Classification of Proximal Tibial Fractures and Algorithm of Intramedullary Nailing: Efficacy Evaluation

Background. Intramedullary nailing of proximal tibial fractures is challenging due to difficulties with fracture reduction and achievement of stable fixation. Preoperative planning based on proximal fragment length, fracture pattern and bone quality evaluation is a prerequisite for a successful operation. However, there is no classification that could adequately access these factors and guide us towards the most effective methods of fracture reduction and fixation with intramedullary nail. The purpose of this study was to evaluate a classification of extra-articular proximal tibial fractures and algorithm for intramedullary nailing in clinical conditions. Materials and Methods. We compared the treatment outcomes before (Group 1) and after (Group 2) the introduction of the new PFL-TN classification algorithm of intramedullary nailing of proxamal tibial fractures. The group 1 included 43 patients from 18 to 71 years old (males 28; females 15; average age 44.52.0 years). The group 2 included 42 patients from 18 to 72 years old (males 30; females 12; average age 46.12.0 years). The data analysis was carried out after a minimum follow-up period of 12 months. The results were analyzed by the following criteria: reduction quality assesed with reduction quality scale, number of complications, quality of life with SF-36 questionnaire and leg function with LEFS scale. Results. The introduction of the proposed algorithm allowed to reduce the number of late complications by more than 5 times, and the number of required additional surgical interventions by more than 4 times compared to with a control group. The introduction of the proposed algorithm made it possible to improve the functional outcomes 1 year after surgery from 83.58 to 93.29% (p = 0.00002) by the LEFS scale, and the patients quality of life from the 77.501.88 to 86.712.03 points (p = 0.00072) and from the 81.251.88 to 86.842.26 points (p = 0.00116) by the physical and role functioning scales SF-36 questionnaire. Conclusion. The proposed algorithm, based on the new classification, allows to optimize the surgical technique of intramedullary nailing of proximal tibial fractures.

Outcome of Two Ring Hybrid Ilizarov Fixator in the Management of Proximal Tibial Fractures in Adults

Objective: The aim of this study is to determine the outcomes of using two ring hybrid ilizarov fixator for the management of proximal tibial fractures in adult patients. Study Design: Descriptive Study Place and Duration: Methods: There were 60 patients of both genders were presented in this study. Patients were aged between 25-65 years. Informed written consent was taken from all the patients for detailed demographics age, sex, body mass index and cause of fracture. All the patients had proximal tibial fractures were included, type of fractures were assessed by schatzker technique. Outcomes were assessed by using Rasmussen score in terms of excellent, good and fair. Radiological outcome was measured by fracture healing on radiography. Student t-test and chi square test was used. SPSS 24.0 was used to analyze all of the data. Results: There were 45 (75%) patients were males and 15 (25%) were female patients. Mean age of the patients was 42.3±7.43 years with mean BMI 25.07±6.29 kg/m2. Falling was the most common cause of fracture found in 33 (55%), followed by road traffic accidents in 17 (28.3%) and 10 (16.7%) fractures by assault. Majority of the patients were schatzker type VI fractures 34 (56.7%) followed by schatzker type V fractures in 11 (18.3%), metaphyseal fractures found in 8 (13.3%) cases and proximalone third shaft fractures in 7 (11.7%) cases. Mean surgery time was 4.2±6.17 hours and mean union time of fractures was 19.8±6.61 weeks. According to Rasmussen score 39 (65%) cases showed excellent results with knee flexion more than 90 degree, good results found in 17 (28.3%) patients and fair results in 4 (6.7%) cases. Pin tract infection was the most common complication found in 12 (20%) cases, followed by compartment syndrome in 4 (6.7%) and delayed union in 3 (5%). No any poor outcome was assessed in this study. Conclusion: We concluded in this study that the use of two ring hybrid ilizarov fixator in the management of proximal tibial fractures were effective and useful in terms of excellent and good outcomes of knee flexion. The ilizarov approach allowed for early definitive treatment with a low rate of complications and a favourable clinical outcome. Keywords: Proximal Tibial fracture, Ilizarov Fixator, Shatzker, Rasmussen score, Outcomes

Functional and clinical outcome of MIPPO anterolateral plating for proximal tibia fracture both proximal one third and coronal intrarticular fracture

<p class="abstract"><strong>Background: </strong>The proximal tibial fractures are one of the commonest intraarticular fractures. Generally these injuries fall into two broad categories, high energy fractures and low energy fractures. The tibial plateau fractures are mostly due to high velocity road traffic accidents and fall from height, where fractures result from direct axial compression, usually with a valgus (more common) or varus moment and indirect shear forces.</p><p class="abstract"><strong>Methods: </strong>This is a prospective study and includes operations by MIPPO technique that were undertaken between January 2020 till June 2021 in RNT government hospital; Udaipur. The total number of cases studied were 25 with the youngest being 25 years old and oldest 70 years old. Intraoperative complications were noted. Functional outcome was assessed using Modified Rasmussen’s Criteria.</p><p class="abstract"><strong>Results: </strong>Patients with fracture in our study occurred between the age of 25 to 70 years with maximum incidence involving the productive age group of 21-30 years (90%). Majority of the patients was males- 90%.</p><p class="abstract"><strong>Conclusions: </strong>From the minimally invasive percutaneous plate osteosynthesis of proximal tibial fracture there is an increase in the complexity of proximal tibial fractures with increasing road traffic accident. As most of the patients sustained these fractures belong to physically highly active and productive age group, they need optimal treatment to get back to their previous work capacity and avoid long term complications like osteoarthritis. We treated all fractures in our study with MIPPO technique and found rapid healing by secondary fracture union and hence achieving strong bone union across the fracture site due to inherent benefits of less tissue damage and minimal disturbance of fracture site biology. We operated 20 proximal tibial fractures with MIPPO technique and observed rapid healing and good functional recovery.</p>

