Intramedullary nailing treatment of proximal and distal tibia metaphyseal fractures. Medial parapatellar approach in semi-extended position
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Published:
May 2, 2020
Keywords:
Metaphyseal tibial fracture, intramedullary nail, semi-extended position
Main Article Content
Abstract
Abstract
Objective: To review the results of a series of metaphyseal tibial fractures treated with intramedullary nailing (IMN) in a semi-extended position using a medial parapatellar approach. To report reduction quality, bone consolidation, range of motion (ROM) and postoperative knee pain at final follow-up.
Materials and Method: Twenty-three metaphyseal tibia fractures were treated with IMN. Twelve were distal tibial fractures (AO/OTA 43A), nine were proximal tibial fractures (AO/OTA 41A2/3), and two had segmental tibia fractures (AO/OTA 42C2). The minimum follow-up was 1 year.
Results: Radiograph angulation at the fracture site was <5 degrees. All patients achieved bone healing. One patient (AO/OTA 42C2) required plate augmentation and bone autografting. Twenty-one out of 23 patients had knee pain scores of >20 according to the Lysholm scale.
Conclusion: The parapatellar approach in a semi-extended position is a safe and useful technique for IMN of metaphyseal tibia fractures with no associated increased postoperative knee pain.
Objective: To review the results of a series of metaphyseal tibial fractures treated with intramedullary nailing (IMN) in a semi-extended position using a medial parapatellar approach. To report reduction quality, bone consolidation, range of motion (ROM) and postoperative knee pain at final follow-up.
Materials and Method: Twenty-three metaphyseal tibia fractures were treated with IMN. Twelve were distal tibial fractures (AO/OTA 43A), nine were proximal tibial fractures (AO/OTA 41A2/3), and two had segmental tibia fractures (AO/OTA 42C2). The minimum follow-up was 1 year.
Results: Radiograph angulation at the fracture site was <5 degrees. All patients achieved bone healing. One patient (AO/OTA 42C2) required plate augmentation and bone autografting. Twenty-one out of 23 patients had knee pain scores of >20 according to the Lysholm scale.
Conclusion: The parapatellar approach in a semi-extended position is a safe and useful technique for IMN of metaphyseal tibia fractures with no associated increased postoperative knee pain.
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How to Cite
Pereira, S., Vindver, G., & Bidolegui, F. (2020). Intramedullary nailing treatment of proximal and distal tibia metaphyseal fractures. Medial parapatellar approach in semi-extended position. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(2), 99-106. https://doi.org/10.15417/issn.1852-7434.2020.85.2.974
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Clinical Research
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References
1. Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg Am 1986;68:877-87. PMID: 3733776
2. Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res 1995;(315):25-33. PMID: 7634677
3. 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. PMID: 7634688
4. Lindvall E, Sanders R, DiPasquale T, Herscovici D, Haidukewych G, Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma 2009;23(7):485-92. https://doi.org/10.1097/BOT.0b013e3181b013d2
5. Yaligod V, Rudrappa GH, Nagendra S, Shivanna UM. Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures. J Orthop 2013;11(1):10-8. https://doi.org/10.1016/j.jor.2013.12.002
6. Tornetta P 3rd, Collins E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop 1996;(328):185-9. https://doi.org/10.1097/00003086-199607000-00029
7. Kubiak EN, Widmer BJ, Horwitz DS. Extra-articular technique for semiextended tibial nailing. J Orthop Trauma 2010;24(11):704-8. https://doi.org/10.1097/BOT.0b013e3181d5d9f4
8. Cole JD. Distal tibia fracture: Opinion: intramedullary nailing. J Orthop Trauma 2006;20:73-4. https://doi.org/10.1097/01.bot.0000196658.55293.e6
9. Gustilo RD, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analysis. J Bone Joint Surg Am 1976;58:453-8. PMID: 773941
10. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S208-28. https://doi.org/10.1002/acr.20632
