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Fratture diafisarie di tibia: chiodo o MIPO

Tibial diaphyseal fractures: nail versus plate

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Riassunto

Per le fratture della diafisi tibiale il trattamento chirurgico è considerato essenziale, ma è dibattuto quale sia la migliore tecnica. Scopo del lavoro è confrontare, analizzando la letteratura, l’efficacia dell’inchiodamento endomidollare rispetto alla fissazione con placche nel trattamento delle fratture extraarticolari di tibia. Negli articoli selezionati, 318 pazienti erano affetti da frattura prossimale (234 chiodo, 84 placca), 226 da frattura distale (135 chiodo, 93 placca). Sono stati considerati esiti specifici differenti per le fratture prossimali e distali. Nelle fratture prossimali la placca garantisce minore insorgenza di sindrome compartimentale (p = 0,0488) e di fallimento dell’impianto (p = 0,0176), il chiodo comporta meno infezioni (p = 0,0019). Nelle fratture metafisarie distali, la placca assicura minor difetto di allineamento (p = 0,01), il chiodo comporta meno infezioni (p = 0,02) e maggior angolo di dorsiflessione (p = 0,001). La letteratura esaminata mostra variabilità degli outcome nei gruppi a confronto. La scelta di chiodo o placca deve essere effettuata in base alle caratteristiche cliniche e radiologiche.

Abstract

Surgical treatment is considered essential for tibial shaft fractures, but it is debated which technique is best. The purpose of this work is comparing, analyzing literature, the effectiveness of intramedullary nailing compared to fixation with plates in the treatment of extra-articular tibial fractures. The selected articles included 318 patients with proximal fractures (234 nail, 84 plaque), 226 with distal fracture (135 nail, 93 plaque). Results were considered specific for different proximal and distal fractures. In proximal fractures the plaque ensures fewer onset of the compartimental syndrome (p = 0.0488) and of implant failure (p = 0.0176), the nailing results in fewer infections (p = 0.0019). In distal metaphyseal fractures, the plaque ensures less misalignment (p = 0.01), the nail results in fewer infections (p = 0.02) and greater angle of dorsiflexion (p = 0.001). The examined literature shows variability of outcomes in the compared groups. The choice of nail or plate should be made based on clinical and radiological features.

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Authors and Affiliations

  1. SCDU Ortopedia e Traumatologia, AOU San Luigi Gonzaga, Orbassano, Italy

    A. Massè, M. Favuto, M. Cicirello, S. Mortera & M. Schirò

  2. AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano (TO), Italy

    A. Massè, M. Favuto, M. Cicirello, S. Mortera & M. Schirò

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  1. A. Massè
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  2. M. Favuto
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  3. M. Cicirello
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  4. S. Mortera
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  5. M. Schirò
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Correspondence to A. Massè.

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Massè, A., Favuto, M., Cicirello, M. et al. Fratture diafisarie di tibia: chiodo o MIPO. Aggiornamenti 18, 25–32 (2012). https://doi.org/10.1007/s10351-012-0004-2

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  • DOI: https://doi.org/10.1007/s10351-012-0004-2

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