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Background One of the most frequent long bone fractures that most orthopaedic surgeons see is a tibial diaphyseal fracture. The tibia has more open fractures than any other major long bone because it is covered by skin for the majority of its length. The best course of therapy is still up for debate due to the high occurrence of comorbidities linked to these fractures. Materials and methods In this prospective study, 30 patients who met the inclusion criteria were admitted to the Department of Orthopaedics of Shri B. M. Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India. The period of study was from January 2021 to May 2022. The patients were followed up for a period of six months. Longer follow-up was required for some patients. Results In our study, there were 26 (86.7%) male and four (13.3%) female patients. The mode of injury was road traffic accidents in all cases. The functional outcomes obtained using the modified Anderson and Hutchinson's criteria were good results in 22 (73.3%), moderate results in five (16.7%), and poor results in three (10%) of the study population. Pin tract infections (six cases; 20%) and shortening (eight cases; 26.7%) were the most frequent complications Conclusion Because of the ease of use, good fracture stability, adjustable geometry, light weight, reasonable price, and patient friendliness, the limb reconstruction system (LRS) provides an excellent alternative treatment option for treating compound fractures of the tibia.

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Introduction: Tibial fractures are common long bone injuries, often surgically fixed with intramedullary nails. Modern intramedullary tibial nails allow for two different fixation modes, namely static and dynamic modes. While studies have demonstrated benefits of using either fixation modes, there has been no consensus as to which fixation mode would produce better outcomes and less complications. This systematic review and meta-analysis aims to compare the efficacy and safety of dynamic versus static fixation of intramedullary nails in the operative fixation of tibial diaphyseal fractures. Methods: A meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on April 15, 2021. Data from all published literature meeting inclusion criteria were extracted and analysed with fixed- and random-effects models.Findings/results: A total of 478 statically fixed and 234 dynamically fixed patients were included in this meta-analysis. Dynamically fixed patients had a significantly shorter mean time to union (mean difference, MD = 5.18 weeks, 95%CI: 1.95-8.41 weeks, p = 0.002) and reoperation rates (OR = 0.21, 95%CI: 0.10-0.47, p < 0.001) than statically fixed patients. No significant difference was found between both groups in terms of malrotation (OR = 0.57, 95% CI: 0.07-4.41, p = 0.59), non-union (OR = 1.10, 95% CI: 0.24-5.05, p = 0.91), delayed union (OR = 1.15, 95%CI: 0.19-7.17, p = 0.88) and malunion (OR = 2.73, 95% CI: 0.29-25.26, p = 0.38). Conclusion: While acknowledging that there is widespread surgeon preference to dyanamise or statically fix intramedullary nails in certain tibial fracture configurations, primary dynamic fixation of intramedullary tibial nails demonstrated significantly shorter times to bony union and less complications than static nailing in our meta-analysis. Further research on identifying patient factors and fracture patterns that would best benefit from dynamic fixation is required.

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PURPOSE: The aim of our study was to compare the results of using small-diameter versus large-diameter interlocking reamed intramedullary nails in treatment of simple tibial shaft fractures. METHODS: This prospective randomized control trial involved 60 patients, divided into two groups, Group A (Small IMN) (10 mm in males and 9 mm in females) and Group B (Large IMN) (12 mm in males and 11 mm in females). All patients were followed up for at least 1 year. RESULTS: The mean operative time in Group A was 79 min versus 94.6 min in Group B. The mean time of radiological exposure in Group A was 2.27 min compared to 3.73 min in Group B. The mean union time in Group A was 15.2 weeks, while in Group B, the mean union time was 12.8 weeks. Implant failure (screw breakage or nail breakage) or nonunion did not occur in any case in the two groups. CONCLUSION: Small IMN showed comparable clinical and radiological results to large IMN with lesser operative and radioscopic time. We can recommend that small IMN should be used more often in treating simple stable tibial fractures.

