Rommens P M, El Attal R, Hansen M, Kuhn S
Zentrum für muskuloskeletale Chirurgie, Klinik und Poliklinik für Unfallchirurgie, Universitätsmedizin, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland.
Oper Orthop Traumatol. 2011 Dec;23(5):411-22. doi: 10.1007/s00064-011-0127-6.
Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for early functional aftercare. Maintaining mobility of knee joint. Bone healing in closed and open fractures.
Closed and open isolated proximal tibia and lower leg fractures (AO 42). Extraarticular fractures of the proximal tibia (AO 41 A2/A3). Intraarticular fractures of the proximal tibia (AO 41 C1/C2) in combination with other implants. Segmental tibia fractures (AO 42 C1/C2) with short proximal fragment. Comminuted tibia shaft fractures (AO 42 C3) with short proximal fragment.
Very poor general condition (e.g., bedridden). Flexion of knee less than 90°. Infection in the nail's and bolt's insertion area. Infection of the tibia intramedullary canal. Complex fractures of the tibia plateau (AO 41 C3). Open physis.
Closed reduction of the fracture. If necessary, use of reduction clamps through additional stab incisions or open surgical procedures. In some cases, additional osteosynthesis procedures are necessary (e.g., compression screws). Positioning of the patient on a radiolucent table or a traction table. Opening of the proximal tibia in line with the medullary canal. Cannulated or noncannulated insertion of the nail with or without reaming of the medullary canal. Control of axis, length, and rotation of the lower leg. Triple proximal interlocking in three different planes with the targeting device. Double distal interlocking.
Immediate mobilization of the knee joint. Depending on the type of fracture, mobilization with 20 kg partial weight bearing or pain-dependent full weight bearing with crutches. X-ray controls after 3, 6, and 12 weeks and increase of weight bearing depending on the fracture status.
In a prospective multicenter study on the stabilization of tibia fractures with the Expert Tibial Nail, 22 patients with proximal third tibia fractures were documented. Seventeen patients could be reviewed clinically and radiologically after 1 year. A non-union was registered in 1 patient (5.9%), a malalignment in any plane above 5° in 3 fractures (17.6%).
恢复小腿的轴线、长度及旋转。实现骨接合处足够的初始稳定性以利于早期功能康复护理。维持膝关节的活动度。实现闭合性和开放性骨折的骨愈合。
闭合性和开放性孤立性胫骨近端及小腿骨折（AO 42）。胫骨近端关节外骨折（AO 41 A2/A3）。胫骨近端关节内骨折（AO 41 C1/C2）并需结合其他植入物。胫骨节段性骨折（AO 42 C1/C2）且近端骨折块较短。胫骨骨干粉碎性骨折（AO 42 C3）且近端骨折块较短。
一般状况极差（如卧床不起）。膝关节屈曲小于90°。髓内钉和螺栓插入区域感染。胫骨髓内管感染。胫骨平台复杂骨折（AO 41 C3）。骨骺开放。
骨折闭合复位。必要时，通过额外的小切口或开放手术操作使用复位夹。在某些情况下，需要额外的骨接合手术（如加压螺钉）。将患者置于可透X线的手术台或牵引台上。沿髓腔方向切开胫骨近端。带锁髓内钉有或无髓腔扩髓的插入。控制小腿的轴线、长度及旋转。使用瞄准装置在三个不同平面进行近端三点交锁固定。远端两点交锁固定。
立即活动膝关节。根据骨折类型，以20千克部分负重或使用拐杖根据疼痛情况完全负重进行活动。术后3周、6周和12周进行X线检查，并根据骨折情况增加负重。
在一项关于使用Expert胫骨钉稳定胫骨骨折的前瞻性多中心研究中，记录了22例胫骨近端三分之一骨折患者。1年后，17例患者接受了临床和影像学复查。1例患者（5.9%）出现骨不连，3例骨折（17.6%）在任何平面出现大于5°的畸形愈合。
