Semenistyy Anton A, Litvina Ea Elena A, Fedotova Anna G, Gwam Chukwuweike, Mironov Andrey N
City Clinical Hospital №13, 1/1 Velozavodskaya str., Moscow, 115088, Russia; F.I. Inozemtsev City Clinical Hospital, 1 Fortunatovskay str., Moscow, 105187, Russia; Russian Medical Academy of Continuous Professional Education, 2 Barrikadnaya str, Moscow, 123242, Russia.
F.I. Inozemtsev City Clinical Hospital, 1 Fortunatovskay str., Moscow, 105187, Russia; Russian Medical Academy of Continuous Professional Education, 2 Barrikadnaya str, Moscow, 123242, Russia.
Injury. 2019 Feb;50(2):515-520. doi: 10.1016/j.injury.2018.11.015. Epub 2018 Nov 10.
Intramedullary nailing is considered a "gold standard" for treatment of tibial shaft fractures. However, some types of fractures are typically considered as "difficult for nailing". This group includes the periarticular fractures, fractures of both bones at the same level, comminuted and segmental fractures of the tibia. Fixator-assisted nailing (FAN) is an effective method treatment of these types of fractures. The main requirements for the ideal reduction device are an ease of its installation and an ability of multiplanar fracture reduction. Fixator-assisted nailing (FAN) with the use of two perpendicular to each other monolateral tubular frames perfectly meets these requirements. In this study we present this new surgical technique and the analysis of first 30 cases.
A prospective analysis was conducted for 30 patients with "difficult for nailing" tibial fractures treated with fixator-assisted nailing in our institution between September 1, 2017, and March 1, 2018. The duration of surgery and its different stages, the time of fluoroscopy, difficulties encountered during surgery, were analyzed. Clinical and radiological methods were used to evaluated reduction quality.
In all 30 cases the acceptable reduction was achieved. The mean duration of the surgical procedure was 73.7 ± 3 min. The mean duration of fluoroscopy 85.9 ± 4.8 s. In 7 cases we faced with technical difficulties, which were successfully addressed.
The described technique of FAN is an effective method for the treatment of "difficult for nailing" tibial fractures. Future multi-centered studies with a larger number of patients are needed to validate our results.
髓内钉固定术被认为是治疗胫骨干骨折的“金标准”。然而，某些类型的骨折通常被认为“难以进行髓内钉固定”。这组骨折包括关节周围骨折、同一水平的双骨折、胫骨的粉碎性骨折和节段性骨折。固定器辅助髓内钉固定术（FAN）是治疗这些类型骨折的有效方法。理想复位装置的主要要求是易于安装以及能够进行多平面骨折复位。使用两个相互垂直的单侧管状框架的固定器辅助髓内钉固定术（FAN）完全满足这些要求。在本研究中，我们介绍了这种新的手术技术并分析了前30例病例。
对2017年9月1日至2018年3月1日期间在我院接受固定器辅助髓内钉固定术治疗的30例“难以进行髓内钉固定”的胫骨骨折患者进行前瞻性分析。分析手术持续时间及其不同阶段、透视时间、手术中遇到的困难。采用临床和影像学方法评估复位质量。
所有30例均实现了可接受的复位。手术平均持续时间为73.7±3分钟。透视平均持续时间为85.9±4.8秒。我们在7例中遇到了技术困难，但均成功解决。
所描述的FAN技术是治疗“难以进行髓内钉固定”的胫骨骨折的有效方法。未来需要进行更多患者参与的多中心研究来验证我们的结果。
