Extreme Nailing: Is It Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)?
| