Skip to main content
Erschienen in:

01.03.2017 | original article

Distal tibial fractures: evaluation of different fixation techniques

verfasst von: Julian Jöstl, MD, Thomas Manfred Tiefenböck, MD, Marcus Hofbauer, MD, Markus Winnisch, MD, Nikolaus Lang, MD, Assoc. Prof. Stefan Hajdu, MD, MBA, Assoc. Prof. Kambiz Sarahrudi, MD, PD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 5-6/2017

Einloggen, um Zugang zu erhalten

Summary

Purpose

The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1).

Methods

A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed.

Results

A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively.

Conclusion

Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient’s condition and the local fracture situation allow it.
Literatur
1.
Zurück zum Zitat Sirkin M, Sanders R. The treatment of pilon fractures. Orthop Clin North Am. 2001;32(1):91–102.CrossRefPubMed Sirkin M, Sanders R. The treatment of pilon fractures. Orthop Clin North Am. 2001;32(1):91–102.CrossRefPubMed
2.
Zurück zum Zitat Gao H, Zhang CQ, Luo CF, Zhou ZB, Zeng BF. Fractures of the distal tibia treated with polyaxial locking plating. Clin Orthop Relat Res. 2009;467(3):831–7.CrossRefPubMed Gao H, Zhang CQ, Luo CF, Zhou ZB, Zeng BF. Fractures of the distal tibia treated with polyaxial locking plating. Clin Orthop Relat Res. 2009;467(3):831–7.CrossRefPubMed
3.
Zurück zum Zitat Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15(3):153–60.CrossRefPubMed Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15(3):153–60.CrossRefPubMed
4.
Zurück zum Zitat Endres T, Grass R, Biewener A, Barthel S, Zwipp H. Advantages of minimally-invasive reposition, retention, and Ilizarov-(hybrid)fixation for pilon-tibial-fractures fractures with particular emphasis on C2/C3 fractures. Unfallchirurg. 2004;107(4):273–84.CrossRefPubMed Endres T, Grass R, Biewener A, Barthel S, Zwipp H. Advantages of minimally-invasive reposition, retention, and Ilizarov-(hybrid)fixation for pilon-tibial-fractures fractures with particular emphasis on C2/C3 fractures. Unfallchirurg. 2004;107(4):273–84.CrossRefPubMed
5.
Zurück zum Zitat Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 2006;37(6):531–5.CrossRefPubMed Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 2006;37(6):531–5.CrossRefPubMed
6.
Zurück zum Zitat Ristiniemi J, Luukinen P, Ohtonen P. Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: external fixation versus intramedullary nailing. J Orthop Trauma. 2011;25(2):101–5.CrossRefPubMed Ristiniemi J, Luukinen P, Ohtonen P. Surgical treatment of extra-articular or simple intra-articular distal tibial fractures: external fixation versus intramedullary nailing. J Orthop Trauma. 2011;25(2):101–5.CrossRefPubMed
7.
Zurück zum Zitat Duan X, Al-Qwbani M, Zeng Y, Zhang W, Xiang Z. Intramedullary nailing for tibial shaft fractures in adults. Cochrane Database Syst Rev. 2012;1:CD008241.PubMed Duan X, Al-Qwbani M, Zeng Y, Zhang W, Xiang Z. Intramedullary nailing for tibial shaft fractures in adults. Cochrane Database Syst Rev. 2012;1:CD008241.PubMed
8.
Zurück zum Zitat 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(6):1213–21.PubMed 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(6):1213–21.PubMed
9.
Zurück zum Zitat Borg T, Larsson S, Lindsjo U. Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury. 2004;35(6):608–14.CrossRefPubMed Borg T, Larsson S, Lindsjo U. Percutaneous plating of distal tibial fractures. Preliminary results in 21 patients. Injury. 2004;35(6):608–14.CrossRefPubMed
10.
Zurück zum Zitat Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma. 1996;10(Suppl. 1):v–ix, 1–154. Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma. 1996;10(Suppl. 1):v–ix, 1–154.
11.
Zurück zum Zitat Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31(5):709–14.CrossRefPubMed Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007;31(5):709–14.CrossRefPubMed
12.
Zurück zum Zitat Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma. 2012;26(3):178–83.CrossRefPubMed Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma. 2012;26(3):178–83.CrossRefPubMed
13.
Zurück zum Zitat Deleanu B, Prejbeanu R, Poenaru D, Vermesan D, Haragus H. Reamed versus unreamed intramedullary locked nailing in tibial fractures. Eur J Orthop Surg Traumatol. 2014;24(8):1597–601.CrossRefPubMed Deleanu B, Prejbeanu R, Poenaru D, Vermesan D, Haragus H. Reamed versus unreamed intramedullary locked nailing in tibial fractures. Eur J Orthop Surg Traumatol. 2014;24(8):1597–601.CrossRefPubMed
14.
Zurück zum Zitat 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(5):781–7.PubMed 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(5):781–7.PubMed
15.
Zurück zum Zitat Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998;12(1):1–7.CrossRefPubMed Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998;12(1):1–7.CrossRefPubMed
16.
Zurück zum Zitat Tornetta P, 3rd, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994;76(1):13–9.PubMed Tornetta P, 3rd, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994;76(1):13–9.PubMed
17.
Zurück zum Zitat Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, et al. Distal tibia fractures: management and complications of 101 cases. Int Orthop. 2010;34(4):583–8.CrossRefPubMed Joveniaux P, Ohl X, Harisboure A, Berrichi A, Labatut L, Simon P, et al. Distal tibia fractures: management and complications of 101 cases. Int Orthop. 2010;34(4):583–8.CrossRefPubMed
18.
Zurück zum Zitat Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence-Based Orthopaedic Trauma Working Group. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma. 2006;20(1):76–9.CrossRefPubMed Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M, Evidence-Based Orthopaedic Trauma Working Group. Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma. 2006;20(1):76–9.CrossRefPubMed
19.
Zurück zum Zitat McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6(2):195–200.CrossRefPubMed McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6(2):195–200.CrossRefPubMed
20.
Zurück zum Zitat Lang GJ, Cohen BE, Bosse MJ, Kellam JF. Proximal third tibial shaft fractures. Should they be nailed? Clin Orthop Relat Res. 1995;(315):64–74. Lang GJ, Cohen BE, Bosse MJ, Kellam JF. Proximal third tibial shaft fractures. Should they be nailed? Clin Orthop Relat Res. 1995;(315):64–74.
21.
Zurück zum Zitat Vaisto O, Toivanen J, Kannus P, Jarvinen M. Anterior knee pain and thigh muscle strength after intramedullary nailing of tibial shaft fractures: a report of 40 consecutive cases. J Orthop Trauma. 2004;18(1):18–23.CrossRefPubMed Vaisto O, Toivanen J, Kannus P, Jarvinen M. Anterior knee pain and thigh muscle strength after intramedullary nailing of tibial shaft fractures: a report of 40 consecutive cases. J Orthop Trauma. 2004;18(1):18–23.CrossRefPubMed
Metadaten
Titel
Distal tibial fractures: evaluation of different fixation techniques
verfasst von
Julian Jöstl, MD
Thomas Manfred Tiefenböck, MD
Marcus Hofbauer, MD
Markus Winnisch, MD
Nikolaus Lang, MD
Assoc. Prof. Stefan Hajdu, MD, MBA
Assoc. Prof. Kambiz Sarahrudi, MD, PD
Publikationsdatum
01.03.2017
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 5-6/2017
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0730-x