original article Wien Klin Wochenschr DOI 10.1007/s00508-015-0730-x
Distal tibial fractures: evaluation of different fixation techniques Julian Jöstl · Thomas Manfred Tiefenböck · Marcus Hofbauer · Markus Winnisch · Nikolaus Lang · Stefan Hajdu · Kambiz Sarahrudi
Received: 24 June 2014 / Accepted: 19 January 2015 © Springer-Verlag Wien 2015
Summary Purpose The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). Methods A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. Results A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the platefixation group (135.75 ± 110.75 days) versus the externalfixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullarynailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Conclusion Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient’s condition and the local fracture situation allow it.
Keywords Distal tibial fractures · IM nailing · Plate fixation · External fixation · ROM · Bony consolidation
Assoc. Prof. K. Sarahrudi, MD, PD () · J. Jöstl, MD · T. M. Tiefenböck, MD · M. Hofbauer, MD · M. Winnisch, MD · N. Lang, MD · Assoc. Prof. S. Hajdu, MD, MBA Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria e-mail: [email protected]
Materials and Methods
13
Introduction Distal tibial fractures occur in 7 % of the long bone fractures in adults. The management of distal tibial fractures can be a therapeutic challenge to most orthopedic trauma surgeons [1, 2]. The use of different surgical techniques is possible for the treatment of these fractures. External fixation (Ex-Fix), intramedullary nailing (IMN), and plate fixation (PF) are the most commonly used techniques with the goal to restore anatomy and function [3, 4]. IMN and PF (locking compression plate; LCP) are considered as the gold standard for the treatment of distal tibial fractures; however, specific cases require primary Ex-Fix [5, 6]. Previous investigators suggested several concerns regarding the stability of the fixation, breakage of the nail or plate and locking screws, unsatisfactory limb alignment, and prolonged time to bony healing following these different types of fixation [7–9]. However, to the best of our knowledge, no comparison of the clinical outcome between these different surgical techniques has been performed to date. Therefore, the aim of this study was to evaluate and compare the clinical outcome between the different techniques for the treatment of extra-articular fractures of the distal tibia in an adult population. The complication rate, range of motion (ROM), and radiographic consolidation were considered as the primary outcome measures.
A retrospective analysis of all patients with extra-articular fractures of the distal tibia that were treated at our level I trauma center between July 1992 and June 2011
Distal tibial fractures: evaluation of different fixation techniques
1
original article
with either closed IMN, ORIF with PF, or Ex-Fix was performed. Inclusion criteria were as follows: closed IMN, PF, or Ex-Fix for extra-articular distal tibia fractures; a minimum follow-up of 1 year; and age ≥ 18 years and a complete set of data including patients demographics, type of fractures (AO/OTA classification 42-A, B, C or 43-A, B1) [10], ROM, X-ray, complication rate, and clinical outcome. Exclusion criteria’s were as follows: open fractures (grade II and III according to the Gustilio and Anderson classification), pathological fractures, fractures of AO/OTA classification type 43-B2, B3, C [10], polytraumatized patients, PAD, diabetes, corticosteroid therapy, NSAR therapy, osteoporosis, and incomplete data set. Incomplete data sets were defined as missing pertinent clinical or radiographic data at follow-up visit. Prior to investigation, the study was approved by the institutional review board (EK number 692/2011).
Statistical analysis First, univariate tests (Fisher’s exact, Kruskal–Wallis test) were used to investigate the dependence of the three different surgical methods on the measured parameters (age, sex, ROM, radiographic consolidation). All analyses were performed using the SPSS system (Armonk, New York) and Microsoft Excel (Redmond, Washington). P values
Distal tibial fractures: evaluation of different fixation techniques Julian Jöstl · Thomas Manfred Tiefenböck · Marcus Hofbauer · Markus Winnisch · Nikolaus Lang · Stefan Hajdu · Kambiz Sarahrudi
Received: 24 June 2014 / Accepted: 19 January 2015 © Springer-Verlag Wien 2015
Summary Purpose The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). Methods A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. Results A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the platefixation group (135.75 ± 110.75 days) versus the externalfixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullarynailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Conclusion Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient’s condition and the local fracture situation allow it.
Keywords Distal tibial fractures · IM nailing · Plate fixation · External fixation · ROM · Bony consolidation
Assoc. Prof. K. Sarahrudi, MD, PD () · J. Jöstl, MD · T. M. Tiefenböck, MD · M. Hofbauer, MD · M. Winnisch, MD · N. Lang, MD · Assoc. Prof. S. Hajdu, MD, MBA Department of Trauma Surgery, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria e-mail: [email protected]
Materials and Methods
13
Introduction Distal tibial fractures occur in 7 % of the long bone fractures in adults. The management of distal tibial fractures can be a therapeutic challenge to most orthopedic trauma surgeons [1, 2]. The use of different surgical techniques is possible for the treatment of these fractures. External fixation (Ex-Fix), intramedullary nailing (IMN), and plate fixation (PF) are the most commonly used techniques with the goal to restore anatomy and function [3, 4]. IMN and PF (locking compression plate; LCP) are considered as the gold standard for the treatment of distal tibial fractures; however, specific cases require primary Ex-Fix [5, 6]. Previous investigators suggested several concerns regarding the stability of the fixation, breakage of the nail or plate and locking screws, unsatisfactory limb alignment, and prolonged time to bony healing following these different types of fixation [7–9]. However, to the best of our knowledge, no comparison of the clinical outcome between these different surgical techniques has been performed to date. Therefore, the aim of this study was to evaluate and compare the clinical outcome between the different techniques for the treatment of extra-articular fractures of the distal tibia in an adult population. The complication rate, range of motion (ROM), and radiographic consolidation were considered as the primary outcome measures.
A retrospective analysis of all patients with extra-articular fractures of the distal tibia that were treated at our level I trauma center between July 1992 and June 2011
Distal tibial fractures: evaluation of different fixation techniques
1
original article
with either closed IMN, ORIF with PF, or Ex-Fix was performed. Inclusion criteria were as follows: closed IMN, PF, or Ex-Fix for extra-articular distal tibia fractures; a minimum follow-up of 1 year; and age ≥ 18 years and a complete set of data including patients demographics, type of fractures (AO/OTA classification 42-A, B, C or 43-A, B1) [10], ROM, X-ray, complication rate, and clinical outcome. Exclusion criteria’s were as follows: open fractures (grade II and III according to the Gustilio and Anderson classification), pathological fractures, fractures of AO/OTA classification type 43-B2, B3, C [10], polytraumatized patients, PAD, diabetes, corticosteroid therapy, NSAR therapy, osteoporosis, and incomplete data set. Incomplete data sets were defined as missing pertinent clinical or radiographic data at follow-up visit. Prior to investigation, the study was approved by the institutional review board (EK number 692/2011).
Statistical analysis First, univariate tests (Fisher’s exact, Kruskal–Wallis test) were used to investigate the dependence of the three different surgical methods on the measured parameters (age, sex, ROM, radiographic consolidation). All analyses were performed using the SPSS system (Armonk, New York) and Microsoft Excel (Redmond, Washington). P values