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Fijación Intramedular de Fracturas , Fracturas de la Tibia , Clavos Ortopédicos , Femenino , Fijación Intramedular de Fracturas/métodos , Curación de Fractura , Humanos , Masculino , Estudios Prospectivos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Resultado del Tratamiento

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OBJECTIVES: Acute compartment syndrome (CS) is a common complication of tibia shaft fractures (TSFs), and occurs when the pressure inside a myofascial compartment rises and impairs tissue perfusion. If treatment is delayed due to a missed diagnosis, amputation or permanent loss of function can result. This study aims to determine the incidence, clinical associations, and risk factors for missed CS following surgical stabilization of tibia shaft fractures (TSFs) using data from the National Trauma Data Bank (NTDB). METHODS: NTDB data files from 2007 to 2016 were accessed to collect information on patients undergoing surgical fixation of TSFs. Patients with an Injury Severity Score (ISS) > 15 or inferred Gustilo-Anderson IIIB/IIIC fractures were excluded to create a more homogenous sample of lower-grade TSFs. Compartment syndrome that was originally missed leading to late intervention was the main outcome under investigation. Bivariate tests were used to assess the relationships between missed CS and the preoperative variables. If a variable and a complication had an association with a P ≤ 0.2, it was included in a multivariate logistic regression model. RESULTS: A total of 184,612 patients met our inclusion criteria, and 1,269 patients (0.76%) had a missed CS diagnosis. Bivariate analysis demonstrated that male gender had a significant positive association with a missed CS diagnosis, while older age had a significant negative association (odds ratio [OR] = 2.17, 0.99; P < 0.001). Multivariate analysis revealed that male gender was the most significant independent risk factor for a missed diagnosis of compartment syndrome (OR = 1.84, P < 0.00001), followed by alcoholism, penetrating trauma, and smoking (OR = 1.51, 1.46, 1.43; P < 0.02). The only significant protective factor was open fracture (OR = 0.70, P < 0.0001). CONCLUSIONS: Our research identified several significant risk factors for missed CS after TSF, as well as positive and negative associations. Male gender, age, and lifestyle choices such as alcohol use and smoking conferred increased risks. These variables may assist physicians in identifying at-risk patients who may benefit from increased monitoring, and potentially prevent the high morbidity associated with this condition.

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Síndromes Compartimentales , Fracturas de la Tibia , Anciano , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/etiología , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Tibia , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/epidemiología , Fracturas de la Tibia/cirugía , Resultado del Tratamiento

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BACKGROUND: Postoperative malalignment in fractures treated by monolateral external fixation is not uncommon in clinical practice. Accurate reduction without excessive tissue disruption caused by surgical intervention and sequentially manage the fractures using monolateral external fixation for definitive treatment is still a challenge for surgeons. The purpose of our study was to evaluate the feasibility and effectiveness of the temporary application of the hexapod external fixator (HEF) for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation. METHODS: We carried out a retrospective analysis of 23 trauma patients with tibial diaphyseal fracture treated by the monolateral external fixation at our institution from January 2016 to May 2019. There were 21 males and 2 females with a mean age of 38 years (range 18-60 years). The hexapod external fixator was temporarily applied due to postoperative malalignment within two weeks and who unwilling to undergo a secondary surgical intervention. For patients with postoperative malalignment requiring correction, the HEF components were installed on the original existing half pins of the monolateral external fixator after removing the connecting rod. The standard anteroposterior and lateral X-rays of the injured limb combined with the temporary HEF were conducted to measure the hexapod external fixator parameters. Any residual deformities were corrected by gradual struts adjustment with the aid of computer-based software. When satisfactory alignment was achieved, the HEF was removed, and the monolateral external fixator was sequentially used as the definitive structure. RESULTS: All patients acquired functional reduction, which was evaluated by radiographs. The mean correction time was 4 days (range 2 to 8 days). The mean coronal plane translation (1.3±1.0 mm), coronal plane angulation (0.9±0.7°), sagittal plane translation (1.4±1.1 mm), and sagittal plane angulation (0.7±0.7°) after correction were all less than those (7.0±4.9 mm, 4.7±2.3°, 5.6±3.6 mm, 3.2±2.5°) before correction. CONCLUSIONS: The temporary application of the hexapod external fixator is an alternative and feasible method for the postoperative malalignment correction in tibial diaphyseal fractures treated by monolateral external fixation.

