A novel assisted reduction method in extra-articular fractures of the distal tibia treated with intramedullary nail.

Background: To explore the clinical efficacy and safety of Kirschner wires (KWs) as a blocking screw technique for extra-articular fractures of the distal tibia treated with intramedullary nails (IMNs). Methods: Fifty-three patients were treated with KW-assisted IMN for extra-articular fractures of the distal tibia via the blocking screw technique or Poller screw (PS) technique. The operation time, number of fluoroscopies, number of blocking screws used, blood loss and time to union were compared between the two groups. Additionally, the functional outcomes of the two groups were compared using range of motion (ROM), visual analog scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), and Lysholm scores. Results: Compared with those in the PS group, the operation time in the KW group was significantly shorter, and the number of fluoroscopy procedures and amount of blood loss during KW surgery were also significantly lower (p = 0.014, 0.001, and 0.036, respectively). Regarding the functional outcomes, there were no significant differences in the ROM, VAS score, AOFAS score or Lysholm score between the two groups (p > 0.05). Conclusion: In the treatment of extra-articular fractures of the distal tibia with nails, the use of KW as a blocking screw technique is safe and reliable.

Suprapatellar nailing in complex Tibial Fractures.

PURPOSE: This study evaluates the functional and radiological outcomes of segmental and comminuted tibial fractures using a suprapatellar approach in semi extended position. METHODS: A total of 62 patients, with a mean age of 40.8 (range: 21-78 yrs) and 43 males and 19 females, were retrospectively evaluated between January 2017 and December 2022. Patients with comminated tibial fracture AO Type 42 C3 (32) and segmental AO Type 42 C2 (21) AO Type 42 C1 (9) were treated with a IMN using the suprapatellar technique. There were 51 closed fractures and 11 grade-one open fractures. All patients were subjected to the suprapatellar nailing technique in the semi-extended position. RESULTS: Fracture healing 20.4 weeks on average was needed for the fracture to heal in segmental and 21.2 weeks in comminuted fracture. There were two instances of the delayed union in comminuted fractures. In two cases of segmental fracture dynamization is required. One case of non-union required bone grafting in a segmental fracture and in two instances in comminuted fractures to improve union after four months of monitoring. Primary union occurred in 56 patients. After minimum of 10.2 months of follow-up. According to Johner and Wruh's criteria with modifications, out of 62 patients, 47 had excellent results, 10 had good results, and 5 had fair results. CONCLUSIONS: In segmental and comminuted fracture tibia, the suprapatellar IMN technique in a semi-extended position results in a significantly lower rate of malalignment, and good union because of soft tissue friendly bypass surgery.

Optimal use of transmedullary support screws and fibular management in distal tibial fracture nailing based on a new biomechanical classification.

INTRODUCTION: Based on a novel simple frontal view classification, a comprehensive concept for systematic management of intramedullary fixation of distal tibial fractures is introduced. Even the usage of thin (unreamed) nails allows for anatomic reduction and stable fixation if applied in combination with transmedullary support (TMS) screws. Our classification system guides the placement of the TMS screw (medial or lateral) and suggests whether to fix the fibula or not. PATIENTS AND METHODS: The fixation concept of the classification was applied to 67 distal tibial fracture cases. Patients were followed up until nail removal after at least 12 months. RESULTS: All fractures united. Besides 5 cases of slight external malrotation (<5 degrees) no axial malunion was found. Two infections were encountered, but both were treated effectively by exchange nailing, antibiotic therapy until wound healing and C-reactive protein normalization. Final functional assessment according to Olerud/Molander Score was 85 pts (100 pts. possible, range 50-100 pts). DISCUSSION: The stability we achieved even with single screw interlocking was high due to anatomic reduction with interfragmental compression in the lowest fracture line. In cases of fracture extension into the ankle joint, interfragmental compression screws were applied before nail insertion. In more comminuted fracture types additional screws are advisable. CONCLUSIONS: The frontal view classification has proven to be a reliable guideline for effective intramedullary fracture fixation by minimally invasive means, allowing for optimized soft tissue protection.