EFFECTIVENESS COMPARISON OF DIFFERENT OPERATIVE METHODS IN TREATMENT OF CLOSED FRACTURE OF TIBIAL SHAFT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANHongkai ¹ ,  HUANGJincheng ²

1. Department of Orthopedics, the First People's Hospital of Zhengzhou, Zhengzhou Henan, 450000, P. R. China;
2. Graduate School of Southern Medical University;

Corresponding author：

HUANGJincheng, Email: drlaohuang@163.com

Keywords：

Tibial shaft fracture; Locking plate; Minimally invasive internal fixation; Intramedullary nail

DOI：

10.7507/1002-1892.20150231

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of three different operative methods in the treatment of closed fracture of the tibial shaft. Methods Between January 2012 and May 2014, 94 patients with closed fracture of the tibial shaft were treated, and the clinical data were retrospectively analyzed. Fracture was fixed with locking plate (external fixation) in 25 cases (group A), with intramedullary nail in 34 cases (group B), and with minimally invasive locking plate in 35 cases (group C). There was no significant difference in gender, age, reasons of injury, fracture types, and time from injury to operation among groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency during operation, fracture union time, and complications were recorded. The effectiveness was evaluated according to Johner-Wruhs criteria. Results The operation time and fluoroscopy frequency during operation in groups A and C were significantly less than those in group B (P<0.05), but there was no significant difference between groups A and C (P>0.05). The intraoperative blood loss in groups A and C was significantly less than that in group B (P<0.05), and the blood loss in group A was significantly less than that in group C (P<0.05). All patients were followed up 15.61 months on average (range, 12-41 months). There was no significant difference in fracture union time among 3 groups (F=1.712, P=0.186). The excellent and good rates of groups A, B, and C were 92.00%, 88.24%, and 91.43% respectively according to Johner-Wruhs criteria at 12 months after operation, showing no significant difference (χ²=0.301, P=0.860). At 12 months after operation, the complication incidences of groups A (12.00%, 3/25), and C (15.55%, 5/35) were significantly lower than that of group B (44.12%, 15/34) (P<0.017), but no significant difference was found between groups A and C (P>0.017). Conclusion Using locking plate as external fixation and minimally invasive locking plate internal fixation are better than intramedullary nail fixation in treating closed fracture of tibial shaft because of less injury and lower complication incidence, and locking plate as external fixation is better than minimally invasive locking plate internal fixation because of less injury.

Citation： LIANHongkai, HUANGJincheng. EFFECTIVENESS COMPARISON OF DIFFERENT OPERATIVE METHODS IN TREATMENT OF CLOSED FRACTURE OF TIBIAL SHAFT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1067-1071. doi: 10.7507/1002-1892.20150231 Copy

