Hessmann Martin H, Buhl Michael, Finkemeier Chris, Khoury Amal, Mosheiff Rami, Blauth Michael
Academic Teaching Hospital Fulda, Pacelliallee 4, 36043, Fulda, Germany.
Sutter Roseville Medical Center, PO Box 2070, 95746, Granite Bay, CA, USA.
Oper Orthop Traumatol. 2020 Oct;32(5):440-454. doi: 10.1007/s00064-020-00649-9. Epub 2020 Jan 29.
Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures.
Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries.
Gustilo grade 3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point.
Via a suprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20-30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics.
In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17 patients had a distal third fracture, 8 sustained a proximal third fracture and 36 had a shaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9 weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.
通过髌上经关节入路，在膝关节屈曲20 - 30°时对胫骨骨折进行髓内钉固定，并使用特定的保护管以保护关节内结构。
胫骨近端关节外骨折；胫骨干简单骨折和粉碎性骨折；胫骨干节段性骨折；胫骨远端关节外骨折以及伴有简单关节内远端延伸的骨折；浮动膝损伤。
胫骨Gustilo 3C级开放性骨折；髌上区域严重的软组织撕裂、污染或感染；同侧膝关节假体；膝关节融合术；植入物阻挡髓内钉进针点。
通过髌上经关节入路，在胫骨骨折解剖复位后，膝关节屈曲20 - 30°时插入胫骨髓内钉。使用特定的保护管以保护关节内结构。近端和远端锁定构型取决于具体的骨折特征。
共有61例患者接受了髌上胫骨髓内钉固定术，至少随访至骨折愈合。12例患者为开放性骨折。共有17例患者为远端三分之一骨折，8例为近端三分之一骨折，36例为骨干骨折。随访重点关注远端骨折患者；17例中有6例为开放性骨折。平均愈合时间为9周。1例骨折未愈合，需要更换髓内钉。2例患者主诉膝关节前方疼痛。在功能方面，所有患者均恢复了全范围活动。