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Fijadores Externos , Fracturas de la Tibia , Adolescente , Adulto , Diáfisis/diagnóstico por imagen , Diáfisis/cirugía , Femenino , Fijación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Resultado del Tratamiento , Adulto Joven

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Aims The aim of this study was to assess functional outcome, at medium-term follow up, in patients undergoing intra-medullary nailing of tibial shaft fractures, using the supra-patellar approach. Materials and methods The study included patients with intra-medullary nailing, for diaphysial tibia fractures, between March 2013 to August 2015. An initial audit compared short-term functional outcomes at 15 months, between the supra and infra-patellar approaches, using a cohort of 20 patients (10 in each group). Subsequently, a larger cohort of 22 patients with supra-patellar nailing, were reviewed for medium term assessment of their functional outcomes at average 60 months (50 - 78 months) and the results between all 3 groups were compared. All patients were assessed using the Kujala and Oxford Knee Scores. Results The mean age of the cohorts was 38 years (18-87years). The mean follow-up was 15 months for the initial audit and 60 months for the medium-term results. The initial audit showed that the supra-patellar group had statistically significantly better Oxford and Kujala scores when compared to infra-patellar group (p < 0.05). At 5 years following supra-patellar nailing, the medium-term cohort showed improved outcome scores compared to the infra-patellar group at 1 year (p < 0.01) but showed no difference with the supra-patellar group at 1 year (p value >0.1). Conclusion Our study suggests that patients undergoing supra-patellar tibial nailing have better outcomes at 15 months compared to traditional infra-patellar nailing and more importantly, they continue to do well even at 5 years, despite perceived risks associated with this technique.

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Clavos Ortopédicos , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fijación Intramedular de Fracturas/efectos adversos , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/fisiopatología , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Fracturas de la Tibia/fisiopatología , Centros Traumatológicos , Adulto Joven

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BACKGROUND: The treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries, meanwhile it has the advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Nevertheless, its application is accompanied by a series of problems in alignment and bone healing. Therefore, limited internal fixation (LIF), such as cortical screws, has been used based on the external fixator for better therapeutic effect. The aim of this study is to compare the outcomes of EF combined with LIF and simple EF in the management of open tibial shaft fractures, evaluating the efficacy and safety of using the combined technique in treating such fractures. METHODS: From January 2012 to December 2016, patients with open tibial shaft fractures treated with EF with or without LIF augmentation were identified. A total of 152 patients were included in the analysis, and there were 85 patients in the simple external fixation group and 67 patients in the EF-LIF group. General assessment indicators included the direct cost of hospitalization and the times of first surgery, full weight bearing, and complete union. Infections and complications in union or limb alignment were compared as primary outcomes. Additionally, the number of patients who changed the fixation system for various reasons were analysed. RESULTS: Effective follow-up of all participants for statistical analysis was obtained. The follow-up time averaged 17.15 months (range: 12.00 to 24.00 months) in the EF group and 16.20 months (range: 12.00 to 19.00 months) in the EF-LIF group. Combined fixation provided shortened time to bear full weight and achieve complete bone union, while requiring additional first surgery time. No significant difference was found in infection rates or direct cost of hospitalization. Delayed union and non-union in the EF-LIF group were significantly decreased (20.9% versus 40.0, 1.5% versus 14.1%, p < 0.05). In limb alignment, patients with combined fixation exhibited reduced malreduction, loss of reduction, and malunion. In terms of secondary fixation, the EF-LIF group showed a markedly lower incidence (5.8% versus 34.1%, p < 0.001). CONCLUSION: Compared with simple EF, combined fixation is an effective and safe alternative for management of open tibial diaphyseal fractures. It provides superior initial reduction, better stability and decreases the risk of inferior alignment and delayed union without increasing the risk of infection.

