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A Technique for Intramedullary Nailing of Proximal Third Tibia Fractures
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Jung Jae Kim, Kyung Min Noh, Woo Shin Cho, Yung Tae Kim, Key Yong Kim
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J Korean Soc Fract 1998;11(2):456-463. Published online April 30, 1998
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DOI: https://doi.org/10.12671/jksf.1998.11.2.456
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 Abstract
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- INTRODUCTION : Recently, intramedullary nailing is the treatment of choice in the management of fractures in the tibial diaphysis. But fractures of the proximal third of the tibial shaft including segmental fractures do not appear to respond as favorably to intramedullaryu nailing as do fractures in the distal 2/3 of the tibia. One of the msot frequent complications of intramedullary nailing of proximal third tibia is fracture malalignment leading to anterior angulation, anterior displacement or valgus angulation. There are several factors combine to make these fractures difficult to reduce when nailing. 1) The pull of the patellar tendon and muscles around the proximal tibia on the shory proximal fracture fragment. 2) The traditional medial entrance point of nailing in the proximal tibia. The author`s objective is to introduce a new technique to neutralize these factors so that intramedullary nailing can be consistently used to treat poximal third ribia fractures.
MATERIALS AND METHODS
: Five of proximal third tibial shaft including one segmental fracture were treated with a new technique for intramedullary nailing of these fractures. The clinical summary was s belows. 1) Inserted two 0.125inch Steinmann pins at the proximal tibial fragment, which authors called as 'blocking pin'. These pins were crossed with 10-15degree angle at midpoint of the proximal tibia anteroposteriorly and mediolaterally. 3) Made the entrance hole using awl which was introduced just anterior to the cross point of two blocking pins. 4) The AO unreamed tibial nail was inserted anterior to two blocking pins, After then, continued the nail insertion with closed technique. 5) Performed proximal(3 screws) and distal(2 or 3 screws) locking. 6) Removed two blocking pins finally. Outcomes were evaluated immediately postoperatively and at follow-up visit by measurement of alignment in both the anteroposterior and lateral planes. All patient were evaluated clinically also.
RESULTS
: The average anterior angulation and anterior displacement immediately postoperatively were 3.0degree (range 1degree to 5degree) and 2.8mm (range 1mm to 4mm) respectively. The average coronal plane alignement was 3.2degree valgus(range 2degree to4degree valgus). There was no complication from the use of this technique either intraoperatively or postoperatively. Fracture alignment at the time of last follow-up was unchanged from immediate postoperative measurements. All 5 cases healed clinically and radiologically. In 3 casesm bone graft was performed at postoperative 6 weeks due to delayed union. The average time to radiologic healing was 21weeks(17-26 weeks).
CONCLUSIONS
: Intramedullary nailing of proximal third tibial fractures including segmental fractures is technically demending and has a problem of the high rate of malalignments. However, through a new technique above mentioned which neutralize deforming factors, reliable alignments and healing were achieved successfully in proximal third tibial fractures. The authors introduce and recommend a new technique in intramedullary nailing to treat the authors introduce and recommend a new technique in intramedullary nailing to treat the fractures of the proximal third of the tibial shaft(esp. segmental fractures).
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Citations
Citations to this article as recorded by  - Fractures of the Middle Third of the Tibia Treated with a Functional Brace
Augusto Sarmiento, Loren L. Latta
Clinical Orthopaedics & Related Research.2008; 466(12): 3108. CrossRef
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Clinical Application of Halo-Vest Apparatus in Cervical Spine Lesions
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Yung Tae Kim, Yong Jung Kim, Ho Seung Lee
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J Korean Soc Fract 1995;8(1):262-268. Published online January 31, 1995
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DOI: https://doi.org/10.12671/jksf.1995.8.1.262
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- Halo-vest apparatus has the mechanical advantages that provides immediate cervical stabilization and can afford the diagnostic work-up for the acute cervical spine injuried patients, and does not interfere with MRI test. Furthermore, we can take the reduction of the dislocation by controlling it in any plane.
Especially it is effective in conseuative treatment in upper cervical lesion without neurologic deficit or patient with high risk of operation.
We put on the Halo-vest apparatus in seventeen patients with cervical spine lesion. There were fifteen cases of fracture-dislocation, one case of pathologic fracture, and one case of tuberculous spondylitis. The lesion site were upper ceuical in ten cases and others were lower cervical lesion. Three cases were undergone surgical intervention and were fixed with Halo-vest apparstus for further stabilization. We could get the external fixation for the unstable cervical lesion after several segment fusion. Initial immobilization were undertaken with Gardner well tong, Halter or Halo treation for 1.6 weeks in average. They were changed to Halo-vest apparatus for further immobilization and concomitant ambulation. Halo-vest apparatus were put on for 10.2 weeks to get solid bony union. After then other conventional brace were worn such as neck collar,S.0.M.I., four-poster or Philadelphia brace.
The complications were one case of pin loosening, and three cases of pin tract infection.
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