Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, South Korea.
Department of Orthopaedic Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
Orthop Surg. 2022 Mar;14(3):536-542. doi: 10.1111/os.13210. Epub 2022 Feb 1.
To evaluate clinical and radiological outcomes including hindfoot alignment after plate vs intramedullary nailing (IMN) for distal tibia fracture and to define radiologic parameters that influence changes in hindfoot alignment.
Among 92 patients with distal tibia metaphyseal fractures treated from 2002 to 2015, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Union rate and complication rate were compared in both groups. Radiographic measurements including hindfoot angulation, moment arm, calcaneal pitch angle, and Meary angle were evaluated at a minimum of 1-year follow-up. Hindfoot alignment changes after surgery were compared between both groups using student t-test. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment.
All patients ultimately healed, with an average union period of 26 weeks in both groups. The AOFAS and VAS scores were not significantly different between the two groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch, and Meary angle showed no significant differences between the groups. The hindfoot moment arm increased with valgus in the IMN group. A low correlation was detected between angulation at the fracture site in the coronal view and hindfoot alignment (angulation and moment arm) changes (R = 0.38). A significantly high correlation was noted only between transverse rotation and hindfoot alignment changes (R = 0.79).
Rotation in the transverse plane notably influenced changes in hindfoot alignment. And this suggests that patients with distal tibia fracture should be closely monitored for hindfoot alignment changes caused by intraoperative transverse rotation regardless of the fixation method.
评估钢板与髓内钉（IMN）治疗胫骨远端骨折的临床和影像学结果，包括后足对线，并确定影响后足对线变化的影像学参数。
在 2002 年至 2015 年间治疗的 92 例胫骨骨干骨折患者中，39 例行髓内钉固定，53 例行标准钢板内固定。比较两组患者的愈合率和并发症发生率。在至少 1 年的随访中，评估后足角度、力臂、跟骨倾斜角和 Meary 角等影像学测量值。使用学生 t 检验比较两组手术后后足对线的变化。分析骨折对线参数与后足对线之间的相关性和回归关系。
所有患者最终均愈合，两组平均愈合时间均为 26 周。两组 AOFAS 和 VAS 评分无显著差异。两组并发症相似。两组后足对线角度、跟骨倾斜角和 Meary 角无显著差异。IMN 组后足力臂随外翻而增加。冠状面骨折部位的角度与后足对线（角度和力臂）变化之间相关性较低（R=0.38）。仅在横断旋转与后足对线变化之间存在显著高相关性（R=0.79）。
横断面上的旋转显著影响后足对线的变化。这表明，无论固定方法如何，对于因术中横断旋转引起的后足对线变化，胫骨远端骨折患者应密切监测。
