Gershuni D H, Skyhar M J, Thompson B, Resnick D, Donald G, Akeson W H
J Bone Joint Surg Am. 1985 Dec;67(9):1388-95.
Spiral fractures of the distal third of the tibial shaft can have problems of malunion or non-union that may be related to inability to assess the quality of the initial reduction of the fracture. We created typical two-fragment torsional tibial fractures in cadaver bones. The fracture fragments were mounted in a specially constructed jig that allowed simulation of various malreduction positions including varus and valgus angulation, antecurvatum, recurvatum, malrotation, and shortening. Anteroposterior and lateral radiographs and computed tomographic scans of the specimens were made. Measurements of the fracture gap were made at defined distances along the fractures, directly on the specimens as well as on the radiographs and computed tomographic scans. Excellent correlation was obtained between measurements of the gap on the specimens and on the computed tomographic scans, but plain radiographic measurements in thirty of thirty-four instances underestimated the true width of the gap. When shortening was introduced larger maximum gaps (of as much as eighteen millimeters) as well as greater discrepancies between measurements on the scans and plain radiographs were seen. The sizes of the fracture gaps were also greater for a given degree of shortening when the pitch of the spiral fracture was greater.
胫骨干远端三分之一处的螺旋骨折可能会出现愈合不良或不愈合的问题，这可能与无法评估骨折初始复位的质量有关。我们在尸体骨上制造了典型的两骨折段扭转性胫骨骨折。将骨折碎片安装在一个特制的夹具中，该夹具允许模拟各种复位不良的位置，包括内翻和外翻成角、前凸、后凸、旋转不良和缩短。对标本进行前后位和侧位X线片及计算机断层扫描。沿着骨折在特定距离处直接在标本以及X线片和计算机断层扫描上测量骨折间隙。标本上的间隙测量值与计算机断层扫描上的测量值之间获得了极好的相关性，但在34例中的30例中，普通X线片测量低估了间隙的真实宽度。当出现缩短时，会出现更大的最大间隙（多达18毫米）以及扫描测量值与普通X线片测量值之间更大的差异。当螺旋骨折的螺距更大时，对于给定程度的缩短，骨折间隙的大小也更大。
