DESIGN AND CLINICAL APPLICATION OF SURGICAL DEVICE FOR CLOSED REDUCTION OF TIBIAL FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DONG Wenwei , SHI Zengyuan , LIU Zhenxin , XU Haiping.

Department of Traumatic Orthopaedics, the Affiliated Hospital, School of Medicine of Ningbo University, Ningbo Zhejiang, 315000, P.R.China. Corresponding author: SHI Zengyuan, E-mail: szy580@sohu.com;

Corresponding author：

Keywords：

Tibial fracture Intramedullary nailing; Closed reduction; Surgical device for closed reduction of bitial fracture

DOI：

10.7507/1002-1892.20130280

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Objective To describe a surgical device for closed reduction of tibial fracture and investigate its clinical effectiveness. Methods Between June 2010 and December 2012, 24 cases of tibial fractures were treated with intramedullary nailing using a surgical device for closed reduction. There were 18 males and 6 females with an average age of 40 years (range, 20-64 years). All fractures were closed. There were 3 proximal third fractures, 12 middle third fractures, and 9 distal third fractures. According to AO classification, 12 cases were classified as type A, 8 cases as type B, and 4 cases as type C. The mean time between injury and operation was 3 days (range, 1-12 days). The intraoperative fluoroscopy frequency to confirm closed reduction and guide wire passing the fracture site, and the duration between fracture reduction and nail insertion were recorded. The injured limb alignment and fracture angular deformity were measured as described by Freedman et al. The fuction of affected limb was estimated by Johner-Wruhs criteria. Results Closed reduction was successfully performed in 24 patients. The mean fluoroscopy frequency to confirm closed reduction was 3 (range, 2-5). The fluoroscopy frequency to confirm guide wire passing the fracture site was 2. The mean duration between fracture reduction and nail insertion was 30 minutes (range, 20-42 minutes). No intraoperative or postoperative complication occurred, such as infection, vessel and nerve injuries. All incisions healed by first intention. Seventeen patients were followed up 6-16 months (mean, 10 months). Radiographic evidence showed that bridging callous was observed at 2-4 months (mean, 2.5 months). The injured limb alignment was normal on anteroposterial and lateral radiographs at 5 months postoperatively, no malalignment and obvious angular deformity was observed. The internal fixator had good position. According to Johner-Wruhs criteria for evaluation of the affected limb function, the results were excellent in 12 cases and good in 5 cases with an excellent and good rate of 100%. Conclusion The surgical device for closed reduction of tibial fracture is simple and easy to use, and has good effectiveness combined with intramedullary nailing.

Citation： DONG Wenwei,SHI Zengyuan,LIU Zhenxin,XU Haiping.. DESIGN AND CLINICAL APPLICATION OF SURGICAL DEVICE FOR CLOSED REDUCTION OF TIBIAL FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(11): 1281-1285. doi: 10.7507/1002-1892.20130280 Copy

1.	Brumback RJ. The rationales of interlocking nailing of the femur, tibia, and humerus. Clin Orthop Relat Res, 1996, (324): 292-320.
2.	Bhandari M, Guyatt GH, Swiontkowski MF, et al. Surgeon’s preferences for the operative treatment of fractures of the tibial shaft. J Bone Joint Surg (Am), 2001, 83-A(11): 1746-1752.
3.	Arbuthnot JE, Perera A, Powers D. Primary rigid intramedullary nail for fractures of the tibia: current concepts and techniques. Eur J Orthop Surg Traumatol, 2008, 18(6): 435-440.
4.	Robertson A, Giannoudis PV, Matthews SJ. Maintaining reduction during undreamed nailing of a segmental tibial fracture: the use of a Farabeuf clamp. Injury, 2003, 34(5): 389-391.
5.	Malik MHA, Harwood P, Diggle P, et al. Factors affecting rates of infection and nonunion in intramedullary nailing. J Bone Joint Surg (Br), 2004, 86(4): 556-560.
6.	Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res, 1995, (315): 25-33.
7.	Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
8.	Seyhan M, Kocaoglu B, Nalbantoglu U, et al. A positioning technique for closed intramedullar nailing of tibia fractures. J Trauma, 2008, 64(5): 1408-1411.
9.	Hill RA, Albert JS. Patient positioning for closed locked tibial nailing. Injury, 1990, 21(3): 193-194.
10.	McBirnie JM, Burnett R. A traction technique for intramedullary nailing of tibial fractures. Injury, 1996, 27(10): 733-734.
11.	Gibbons CE, Solan MC, Bendall SP. The use of the ankle arthroscopy strap during intramedullary tibial nailing. Injury, 1999, 30(1): 72-73.
12.	Jackson M, Topliss CJ, Atkins RM. Fine wire frame-assisted intramedullary nailing of the tibia. J Orthop Trauma, 2003, 17(3): 222-224.
13.	Moed BR, Watson JT. Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique. J Orthop Trauma, 1994, 8(3): 195-202.
14.	Krause PC, Whatley AN, Mautner JF. A technique for nailing severely shortened and displaced tibia fractures. J Orthop Trauma, 2008, 22(2): 138-141.
15.	高士濂. 实用解剖图谱: 下肢分册. 2版. 上海: 上海科学技术出版社, 2004: 140-247.
16.	Vernon P, Delattre JF, Johnson EJ, et al. Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee. Surg Radiol Anat, 1987, 9(1): 37-41.
17.	周锦年, 高剑锐, 路通. 交锁髓内钉治疗胫骨骨折87例报告. 中华创伤骨科杂志, 2008, 10(4): 395-396.
18.	Sarangi PP, Karachalios T. Posterior tibial nerve palsy after intramedullary nailing. Int Orthop, 1993, 17(2): 125-126.
19.	Robinson CM, Donnell JO, Will E, et al. Dropped hallux after the intramedullary nailing of tibial fractures. J Bone Joint Surg (Br), 1999, 81(3): 481-484.

