Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI 48187, USA.
School of Medicine, Wayne State University, Detroit, MI 48201, USA.
Medicina (Kaunas). 2022 Mar 5;58(3):389. doi: 10.3390/medicina58030389.
Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as shortening, lengthening, abnormal rotation, or angulation. These deformities can have adverse effects on patients, such as pain and gait disturbance, as well as long term development of post-traumatic arthritis. This paper seeks to highlight some of the options for surgical management of malunions and detail the strategies and approaches used to manage these complicated cases. Materials and Methods: An exhaustive search was conducted on PubMed using the key search terms “Tibial” OR “Tibia” AND “Malunion” to be included in the title. Exclusions to the search included any article with patients aged < 18 years, any nonhuman subjects, and any article not published or translated into English. Results: A systematic review of the literature revealed 26 articles encompassing 242 patients who had undergone surgical correction for tibia malunion. A total of 19 patients suffered from complications. Methods of treatment included osteotomies, with plate and screws, external fixator, angled blade plate, intramedullary nails, Ilizarov fixator, Taylor Spatial Frame, Precise nail, and total knee arthroplasty. Restoring alignment and the articular surface led to overwhelmingly positive patient outcomes. Conclusions: Tibial malunions take many forms, and as such, there are many approaches to correcting deformities. The literature supports the following radiological parameters to diagnose tibial malunion: 5−10 degrees angulation, 1−2 cm shortening, 10−15 degrees internal rotation, and 10−20 degrees external rotation. Surgical plans should be customized to each individual patient, as there are many approaches to tibial malunion that have been shown to be successful in delivering excellent clinical outcomes.
胫骨畸形愈合是指骨折在临床不可接受的位置愈合，导致畸形，如缩短、延长、旋转或成角。这些畸形会对患者产生不良影响，如疼痛和步态障碍，以及创伤后关节炎的长期发展。本文旨在强调胫骨畸形愈合的一些手术治疗选择，并详细介绍处理这些复杂病例的策略和方法。
在 PubMed 上使用关键词“Tibial”或“Tibia”和“Malunion”进行了全面搜索，将标题中包含的文章纳入研究。排除标准为患者年龄<18 岁、非人类受试者以及未发表或未翻译成英文的文章。
对文献进行系统回顾，共纳入 26 篇文章，涵盖了 242 例接受胫骨畸形愈合手术矫正的患者。共有 19 例患者发生并发症。治疗方法包括截骨术、钢板和螺钉、外固定架、角度钢板、髓内钉、伊利扎洛夫固定器、泰勒空间框架、精确钉和全膝关节置换术。恢复对线和关节面导致了绝大多数患者的良好结局。
胫骨畸形愈合有多种形式，因此，有许多方法可以矫正畸形。文献支持以下影像学参数来诊断胫骨畸形愈合：5-10 度成角、1-2cm 缩短、10-15 度内旋和 10-20 度外旋。手术计划应根据每个患者的具体情况定制，因为已经有许多成功的方法可以用于胫骨畸形愈合，以获得出色的临床结果。
