Martin H Hessmann1, Michael Buhl2, Chris Finkemeier3, Amal Khoury4, Rami Mosheiff5, Michael Blauth6,7. 1. Academic Teaching Hospital Fulda, Pacelliallee 4, 36043, Fulda, Germany. Martin.Hessmann@klinikum-fulda.de. 2. Academic Teaching Hospital Fulda, Pacelliallee 4, 36043, Fulda, Germany. 3. Sutter Roseville Medical Center, PO Box 2070, 95746, Granite Bay, CA, USA. 4. Orthopedic Trauma Unit, Hadassah Ein Kerem Hospital, Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel. 5. Orthopedic Surgery Department, Hadassah Ein Kerem Hospital, Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel. 6. Department for Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria. 7. Trauma, CMF, Biomaterials, DePuy Synthes, Synthes GmbH, Luzernstr. 21, 4528, Zuchwil, Switzerland.
Abstract
OBJECTIVE: Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures. INDICATIONS: Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries. CONTRAINDICATIONS: Gustilo grade 3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point. SURGICAL TECHNIQUE: Via a suprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20-30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics. RESULTS: In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17 patients had a distal third fracture, 8 sustained a proximal third fracture and 36 had a shaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9 weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.
OBJECTIVE: Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures. INDICATIONS: Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries. CONTRAINDICATIONS: Gustilo grade 3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point. SURGICAL TECHNIQUE: Via a suprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20-30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics. RESULTS: In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17 patients had a distal third fracture, 8 sustained a proximal third fracture and 36 had a shaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9 weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.
Entities:
Keywords:
Approach; Bone nails; Complications; Expert Tibia Nail®; Surgical technique
Authors: Yao Lu; Gen Wang; Bin Hu; Cheng Ren; Liang Sun; Zhimeng Wang; Changjun He; Hanzhong Xue; Zhong Li; Kun Zhang; Teng Ma; Qian Wang Journal: J Orthop Surg Res Date: 2020-09-17 Impact factor: 2.359
Authors: Nils Jan Bleeker; Inge H F Reininga; Bryan J M van de Wall; Laurent A M Hendrickx; Frank J P Beeres; Kaj Ten Duis; Job N Doornberg; Ruurd L Jaarsma; Gino M M J Kerkhoffs; Frank F A IJpma Journal: J Orthop Trauma Date: 2021-08-01 Impact factor: 2.512