Intramedullary Nailing Combined With Adjunct Plate or Blocking Screw for Proximal Tibial Fractures

Objective: To compare the traditional approach of intramedullary nail with an extra plate versus the nail combined with blocking screws for proximal tibia fractures without the knee involved. Methods: From January 2013 to January 2017, a total of 36 patients who suffered from proximal tibial fractures unaffecting the knee were enrolled into this prospective study, and divided into two groups by random number table method. Of them, 19 patients received an interlocking intramedullary nail combined with an extra plate for internal fixation of the fractures (the plate group), while the remaining 17 patients had fractures fixed with the nail combined with blocking screws (the screw group). The perioperative, follow-up and radiographic data were compared between the two groups. Results: All the 36 patients underwent operation smoothly without iatrogenic neurovascular injuries. The plate group proved superior the screw group regarding to operation time and intraoperative X-ray exposure (P＜0.05) , nevertheless the former was inferior to the latter in implant cost and hospital stay (P＜0.05) . The follow-up period lasted for 12～24 months with a mean of (15.62±4.71) months. There were no statistically significant differences in the time to return ambulation and the time to full weight-bearing activity between the two groups (P＞0.05) . At the latest follow up, no statistically significant differences were found between the two groups regarding knee range of motion and Johner-Wruhs grades for clinical consequences (P＞0.05) . In terms of anterior knee pain, the difference between the two groups was not statistically significant (P＞0.05) . In respect of radiographic assessment, the plate group had significantly less residual malalignment than the screw group, including anteroposterior and lateral displacements, as well as angulations in coronal and sagittal planes (P＜0.05) . To the latest follow up, all patients in both group got bony healing of the fractures without a statistical difference in fracture healing time between them (P＞0.05) , and no loosening or breaking of the implants were showed on images in anyone of them. Conclusion: Both the nail plus plate and nail plus blocking screw do achieve satisfactory clinical outcomes for proximal tibial fractures unaffecting the knee. By comparison, the nail combined with plate facilitates to regain and maintain better alignment of the leg regardless of higher implant cost.

Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

Objective: This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. Methods: We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Results: Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Conclusions: Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.

STUDY ON FUNCTIONAL OUTCOME OF TIBIAL PLATEAU FRACTURES TREATED WITH LOCKING COMPRESSION PLATE

Proximal tibial fractures, one of the commonest intra articular fractures. Incidence of these fractures is increasing due to road trafc accidents. At the same time surgical treatment options for the same are also being modied continuously. Any fracture around the weight bearing joint like knee joint is of paramount importance as it would result in signicant morbidity. Hence the treatment of proximal tibial fractures has become a challenge for the orthopaedic surgeons. Methods: During the study period 31 patients were treated with locking compression plate on lateral side through anterolateral approach for varying types of tibial plateau fractures. Out of 31, 28 patients were available at nal follow up. The functional and radiological outcome assessed with Rasmussen scoring system. At the end of study stability of the knee joint assessed with standard stability tests. Results: Most of the patients were sustained injury following major road trafc accidents and most of them were males. At nal follow up the functional outcome was excellent in 65 % of patients and good to fair in 35% of patients. No patient had poor functional outcome, though 10% of patients had poor radiological outcome. At the end of study 3 patients had posterior laxity, 2 patients had lateral meniscal injury and 4 patients had varus laxity. Conclusion: The functional outcome of tibial plateau fractures treated with single lateral locking compression plate was satisfactory in all our patients. All patients had acceptable clinical outcome though few patients had poor radiological outcome. We found 32% of patients with instability at the end of our study

Proximal Triplane Tibial Fracture in a 6-Year-Old Girl

Proximal tibial fractures are very rare. Our case is about a six-year-old girl presented with proximal tibial triplane fracture associated with proximal and distal fibula and distal tibial fractures, as a result of a fall of a cement wall on her right knee. A radiograph and computerized tomography (CT) scan were reported as Salter-Harris type III fracture. She was treated by an open reduction and internal fixation by a screw and Kirschner wires. She was followed up for 12 months and showed an excellent knee outcome and her knee range of motion was 10-130o. Anatomical reduction and stable fixation are necessary to prevent future pain, deformity and arthritis. The case demonstrates the efficacy of using an open reduction and internal fixation by a screw and Kirschner wires in treating children with triplane proximal tibial fracture. This type of fracture is not frequently seen and a right diagnosis leads to better management, which could prevent future complications