OTA paper 1998

The tibia shaft section of the AO Surgery Reference. The whole surgical management described, including decision-making support, approaches, and surgical procedures. Highly Reputable

18th Annual Meeting of the Orthopaedic Trauma Association New-generation tibial nails incorporate multiple holes in different planes in order to maximize options for interlocking and allow nailing of fractures near the proximal and distal ends of the tibia. Russell Weisz, MD,[25] from Tampa General Hospital in Tampa, Florida, presented "Distal Fourth Tibia-Fibula Fractures Treated with an Intramedullary Nail: Factors Affecting Alignment." This retrospective study evaluated intramedullary nailing of distal tibial fractures with fibula fractures at the same level. Weisz and colleagues performed a radiographic analysis of postoperative malalignment. Malalignment was defined as more than 5° of varus-valgus angulation or more than 10° of anterior-posterior angulation. Immediate malalignment was found in 13% (9/72) of patients. Eight of the 9 malaligned fractures had no supplemental fibular fixation, but this was not statistically significant. Late malalignment was found in 10% of patients; follow-up in the late-malalignment group averaged 25 weeks. None of the malaligned fractures had fibular fixation. No fracture with more than 1 medial-to-lateral distal interlocking bolt had shifted. Distal locking screw configuration was the only variable that was statistically significant for malalignment in the late group. When both the immediate and late groups of malalignment were combined, 14 of the 15 malaligned fractures had no fibular fixation. The study authors concluded that because of limited bony contact during intramedullary nailing of distal tibia fractures, plate fixation of the fibula prior to intramedullary nailing helped to obtain and maintain fracture reduction. To maintain the reduction, at least 2 medial-to-lateral distal locking screws were needed. (other papers also summarized)

Medscape Report

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Wheeless Textbook of Orthopaedics Discussion: (see non union general discussion): - definition: no evidence of healing over 3 months; - FDA definition: frx that is over 9 months old and that has not shown radiographic signs of progression toward healing for three consecutive months;

Tibial Nonunions Author: Minoo Patel, MD, MS, FRACS, Senior Lecturer, Monash University, Melbourne, Australia; Consulting Adult/Pediatric Orthopedic Surgeon, Department of Orthopedic Surgery, Monash Medical Center, Melbourne, Australia Coauthor(s): James McCarthy, MD, FAAOS, Associate Professor of Orthopedic Surgery, Temple University School of Medicine; Assistant Chief of Staff, Medical Director of Gait Laboratory, Shriners Hospital for Children of Philadelphia; John Herzenberg, MD, FRCSC, Professor, Department of Orthopedic Surgery, Associate Professor, Department of Pediatrics, University of Maryland Medical School, Codirector of International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore Tibial fractures can now be successfully treated in the majority of patients, yet nonunions of the tibia are not uncommon and may result in significant morbidity, require numerous operative procedures to treat, and leave the patient with functional deficits. The subcutaneous position of the tibia results in a greater incidence of open fractures and provides less soft tissue coverage, factors that produce a higher incidence of nonunion and infected nonunion. Although appropriate and prompt treatment is needed to successfully treat tibial injuries, the incidence of a nonunion is more closely related to the fracture characteristics than subsequent treatment. Establish realistic expectations of the outcome with the patient as early in the treatment course as possible, preferably prior to treatment intervention. Sections on - Introduction, Indications, Relevant Anatomy And Contraindications, Workup, Treatment, Complications, Outcome And Prognosis, Future And Controversies, Pictures, Bibliography

eMedicine 2004 Patel
Synonyms and related keywords: tibial delayed union, aseptic nonunion, infected nonunion, tibial fractures, fractures of the tibia, nonunions of the tibia, broken leg, leg fracture, delayed healing, hypertrophic nonunions, atrophic nonunions, normotrophic nonunions, long bone fractures

The management of tibial plafond fractures is difficult and controversial. Expert

There are three techniques: 1) ORIF (Open Reduction Internal Fixation) 2) ORIF with a spanning fixator across the joint (either talus or calcaneus) 3) Hybrid external fixation Expert

Flinders' Registrars' Notebook

Medscape 2000 Kyle & Winquist

OTA paper 1998

OTA 1998

OTA Mailing List Case Discussion 18 Dec 2003 03:31:56 +0500 From: Alexander Chelnokov Subject: Unhappy (valgus) tibia nailing A female 24 years old, a sister of a friend of mine (not physician) living in Moscow, 3 weeks ago admitted to the hospital in Moscow after a car accident (was a pedestrian) with a tibial shaft fracture. 3 days ago closed locked nailing was performed, see attached films. Now he is in panic because they are going to remove the nail and perform plating.