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Original Article Results of Intramedullary Nailing for Distal Metaphyseal Intra-Articular Fractures of Tibia
Jun Young Lee, Yongjin Cho, Hyung Seok Park, Se Woong Jang
Journal of Musculoskeletal Trauma 2020;33(4):196-203.
DOI: https://doi.org/10.12671/jkfs.2020.33.4.196
Published online: October 31, 2020
Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University, Gwangju, Korea

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Abstract

Purpose
This study examined the results of internal fixation using an intramedullary nail in the treatment of distal metaphyseal fractures involving the articular surface.
Materials and Methods
From November 2009 to November 2018, distal tibia fractures involving the articular surface were treated with intramedullary nailing only for fractures corresponding to AO type 43 B and 43 C1, twenty-four cases were studied retrospectively. The tibial alignment was measured preoperatively and postoperatively, and the bone union time and nonunion were assessed. In addition, the clinical evaluation of ankle joint function was assessed using the Olerud and Molander ankle score (OMAS).
Results
Complete bone union was obtained in all cases, and the mean union time was 17.7±1.87 weeks (range, 15-20 weeks). The average preoperative coronal alignment was 6.4°±1.0° (range, 5.2°-8.4°), and sagittal alignment was 2.7°±0.6° (range, 1.9°-3.8°). The average postoperative coronal alignment was 2.5°±0.13° (range, 2.2°-2.6°) and sagittal alignment was 0.4°±0.25° (range, 0.09°-0.95°). There was no nonunion. The OMAS had an average of 85±7.9 points (range, 70-95 points).
Conclusion
In the treatment of distal metaphyseal fractures involving the articular surface, internal fixation using an intramedullary nail reduces complications and achieves satisfactory reduction and union. This method is considered an excellent treatment to obtain good clinical results.


J Korean Fract Soc. 2020 Oct;33(4):196-203. Korean.
Published online Oct 22, 2020.
https://doi.org/10.12671/jkfs.2020.33.4.196
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Original Article

Results of Intramedullary Nailing for Distal Metaphyseal Intra-Articular Fractures of Tibia

Jun Young Lee, M.D., Yongjin Cho, M.D., Hyung Seok Park, M.D. and Se Woong Jang, M.D.
    • Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University, Gwangju, Korea.
  • Correspondence to: Jun Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, School of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: +82-62-220-3147, Fax: +82-62-220-3147, Email: leejy88@chosun.ac.kr
Received December 22, 2019; Revised February 25, 2020; Accepted August 04, 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 results of internal fixation using an intramedullary nail in the treatment of distal metaphyseal fractures involving the articular surface.

Materials and Methods

From November 2009 to November 2018, distal tibia fractures involving the articular surface were treated with intramedullary nailing only for fractures corresponding to AO type 43 B and 43 C1, twenty-four cases were studied retrospectively. The tibial alignment was measured preoperatively and postoperatively, and the bone union time and nonunion were assessed. In addition, the clinical evaluation of ankle joint function was assessed using the Olerud and Molander ankle score (OMAS).

Results

Complete bone union was obtained in all cases, and the mean union time was 17.7±1.87 weeks (range, 15–20 weeks). The average preoperative coronal alignment was 6.4°±1.0° (range, 5.2°–8.4°), and sagittal alignment was 2.7°±0.6° (range, 1.9°–3.8°). The average postoperative coronal alignment was 2.5°±0.13° (range, 2.2°–2.6°) and sagittal alignment was 0.4°±0.25° (range, 0.09°–0.95°). There was no nonunion. The OMAS had an average of 85±7.9 points (range, 70–95 points).

Conclusion

In the treatment of distal metaphyseal fractures involving the articular surface, internal fixation using an intramedullary nail reduces complications and achieves satisfactory reduction and union. This method is considered an excellent treatment to obtain good clinical results.

Keywords
Tibia, Distal tibia metaphyseal intra-articular fracture, Intramedullary nail

Figures

Fig. 1
Fluoroscopic X-rays show the use of a poller screw for accurate insertion of the nail. (A) Using the poller screw before nail insertion. (B) Ball tip guide insertion. (C) Accurate nail insertion at the site.

Fig. 2
Intra-articular fracture fixation using 4.0 cannulated screw.

Fig. 3
Using an angular stable locking system screw for rotational stability.

Fig. 4
A 54-year-old male patient had a tibia fracture in AO classification 43-B2 after falling. Internal fixation with an interlocking nail was performed. A 1/3 semitubular plate was used to fix the fibula. The postoperative eighteen-month radiograph shows the healed distal tibia fracture.

Fig. 5
(A) Preoperative alignment (anteroposterior plane). (B) Preoperative alignment (sagittal plane). (C) Tibial anterior surface angle (TAS). (D) Tibial lateral surface angle (TLS).

Tables

Table 1
Patients' Demographics and Results

Table 2
Pre-OP & Post-OP Ankle Alignment

Notes

Financial support:None.

Conflict of interests:None.

References

    1. Court-Brown CM, Christie J, McQueen MM. Closed intramedullary tibial nailing. Its use in closed and type I open fractures. J Bone Joint Surg Br 1990;72:605–611.
    1. Casstevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg 2012;20:675–683.
    1. Klemm KW, Börner M. Interlocking nailing of complex fractures of the femur and tibia. Clin Orthop Relat Res 1986;(212):89–100.
    1. Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma 2000;14:187–193.
    1. Whittle AP, Russell TA, Taylor JC, Lavelle DG. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am 1992;74:1162–1171.
    1. Böstman O, Hänninen A. The fibular reciprocal fracture in tibial shaft fractures caused by indirect violence. Arch Orthop Trauma Surg 1982;100:115–121.
    1. Tyllianakis M, Megas P, Giannikas D, Lambiris E. Interlocking intramedullary nailing in distal tibial fractures. Orthopedics 2000;23:805–808.
    1. Konrath G, Moed BR, Watson JT, Kaneshiro S, Karges DE, Cramer KE. Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement. J Orthop Trauma 1997;11:200–205.
    1. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am 2005;87:1213–1221.
    1. Beytemür O, Barış A, Albay C, Yüksel S, Çağlar S, Alagöz E. Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2). Acta Orthop Traumatol Turc 2017;51:12–16.
    1. Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD. Tibial pilon fractures: a comparison of treatment methods. J Trauma 1999;47:937–941.
    1. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 2011;25:736–741.
    1. Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg 1984;103:190–194.
    1. Martin JS, Marsh JL, Bonar SK, DeCoster TA, Found EM, Brandser EA. Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma 1997;11:477–483.
    1. Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma 1999;13:92–97.
    1. Wyrsch B, McFerran MA, McAndrew M, et al. Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am 1996;78:1646–1657.
    1. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res 1993;(292):108–117.
    1. Robinson CM, McLauchlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. J Bone Joint Surg Br 1995;77:781–787.
    1. Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma 2008;22:307–311.
    1. Helfet DL, Suk M. Minimally invasive percutaneous plate osteosynthesis of fractures of the distal tibia. Instr Course Lect 2004;53:471–475.
    1. Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma 2010;24:24–29.
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    Results of Intramedullary Nailing for Distal Metaphyseal Intra-Articular Fractures of Tibia
    J Korean Fract Soc. 2020;33(4):196-203.   Published online October 31, 2020
    DOI: https://doi.org/10.12671/jkfs.2020.33.4.196
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