Abstract
Introduction
Segmental fractures of the tibial shaft (AO type 42-C2) often occur after a high energy direct trauma with consecutive severe soft tissue injury and a high rate of open fractures. The blood supply of the intermediate bone fragment can be severely disturbed and therefore operative treatment is demanding. In this retrospective study, we compared three different methods of stabilisation.
Materials and methods
We reviewed the clinical charts and postoperative problems of 26 patients in a ten year period. Sixteen (62%) fractures were stabilised with an intramedullary nail, five (19%) fractures by plate osteosynthesis and five (19%) fractures with an external fixator.
Results
Bony consolidation was obtained in all patients after an average time of 11.4 months. In 17 patients (65.4%) a second operative procedure had to be performed. Pseudarthrosis was seen in 11 fractures (40%), three times in the proximal and eight times in the distal fracture. In the intramedullary nailing group, pseudarthrosis occurred in nine patients. In the group treated with an external fixator, pseudarthrosis was seen three times. After changing to a different implant bony consolidation was achieved in every patient.
Conclusion
Conventional intramedullary nailing is not suitable for stabilisation of segmental fracture types with a short metaphyseal fracture fragment. New nails with proximal and distal interlocking in three different planes offer better stability. Bone vascularisation should not be endangered by the stabilisation procedure and optimal reduction of the fracture is an important prerequisite for uneventful fracture healing, especially in this difficult fracture configuration
Similar content being viewed by others
Abbreviations
- RTN:
-
Reamed tibia nail
- UTN:
-
Unreamed tibial nail
- TNS:
-
Tibial nail system
- PTN:
-
Proximal tibial nail
- ETN:
-
Expert tibial nail
References
Rommens PM, Coosemans W, Broos PLO (1989) The difficult Healing of Segmental Fractures of the tibial shaft. Arch Orthop Trauma Surg 108:238–242
Rommens PM, Broos P, Gruwez JA (1986) Nachuntersuchungsergebnisse von 102 mit DC Plattenosteosynthese stabilisierten Tibiaschaftfrakturen. Unfallchirurgie 12:320–326
Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746
Giannoudis PV, Hinsche AF, Cohen A, Macdonald DA, Matthews SJ, Smith RM (2003) Segmental tibial fractures: an assessment of procedures in 27 cases: Injury, Int. J Care Inj 34:756–762
Melis GC, Sotgiu F, Lepors M, Guido P (1981) Intramedullary nailing in segmental tibial fractures. J Bone Joint Surg 63–A:1310–1318
Rhinelander FW (1974) Tibial blood supply in relation to fracture healing. Clin Orthop 105:34–40
Hansen M, Gercek E, Blum J, Rommens PM (1999) Osteosynthetische Versorgung proximaler extraartikulärer Tibiafrakturen. Unfallchirurgie 25:174–182
Johner R, Wruhs O (1983) Classification of tibial shaft fractures and correlation with results of rigid internal fixation. Clin Orthop 178:7–24
Mommsen U, Stammer HJ, Junbluth KH (1980) Der Unterschenkeletagenbruch. Unfallchirurgie 6:178–182
Langard O, Bo O (1976) Segmental tibial shaft fractures. Acta Orthop Scand 47:351–357
Ekeland A, Thoresen BO, Alho A et al (1988) Interlocking intramedullary nailing in the treatment of tibial fractures-a report of 45 cases. Clin Orthop 231:205–215
Hansen M, Mehler D, Rommens PM (2004) Das biomechanische Verhalten winkelstabiler Implantatsysteme an der proximalen Tibia. Verlag Hans Huber ISBN 3-456-84072-1
Hansen M, Mehler D, Hessmann MH, Blum J, Rommens PM (2007) Intramedullary stabilization of extraarticular proximal tibial fractures: a biomechanical comparison of intramedullary and extramedullary implants including a new proximal tibia nail (PTN). J Orthop Trauma 21:701–709
Krettek C (2001) Prinzipien der intramedullären Knochenstabilisierung. Unfallchirurg 104:639–653
Siebenrock KA, Schilling B, Jacob RP (1993) Treatment of complex tibial shaft fractures. Arguments for early secondary intramedullary nailing. Clin Orthop 290:269–274
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Beardi, J., Hessmann, M., Hansen, M. et al. Operative treatment of tibial shaft fractures: a comparison of different methods of primary stabilisation. Arch Orthop Trauma Surg 128, 709–715 (2008). https://doi.org/10.1007/s00402-008-0619-5
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-008-0619-5