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Primary rigid intramedullary nailing for fractures of the tibia: current concepts and technique

  • James E. Arbuthnot
  • Anthony Perera
  • David Powers
Review
  • 187 Downloads

Abstract

Intramedullary nailing of tibial shaft fractures is the preferred treatment of many tibial shaft fractures—displaced and undisplaced, open and closed, simple and multi-fragmentary. In this paper we address several important issues relating to the concepts of the procedure and review the literature available: reaming of the intramedullary cavity; the problems of achieving stability with metaphyseal fractures; achieving fracture reduction; the issue of the ideal entry point; the complications that can occur; and the timing of surgery.

Keywords

Tibia Fracture Nailing 

Notes

Conflict of interest statement

No funds were received in support of this study.

References

  1. 1.
    Bedi A, Le TT, Karunakar MAJ (2006) Surgical Treatment of nonarticular distal tibia fractures. Am Acad Orthop Surg 14(7):406–416Google Scholar
  2. 2.
    Gómez-Benito MJ, Fornells P, García-Aznar JM, Seral B, Seral-Iñnigo F, Doblaré MJ (2007) Computational comparison of reamed versus unreamed intramedullary tibial nails. Orthop Res 25(2):191–200CrossRefGoogle Scholar
  3. 3.
    Pell AC, Christie J, Keating JF, Sutherland GR (1993) The detection of fat embolism by transoesophageal echocardiography during reamed intramedullary nailing. A study of 24 patients with femoral and tibial fractures. J Bone Joint Surg Br 75(6):921–925PubMedGoogle Scholar
  4. 4.
    Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R (1995) Transcardiac echocardiography during invasive intramedullary procedures. J Bone Joint Surg Br 77(3):450–455PubMedGoogle Scholar
  5. 5.
    Anwar IA, Battistella FD, Neiman R, Olson SA, Chapman MW, Moehring HD (2004) Femur fractures and lung complications: a prospective randomized study of reaming. Clin Orthop Relat Res 422:71–76PubMedCrossRefGoogle Scholar
  6. 6.
    Giannoudis PV, Smith RM, Bellamy MC, Morrison JF, Dickson RA, Guillou PJ (1999) Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures. An analysis of the second hit. J Bone Joint Surg Br 81(2):356–361PubMedCrossRefGoogle Scholar
  7. 7.
    Pape HC, Zelle BA, Hildebrand F, Giannoudis PV, Krettek C, van Griensven M (2005) Reamed femoral nailing in sheep: does irrigation and aspiration of intramedullary contents alter the systemic response? J Bone Joint Surg Am 87(11):2515–2522PubMedCrossRefGoogle Scholar
  8. 8.
    Karunakar MA, Frankenburg EP, Le TT, Hall J (2004) The thermal effects of intramedullary reaming. J Orthop Trauma 18(10):674–679PubMedCrossRefGoogle Scholar
  9. 9.
    Giannoudis PV, Snowden S, Matthews SJ, Smye SW, Smith RM (2002) Friction burns within the tibia during reaming. Are they affected by the use of a tourniquet? J Bone Joint Surg Br 84(4):492–496PubMedCrossRefGoogle Scholar
  10. 10.
    Hupel TM, Weinberg JA, Aksenov SA, Schemitsch EH (2001) Effect of unreamed, limited reamed, and standard reamed intramedullary nailing on cortical bone porosity and new bone formation. J Orthop Trauma 15(1):18–27PubMedCrossRefGoogle Scholar
  11. 11.
    Hoegel F, Mueller CA, Peter R, Pfister U, Suedkamp NP (2004) Bone debris: dead matter or vital osteoblasts. J Trauma 56(2):363–367PubMedGoogle Scholar
  12. 12.
    Forster MC, Bruce AS, Aster AS (2005) Should the tibia be reamed when nailing? Injury 36(3):439–444PubMedCrossRefGoogle Scholar
  13. 13.
    Freedman EL, Johnson EE (1995) Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res 315:25–33PubMedGoogle Scholar
  14. 14.
    Lang GJ, Cohen BE, Bosse MJ, Kellam JF (1995) Proximal third tibial shaft fractures. Should they be nailed? Clin Orthop Relat Res 315:64–74PubMedGoogle Scholar
  15. 15.
    Nork SE, Barei DP, Schildhauer TA, Agel J, Holt SK, Schrick JL, Sangeorzan BJ (2006) Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma 20(8):523–528PubMedCrossRefGoogle Scholar
  16. 16.
    Roth SE, Kreder H, Stephen D, Whyne CM (2005) Biomechanical stability of intramedullary nailed high proximal third tibial fractures with cement augmented proximal screws. J Orthop Trauma 19(7):457–461PubMedCrossRefGoogle Scholar
  17. 17.
    Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M (2006) Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 20(1):76–79PubMedCrossRefGoogle Scholar
  18. 18.
    Im GI, Tae SK (2005) Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma 59(5):1219–1223PubMedGoogle Scholar
  19. 19.
    Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA (2005) Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am 87(6):1213–1221PubMedCrossRefGoogle Scholar
