Prasad Pnvsv, Nemade Amit, Anjum Rashid, Joshi Nilesh
Department of Orthopaedics, Srujan Ortho and Accident Care Hospital, Khammam, AP, India.
Department of Orthopaedics, Children Orthopaedic Centre, Mumbai, India.
Chin J Traumatol. 2019 Apr;22(2):103-107. doi: 10.1016/j.cjtee.2018.12.005. Epub 2019 Feb 28.
Distal tibia fractures comprise about 7%-10% of lower extremity trauma. Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures. Plating is fraught with complications of wound dehiscence and infection. There are limited studies which document outcomes in such cases using intramedullary interlocking nail. We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.
This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India. There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study. Only cases with fresh injury (less than 1 week), fracture below the isthmus, closed and open Gustilo Anderson type 1 and 2 fractures were included in the study. Patients were reviewed at 3, 6, 12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing, any complications, time to union and functional outcome.
There were 102 males and 45 females (male/female ratio is 2.3:1) with a mean age of 38.96 (range 23-65) years. According to AO classification, there were 78 cases (53.06%) of 43-A1, 39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%. The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks), none of the patient in our series had a delayed or non-union. Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°). The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score, there were no cases with poor score.
Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome. Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.
胫骨干骺端骨折约占下肢创伤的7%-10%。由于该部位软组织及骨骼皮下位置的特殊性，在胫骨干骺端骨折尤其是关节外pilon骨折的理想治疗方面存在诸多争议。钢板固定易出现伤口裂开和感染等并发症。关于使用髓内交锁钉治疗此类病例的疗效研究有限。我们旨在研究交锁髓内钉治疗关节外胫骨干骺端骨折的疗效及并发症。
这是一项在印度南部一家三级骨科医院进行的前瞻性研究。本研究纳入了147例采用髓内钉固定治疗的胫骨干骺端关节外骨折患者，随访时间超过1年。仅纳入新鲜损伤（小于1周）、峡部以下骨折、闭合性及开放性Gustilo Anderson 1型和2型骨折的病例。术后3、6、12和24周对患者进行复查，此后每年复查一次，评估愈合的临床和影像学征象、有无并发症、愈合时间及功能结局。
男性102例，女性45例（男/女比例为2.3:1），平均年龄38.96岁（范围23-65岁）。根据AO分类，43-A1型78例（53.06%），43-A2型39例（26.53%），43-A3型30例（20.40%）。所有患者骨折平均在18周（范围16-22周）愈合，本系列中无患者出现延迟愈合或不愈合。2例患者（1.47%）骨折愈合时有轻度外翻，但在可接受范围内（<5°）。在末次随访时使用Olerud和Molander评分对所有患者的功能结局进行评估，所有患者评分均为优至良，无评分差的病例。
髓内钉固定是治疗胫骨干骺端骨折的可行选择，疗效优良。可避免与钢板固定相关的伤口并发症，但细致的手术技术是避免畸形愈合的关键。
