- PreOp Planning:
- Contra-indications:
- open growth plates; (
pediatric tibial frx);
- fractures w/ 4 cm of the ankle joint;
-
previous application of external fixator (relative contraindication - controversial);
-
proximal fourth tibial fractures (relative contraindication - controversial)
- Soft tissue injury:
-
Open tibial frx (
Gustillo classification):
-
Reconstruction for leg defects:
- Comminution: (see
Winquist classification):
- Technique of IM Nailing:
- Outcomes for IM Nails vs Other Treatment Methods:
-
external fixation vs IM nailing for tibial frx
- Klemm and Borner; Clinical Orthopaedics, 212: 89-100, 1986;
- 401 tibial fractures: 308 closed, 93 open grade I (delayed nailing)
- 81% of frx were considered unstable to shortening or rotation;
- 94% w/ good to excellent results, 2.2% deep infection
- Puno et. al. Clinical Orthopaedics:
212: 113-121; 1986;
- 201 tibial fractures:
AO type reamed slotted tibial nail w/ closed technique versus closed
reduction w/
cast application;
- IM nail: 98% union rate (no malunions), 3.3% infection rate;
-
cast immobilzation:
- 90.1% unions, 4.3% malunions, 1.4% infections;
- initially 13% of fractures lost the reduction and required operation;
-
Bone and Johnson
- 76 primary fractures and 36 2ndary fractures (exfix/closed failures)
- using AO or Grosse-Kemph IM Nailing;
- union rate: 97% for both groups;
- time to union: primary group: av 17.8 weeks vs secondary group: av 21.6 weeks
- infection: 9% - mostly pts rx'ed w/ open procedures or open frx;
- Bone et al 1997.
- retrospective study of 99 patients w/ closed tibial shaft fractures treated either w/ cast or IM nail;
- avg. time to union w/ IM nail was 18 weeks vs 26 weeks with a cast;
- non-union occur in 2% of IM nail patients vs 10% in casted patients;
- 26 of 47 patients requested that the IM nail be removed;
- IM nail group had higher Iowa knee and ankle evaluation rating system scores than casted group;
- references:
-
Treatment of tibial fractures by reaming and intramedullary nailing.
-
The use of the Lottes nail in the treatment of closed and open tibial shaft fractures.
-
Conservative management or closed nailing for tibial shaft fractures. A randomised prospective trial.
-
Locked intramedullary nailing for displaced tibial shaft fractures
-
Infection after intramedullary nailing of the tibia. Incidence and protocol for management.
-
Diagnosis and management of infection after tibial intramedullary nailing.
-
Unstable fractures of the tibia treated with a reamed intramedullary interlocking nail.
-
Radiographic analysis of tibial fracture malalignment following intramedullary nailing.
- Comparison of functional bracing and locked IM nailing in the treatement of displaced tibial shaft fractures.
A Alho et al.
CORR.
Vol 277. 1992. p 243-250.
- Displaced isolated fractures of the tibial shaft treated with either a cast or IM nailing. An outcome with analysis of matched pairs of patients.
LB Bone et al.
JBJS. Vol 79-A. No 9. Sep 1997. p 1336.
- Use of IM Nails in Open Fractures: (see
open tibial frx and
exchange nailing)
- references:
-
The use of the Lottes nail in the treatment of closed and open tibial shaft fractures.
-
Locked intramedullary nailing of open tibial fractures.
-
Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming.
-
Infection after intramedullary nailing of the tibia. Incidence and protocol for management.
-
Diagnosis and management of infection after tibial intramedullary nailing.
- Prospective study of union rate of open tibial fractures with locked unreamed intramedullary nails.
LB Bone et al.
J. Orthop. Trauma. Vol 8. 1994. p 45-49.
- Closed intramedullary tibial nailing: its use in closed and type I open fractures.
CM Court-Brown et al.
JBJS Vol 73-B. 1991. p 959-964.
- Lower infection rate after interlocking nailing in open fractures of the femur and tibia.
G Kaltenecker et al.
J. Trauma. Vol 30. 1990. p 474-470.
Treatment of infected non-unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone-grafting.
Treatment of unstable tibial shaft fractures by closed intramedullary nailing with flexible (Ender-type) pins.
Locked nailing for nonunion of the tibia.
Open intramedullary nailing and bone-grafting for non-union of tibial diaphyseal fracture.
The use of Ender nails in fractures of the tibial shaft.
The treatment of 143 tibial shaft fractures by Ender's nailing and early weight-bearing.
Flexible medullary nailing of acute tibial shaft fractures.
The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury.
