Alderlieste Dagmar S, Cain Megan E, van der Gaast Nynke, Verbakel Joy, Edwards Britt, Jaarsma Emily H, Hendrickx Laurent A M, IJpma F F A, Hermans Erik, Edwards Michael J R, Doornberg Job N, Jaarsma Ruurd L
Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
JB JS Open Access. 2024 Apr 18;9(2). doi: 10.2106/JBJS.OA.23.00134. eCollection 2024 Apr-Jun.
Up to 30% of patients with a tibial shaft fracture sustain iatrogenic rotational malalignment (RM) after infrapatellar (IP) nailing. Although IP nailing remains the management of choice for most patients, suprapatellar (SP) nailing has been gaining popularity. It is currently unknown whether SP nailing can provide superior outcomes with regard to tibial RM. The aim of this study was to compare the differences in the prevalence of RM following IP versus SP nailing.
This retrospective study included 253 patients with a unilateral, closed tibial shaft fracture treated with either an IP or SP approach between January 2009 and April 2023 in a Level-I trauma center. All patients underwent a postoperative, protocolized, bilateral computed tomography (CT) scan for RM assessment.
RM was observed in 30% and 33% of patients treated with IP and SP nailing, respectively. These results indicate no significant difference (p = 0.639) in the prevalence of RM between approaches. Furthermore, there were no significant differences in the distribution (p = 0.553) and direction of RM (p = 0.771) between the 2 approaches. With the IP and SP approaches, nailing of left-sided tibial shaft fractures resulted in predominantly internal RM (85% and 73%, respectively), while nailing of right-sided tibial shaft fractures resulted in predominantly external RM (90% and 80%, respectively). The intraobserver reliability for the CT measurements was 0.95.
The prevalence of RM was not influenced by the entry point of tibial nailing (i.e., IP versus SP). Hence, the choice of surgical approach should rely on factors other than the risk of RM.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
高达30%的胫骨干骨折患者在髌下（IP）髓内钉固定后会出现医源性旋转畸形（RM）。尽管IP髓内钉仍是大多数患者的首选治疗方法，但髌上（SP）髓内钉的应用越来越广泛。目前尚不清楚SP髓内钉在治疗胫骨RM方面是否能提供更好的疗效。本研究的目的是比较IP与SP髓内钉固定后RM发生率的差异。
这项回顾性研究纳入了2009年1月至2023年4月期间在一级创伤中心接受IP或SP方法治疗的253例单侧闭合性胫骨干骨折患者。所有患者术后均接受标准化的双侧计算机断层扫描（CT）以评估RM。
接受IP和SP髓内钉固定的患者中，RM的发生率分别为30%和33%。这些结果表明两种方法之间RM的发生率没有显著差异（p = 0.639）。此外，两种方法之间RM的分布（p = 0.553）和方向（p = 0.771）也没有显著差异。采用IP和SP方法时，左侧胫骨干骨折的髓内钉固定主要导致内旋畸形（分别为85%和73%），而右侧胫骨干骨折的髓内钉固定主要导致外旋畸形（分别为90%和80%）。CT测量的观察者内可靠性为0.95。
RM的发生率不受胫骨髓内钉进针点（即IP与SP）的影响。因此，手术方法的选择应基于RM风险以外的因素。
治疗性三级证据。有关证据水平的完整描述，请参阅作者指南。
