Abstract:
OBJECTIVES:Malalignment has been frequently reported after intramedullary stabilization of distal tibia fractures. Nails have also been associated with knee pain in several studies. Historically, plate fixation has resulted in increased risks of infection and nonunion. Our purposes were to compare plate and nail stabilization for distal tibia shaft fractures by assessing complications and secondary procedures. We hypothesized that nails would be associated with more malalignment and nonunion. DESIGN:Randomized, prospective study. SETTING:Level I trauma center. PATIENTS/PARTICIPANTS:One hundred four skeletally mature patients with extra-articular distal tibia shaft fractures with a mean age of 38 years (range, 18-95 years) and mean Injury Severity Score of 13.5 (range, 9-50). The majority had high-energy injuries. INTERVENTION:Patients were randomized to a reamed intramedullary nail (n = 56) or a large fragment medial plate (n = 48). Forty fractures (39%) were open. Twenty-eight (27%) had concomitant fibula fractures that were stabilized. MAIN OUTCOME MEASUREMENTS:Malunion, nonunion, infection, and secondary operations. RESULTS:The two treatment groups were evenly matched with respect to age, gender, Injury Severity Score, fracture pattern, and presence of open fracture. Six patients (5.8%) developed deep infection with equal numbers in the two groups. Eighty-three percent of infections occurred after open fracture (P < 0.001). Four patients (7.1%) developed nonunion after nailing versus two (4.2%) after plating (P = 0.25) with a trend for nonunion in patients who had distal fibula fixation (12% versus 4.1%, P = 0.09). All nonunions occurred after open fracture (P = 0.0007); the primary union rate for closed fractures was 100%. Primary angular malalignment of 5° or greater occurred in 13 patients with nails (23% of all nails) and four with plates (8.3% of all plates; P = 0.02 for plates versus nails). Six additional patients experienced malalignment after immediate weightbearing against medical advice. Valgus was the most common deformity (n = 16). Malunion was more common after open fracture (55%, P = 0.04). Eighty-five percent of patients with malalignment after nailing did not have fibula fixation. Eleven patients underwent 15 secondary procedures after plating, five of which were for prominent implant removal. This was not significantly different from patients treated with nailing: 10 patients had 14 procedures and five for prominent implant removal. CONCLUSIONS:High primary union rates were noted after surgical treatment of distal tibia shaft fractures with both nonlocked plates and reamed intramedullary nails. Rates of infection, nonunion, and secondary procedures were similar. Open fractures had higher rates of infection, nonunion, and malunion. Intramedullary nailing was associated with more malalignment versus plating. Fibula fixation may facilitate reduction of the tibia at the time of surgery. The effect of fibula fixation on tibia healing deserves further study. Economic assessment and functional outcomes data for this population will help to enhance our treatment decision-making.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Vallier HA,Cureton BA,Patterson BMdoi
10.1097/BOT.0b013e318213f709subject
Has Abstractpub_date
2011-12-01 00:00:00pages
736-41issue
12eissn
0890-5339issn
1531-2291journal_volume
25pub_type
杂志文章,随机对照试验abstract:PURPOSE:The purpose of this OTA-approved pilot study was to compare the clinical and functional outcomes of the knee joint after infrapatellar (IP) versus suprapatellar (SP) tibial nail insertion. DESIGN:Prospective, randomized. SETTING:Level I trauma center. METHODS:After institutional review board approval, skelet...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,随机对照试验
doi:10.1097/BOT.0000000000000499
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVES:Performing an examination under general anesthesia (EUA) using dynamic stress fluoroscopy of patients with posterior wall acetabular fractures has been used as a tool to determine hip stability and the need for surgical intervention. The purpose of this study was to further evaluate the effectiveness of this...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000308
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture. METHODS:Data from the National Trauma Data Bank for the years 2004-2016 were analyzed, and we identified 301,351...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001702
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVES:To investigate whether rotational malalignment of tibia, after fracture management with minimally invasive plate osteosynthesis technique (MIPO), leads to impaired results in knee and ankle joint functional scores. DESIGN:Prospectively collected data was retrospectively analyzed for this study. SETTING:Lev...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000002053
更新日期:2020-12-31 00:00:00
abstract::Successful management of intramedullary long bone osteomyelitis remains a challenge for both surgeons and patients. Patients are often immune compromised and have endured multiple surgeries. Treatment principles include antibiotic administration (systemically ± locally), surgical debridement of the infection site, and...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000587
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:The open reduction and internal fixation of radial shaft fractures and osteotomies with standard 3.5-mm plates can be complicated by tendon irritation, hardware prominence, and fracture through the screw holes. With the advent of locking plate technology, implant companies and some surgeons have recommended e...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181f8bf9b
更新日期:2011-06-01 00:00:00
abstract::A case of intracardiac malpositioning of a sternoclavicular Kirschner pin is reported. After an uneventful closed wire-fixation of sternoclavicular subluxation and a normal postanesthetic recovery, a 17-year-old male patient developed opacification of the right hemithorax and signs of internal bleeding. The lateral ch...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVES:With the transition to a value-based model of care delivery, bundled payment models have been implemented with demonstrated success in elective lower extremity joint arthroplasty. Yet, hip fracture outcomes are dependent on patient-level factors that may not be optimized preoperatively due to acuity of care....
