Department of Orthopaedic Surgery and Traumatology, Musculoskeletal Unit, Strasbourg Academic Hospital Group, Hautepierre Hospital, 1, avenue Molière, 67098 Strasbourg, France.
Orthop Traumatol Surg Res. 2012 Sep;98(5):564-9. doi: 10.1016/j.otsr.2012.04.013. Epub 2012 Aug 17.
Intramedullary nailing is a common method of treating tibial shaft fractures. However, precise control of reduction at the proximal and distal quarters is difficult to achieve. The purpose of this study was to assess the results of plating using locking screws and the feasibility of a minimally-invasive approach.
PATIENTS/PARTICIPANTS: All patients with tibial shaft fracture treated by means of locking plates from January 2004 to October 2006. Thirty-two fractures were treated in 32 patients with a mean age of 43.8 years.
Internal fixation with a locking plate and screw construct, using a minimally-invasive or standard approach.
Surgical approach, time to weight bearing, complications and their type, time to bone union, alignment in the frontal and sagittal planes on anteroposterior and lateral radiographs.
The minimally-invasive approach was performed in 28 cases and immediate full weight bearing allowed in 25 cases. At a mean follow-up of 27 months, two patients had died and two patients were lost to follow-up. The mean time to bone union was 9.1 weeks. Four cases had a complicated course: one infection, one compartment syndrome, one hardware breakage and one pseudarthrosis. Six cases ended up with valgus malunion exceeding 5° in the frontal plane, already present at the time of surgery.
Where a minimally-invasive approach can be performed, immediate pain-free weight bearing can be allowed without further displacement at follow-up. The observed rate of malunion underlines the need for adequate reduction and shows that the rationale for success does not solely depend on the plate anatomic design but also on the skills of the operating surgeon.
Level I university regional hospital Cohort study.
髓内钉是治疗胫骨骨干骨折的常用方法。然而，很难精确控制近段和远段的复位。本研究旨在评估使用锁定螺钉接骨板治疗的结果和微创入路的可行性。
患者/参与者：2004 年 1 月至 2006 年 10 月采用锁定钢板治疗的胫骨骨干骨折患者。32 例 32 名患者，平均年龄 43.8 岁。
使用锁定钢板和螺钉固定，采用微创或标准入路。
手术入路、负重时间、并发症及其类型、骨愈合时间、前后位和侧位 X 线片矢状面和冠状面的对线。
28 例采用微创入路，25 例立即完全负重。平均随访 27 个月，2 例患者死亡，2 例患者失访。平均骨愈合时间为 9.1 周。4 例出现并发症：1 例感染，1 例骨筋膜室综合征，1 例内固定断裂，1 例假关节。6 例出现超过 5°的冠状面外旋畸形，在手术时已经存在。
在可以采用微创入路的情况下，可以允许立即无痛负重，而不会在随访时进一步移位。观察到的畸形愈合率强调了需要充分复位，并且表明成功的理由不仅取决于接骨板的解剖设计，还取决于手术医生的技术。
一级大学区域医院队列研究。
