Medscape 2000

OTA paper 1998

Reports from Medscape Orthopaedics and Sports Medicine 1999

AONA posting of the AO Classification of Long Bone Fractures Highly Reputable

Medscape Conference Coverage from American Academy of Orthopaedic Surgeons Annual Meeting Day 4 - Saturday, March 18. Overview of the controveries of intramedullary nailing in femoral shaft fractures and severe open tibial fractures.

Displaced tibial shaft fractures: A prospective randomized study of closed intramedullary nailing versus cast treatment in 53 patients Authors: Karladani A.H.; Granhed H.; Edshage B.; Jerre R.; Styf J. Source: Acta Orthopaedica Scandinavica, Volume 71, Number 2, 1 April 2000, pp. 160-167(8) Abstract: Of 53 patients with unilateral, displaced and closed or grade 1 open tibial shaft fractures, 27 patients (group I) were randomized to treatment with an intramedullary nail and 26 patients (group II) to treatment with a plaster cast. 12 fractures in the latter group were considered stable enough for treatment with only a cast (group IIa), while 14 fractures in group II showed redisplacement during reduction under anesthesia or at 1 week follow-up. Therefore, these fractures were stabilized with cerclage or screws (group IIb), which was a prerequisite for continuing cast treatment. The mean time-to-union was 19 weeks for group I, and 25 weeks for group II. 6 patients in group I and 16 in group II had delayed union. The Nottingham Health Profile index scores on physical mobility, social isolation, work ability, and sexual life were significantly better in group I than in group II at 3 months after injury. Delayed union, malunion, and restricted range of motion at the ankle joint were common complications when these fractures were treated with a cast. We recommend intramedullary nailing for these fractures. Full Text available

High energy intraarticular fractures of the distal tibia (tibial plafond fractures, or pilon fractures) present a great challenge to the orthopaedic surgeon. These injuries often result in a significant soft tissue damage, comminution of bone, and disruption of the articular cartilage and subchondral bone. The treatment strategy used in dealing with tibial plafond fractures is strongly influenced by the often-precarious soft tissue conditions. Due to the great treatment challenges posed by this high-energy injury, there has been much controversy about the most appropriate and best treatment for tibial plafond fractures. Factors such as timing of treatment, method of stabilization, techniques of operative care, and postoperative rehabilitation have all been hotly debated and, at times, contested by various orthopaedists. This chapter will attempt to comprehensively address the anatomy, physiology, and diagnosis of this injury; it will also discuss various treatment modalities, and the importance of tailoring treatment to the extent of the bony and soft tissue injuries.

Wheeless Textbook of Orthopaedics Distal Tibia Fracture: with frx extension into the joint, consider placement of percutaneous lag screws to repair intra-articular fracture lines before nailing is performed; ORIF of distal fibula: some authors recommend concomitant ORIF of the distal fibula (if frx is present), inorder to improve rotational stability; blocking screws: antero-posterior blocking screws are inserted on either side of the central nail insertion zone inorder to effect an anatomic reduction; with fracture demonstrating preoperative varus displacement, consider an antero-posterior blocking screw inserted on the medial side of the distal fragment; in contrast distal fractures with tendency for valgus displacment, consider placement of AP blocking screw inserted on the lateral side of the distal fragment;

OTA poster 2004

OTA Poster 2004

Book of Orthopaedics and Traumatology N & M

OTA 2004 Paper (Fasciotomy, Closed Fracture, Grade IIIb/IIIc Open Fracture, and Amputation)

Wheeless IM naling of these fractures is technically difficult and often results in malalignment; surgeons without strong enthusiasm for nailing these fractures should consider lateral plating (for closed fractures)and external fixation for open fractures

Orthopedics 08/06/2000 (Volume 23, Number 8) Interlocking Intramedullary Nailing in Distal Tibial Fractures Tyllianakis M, Megas P, Giannikas D, Lambiris E Orthopedics. 2000;23(8):805-808 The management of distal tibial fractures remains challenging. Despite an earlier report from very well-respected fracture surgeons showing excellent results from interlocking nailing, this option is still usually not considered.[1] Although patients with distal tibial metaphyseal fractures may be cared for nonoperatively, these fractures can be very unstable and difficult to control in a cast. Additionally, many distal tibial fractures are associated with lateral malleolar fractures, and the need for fixation of the distal fibula remains controversial.

More than 20 years ago, the Strasbourg Trauma Centre group, then headed by Ivan Kempf, developed locked intramedullary nailing. Arsène Grosse was chiefly involved with this technique, which was eventually adopted world-wide and which has revolutionized the treatment of limb shaft fractures. Maîtrise Orthopédique met this surgeon who has dedicated himself to traumatology, at one of the workshops he organizes within the International Association for Dynamic Osteosynthesis (AIOD).