Skip to main content
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 8/2014

01.12.2014 | Technical Note

A tip to reduce the malrotation of the spiral tibial fracture intraoperatively

verfasst von: Jialiang Guo, Yingze Zhang, Zhiyong Hou, Zengyan Li

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 8/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Tibial spiral fractures treated by closed intramedullary (IM) nailing are at risk for malrotational deformities. The purpose of this study was to examine a method to minimize the risk of tibial malrotation during closed IM nailing of spiral tibial fractures.

Methods

This trial is done through 24 patients of spiral tibial fractures with a mean age of 38.5 years (range 26–63 years). The patients were divided into two groups. One group the fractures were reduced by rotating the distal locked nail to obtain rotational alignment and another group by the standard assistant rotated technique. All the patients were evaluated with CT scans postoperatively. The parameters such as rotational values, operative and radiation exposure time were recorded and compared between two groups. Mann–Whitney test was used to test the significance of these parameters.

Results

The group using the tip had a smaller mean rotational value, which was (6.8° ± 2.1° vs. 11.8° ± 5.2°; P < 0.01). The mean operative time was not statistically different (70.6 ± 4.4 vs. 63.0 ± 2.9 min; P > 0.05), so did the mean radiation exposure time (48.1 ± 4.2 vs. 42.6 ± 4.8 s; P > 0.05).

