Journal of Musculoskeletal Trauma

Original Articles

A Technique for Intramedullary Nailing of Proximal Third Tibia Fractures: Jung Jae Kim, Kyung Min Noh, Woo Shin Cho, Yung Tae Kim, Key Yong Kim; J Korean Soc Fract 1998;11(2):456-463. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.456

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).

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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Surgical Treatment of the Pilon Fractures: Jung Jae Kim, Jong Hi Park, Woo Shin Cho, Key Yong Kim; J Korean Soc Fract 1997;10(3):492-500. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.492

Abstract PDF: The intraarticular fractures of the distal tibia. so-called pilon fractures have been difficult in management due to the severe comminution of articular surface and frequent soft tissue problems. So there have been many controversies in the method of treatment. Although historically the results of various type of treatment of these fractures have been less than optimal, there has been a recent trend that suggests success in the majority of cases through operative treatment following the principles outlined by the AO/ASIF group. Among the patients of pilon fracture admitted to our hospital from October 1989 to August 1995 who were treated by open reduction and internal fixation, 32 patients(34 cases) were included who could be follow up for more than 2 years. According to AO/ASIF classification, type B1 5 cases, type B2 7 cases, type B3 5 cases, type C1 3 cases, type C2 4 cases, type C3 10 cases. The authors analyaed the clinical and radiological results of tibial pilon fractures exclusively treated by internal fixation. The results as follow : 1. Among 34 cases, 12 cases(35.3%) were not associated with of fibula fracture. There was no stastical relationship between the severity of pilon fracture and the presence of flbula fracture. 2. Good results in fracture reduction was obtained at 26 cases(76.5%) and good functional reults was obtained at 26 cases(76.5%). 3. The most commom postoperative complication was infection combined with skin problem(6 cases), which were treated by antibiotics and flap surgery. 4. Anatomical reduction and stable internal fixation of articular surface, careful manipulation of soft tissues and early range of motion exercise yielded good results of surgical treatment of pilon fracture.

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Radiological Findings and Classification of the Acetabular Fractures: Woo Shin Cho; J Korean Soc Fract 1997;10(3):458-464. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.458

Abstract PDF: Correct classification based on the accurate radiological evaluation is the keypoint in proper management of the acetabular fracture. Interpretation of the radiologic features of the acetabular fracture requires understanding of the relationship between radiologic landmarks and anatomic structures composing acetabulum. The standard radiographic views include acetabular A-P, iliac oblique and obturator oblique views. CT is mandatory for evaluation and provides more accurate informations, such as size and location of the fragment, joint impaction, intraarticular fragment, comminution, dislocation of the femoral head and sacroiliac joint involvement. Combined interpretation of the standard radiographic views and CT is essential. Tomography and 3-D CT provide additional information. Two representative classification systems of the acetabular fracture are Judet and Leteurnal classification and comprehensive classification of AO. Judet and Letpurnal focused on anatomic two columns and two walls, and devided the acetabular fracture into five elementary and five associated fracture types. The elementary fracture types are basically two part and the associated fractures are combination of at least two elementary types and so, they are three or four part fractures. Comprehensive classification system is based on Judet and Letournal classification and follows skeletal AO classification system. It is apprehensive, logic, universal and easy to computerize. Besides, it shows fracture personality which is important prognostic factors. Type A represnets single wall or column fractures, type B tran,iverse oriented fractures, and type C complete articular fracture, namely floating acetaoulum. The sequence in groups under the type is correlated with the prognosis but not always in types.

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