Marks Daniel, Dulas Matthew, Egbe Solomon, Dahm James, Christiano Anthony, Strelzow Jason
Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA.
The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
Trauma Case Rep. 2025 Jul 10;58:101218. doi: 10.1016/j.tcr.2025.101218. eCollection 2025 Aug.
To report upon a series of patients who underwent a combined minimally invasive plate osteosynthesis and intramedullary nailing surgical approach for AO/OTA 41C2/3 +/- 42, 41B2/3 + 42 fracture types and highlight the surgical methodology for application.
15 patients were treated with combined plate and intramedullary nail constructs at an academic urban trauma center from 2018 to 2022. All patients had AO/OTA 41C2/3 +/- 42 or 41B2/3 + 42 fractures.
The study intervention included retrospective review of patient charts and radiographs.
Outcome measures included coronal and sagittal alignment at latest follow-up, intra-operative subsidence of articular fragments, reoperation, and complications such as infection, compartment syndrome, screw migration, or component failure.
The average follow-up for patients included was 6.2 months. At final follow-up, 13 patients had available post-operative assessments for review. At latest follow-up, the average coronal alignment ranged from 3.1 degrees of varus to 2.3 degrees of valgus, average sagittal alignment from 2.6 degrees of recurvatum to 2.0 degrees of procurvatum. There was no evidence of intra-operative or post-operative radiographic subsidence of the plateau. No patients underwent reoperation. There was one case of superficial infection and one case of proximal screw loosening.
Plate and nail constructs are a practical option for complex intra-articular fractures of the proximal tibia with metaphyseal or diaphyseal extension (AO/OTA 41C2/3 +/- 42, 41B2/3 + 42). This series demonstrates acceptable radiographic alignment and good clinical results associated with these fracture patterns, with short-to-medium-term follow-up and an overall low complication rate.
报告一系列接受微创钢板接骨术和髓内钉联合手术治疗AO/OTA 41C2/3 +/- 42、41B2/3 + 42骨折类型的患者，并重点介绍该手术方法的应用。
2018年至2022年期间，在一家城市学术创伤中心，15例患者接受了钢板和髓内钉联合固定治疗。所有患者均为AO/OTA 41C2/3 +/- 42或41B2/3 + 42骨折。
本研究的干预措施包括对患者病历和X线片进行回顾性分析。
观察指标包括末次随访时的冠状面和矢状面力线、关节面骨折块术中下沉情况、再次手术情况以及感染、骨筋膜室综合征、螺钉移位或内固定失败等并发症。
纳入患者的平均随访时间为6.2个月。末次随访时，13例患者有术后评估结果可供复查。在末次随访时，平均冠状面力线内翻范围为3.1度至外翻2.3度，矢状面力线后凸范围为2.6度至前凸2.0度。没有证据表明平台有术中或术后影像学下沉。没有患者接受再次手术。有1例浅表感染和1例近端螺钉松动。
对于伴有干骺端或骨干延伸的胫骨近端复杂关节内骨折（AO/OTA 41C2/3 +/- 42、41B2/3 + 42），钢板和髓内钉联合固定是一种可行的选择。本系列研究表明，对于这些骨折类型，在短期至中期随访中，影像学力线可接受，临床效果良好，总体并发症发生率较低。
