Pinzur M S
Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Foot Ankle Int. 2001 Sep;22(9):706-10. doi: 10.1177/107110070102200903.
Five diabetic patients who require insulin developed symptomatic malunited stress fracture of the distal tibia and fibula. All were treated with intramedullary fixation crossing the ankle joint. All progressed to stable union without evidence of infection. Two patients treated with antegrade intramedullary nailing required nail exchange for subsidence at the fracture site. One patient sustained a fracture at the proximal tip of a short retrograde nail, requiring replacement with a longer nail. Transarticular intramedullary fixation is an effective method of achieving stabilization for malunited fracture of the distal tibia in individuals with diabetes who are insensate. Due to the risk of fracture at the proximal tip of a standard short intramedullary nail, it is recommended to use a nail that extends to the proximal tibial metaphysis.
五名需要胰岛素治疗的糖尿病患者发生了有症状的胫腓骨远端骨折不愈合。所有患者均接受了跨越踝关节的髓内固定治疗。所有患者均顺利实现稳定愈合，无感染迹象。两名接受顺行髓内钉固定治疗的患者因骨折部位下沉需要更换髓内钉。一名患者短逆行髓内钉近端尖端发生骨折，需要更换为更长的髓内钉。对于感觉减退的糖尿病患者，经关节髓内固定是实现胫腓骨远端骨折不愈合稳定的有效方法。由于标准短髓内钉近端尖端存在骨折风险，建议使用延伸至胫骨近端干骺端的髓内钉。
