Department of Orthopaedic Trauma Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jun 10;4(6). doi: 10.5435/JAAOSGlobal-D-20-00088. eCollection 2020 Jun.
The objective of this study was to evaluate the clinical and functional outcomes of intra-articular distal tibial fractures after intramedullary nail (IMN) and independent fixation compared with extra-articular fracture controls.
A retrospective chart review of distal tibial fractures treated with IMN was performed. Clinical outcomes were compared between fractures with and without intra-articular involvement. Outcomes included nonunion, malunion, ankle arthrosis, and infection. Patient-Reported Outcome Measurement System (PROMIS) scores were used to assess subjective outcomes.
Of the 135 distal tibial fractures, 87 extra-articular and 48 intra-articular, no significant difference was observed in the rate of ankle arthrosis between intra-articular and extra-articular fractures (2% versus 0%; = 0.35). Similarly, no difference was observed in the postoperative rates of infection (8% versus 3%; = 0.25), the rate of nonunion (17% versus 10%; = 0.29), or the rate of malunion (10% versus 21%; = 0.17). No notable difference was observed in PROMIS scores between groups.
This study suggests that IMN is an acceptable method of fixation in select intra-articular distal tibial fractures. In the intra-articular group, low rates of ankle arthrosis were noted at intermediate follow-up, with no increase in nonunion, malunion, or infection compared with extra-articular fractures. Furthermore, PROMIS scores indicate similar functional outcomes in patients, regardless of intra-articular involvement.
本研究旨在评估髓内钉（IMN）与独立固定治疗的关节内胫骨远端骨折的临床和功能结果，并与关节外骨折进行比较。
对采用 IMN 治疗的胫骨远端骨折进行回顾性图表审查。比较了有和无关节内受累的骨折之间的临床结果。结果包括骨折不愈合、畸形愈合、踝关节关节炎和感染。使用患者报告的结局测量系统（PROMIS）评分来评估主观结局。
在 135 例胫骨远端骨折中，87 例为关节外骨折，48 例为关节内骨折，关节内和关节外骨折的踝关节关节炎发生率无显著差异（2%比 0%； = 0.35）。同样，术后感染率（8%比 3%； = 0.25）、骨折不愈合率（17%比 10%； = 0.29）或畸形愈合率（10%比 21%； = 0.17）也无差异。两组间 PROMIS 评分无显著差异。
本研究表明，IMN 是治疗特定关节内胫骨远端骨折的一种可接受的固定方法。在关节内组中，在中期随访时观察到踝关节关节炎的发生率较低，与关节外骨折相比，不愈合、畸形愈合或感染的发生率没有增加。此外，PROMIS 评分表明无论关节内是否受累，患者的功能结局相似。
