Introduction: An accurate selection of tibial nail and screws measurements is paramount in purpose to achieve proper tibial fracture reduction and fixation, avoid irritation of the soft-tissue envelope, and enable extraction of the nail in the future, if needed. To this date, many methods were suggested to determine the length and diameter of an intramedullary tibial nail, preoperatively and intraoperatively. Each method has its disadvantages, and most are lacking in accuracy. Digital aids are currently available for preoperative planning for many types of surgeries.
Methods: Retrospectively, 27 patients operated for diaphysial tibial fracture intramedullary nailing were selected. The contralateral leg was imaged using AP and lateral radiograph views. Six orthopaedic trauma surgeons used the TraumaCad program (Voyant Health) to plan the appropriate nail and distal locking screws measurements, while blinded from the actual hardware used in the operation. Later, they also conducted quality review regarding the operation carried out and suggested correction in measurements of the hardware. Intra-observer and inter-observer reliability was calculated.
Results: The inter-correlation coefficient for the planned nails was 0.97 and 0.84 ( < 0.001) in AP view for length and diameter, respectively, and similarly 0.98 and 0.86 ( < 0.001) in lateral view. The interclass correlation coefficient (ICC) for the locking screws length was 0.7 ( < 0.02) and 0.82 ( < 0.01) for the proximal and distal medio-lateral screws, respectively, and 0.9 ( < 0.001). The ICC between AP and lateral views was 0.98 for length and 0.96 for diameter ( < 0.001). The scores and corrections given by the examiners to the actual selected nail were ICC of 0.98 and 0.96 ( < 0.001) for length and diameter, respectively. The examiners suggested they would correct, post-factum, the length of the nail in average 28% and the diameter in average 30%. The average observer resulted in ICC of 0.94 and 0.91 ( < 0.001) in length and only 0.77 and 0.67 ( < 0.001) in diameter (AP and lateral views, respectively) when comparing the actual nail used and the post-factum plan.
Conclusion: Preoperative planning of tibial fractures' nailing using imaging of the contralateral leg and a digital graphic planning program is an accurate and reliable method. It may serve to reduce errors, surgical time, and radiation dose in the operating room. This method could also be applied for surgical debriefing.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484665 | PMC |
http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00015 | DOI Listing |
Eur J Trauma Emerg Surg
January 2025
Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.
Purpose: To investigate the factors that prolonged the operative duration (OD) in patients who underwent single-stage locked intramedullary nailing of their multiple concurrent long-bone fractures (LBFs) using Surgical Implant Generation Network (SIGN) nails.
Methods: Forty-nine patients who fulfilled the inclusion criteria were enrolled prospectively over 8½ years. Data collected included age, sex, injury mechanism and severity, fracture characteristics, nail types and diameter, OD, fracture-to-fixation time, length of hospital stay (LOS), functional outcomes and complications.
Distal tibial fractures are common lower-limb injuries and are generally associated with a high risk of postoperative complications, especially in patients with multiple medical comorbidities. This study sought to ascertain the efficacy of retrograde intramedullary tibial nails (RTN) for treating extra-articular distal tibial fractures in high-risk patients. Between January 2019 and December 2021, 13 patients considered at high risk for postoperative complications underwent RTN fixation.
View Article and Find Full Text PDFJ Orthop
August 2025
Department of Orthopaedic Surgery, Oita University Hospital, Japan.
Background: This study examines the relationship between the anterior offset of the tibial intramedullary nail (TIN) entry point and the tibial shaft axis to enhance the fit and alignment of TINs, using transparent 3D-CT in an accurate lateral view to minimize rotational artifacts.
Methods: Data were collected from 100 adult patients undergoing tibial CT scans. Measurements included the anterior offset from the tibial axis to the entry point, tibial tubercle offset, tibial plateau length, posterior slope, tibial length, isthmus diameter, and the isthmus-to-tibial length ratio.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi
January 2025
Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233000, P. R. China.
Objective: To analyze the effectiveness of three internal fixation methods, namely hollow screw combined with Kirschner wire tension band, hollow screw combined with anchor nail, and modified 1/3 tubular steel plate, in the treatment of avulsion fracture of tibial tubercle (AFTT) in adolescents.
Methods: Between January 2018 and September 2023, 19 adolescent AFTT patients who met the selection criteria were admitted. According to different internal fixation methods, patients were divided into group A (8 cases, hollow screw combined with Kirschner wire tension band), group B (6 cases, hollow screw combined with anchor nail), and group C (5 cases, modified 1/3 tubular steel plate).
Purpose: Previous studies have shown that subtrochanteric femoral fractures treated with intramedullary nails might lead to varus-procurvatum malalignment. Similar results have been reported when using antegrade intramedullary lengthening nails (ILNs). The purpose of our study is to examine if antegrade telescoping intramedullary lengthening nails lead to varus-procurvatum malalignment of the proximal femur and what are possible predictors of that shift.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!