1. Brumback RJ. The rationales of interlocking nailing of the femur, tibia, and humerus. Clin Orthop Relat Res, 1996, (324): 292-320.
2. Bhandari M, Guyatt GH, Swiontkowski MF, et al. Surgeon’s preferences for the operative treatment of fractures of the tibial shaft. J Bone Joint Surg (Am), 2001, 83-A(11): 1746-1752.
3. Arbuthnot JE, Perera A, Powers D. Primary rigid intramedullary nail for fractures of the tibia: current concepts and techniques. Eur J Orthop Surg Traumatol, 2008, 18(6): 435-440.
4. Robertson A, Giannoudis PV, Matthews SJ. Maintaining reduction during undreamed nailing of a segmental tibial fracture: the use of a Farabeuf clamp. Injury, 2003, 34(5): 389-391.
5. Malik MHA, Harwood P, Diggle P, et al. Factors affecting rates of infection and nonunion in intramedullary nailing. J Bone Joint Surg (Br), 2004, 86(4): 556-560.
6. Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res, 1995, (315): 25-33.
7. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178): 7-25.
8. Seyhan M, Kocaoglu B, Nalbantoglu U, et al. A positioning technique for closed intramedullar nailing of tibia fractures. J Trauma, 2008, 64(5): 1408-1411.
9. Hill RA, Albert JS. Patient positioning for closed locked tibial nailing. Injury, 1990, 21(3): 193-194.
10. McBirnie JM, Burnett R. A traction technique for intramedullary nailing of tibial fractures. Injury, 1996, 27(10): 733-734.
11. Gibbons CE, Solan MC, Bendall SP. The use of the ankle arthroscopy strap during intramedullary tibial nailing. Injury, 1999, 30(1): 72-73.
12. Jackson M, Topliss CJ, Atkins RM. Fine wire frame-assisted intramedullary nailing of the tibia. J Orthop Trauma, 2003, 17(3): 222-224.
13. Moed BR, Watson JT. Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique. J Orthop Trauma, 1994, 8(3): 195-202.
14. Krause PC, Whatley AN, Mautner JF. A technique for nailing severely shortened and displaced tibia fractures. J Orthop Trauma, 2008, 22(2): 138-141.
15. 高士濂. 实用解剖图谱: 下肢分册. 2版. 上海: 上海科学技术出版社, 2004: 140-247.
16. Vernon P, Delattre JF, Johnson EJ, et al. Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee. Surg Radiol Anat, 1987, 9(1): 37-41.
17. 周锦年, 高剑锐, 路通. 交锁髓内钉治疗胫骨骨折87例报告. 中华创伤骨科杂志, 2008, 10(4): 395-396.
18. Sarangi PP, Karachalios T. Posterior tibial nerve palsy after intramedullary nailing. Int Orthop, 1993, 17(2): 125-126.
19. Robinson CM, Donnell JO, Will E, et al. Dropped hallux after the intramedullary nailing of tibial fractures. J Bone Joint Surg (Br), 1999, 81(3): 481-484.

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DESIGN AND CLINICAL APPLICATION OF SURGICAL DEVICE FOR CLOSED REDUCTION OF TIBIAL FRACTURE

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