  20. 20.
    Janssen KW, Biert J, van Kampen A (2006) Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients Int Orthop, Dec 12Google Scholar
  21. 21.
    Obremskey WT, Medina M (2004) Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists. Orthopedics 27(11):1180–1184PubMedGoogle Scholar
  22. 22.
    Krettek C, Miclau T, Schandelmaier P, Stephan C, Möhlmann U, Tscherne H (1999) The mechanical effect of blocking screws (“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small-diameter intramedullary nails. J Orthop Trauma 13(8):550–553PubMedCrossRefGoogle Scholar
  23. 23.
    Laflamme GY, Heimlich D, Stephen D, Kreder HJ, Whyne CM (2003) Proximal tibial fracture stability with intramedullary nail fixation using oblique interlocking screws. J Orthop Trauma 17(7):496–502PubMedCrossRefGoogle Scholar
  24. 24.
    Krettek C, Stephan C, Schandelmaier P, Richter M, Pape HC, Miclau T (1999) The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br 81(6):963–968PubMedCrossRefGoogle Scholar
  25. 25.
    Tang P, Gates C, Hawes J, Vogt M, Prayson MJ (2006) Does open reduction increase the chance of infection during intramedullary nailing of closed tibial shaft fractures? J Orthop Trauma 20(5):317–322PubMedCrossRefGoogle Scholar
  26. 26.
    Dunbar RP, Nork SE, Barei DP, Mills WJ (2005) Provisional plating of Type III open tibia fractures prior to intramedullary nailing. J Orthop Trauma 19(6):412–414PubMedCrossRefGoogle Scholar
  27. 27.
    Kutty S, Laing AJ, Prasad CV, McCabe JP (2005) The effect of traction on compartment pressures during intramedullary nailing of tibial-shaft fractures. A prospective randomised trial. Int Orthop 29(3):186–190. Epub 7PubMedCrossRefGoogle Scholar
  28. 28.
    Hernigou P, Cohen D (2000) Proximal entry for intramedullary nailing of the tibia. The risk of unrecognised articular damage. J Bone Joint Surg Br 82(1):33–41PubMedCrossRefGoogle Scholar
  29. 29.
    Johnson DL, Swenson TM, Livesay GA et al (1995) Insertion- site anatomy of the human menisici: gross, arthroscopic and topographical anatomy as a basis for meniscal transplantation. Arthroscopy 11:386–394PubMedCrossRefGoogle Scholar
  30. 30.
    Kohn D, Moreno B (1995) Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy 11:96–103PubMedGoogle Scholar
  31. 31.
    Althausen PL, Neiman R, Finkemeier CG, Olson SA (2002) Incision placement for intramedullary tibial nailing: an anatomic study. J Orthop Trauma 16(10):687–690PubMedCrossRefGoogle Scholar
  32. 32.
    Toivanen JA, Väistö O, Kannus P, Latvala K, Honkonen SE, Järvinen MJ (2002) Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am 84-A(4):580–585PubMedGoogle Scholar
  33. 33.
    Petrisor B, Anderson S, Court-Brown CM (2005) Infection after reamed intramedullary nailing of the tibia: a case series review. J Orthop Trauma 19(7):437–441PubMedCrossRefGoogle Scholar
  34. 34.
    Katsoulis E, Court-Brown C, Giannoudis PV (2006) Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br 88(5):576–580PubMedCrossRefGoogle Scholar
  35. 35.
    Drosos GI, Bishay M, Karnezis IA, Alegakis AK (2006) Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade 1 open fractures. J Bone Joint Surg Br 88(2):227–231PubMedCrossRefGoogle Scholar
  36. 36.
    Puloski S, Romano C, Buckley R, Powell J (2004) Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 18(7):397–402PubMedCrossRefGoogle Scholar
  37. 37.
    Brinker MR, O’Connor DP (2007) Exchange nailing of ununited fractures. J Bone Joint Surg Am 89(1):177–188PubMedCrossRefGoogle Scholar
  38. 38.
    Pape HC, Schmidt RE, Rice J, van Griensven M, das Gupta R, Krettek C, Tscherne H (2000) Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28:3441–3448PubMedCrossRefGoogle Scholar
  39. 39.
    Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am 71:336–340PubMedGoogle Scholar
  40. 40.
    Pape HC, Grimme KM, Giannoudis PV, Sott AL, Hildebrand F, Krettek C (2003) The impact of fracture fixation on the systemic cytokine response in stable polytrauma patients—a prospective randomized analysis of intramedullary instrumentation versus damage control for femoral fractures. Program and abstracts of the 2003 OTA Annual Meeting; 9–11; Salt Lake City, Utah. Abstract 27Google Scholar
  41. 41.
    Pape HC, van Griensven M, Rice J, Gänsslen A, Hildebrand F, Zech S, Winny M, Lichtinghagen R, Krettek CJ (2001) Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. Trauma 50(6):989–1000CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • James E. Arbuthnot
    • 1
  • Anthony Perera
    • 1
  • David Powers
    • 1
  1. 1.Department of Orthopaedics and TraumaUniversity Hospital Coventry and WarwickSolihullUK

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