-
Rim plate-assisted intramedullary nail and plate combination technique for complex tibial plateau-to-diaphysis fractures: a technical note and case series
-
Whee Sung Son
-
J Musculoskelet Trauma 2026;39(1):62-71. Published online December 4, 2025
-
DOI: https://doi.org/10.12671/jmt.2025.00290
-
-
 Abstract
 PDF
- Complex tibial plateau-to-diaphysis fractures present a significant surgical challenge due to their intricate fracture patterns and frequent association with severe soft tissue damage and concomitant injuries. This technical note introduces a novel fixation strategy: the rim plate-assisted intramedullary nail-plate combination (NPC) technique. In this approach, a rim plate simplifies the conventional NPC procedure by unifying the tibial plateau fracture into a single structural segment. This modification eliminates the need to address the articular and diaphyseal components simultaneously while enhancing articular stability. Furthermore, the technique preserves soft tissue integrity and promotes early rehabilitation. Clinical case examples demonstrate its successful application in managing complex tibial plateau-to-diaphysis injuries.
Level of evidence: V.
-
Computed tomography–based validation of percutaneous anterior leverage for achieving anteromedial cortical support in femoral intertrochanteric fractures in Korea: a single-center retrospective case series:
-
Whee Sung Son, Bum Jin Shim, Oog-jin Shon
-
Received September 24, 2025 Accepted December 10, 2025 Published online January 9, 2026
-
DOI: https://doi.org/10.12671/jmt.2025.00311
-
-
Abstract
- Background
Anteromedial cortical support (AMCS) improves mechanical stability in intertrochanteric femur fractures, but a reproducible, CT-validated approach to reliably achieve AMCS is lacking. We validated a percutaneous anterior leverage technique using computed tomography (CT).
Methods
We retrospectively reviewed patients treated by a single surgeon in Korea between March 2022 and December 2024. Inclusion criteria were AO/OTA A1–A3 fractures, application of the leverage technique, preoperative and postoperative CT scans, and at least 6 months of follow-up. AMCS was assessed on CT as anterior support on axial images and medial support on coronal images, each graded as positive, neutral, or negative. Outcomes included time to union, union rate, change in neck-shaft angle, and treatment failure. Risk factors for failure were explored.
Results
Of 273 patients screened, 53 met inclusion criteria. Follow-up was at least 6 months in all cases. Positive anterior support was achieved in 37 patients (69.8%) and positive medial support in 42 (79.2%). No patient demonstrated negative anterior support; one (1.9%) had negative medial support. Cortical support improved significantly after surgery (anterior P=0.026; medial P=0.001). Union occurred in 50 patients (96.2%) at 3.93±1.48 months. Mean varus change in neck-shaft angle at final follow-up was 1.75°±2.34°. Treatment failure occurred in three patients (5.7%). Anteromedial cortical breakage during follow-up differed between failure and non-failure groups (P=0.002), but regression identified no independent predictors. No technique-related complications were observed.
Conclusions
Percutaneous anterior leverage produced favorable CT-confirmed AMCS and high union with low failure, supporting its safety and effectiveness in intertrochanteric femur fractures.
Level of evidence: IV.
|
E-submission
KOTA
TOTA
TOTS