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,多中心研究
doi:10.1097/BOT.0000000000001454
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the results after closed reduction and percutaneous fixation of displaced fractures of the proximal humerus with the Humerusblock system. DESIGN:Prospective case series. SETTING:Level 1 trauma center. PATIENTS AND METHODS:Fifty-eight consecutive patients with displaced proximal humerus fracture...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181c81b1c
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:To determine humeral diaphyseal fractures at risk for nonunion with functional brace treatment. DESIGN:Retrospective case series. SETTING:A single surgeon's practice. PATIENTS:Forty-nine of 52 consecutive patients treated nonoperatively for an isolated diaphyseal fracture of the humerus during a 6-year per...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000249423.48074.82
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVE:To examine the impact of number and position of locking screws in the diaphyseal portion of an osteoporotic distal femoral fracture model with hybrid fixation. METHODS:Four groups containing 5 osteoporotic bone models were used with varying combinations of diaphyseal screw fixation: 4 nonlocking screws (cont...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318238c086
更新日期:2012-09-01 00:00:00
abstract::The surgical treatment of pelvic and acetabular fractures can be technically challenging. Various techniques are available for the reconstruction of pelvic and acetabular fractures. Less invasive percutaneous fracture stabilization techniques, with closed reduction or limited open reduction, have been developed and ar...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0b013e318288c0c3
更新日期:2014-01-01 00:00:00
abstract::A rare case of bilateral atlantoaxial rotatory dislocation (Fielding type V) in an adult is presented. The diagnosis was rapidly made by computed axial tomography. Prior reports of this entity have not clearly defined the pathoanatomy, which in our case was confirmed by three-dimensional tomographic reconstruction. We...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-199402000-00015
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVES:The aim of the current study was to analyze distraction osteogenesis histomorphometrically to investigate the amount of enchondral ossification adjacent to intramembranous ossification. STUDY DESIGN:Species-specific, longitudinal time study. METHODS Lengthening of 25% of the right tibia was performed in 24 ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200302000-00006
更新日期:2003-02-01 00:00:00
abstract::A laboratory study was performed to compare the stability and ultimate strength of three standard fixation techniques for split-type lateral tibial plateau fractures. The three methods of fixation were (a) three 6.5-mm cancellous lag screws with washers; (b) two 6.5-mm cancellous lag screws with washers and an additio...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199607000-00003
更新日期:1996-01-01 00:00:00
abstract::Nail plate combination technique can be applied in the setting of periprosthetic and interprosthetic fractures to promote reliable healing with a biomechanically favorable construct. Here, technical aspects and discussion of the technique are reviewed through a case of an 87-year-old woman who suffered from an interpr...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001571
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVES:To relate the incidence of implant failure after internal anterior fixation of the pelvic ring to functional outcome and the health-related quality of life in patients. DESIGN:Retrospective chart and radiographic review. SETTING:Level I Trauma center. METHODS:We retrospectively identified all patients who...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000501
更新日期:2016-06-01 00:00:00
abstract::The induced membrane technique for reconstruction of bone defects has proved its effectiveness and is now widely accepted. The 2 stages procedure, implying a cement spacer in the first stage and a huge bone graft in the second stage, responds to rigorous technical details involving each phase of the procedure. Prerequ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0000000000000979
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVE:To evaluate objectively the effectiveness of current surgical management of displaced acetabular fractures. To provide insight into how these evaluation methods can be used to identify areas in which improvements in surgery and rehabilitation can be pursued to improve patient outcomes. DESIGN:Consecutive cas...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200202000-00001
