Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan; Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan.
Department of Orthopedic Surgery, Okayama University Hospital, Okayama, Japan.
Injury. 2024 Aug;55(8):111634. doi: 10.1016/j.injury.2024.111634. Epub 2024 May 28.
The distal tibial nail (DTN) is a novel retrograde intramedullary nail used for distal tibial fracture stabilization. We investigated the clinical results of DTN use for distal tibial fractures and compared them with those reported in the literature on locking plates and antegrade intramedullary nails.
This multicenter, prospective, observational cohort study examined distal tibial fractures with AO/OTA classification 43 types: A1, A2, A3 or C1. The primary outcomes included bone union rate, soft tissue problems, and surgical complications. Secondary outcomes were EuroQol-5 Dimension-5 Level (EQ-5D-5L), Self-Administered Foot Evaluation Questionnaire (SAFE-Q), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot clinical scores 1 year postoperatively. Incidence of varus or valgus/anterior-posterior flexion deformity with a difference of ≥5° and postoperative reduction loss rate were evaluated.
Five men and five women were enrolled (mean age, 69 years [range, 30-77 years]), including one open-fracture-type Gustilo type IIIB case. Bone union was observed in all patients at 6 months postoperatively. Delayed union, leg edema, and guide pin breakage were observed in three, one, and one cases, respectively. No soft tissue or surgical complications were observed. During the final follow-up, the EQ-5D-5L, SAFE-Q, and AOFAS hindfoot scores were 0.876 (0.665-1.0), 83-92, and AOFAS 92.6 (76-100), respectively. Varus and retroflexion deformities were observed in one case each.
DTN has been reported to have biomechanically equivalent or stronger fixation strength than locking plates or antegrade intramedullary nails. In addition, while DTN was thought to be less invasive for soft tissue and can avoid injury to the knee, it was thought that care should be taken to avoid medial malleolus fractures and posterior tibialis tendon injuries. Comparisons with literature treatment results for locking plates and antegrade intramedullary nails showed comparable to advantageous results.
DTN treatment results for distal tibial fractures were as good as those for locking plates and antegrade intramedullary nails. DTN is useful for stabilization and does not compromise the surrounding soft tissues.
胫骨远端锁定钉（DTN）是一种新型的逆行髓内钉，用于治疗胫骨远端骨折。我们研究了 DTN 治疗胫骨远端骨折的临床结果，并将其与锁定钢板和顺行髓内钉的文献报告进行了比较。
这项多中心、前瞻性、观察性队列研究纳入了 AO/OTA 分类 43 型的胫骨远端骨折：A1、A2、A3 或 C1。主要结局包括骨愈合率、软组织问题和手术并发症。次要结局是术后 1 年的欧洲五维健康量表-5 维度（EQ-5D-5L）、自我管理足部评估问卷（SAFE-Q）和美国矫形足踝协会（AOFAS）后足临床评分。评估了 5°以上的内翻或外翻/前后弯曲畸形的发生率和术后复位丢失率。
纳入了 5 名男性和 5 名女性患者（平均年龄 69 岁[范围 30-77 岁]），包括 1 例 Gustilo ⅢB 型开放性骨折。所有患者术后 6 个月均观察到骨愈合。3 例出现延迟愈合、下肢水肿，1 例出现导针断裂。未观察到软组织或手术并发症。在末次随访时，EQ-5D-5L、SAFE-Q 和 AOFAS 后足评分分别为 0.876（0.665-1.0）、83-92 和 AOFAS 92.6（76-100）。1 例出现内翻畸形，1 例出现后反屈畸形。
DTN 的生物力学固定强度被报道与锁定钢板或顺行髓内钉相当或更强。此外，虽然 DTN 被认为对软组织的侵袭性更小，可以避免膝关节损伤，但应注意避免内踝骨折和胫骨后肌腱损伤。与锁定钢板和顺行髓内钉文献治疗结果的比较显示，结果相当或更有优势。
DTN 治疗胫骨远端骨折的结果与锁定钢板和顺行髓内钉相当。DTN 有助于稳定骨折，且不会对周围软组织造成损害。
