Proximal tibia fractures and intramedullary nailing: The impact of nail trajectory to varus/valgus deformity
| Autor: | C. Garnavos, N. Lasanianos |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Reoperation medicine.medical_treatment Radiography Pilot Projects Knee Injuries Bone Nails law.invention Intramedullary rod Proximal tibia Prosthesis Implantation Young Adult law Genu Varum Fracture fixation medicine Humans Fractures Malunited Reduction (orthopedic surgery) General Environmental Science Valgus deformity Aged Orthodontics business.industry Middle Aged medicine.disease Fracture Fixation Intramedullary Genu Valgum Tibial Fractures medicine.anatomical_structure Treatment Outcome Coronal plane Nail (anatomy) General Earth and Planetary Sciences Female business |
| Zdroj: | Injury. 42(12) |
| ISSN: | 1879-0267 |
| Popis: | Although intramedullary nailing has been the treatment of choice for diaphyseal tibial fractures, its role in the management of fractures occurring at the proximal tibial metaphysis remains controversial, as high complication rates that mostly refer to unsuccessful reduction and malalignment have been reported. To overcome these problems and improve outcomes, certain modifications to the standard operative technique have been proposed, such as the use of blocking screws, additional buttress plate, different patient positioning, and extended parapatellar or retropatellar approaches. Remarkably, the role of location of the entry portal for the nail in the coronal plane in achieving and maintaining fracture reduction has not been thoroughly investigated. In the present study, we evaluated the hypothesis that, in the management of extra-articular proximal tibial fractures with intramedullary nailing, proper selection of the nail-entry portal that determines the trajectory of the nail could contribute towards fracture reduction, simplify the procedure and reduce complications. This hypothesis was investigated with careful observation of past X-rays (Figs. 1 and 2) that enabled us to propose a specific guideline about the proper site of the entry portal of the nail for the avoidance of varus/valgus deformity. According to this guideline, the entry portal of the nail on the coronal level must be lateral or medial, depending on the side where the fracture approximates most the articular surface of the proximal tibia on the anteroposterior (AP) view. Validation of the hypothesis could result in simplifying the operative procedure and, thus, less operating time and morbidity by reducing the need for additional implants or other relevant modifications of the standard intramedullary nailing technique. 10,12,18–24 A R T I C L E I N F O |
| Databáze: | OpenAIRE |
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