Conclusion

The described technique of rotating the nail after initial distal interlocking can correct rotational abnormalities in spiral tibial shaft fractures in the premise of not increasing the operative and radiation exposure times statistically.
Literatur
1.
Zurück zum Zitat Lefaivre KA, Guy P, Chan H et al (2008) Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma 22:525–529PubMedCrossRef Lefaivre KA, Guy P, Chan H et al (2008) Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma 22:525–529PubMedCrossRef
2.
Zurück zum Zitat Bone LB, Sucato D, Stegemenn PM et al (1997) Displaced isolated fractures of the tibial shaft treated with either a cast or intramedullary nailing. An outcome analysis of matched pairs of patients. J Bone Jt Surg Am 79:1336–1341 Bone LB, Sucato D, Stegemenn PM et al (1997) Displaced isolated fractures of the tibial shaft treated with either a cast or intramedullary nailing. An outcome analysis of matched pairs of patients. J Bone Jt Surg Am 79:1336–1341
3.
Zurück zum Zitat Webb LX, Bosse MJ, Castillo RC et al (2007) Analysis of surgeon-controlled variables in the treatment of limb-threatening type-III open tibial diaphyseal fracture. J Bone Jt Surg Am 89:923–928CrossRef Webb LX, Bosse MJ, Castillo RC et al (2007) Analysis of surgeon-controlled variables in the treatment of limb-threatening type-III open tibial diaphyseal fracture. J Bone Jt Surg Am 89:923–928CrossRef
4.
Zurück zum Zitat Jaarsma RL, Ongkiehong BF, Gruneberg C et al (2004) Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures. An analysis by plantar pressure measurements during gait. Injury 35(12):1270–1278PubMedCrossRef Jaarsma RL, Ongkiehong BF, Gruneberg C et al (2004) Compensation for rotational malalignment after intramedullary nailing for femoral shaft fractures. An analysis by plantar pressure measurements during gait. Injury 35(12):1270–1278PubMedCrossRef
5.
Zurück zum Zitat Theriault B, Turgeon AF, Pelet S et al (2012) Functional impact of tibial malrotation following intramedullary nailing of tibial shaft fractures. J Bone Jt Surg Am 94:2033–2039CrossRef Theriault B, Turgeon AF, Pelet S et al (2012) Functional impact of tibial malrotation following intramedullary nailing of tibial shaft fractures. J Bone Jt Surg Am 94:2033–2039CrossRef
6.
Zurück zum Zitat Puloski S, Romano C, Buckley R et al (2004) Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 18:397–402PubMedCrossRef Puloski S, Romano C, Buckley R et al (2004) Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 18:397–402PubMedCrossRef
7.
Zurück zum Zitat Gregory P, Sanders R (1995) The treatment of closed, unstable tibial shaft fracture with un-reamed interlocking nails. Clin Orthop Relat Res 315:48–55PubMed Gregory P, Sanders R (1995) The treatment of closed, unstable tibial shaft fracture with un-reamed interlocking nails. Clin Orthop Relat Res 315:48–55PubMed
8.
Zurück zum Zitat Johner R, Wruhs O (1983) Classification of tibial shaft fracture and correlation with results after rigid fixation. Clin Orthop Relat Res 178:7–25PubMed Johner R, Wruhs O (1983) Classification of tibial shaft fracture and correlation with results after rigid fixation. Clin Orthop Relat Res 178:7–25PubMed
9.
Zurück zum Zitat Boucher M, Leone J, Pierrynowski M et al (2002) Three-dimensional assessment of tibial malunion after intramedullary nailing: a preliminary study. J Orthop Trauma 16:473–483PubMedCrossRef Boucher M, Leone J, Pierrynowski M et al (2002) Three-dimensional assessment of tibial malunion after intramedullary nailing: a preliminary study. J Orthop Trauma 16:473–483PubMedCrossRef
10.
Zurück zum Zitat Kettelkamp DB, Hillbury BM, Murrish DE et al (1988) Degenerative arthritis of the knee secondary to fracture malunion. Clin Orthop Relat Res 234:159–169PubMed Kettelkamp DB, Hillbury BM, Murrish DE et al (1988) Degenerative arthritis of the knee secondary to fracture malunion. Clin Orthop Relat Res 234:159–169PubMed
11.
Zurück zum Zitat Kristensen KD, Kiaer T, Blicher J (1989) No arthrosis of the ankle twenty years after tibial shaft fracture. Acta Orthop Scand 60:208–209PubMedCrossRef Kristensen KD, Kiaer T, Blicher J (1989) No arthrosis of the ankle twenty years after tibial shaft fracture. Acta Orthop Scand 60:208–209PubMedCrossRef
12.
Zurück zum Zitat Kyrö A (1997) Malunion after intramedullary nailing of tibial shaft fractures. Ann Chirurg Gynaecol 86:56–64 Kyrö A (1997) Malunion after intramedullary nailing of tibial shaft fractures. Ann Chirurg Gynaecol 86:56–64
13.
Zurück zum Zitat McKellop HA, Llinas A, Sarmiento A (1994) Effects of tibial malalignment on the knee and ankle. Orthop Clin North Am 25:415–423PubMed McKellop HA, Llinas A, Sarmiento A (1994) Effects of tibial malalignment on the knee and ankle. Orthop Clin North Am 25:415–423PubMed
14.
Zurück zum Zitat Puno RM, Vaughan JJ, Stetten ML et al (1991) Long-term effects of tibial angular malunion on the knee and ankle joints. Clin Orthop Relat Res 5(3):247–254 Puno RM, Vaughan JJ, Stetten ML et al (1991) Long-term effects of tibial angular malunion on the knee and ankle joints. Clin Orthop Relat Res 5(3):247–254
15.
Zurück zum Zitat Puno RM, Vaughan JJ, Von Fraunhofer JA et al (1987) A method of determining the angular malunion of the knee and ankle joints resulting from tibial malunion. Clin Orthop Relat Res 223:213–219PubMed Puno RM, Vaughan JJ, Von Fraunhofer JA et al (1987) A method of determining the angular malunion of the knee and ankle joints resulting from tibial malunion. Clin Orthop Relat Res 223:213–219PubMed
16.
Zurück zum Zitat Prasad CV, Khalid M, McCarthy P et al (1999) CT assessment of torsion following locked intramedullary nailing of tibial fractures. Injury 30:467–470PubMedCrossRef Prasad CV, Khalid M, McCarthy P et al (1999) CT assessment of torsion following locked intramedullary nailing of tibial fractures. Injury 30:467–470PubMedCrossRef