更新日期:2002-02-01 00:00:00
abstract::Reamed intramedullary nailing was used to treat 102 closed tibial shaft fractures. Although a high rate of union was achieved (98%), we noted a higher incidence of complications than previously reported. Thirty-five (37%) patients exhibited one or more components of malunion. In 17 (18%) patients, further operative pr...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199509060-00004
更新日期:1995-01-01 00:00:00
abstract::Salvage of limb length following oblique proximal foot amputations is presented. The technique, results, and follow-up of this procedure are described and compared with other standard procedures. A prospective study was done on 3 adolescents who presented consecutively during years 1999 and 2000. The salvage procedure...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/01.bot.0000164168.94365.49
更新日期:2005-04-01 00:00:00
abstract::In March 2016, North American academic leaders with an interest in and commitment to the field of global orthopaedics met in Orlando, Florida, to gauge each institution's clinical, research, and educational programs in developing countries, establish the main limitations to participating in global health efforts, and ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001288
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVES:To determine whether uncemented implants would provide similar outcomes while avoiding the complications associated with cement in the treatment of elderly patients with proximal humerus fractures (PHFs) with primary reverse total shoulder arthroplasty (RTSA). DESIGN:Case series. SETTING:A single Level I t...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001465
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVES:Iliosacral screw pathways in the first (S1) and second (S2) sacral segments are commonly used for adult pelvic ring stabilization. We hypothesize that radiographically "safe" pathways exist in pediatric patients. SETTING:Academic level I Trauma Center. PATIENTS:All patients between ages 2 and 16 years with...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章
doi:10.1097/BOT.0000000000000421
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVES:Improved patient outcomes after plating of displaced clavicle fractures have been demonstrated by recent clinical studies. Many of these patients, however, complain of anterior chest wall numbness after this procedure; we hypothesize that numbness likely persists long term for many patients, but without effe...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000095
更新日期:2014-11-01 00:00:00
abstract::The Galeazzi fracture-dislocation of the forearm consists of a transverse or short oblique fracture of the radius at the junction of the middle and distal thirds with an associated subluxation or dislocation of the distal radioulnar joint. Anatomic reduction with rigid internal fixation of the radius typically produce...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-198903010-00015
更新日期:1989-01-01 00:00:00
abstract:BACKGROUND:Accurate prediction of likelihood of reoperation in patients with tibial shaft fractures would facilitate optimal management. Previous studies were limited by small sample sizes and noncomprehensive examination of possible risk factors. OBJECTIVE:We conducted an observational study to determine which progno...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200305000-00006
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVES:To evaluate the effect of negative pressure wound therapy (NPWT) on deep infection rate in open tibial fractures. DESIGN:Retrospective cohort study. Data was collected from medical records and radiographs. SETTING:Two level-1 trauma centers. PATIENTS/PARTICIPANTS:Patients who sustained an open tibial frac...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31824133e3
更新日期:2012-09-01 00:00:00
abstract::The best results following fractures of the distal humerus are provided by anatomic reduction and rigid internal fixation. Plates of two designs placed in five different fixation configurations were used to determine the construct that would maximize rigidity of fixation of the distal humerus. Using a cadaver distal h...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:OBJECTIVE:To observe and report the clinical results of indirect plating techniques in the treatment of femoral shaft nonunions originally treated with intramedullary nailing. DESIGN:Prospective consecutive. SETTING:Regional trauma center. PATIENTS:A consecutive series of twenty-three patients with nonunion of femor...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200105000-00004
更新日期:2001-05-01 00:00:00