Results of Intramedullary Nailing at Tibia Distal Hypertropic Nonunions

Year 2022, Volume: 17 Issue: 3, 1 - 6, 02.11.2022

Şükrü Demir , Murat Gürger , Gökhan Önce , Ömer Cihan Batur , Sefa Key

https://doi.org/10.17517/ksutfd.885082

Abstract

Abstract

Objective: Nonunion is a common problem in fractures in the lower third of the tibia. Conditions such as thin soft tissue cover and poor blood supply cause this situation. In addition, mechanical problems such as proximity to the ankle and short distal segment makes the treatment of nonunion very difficult. Intramedullary nailing offers a powerful solution to this problem. Because there is no need for wide dissection and the implant remains intraosseous, creating a minimum problem for soft tissues. The aim of this study is to determine the efficacy of reamed intramedullary nail in the treatment of nonunions developed in fractures in the lower 1/3 of the tibia.
Material and Methods: The data of 14 patients who developed nonunion after a fracture of the lower 1/3 tibia and were treated with a reamed intramedullary nail were retrospectively analysed. All patients whose fractures in the 1/3 distal of the tibia and who did not have any signs of active infection were included in the study. Two patients had a history of superficial infection occurring after the first operation, but none of the patients had signs of active infection during the operation. All patients were treated with reamed locked intramedullary nailing.
Results: Union was achieved in all patients. Mean time to union was 5.7 (3-10) months. No patient developed an infection.
Conclusion: Reamed locked intramedullary nailing is a very reliable method in the treatment of nonunions, which are seen in the lower third of the tibia and are difficult to treat.

Keywords

Reamed intramedullary nailing, Distal tibia, Nonunion

Tibia Distal Hipertrofik Kaynamalarda İntramedüller Çivi Sonuçlarımız

Abstract

Özet

Amaç: Tibianın alt 1/3 lük kısmında gelişen kırıklarda kaynamama sık karşılaşılan bir problemdir. Bu durumua ince yumuşak doku örtüsü ve zayıf kanlanma gibi durumlar sebep olurlar. Ayrıca ayak bileğine yakınlık ve kısa distal segment gibi mekanik problemler kaynamama probleminin tedavisini oldukça
güçleştirir. İntramedüller çivileme, bu soruna güçlü bir çözüm sunar. Çünkü geniş diseksiyona gerek kalmaz ve implant intraosseöz kalarak yumuşak dokular için minimum problem oluşturur. Bu çalışmanın amacı, tibianın alt 1/3 lük kısmındaki kırıklarda gelişmiş olan kaynama kusurlarının tedavisinde oyulmuş
intramedüller çivinin etkinliğini belirlemektir.
Gereç ve Yöntemler: Tibia alt 1/3’lük bölge kırığı sonrasında kaynamama gelişen ve sonrasında oymalı intramedüller çivi ile tedavi edilen 14 hastanın verileri retrospektif olarak incelendi. Çalışmaya tibia 1/3 distalindeki kırığı kaynamayan ve aktif enfeksiyon bulgusu olmayan tüm hastalar dahil edildi. İki hastada
ilk operasyon sonrası ortaya çıkan yüzeysel enfeksiyon öyküsü vardı, ancak ameliyat sırasında hiçbir
hastada aktif enfeksiyon belirtisi yoktu. Tüm hastalar oymalı kilitli intramedüller çivileme ile tedavi edildi.
Bulgular: Hastaların hepsinde kaynama elde edildi. Ortalama kaynama süresi 5.7 (3-10) ay idi. Hiçbir hastada enfeksiyon gelişmedi.
Sonuç: Oymalı kilitli intramedüller çivileme, tibianın alt 1/3’lük bölgesinde görülen ve tedavisi oldukça güç olan kaynamamaların tedavisinde gayet güvenilir bir yöntemdir.

Keywords

Oymalı intramedüller çivileme, Distal tibia, Kaynamama

References

• 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(5):307–311.
• Paluvadi SV, Lal H, Mittal D, Vidyarthi K. Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis-A prospective series of 50 patients. J. Clin. Orthop. Trauma 2014;5(3):129–136.
• Im G Il, Tae SK. Distal metaphyseal fractures of tibia: A prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J. Trauma - Inj. Infect. Crit. Care 2005;59(5):1219–1223.
• 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):531–535.
• 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):709–714.
• Reed LK, Mormino MA. Distal Tibia Nonunions. Foot Ankle Clin. 2008;13(4):725–735.
• Wiss DA, Stetson WB. Nonunion of the tibia treated with a reamed intramedullary nail. J. Orthop. Trauma 1994;8(3):189–194.
• Templeman D, Thomas M, Varecka T, Kyle R. Exchange reamed intramedullary nailing for delayed union and nonunion of the tibia. In: Clinical Orthopaedics and Related Research. Springer New York LLC; 1995:169–175.
• Richmond J, Colleran K, Borens O, Kloen P, Helfet DL. Nonunions of the distal tibia treated by reamed intramedullary nailing. J. Orthop. Trauma 2004;18(9):603–610.
• Hak DJ. Management of aseptic tibial nonunion. J. Am. Acad. Orthop. Surg. 2011;19(9):563–573.
• Chin KR, Nagarkatti DG, Miranda MA, Santoro VM, Baumgaertner MR, Jupiter JB. Salvage of distal tibia metaphyseal nonunions with the 90° cannulated blade plate. Clin. Orthop. Relat. Res. 2003;(409):241–249.
• Carpenter CA, Jupiter JB. Blade plate reconstruction of metaphyseal nonunion of the tibia. In: Clinical Orthopaedics and Related Research. Springer New York LLC; 1996:23–28.
• Braly HL, O’Connor DP, Brinker MR. Percutaneous Autologous Bone Marrow Injection in the Treatment of Distal Meta-diaphyseal Tibial Nonunions and Delayed Unions. J. Orthop. Trauma 2013;27(9):527–533.
• Weber B. Pseudarthrosis : Pathophysiology, biomechanics, therapy, results. Bern [etc.]: Hans Huber Publishers; 1976.
• Fadel M, Ahmed MA, Al-Dars AM, Maabed MA, Shawki H. Ilizarov external fixation versus plate osteosynthesis in the management of extra-articular fractures of the distal tibia. Int. Orthop. 2015;39(3):513–519.
• Schoenleber SJ, Hutson JJ. Treatment of hypertrophic distal tibia nonunion and early malunion with callus distraction. Foot Ankle Int. 2015;36(4):400–407.
• Sen MK, Miclau T. Autologous iliac crest bone graft: Should it still be the gold standard for treating nonunions? Injury 2007;38(SUPPL. 1). doi:10.1016/j.injury.2007.02.012.
• Morandi M, Zembo MM CM. Infected tibial pseudarthrosis. A 2-year follow up on patients treated by the Ilizarov technique - PubMed. Orthopedics 1989;12(4):497–508.
• Gorczyca JT, McKale J, Pugh K, Pienkowski D. Modified tibial nails for treating distal tibia fractures. J. Orthop. Trauma 2002;16(1):18–22.
• Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J. Bone Jt. Surg. - Ser. A 2007;89(1):177–188.
• Connolly JF. Common avoidable problems in nonunions. Clin. Orthop. Relat. Res. 1985;194(194):226–235.
• Bedi A, Le TT, Karunakar MA. Surgical treatment of nonarticular distal tibia fractures. J. Am. Acad. Orthop. Surg. 2006;14(7):406–416.