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Fijadores Externos , Fijación Interna de Fracturas/métodos , Curación de Fractura , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Anciano , Placas Óseas , Tornillos Óseos , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven

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Se realizó un estudio descriptivo, longitudinal y retrospectivo de 123 pacientes con fractura diafisaria de tibia, quienes fueron intervenidos mediante la técnica quirúrgica de fijación con clavo intramedular de Küntscher sin fresado del canal, desde agosto del 2012 hasta diciembre del 2013, en el Hospital Especial de Tumbi, de Kibaha, Tanzania, con vistas a evaluar los resultados de dicho procedimiento. En la serie predominaron el sexo masculino (74,0 %), el grupo etario de 26-35 años (37,4 %), los accidentes de tránsito como causa principal de las lesiones (74,0 %) y la reducción de la fractura de forma abierta (90,2 %); asimismo, 29,4 % de los pacientes presentó complicaciones y 80,5 % mostró buenos resultados en la evaluación final. Finalmente, se pudo concluir que el uso del clavo intramedular de Küntscher sin fresado del canal, es una técnica quirúrgica viable para solucionar las fracturas diafisarias de tibia.

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A descriptive, longitudinal and retrospective study of 123 patients with tibial diaphyseal fracture who were surgically treated by means of the surgical technique of fixation with Küntscher intramedullary nail without reaming of channels was carried out from August, 2012 to December, 2013, in Tumbi Special Hospital, Kibaha, Tanzania, with the aim of evaluating the results of this procedure. The male sex (74.0%), the age group 26-35 years (37.4%), the traffic accidents as main cause of the lesions (74.0%) and the reduction of the fracture in an open way (90.2%) prevailed in the series; also, 29.4% of the patients presented complications and 80.5% showed good results in the final evaluation. Finally, it could be concluded that the use of Küntscher intramedullary nail without reaming channels, is a viable surgical technique to solve the tibial diaphyseal fractures.

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Fracturas de la Tibia , Clavos Ortopédicos , Tanzanía

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BACKGROUND: Nonunion of long bones is a difficult clinical problem and challenges the clinical acumen of surgeons. Multiple surgical or nonsurgical modalities have been used to treat nonunions. Noninvasive pulsed electromagnetic stimulation is an entity known to affect the piezoelectric phenomenon of bone forming cells. We conducted a study on 45 long-bone fractures of tibia treated by pulsed electromagnetic stimulation, which are analyzed and reported. MATERIALS AND METHODS: A total of 45 tibial fractures with established atrophic nonunion were enrolled between 1981 and 1988. All the patients had abnormal mobility and no or minimal gap at fracture site with no evidence of callus formation across the fracture site. The patients' age ranged between 24 and 68 years; 40 were men and 5 were women. All patients having evidence of infection, implant in situ, and gap nonunions were excluded from study. Pulsed electromagnetic stimulation was given using above-knee plaster of Paris cast (0.008 Weber/m2 magnetic field was created for 12 h/day). The average duration for pulsed electromagnetic stimulation (PEMS) therapy was 8.35 weeks, with the range being 6-12 weeks. The cases were evaluated at 6 weeks and subsequently every 6-weekly interval for clinical and radiological union. The withdrawal of therapy was decided as per clinicoradiological evidence of union. RESULTS: All but three patients showed evidence of union. About 35% (n = 16) cases showed union in 10 weeks, and 85%(n = 38) cases showed union in 4 months. The average duration of therapy using PEMS was 8.35+/-0.48 weeks, and the average duration of immobilization was 3.02 +/- 0.22 months. Three cases that did not show evidence of union were poorly compliant for the apparatus of PEMS. CONCLUSION: PEMS is a useful noninvasive modality of treatment for difficult nonunion of long bones.

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A group of 30 patients of unstable tibial diaphyseal fractures were managed using unilateral tubular external fixator. The fixator assembly comprised a double stainless steel hollow rod with universal joints and schanz screws as principal implant. Reduction and controlled distraction or compression were achieved by means of distracter/compressor device. Early dynamization was resorted to. The union rate was 100% with average healing time between 20 weeks for closed unstable fractures and 27 weeks for open Gustilo grade-II fractures. Minor pin tract infections accounted for majority of the complications. The unilateral fixator assembly permits early ambulation in unstable tibial diaphyseal fractures without sacrificing a sound anatomical result.