11. Vallier HA, Le TT, Bedi A. Radiographic and clinical comparison of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma 2008;22(5):307-11. https://doi.org/10.1097/BOT.0b013e31816ed974
12. Nork SE, Barei DP, Schildhauer TA. Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma 2006;20(8):523-8. https://doi.org/10.1097/01.bot.0000244993.60374.d6
13. Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC. Semiextended intramedullary nailing of the tibia using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up. J Orthop Trauma 2014;28(5):245-55. https://doi.org/10.1097/BOT.0000000000000082
14. Ryan SP, Steen B, Tornetta P 3rd. Semi-extended nailing of metaphyseal tibia fractures: alignment and incidence of postoperative knee pain. J Orthop Trauma 2014;28(5):263-9. https://doi.org/10.1097/BOT.0000000000000083
15. Rothberg DL, Stuart AR, Presson AP, Haller JM, Higgins TF, Kubiak EN. A comparison of the open semi-extended parapatellar versus standard entry tibial nailing techniques and knee pain: a randomized controlled trial. J Orthop Trauma 2019;33(1):31-6. https://doi.org/10.1097/BOT.0000000000001309
16. Ibrahim I, Johnson A, Rodriguez EK. Improved outcomes with semi-extended nailing of tibial fractures? A systematic review. J Orthop Trauma 2019;33(3):155-60. https://doi.org/10.1097/BOT.0000000000001395
17. Mitchell PM, Weisenthal BM, Collinge CA. No incidence of postoperative knee sepsis with suprapatellar nailing of open tibia fractures. J Orthop Trauma 2017;31(2):85-9. https://doi.org/10.1097/BOT.0000000000000725
2. Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res 1995;(315):25-33. PMID: 7634677
3. 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. PMID: 7634688
4. Lindvall E, Sanders R, DiPasquale T, Herscovici D, Haidukewych G, Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma 2009;23(7):485-92. https://doi.org/10.1097/BOT.0b013e3181b013d2
5. Yaligod V, Rudrappa GH, Nagendra S, Shivanna UM. Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures. J Orthop 2013;11(1):10-8. https://doi.org/10.1016/j.jor.2013.12.002
6. Tornetta P 3rd, Collins E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop 1996;(328):185-9. https://doi.org/10.1097/00003086-199607000-00029
7. Kubiak EN, Widmer BJ, Horwitz DS. Extra-articular technique for semiextended tibial nailing. J Orthop Trauma 2010;24(11):704-8. https://doi.org/10.1097/BOT.0b013e3181d5d9f4
8. Cole JD. Distal tibia fracture: Opinion: intramedullary nailing. J Orthop Trauma 2006;20:73-4. https://doi.org/10.1097/01.bot.0000196658.55293.e6
9. Gustilo RD, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analysis. J Bone Joint Surg Am 1976;58:453-8. PMID: 773941
10. Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S208-28. https://doi.org/10.1002/acr.20632
11. Vallier HA, Le TT, Bedi A. Radiographic and clinical comparison of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma 2008;22(5):307-11. https://doi.org/10.1097/BOT.0b013e31816ed974
12. Nork SE, Barei DP, Schildhauer TA. Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma 2006;20(8):523-8. https://doi.org/10.1097/01.bot.0000244993.60374.d6
13. Sanders RW, DiPasquale TG, Jordan CJ, Arrington JA, Sagi HC. Semiextended intramedullary nailing of the tibia using a suprapatellar approach: radiographic results and clinical outcomes at a minimum of 12 months follow-up. J Orthop Trauma 2014;28(5):245-55. https://doi.org/10.1097/BOT.0000000000000082
14. Ryan SP, Steen B, Tornetta P 3rd. Semi-extended nailing of metaphyseal tibia fractures: alignment and incidence of postoperative knee pain. J Orthop Trauma 2014;28(5):263-9. https://doi.org/10.1097/BOT.0000000000000083
15. Rothberg DL, Stuart AR, Presson AP, Haller JM, Higgins TF, Kubiak EN. A comparison of the open semi-extended parapatellar versus standard entry tibial nailing techniques and knee pain: a randomized controlled trial. J Orthop Trauma 2019;33(1):31-6. https://doi.org/10.1097/BOT.0000000000001309
16. Ibrahim I, Johnson A, Rodriguez EK. Improved outcomes with semi-extended nailing of tibial fractures? A systematic review. J Orthop Trauma 2019;33(3):155-60. https://doi.org/10.1097/BOT.0000000000001395
17. Mitchell PM, Weisenthal BM, Collinge CA. No incidence of postoperative knee sepsis with suprapatellar nailing of open tibia fractures. J Orthop Trauma 2017;31(2):85-9. https://doi.org/10.1097/BOT.0000000000000725