Lo WH. Segmental tibial fractures treated with interlocking nails. A retrospective study of 33 cases. Acta Orthop Scand 1997; 68: 563-6. https://doi.org/10.3109/17453679708999027
  4. Kakar S, Tornetta P, 3rd. Segmental tibia fractures: a prospective evaluation. Clin Orthop Relat Res 2007; 460: 196-201.
  5. Teraa M, Blokhuis TJ, Tang L, Leenen LP. Segmental tibial fractures: an infrequent but demanding injury. Clin Orthop Relat Res 2013; 471: 2790-6. https://doi.org/10.1007/s11999-012-2739-z
  6. McMahon SE, Little ZE, Smith TO, Trompeter A, Hing CB. The management of segmental tibial shaft fractures: A systematic review. Injury 2016; 47: 568-73. https://doi.org/10.1016/j.injury.2015.11.022
  7. Kim KC, Lee JK, Hwang DS, Yang JY, Kim YM. Tibial unreamed intramedullary nailing using schanz screws in displaced diaphyseal segmental fractures. Orthopedics 2007; 30: 906-8.
  8. Ozturkmen Y, Karamehmetoglu M, Karadeniz H, Azboy I, Caniklioglu M. Acute treatment of segmental tibial fractures with the Ilizarov method. Injury 2009; 40: 321-6. https://doi.org/10.1016/j.injury.2008.07.013
  9. Sarmiento A, Latta LL. Functional treatment of closed segmental fractures of the tibia. Acta Chir Orthop Traumatol Cech 2008; 75: 325-31.
  10. Wu CC, Shih CH. Segmental tibial shaft fractures treated with interlocking nailing. J Orthop Trauma 1993; 7: 468-72. https://doi.org/10.1097/00005131-199310000-00010
  11. Yoon RS, Bible J, Marcus MS, Donegan DJ, Bergmann KA, Siebler JC, et al. Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: A multicentre study. Injury 2015; 46: 1097-101. https://doi.org/10.1016/j.injury.2015.03.019
  12. Ma CH, Tu YK, Yeh JH, Yang SC, Wu CH. Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures. J Trauma 2011; 71: 614-9. https://doi.org/10.1097/TA.0b013e3182041175
  13. Reynders P. Open acute segmental tibial fracture fixation using the Less Invasive Stabilisation System (LISS): study of 23 consecutive cases. Injury 2009; 40: 449-54. https://doi.org/10.1016/j.injury.2008.09.007
  14. Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 1999; 79: 371-83.
  15. Rommens PM, Coosemans W, Broos PL. The difficult healing of segmental fractures of the tibial shaft. Arch Orthop Trauma Surg 1989; 108: 238-42. https://doi.org/10.1007/BF00936208
  16. Giannoudis PV, Hinsche AF, Cohen A, Macdonald DA, Matthews SJ, Smith RM. Segmental tibial fractures: an assessment of procedures in 27 cases. Injury 2003; 34: 756-62. https://doi.org/10.1016/S0020-1383(02)00393-5
  17. Woll TS, Duwelius PJ. The segmental tibial fracture. Clin Orthop Relat Res 1992: 204-7.