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HOME > J Musculoskelet Trauma > Volume 33(3); 2020 > Article
Original Article Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis
Jun Young Lee, Hyung Seok Park, Dong Hyuk Cha
Journal of Musculoskeletal Trauma 2020;33(3):142-147.
DOI: https://doi.org/10.12671/jkfs.2020.33.3.142
Published online: July 31, 2020
Department of Orthopaedic Surgery, Chosun University Hospital, College of Medicine, Chosun University, Gwangju, Korea

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Abstract

Purpose
This study examined the clinical outcomes after the treatment of a tibia segmental fracture with intramedullary nailing (IM nailing) and minimal invasive plate osteosynthesis (MIPO).
Materials and Methods
From July 2012 to December 2017, 14 out of 17 cases from a treatment cohort of 32 cases of AO type 42 C2 tibia segmental fractures with IM nailing and MIPO were studied retrospectively. Periodic radiographs were used to evaluate the presence of union, union time, and radiographic evaluation of bony union (varus-valgus deformity, anteroposterior angular deformity, shortening). To evaluate the postoperative clinical function, modified Rasmussen’s system was used for proximal fractures, and the American Orthopaedic Foot and Ankle Society functional score was used for distal fractures.
Results
Bony union was achieved in all 14 cases, and the average union time was 26 weeks. In one case of soil contamination, there were no other complications other than simple debridement after a soft tissue infection. The mean varus was two degrees; the mean anteroposterior angular deformity was three degrees of anterior oblique; the mean length shortening was 5 mm (2-9 mm). The mean functional score of the knee joint with the Modified Rasmussen’s system measured for the postoperative clinical function was relatively good (excellent 9, good 4, fair 1, and poor 0). The results of the Molander and Olerud Functional scores of the ankle joints were also good (excellent 8, good 3, fair 2, poor 0).
Conclusion
The treatment of tibia segmental fractures with IM nailing and MIPO can effectively reduce the gap of fracture sites. Hence, it is possible to increase the bony union probability and obtain relatively satisfactory alignment. Overall, the treatment of tibia segmental fractures with IM nailing and minimally invasive plate osteosynthesis appears to be a useful treatment, considering the preservation of the soft tissue and the alignment of the tibia.


J Korean Fract Soc. 2020 Jul;33(3):142-147. Korean.
Published online Jul 24, 2020.
https://doi.org/10.12671/jkfs.2020.33.3.142
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Original Article

Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis

Jun Young Lee, M.D., Hyung Seok Park, M.D. and Dong Hyuk Cha, M.D.
    • Department of Orthopaedic Surgery, Chosun University Hospital, College of Medicine, Chosun University, Gwangju, Korea.
  • Correspondence to: Jun Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: +82-62-220-3147, Fax: +82-62-226-3379, Email: leejy88@chosun.ac.kr
Received February 23, 2020; Revised March 05, 2020; Accepted May 08, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study examined the clinical outcomes after the treatment of a tibia segmental fracture with intramedullary nailing (IM nailing) and minimal invasive plate osteosynthesis (MIPO).

Materials and Methods

From July 2012 to December 2017, 14 out of 17 cases from a treatment cohort of 32 cases of AO type 42 C2 tibia segmental fractures with IM nailing and MIPO were studied retrospectively. Periodic radiographs were used to evaluate the presence of union, union time, and radiographic evaluation of bony union (varus-valgus deformity, anteroposterior angular deformity, shortening). To evaluate the postoperative clinical function, modified Rasmussen's system was used for proximal fractures, and the American Orthopaedic Foot and Ankle Society functional score was used for distal fractures.

Results

Bony union was achieved in all 14 cases, and the average union time was 26 weeks. In one case of soil contamination, there were no other complications other than simple debridement after a soft tissue infection. The mean varus was two degrees; the mean anteroposterior angular deformity was three degrees of anterior oblique; the mean length shortening was 5 mm (2–9 mm). The mean functional score of the knee joint with the Modified Rasmussen's system measured for the postoperative clinical function was relatively good (excellent 9, good 4, fair 1, and poor 0). The results of the Molander and Olerud Functional scores of the ankle joints were also good (excellent 8, good 3, fair 2, poor 0).

Conclusion

The treatment of tibia segmental fractures with IM nailing and MIPO can effectively reduce the gap of fracture sites. Hence, it is possible to increase the bony union probability and obtain relatively satisfactory alignment. Overall, the treatment of tibia segmental fractures with IM nailing and minimally invasive plate osteosynthesis appears to be a useful treatment, considering the preservation of the soft tissue and the alignment of the tibia.

Keywords
Tibia segmental fracture, Intramedullary nailing, Minimal invasive plate osteosynthesis

Figures

Fig. 1
Clinical photograph and fluoroscopic X-rays show the use of a minimally invasive plate osteosynthesis for provisional fixation (A), anteroposterior (B), and lateral (C). Postoperative X-rays shows anteroposterior (D) and lateral (E) views.

Fig. 2
Clinical photographs and X-rays show the use of minimally invasive plate osteosynthesis for distal tibia segmental fracture. (A) Preoperative X-ray. (B) Minimally invasive plate osteosynthesis. (C) Postoperative X-ray.

Fig. 3
A 57-year-old male patient had a tibia segmental fracture in AO classification 42-C2 after direct stroke and crushing. Intramedullary nailing and minimally invasive plate osteosynthesis were performed. A postoperative 17-month radiograph showed the healed tibia fracture, and the implant was removed. (A) Preoperative X-ray. (B) Postoperative X-ray. (C) Postoperative day 17 month; implant removal.

Tables

Table 1
Functional and Radiological Results

Notes

Financial support:None.

Conflict of interests:None.

References

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    Clinical Outcome after Treatment of Tibia Segmental Fracture with Intramedullary Nailing and Minimal Invasive Plate Osteosynthesis
    J Korean Fract Soc. 2020;33(3):142-147.   Published online July 31, 2020
    DOI: https://doi.org/10.12671/jkfs.2020.33.3.142
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