1.	Sohn OJ, Kang DH. Staged protocol in treatment of open distal tibia fracture:using lateral MIPO. Clin Orthop Surg, 2011, 3(1):69-76.
2.	Tong DK, Ji F, Cai XB. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures. Chin J Traumatol, 2011, 14(4):233-236.
3.	Lindvall E, Sanders R, Dipasquale T, et al. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures:comparison of 56 cases. J Orthop Trauma, 2009, 23(7): 485-492.
4.	马敏, 蔡俊丰, 尹峰, 等. 两种术式治疗胫骨中段闭合性骨折的疗效比较. 中国矫形外科杂志, 2012, 20(18):1661-1664.
5.	肖志林, 周明昌, 冯经旺, 等. 微创经皮钢板接骨术结合锁定加压钢板与切开复位解剖型钢板内固定治疗胫骨远端骨折的疗效比较. 中华创伤骨科杂志, 2014, 16(1):91-92.
6.	布金鹏, 谢新敏, 张太元, 等. 微创带锁髓内钉治疗胫骨骨折两种方法疗效分析. 中国矫形外科杂志, 2010, 18(10):867-869.
7.	杨林, 赵新建, 张毅, 等. 专家型胫骨髓内钉与锁定钢板治疗胫骨干骺端骨折的疗效比较. 中华创伤骨科杂志, 2014, 16(6):547-549.
8.	田文, 王富明, 黄俭, 等. 髓内钉、锁定加压钢板内固定术治疗胫骨下段骨折疗效比较. 山东医药, 2013, 53(31):53-56.
9.	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.
10.	Stannard JP, Wilson TC, Volgas DA, et al. Fracture stabilization of proximal tibial fractures with the proximal tibial LISS:early experience in Birmingham, Alabama (USA). Injury, 2003, 34 Suppl 1: A36-42.
11.	李莹, 张力丹, 王满宜, 等. 经皮微创内固定与切开复位内固定治疗胫骨干远1/3骨折的比较研究. 中华创伤骨科杂志, 2010, 12(7): 642-646.
12.	陈刚, 钱明权, 朱国兴, 等. 经皮闭合复位锁定钢板和交锁髓内钉及切开复位钢板置入修复胫骨中下段骨折:生物稳定性比较. 中国组织工程研究, 2014, 18(44):7151-7156.
13.	Greiwe RM, Archdeacon MT. Locking plate technology:current concepts. J Knee Surg, 2007, 20(1):50-55.
14.	张洪, 叶茶花, 于虎, 等. 不同固定方法治疗96例胫骨骨折的病例对照研究. 中国骨伤, 2012, 25(3):198-201.
15.	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.
16.	Giannoudis PV, Snowden S, Matthews SJ, et al. Temperature rise during reamed tibial nailing. Clin Orthop Relat Res, 2002, (395):255-261.
17.	Klein MP, Rahn BA, Frigg R, et al. Reaming versus non-reaming in medullary nailing:interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg, 1990, 109(6):314-316.
18.	仲飙, 潘垚, 罗从风, 等. 胫骨干骨折髓内钉治疗后膝关节痛的临床研究. 中华创伤骨科杂志, 2004, 6(10):1109-1111.
19.	黄鹏, 唐佩福, 姚琦, 等. LCP钢板和带锁髓内钉治疗新鲜胫骨干骨折的对比分析. 中国修复重建外科杂志, 2007, 21(11):1167-1170.
20.	Forman JM, Urruela AM, Egol KA. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures. Acta Orthop Belg, 2011, 77(6):802-808.
21.	Guo JJ, Tang N, Yang HL, et al. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg (Br), 2010, 92(7):984-988.
22.	查国春, 陈泽林, 齐小波. 经皮微创锁定加压钢板内固定治疗胫骨骨折. 中国修复重建外科杂志, 2008, 22(12):1448-1450.
23.	Apivatthakakul T, Sananpanich K. The locking compression plate as an external fixator for bone transport in the treatment of a large distal tibial defect:a case report. Injury, 2007, 38(11):1318-1325.
24.	Ma CH, Tu YK, Yeh JH, et al. Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures. J Trauma, 2011, 71(3):614-619.
25.	Woon CY, Wong MK, Howe TS. LCP external fixation-external application of an internal fixator:two cases and a review of the literature. J Orthop Surg Res, 2010, 5:19.
26.	Ma CH, Wu CH, Yu SW, et al. Staged external and internal lessinvasive stabilisation system plating for open proximal tibial fractures. Injury, 2010, 41(2):190-196.
27.	Kloen P. Supercutaneous plating:use of a locking compression plate as an external fixator. J Orthop Trauma, 2009, 23(1):72-75.
28.	顾绍飞, 李永成, 刘道声, 等.骨质正常的简单胫骨骨折应用LCP 固定较LC-DCP或是一种过度治疗的对比研究. 中国医药指南, 2013, 11(31):63-64.

