Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 1995
Unstable fractures of the tibia treated with a reamed intramedullary interlocking nail.
One hundred thirty-four acute unstable fractures of the tibia were treated with a reamed intramedullary nail with locking capabilities. There were 101 closed and 33 open fractures (20 Grade 1 fractures, 12 Grade 2 fractures, and 1 fracture from a gunshot wound). Patients were seen in followup for an average of 16 months after nailing. ⋯ In closed fractures, there were 2 superficial (2%) and 3 deep (3%) infections; in open fractures there was 1 superficial (3%) and 7 deep (21%) infections. The authors conclude that reamed intramedullary nails should be restricted to unstable, closed tibial shaft fractures. Its use in open fractures even on a delayed basis cannot be recommended because of unacceptably high infection rates.
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Clin. Orthop. Relat. Res. · Jun 1995
Radiographic analysis of tibial fracture malalignment following intramedullary nailing.
Intramedullary nailing of the tibia was performed on 145 tibiae (137 patients) for fracture or nonunion from 1985 to 1992. There were 133 cases available for radiographic analysis of postoperative tibial alignment. Of the 133 nailings, 16 (12%) were malaligned (12 acute fractures and 4 nonunion-malunions). ⋯ The average anterior bow deformity of 5 proximal third fractures was 7 degrees (range, 5 degrees-12 degrees). Careful attention to operative technique and entrance angle, particularly with proximal third or comminuted fractures, is recommended to prevent angular deformity and malunion after tibial nailing. Proximal third tibial fractures may require a neutral or slightly lateral entrance angle to ensure a more anatomic reduction and centromedullary nail orientation to offset the tendency for valgus angulation.
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Fifty open tibial fractures with circumferential cortical bone loss were reviewed. Prospective treatment protocols included fracture stabilization with repeated irrigation and debridement followed by wound coverage. Bony stabilization was accomplished using external fixators, small diameter unreamed interlocking nails, and, in rare instances, plate fixation. ⋯ Techniques of reconstruction had no correlation to the development of nonunion or infection. They were valuable in determining malunion and total treatment time. These data confirm that carefully staged reconstruction leads to successful outcomes.
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Clin. Orthop. Relat. Res. · Jun 1995
Open tibial diaphyseal fractures. Results of unreamed locked intramedullary nailing.
Forty-three high energy open tibial diaphyseal fractures were treated with unreamed locked intramedullary nails from 1989 to 1992, and were reviewed at a minimum of 1 year from injury. There were 6 Grade I, 2 Grade II, 16 Grade IIIA, 9 Grade IIIB, and 1 Grade IIIC open fractures. Ninety-eight percent of the fractures united in an average time of 6.1 months. ⋯ Complications included 49% of fractures with malunions, 12% deep infections, 41% locking screw breakages, and 20% compartment syndromes. These results are similar to those achieved with external fixation of open tibial fractures. The unreamed locked intramedullary nail has not improved the outcome of open tibial diaphyseal fractures because the biologic consequences of the injury are of greater significance than the methods or techniques of fracture stabilization.