17.
Zurück zum Zitat Prasad M, Yadav S, Sud A et al (2013) Assessment of the role of fibular fixation in distal-third tibia-fibula fractures and its significance in decreasing malrotation and malalignment. Inj Dec 44(12):1885–1891 Prasad M, Yadav S, Sud A et al (2013) Assessment of the role of fibular fixation in distal-third tibia-fibula fractures and its significance in decreasing malrotation and malalignment. Inj Dec 44(12):1885–1891
18.
Zurück zum Zitat Bouchard R, Meeder PJ, Krug F et al (2004) Evaluation of tibial torsion–comparison of clinical methods and computed tomography. Rofo 176:1278–1284PubMedCrossRef Bouchard R, Meeder PJ, Krug F et al (2004) Evaluation of tibial torsion–comparison of clinical methods and computed tomography. Rofo 176:1278–1284PubMedCrossRef
20.
Zurück zum Zitat Wähnert D, Stolarczyk Y, Hoffmeier KL et al (2013) Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures. BMC Musculoskelet Disord 14:66PubMedCentralPubMedCrossRef Wähnert D, Stolarczyk Y, Hoffmeier KL et al (2013) Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures. BMC Musculoskelet Disord 14:66PubMedCentralPubMedCrossRef
21.
Zurück zum Zitat Bishop JA, Dikos GD, Mickelson D et al (2012) Open reduction and intramedullary nail fixation of closed tibial fractures. Orthopedics 35:e1631–e1634PubMedCrossRef Bishop JA, Dikos GD, Mickelson D et al (2012) Open reduction and intramedullary nail fixation of closed tibial fractures. Orthopedics 35:e1631–e1634PubMedCrossRef
22.
Zurück zum Zitat Kumar A, Charlebois SJ, Cain EL et al (2003) Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Jt Surg 85:604–608CrossRef Kumar A, Charlebois SJ, Cain EL et al (2003) Effect of fibular plate fixation on rotational stability of simulated distal tibial fractures treated with intramedullary nailing. J Bone Jt Surg 85:604–608CrossRef
23.
Zurück zum Zitat Ruecker AH, Michael H, Rupprecht ME et al (2009) Distal tibial fractures: intramedullary nailing. Eur J Trauma Emerg Surg 35:520–526CrossRef Ruecker AH, Michael H, Rupprecht ME et al (2009) Distal tibial fractures: intramedullary nailing. Eur J Trauma Emerg Surg 35:520–526CrossRef
24.
Zurück zum Zitat Court-Brown CM, Will E, Christie J et al (1996) Reamed or unreamed nailing for closed tibial fractures: a prospective study in Tscherne C1 fractures. J Bone Jt Surg Br 78:580–583 Court-Brown CM, Will E, Christie J et al (1996) Reamed or unreamed nailing for closed tibial fractures: a prospective study in Tscherne C1 fractures. J Bone Jt Surg Br 78:580–583
25.
Zurück zum Zitat Dursun M, Kalkan T, Aytekin MN et al (2013) Does the magnetic-guided intramedullary nailing technique shorten operation time and radiation exposure? Eur J Orthop Surg Traumatol. July (Epub ahead of print) Dursun M, Kalkan T, Aytekin MN et al (2013) Does the magnetic-guided intramedullary nailing technique shorten operation time and radiation exposure? Eur J Orthop Surg Traumatol. July (Epub ahead of print)
26.
Zurück zum Zitat Gugala Z, Nana A, Lindsey RW et al (2001) Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques. Injury 32:21–25CrossRef Gugala Z, Nana A, Lindsey RW et al (2001) Tibial intramedullary nail distal interlocking screw placement: comparison of the free-hand versus distally-based targeting device techniques. Injury 32:21–25CrossRef
27.
Zurück zum Zitat Sanders R, Koval KJ, DiPasquale T et al (1993) Exposure of the orthopedic surgeon to radiation. J Bone Jt Surg Am 75:326–330 Sanders R, Koval KJ, DiPasquale T et al (1993) Exposure of the orthopedic surgeon to radiation. J Bone Jt Surg Am 75:326–330
28.
Zurück zum Zitat Tsalafoutas IA, Tsapaki V, Kaliakmanis A et al (2008) Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopedic surgeries. Radiat Prot Dosimetry 128(1):112–119 (Epub 11 Jun 2007) Tsalafoutas IA, Tsapaki V, Kaliakmanis A et al (2008) Estimation of radiation doses to patients and surgeons from various fluoroscopically guided orthopedic surgeries. Radiat Prot Dosimetry 128(1):112–119 (Epub 11 Jun 2007)
29.
Zurück zum Zitat Bonnevialle P, Andrieu S, Bellumore Y et al (1998) Torsional abnormalities and length discrepancies after intramedullary nailing for femoral and tibial diaphyseal fracture. Computerized tomography evaluation of 189 fractures. Rev Chir Orthop Reparatrice Appar Mot 84:397–410PubMed Bonnevialle P, Andrieu S, Bellumore Y et al (1998) Torsional abnormalities and length discrepancies after intramedullary nailing for femoral and tibial diaphyseal fracture. Computerized tomography evaluation of 189 fractures. Rev Chir Orthop Reparatrice Appar Mot 84:397–410PubMed
30.
Zurück zum Zitat Clementz BG (1989) Assessment of tibial torsion and rotational deformity with a new fluoroscopic technique. Clin Orthop Relat Res 245:199–209PubMed Clementz BG (1989) Assessment of tibial torsion and rotational deformity with a new fluoroscopic technique. Clin Orthop Relat Res 245:199–209PubMed
31.
Zurück zum Zitat Strecker W, Keppler P, Gebhard F et al (1997) Length and torsion of the lower limb. J Bone Jt Surg Br 79:1019–1023CrossRef Strecker W, Keppler P, Gebhard F et al (1997) Length and torsion of the lower limb. J Bone Jt Surg Br 79:1019–1023CrossRef
Metadaten
Titel
A tip to reduce the malrotation of the spiral tibial fracture intraoperatively
verfasst von
Jialiang Guo
Yingze Zhang
Zhiyong Hou
Zengyan Li
Publikationsdatum
01.12.2014
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 8/2014
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-014-1411-6

Weitere Artikel der Ausgabe 8/2014

European Journal of Orthopaedic Surgery & Traumatology 8/2014 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.