RESUMEN
INTRODUCTION: Based on a novel simple frontal view classification, a comprehensive concept for systematic management of intramedullary fixation of distal tibial fractures is introduced. Even the usage of thin (unreamed) nails allows for anatomic reduction and stable fixation if applied in combination with transmedullary support (TMS) screws. Our classification system guides the placement of the TMS screw (medial or lateral) and suggests whether to fix the fibula or not. PATIENTS AND METHODS: The fixation concept of the classification was applied to 67 distal tibial fracture cases. Patients were followed up until nail removal after at least 12 months. RESULTS: All fractures united. Besides 5 cases of slight external malrotation (<5 degrees) no axial malunion was found. Two infections were encountered, but both were treated effectively by exchange nailing, antibiotic therapy until wound healing and C-reactive protein normalization. Final functional assessment according to Olerud/Molander Score was 85 pts (100 pts. possible, range 50-100 pts). DISCUSSION: The stability we achieved even with single screw interlocking was high due to anatomic reduction with interfragmental compression in the lowest fracture line. In cases of fracture extension into the ankle joint, interfragmental compression screws were applied before nail insertion. In more comminuted fracture types additional screws are advisable. CONCLUSIONS: The frontal view classification has proven to be a reliable guideline for effective intramedullary fracture fixation by minimally invasive means, allowing for optimized soft tissue protection.
Asunto(s)
Peroné/cirugía , Fijación Intramedular de Fracturas , Curación de Fractura/fisiología , Fracturas de la Tibia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Placas Óseas , Tornillos Óseos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/diagnóstico por imagen , Adulto JovenRESUMEN
Although open reduction and internal fixation is considered the best method for treating displaced articular fractures of the calcaneus, lateral approach is at high risk for wound healing complications. For this reason, the authors developed a posterior approach and a new implant to perform both intrafocal reduction and internal fixation. The aim of this technical note is to describe this method of treatment for displaced articular fractures of the calcaneus, which offered the following advantages: (a) the creation of a working channel that provides also a significant bone autograft, (b) the intrafocal reduction of the displaced articular surface, (c) the insertion of a locking nail that maintains the reduced articular surface at the right height, (d) the possibility to switch from an ORIF to a reconstruction arthrodesis with the same approach and instrumentation in case of severely damaged posterior facet.