1. Sohn OJ, Kang DH. Staged protocol in treatment of open distal tibia fracture:using lateral MIPO. Clin Orthop Surg, 2011, 3(1):69-76.
2. Tong DK, Ji F, Cai XB. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures. Chin J Traumatol, 2011, 14(4):233-236.
3. Lindvall E, Sanders R, Dipasquale T, et al. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures:comparison of 56 cases. J Orthop Trauma, 2009, 23(7): 485-492.
4. 马敏, 蔡俊丰, 尹峰, 等. 两种术式治疗胫骨中段闭合性骨折的疗效比较. 中国矫形外科杂志, 2012, 20(18):1661-1664.
5. 肖志林, 周明昌, 冯经旺, 等. 微创经皮钢板接骨术结合锁定加压钢板与切开复位解剖型钢板内固定治疗胫骨远端骨折的疗效比较. 中华创伤骨科杂志, 2014, 16(1):91-92.
6. 布金鹏, 谢新敏, 张太元, 等. 微创带锁髓内钉治疗胫骨骨折两种方法疗效分析. 中国矫形外科杂志, 2010, 18(10):867-869.
7. 杨林, 赵新建, 张毅, 等. 专家型胫骨髓内钉与锁定钢板治疗胫骨干骺端骨折的疗效比较. 中华创伤骨科杂志, 2014, 16(6):547-549.
8. 田文, 王富明, 黄俭, 等. 髓内钉、锁定加压钢板内固定术治疗胫骨下段骨折疗效比较. 山东医药, 2013, 53(31):53-56.
9. 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.
10. Stannard JP, Wilson TC, Volgas DA, et al. Fracture stabilization of proximal tibial fractures with the proximal tibial LISS:early experience in Birmingham, Alabama (USA). Injury, 2003, 34 Suppl 1: A36-42.
11. 李莹, 张力丹, 王满宜, 等. 经皮微创内固定与切开复位内固定治疗胫骨干远1/3骨折的比较研究. 中华创伤骨科杂志, 2010, 12(7): 642-646.
12. 陈刚, 钱明权, 朱国兴, 等. 经皮闭合复位锁定钢板和交锁髓内钉及切开复位钢板置入修复胫骨中下段骨折:生物稳定性比较. 中国组织工程研究, 2014, 18(44):7151-7156.
13. Greiwe RM, Archdeacon MT. Locking plate technology:current concepts. J Knee Surg, 2007, 20(1):50-55.
14. 张洪, 叶茶花, 于虎, 等. 不同固定方法治疗96例胫骨骨折的病例对照研究. 中国骨伤, 2012, 25(3):198-201.
15. 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.
16. Giannoudis PV, Snowden S, Matthews SJ, et al. Temperature rise during reamed tibial nailing. Clin Orthop Relat Res, 2002, (395):255-261.
17. Klein MP, Rahn BA, Frigg R, et al. Reaming versus non-reaming in medullary nailing:interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg, 1990, 109(6):314-316.
18. 仲飙, 潘垚, 罗从风, 等. 胫骨干骨折髓内钉治疗后膝关节痛的临床研究. 中华创伤骨科杂志, 2004, 6(10):1109-1111.
19. 黄鹏, 唐佩福, 姚琦, 等. LCP钢板和带锁髓内钉治疗新鲜胫骨干骨折的对比分析. 中国修复重建外科杂志, 2007, 21(11):1167-1170.
20. Forman JM, Urruela AM, Egol KA. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures. Acta Orthop Belg, 2011, 77(6):802-808.
21. Guo JJ, Tang N, Yang HL, et al. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg (Br), 2010, 92(7):984-988.
22. 查国春, 陈泽林, 齐小波. 经皮微创锁定加压钢板内固定治疗胫骨骨折. 中国修复重建外科杂志, 2008, 22(12):1448-1450.
23. Apivatthakakul T, Sananpanich K. The locking compression plate as an external fixator for bone transport in the treatment of a large distal tibial defect:a case report. Injury, 2007, 38(11):1318-1325.
24. Ma CH, Tu YK, Yeh JH, et al. Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures. J Trauma, 2011, 71(3):614-619.
25. Woon CY, Wong MK, Howe TS. LCP external fixation-external application of an internal fixator:two cases and a review of the literature. J Orthop Surg Res, 2010, 5:19.
26. Ma CH, Wu CH, Yu SW, et al. Staged external and internal lessinvasive stabilisation system plating for open proximal tibial fractures. Injury, 2010, 41(2):190-196.
27. Kloen P. Supercutaneous plating:use of a locking compression plate as an external fixator. J Orthop Trauma, 2009, 23(1):72-75.
28. 顾绍飞, 李永成, 刘道声, 等.骨质正常的简单胫骨骨折应用LCP 固定较LC-DCP或是一种过度治疗的对比研究. 中国医药指南, 2013, 11(31):63-64.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON OF DIFFERENT OPERATIVE METHODS IN TREATMENT OF CLOSED FRACTURE OF TIBIAL SHAFT

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content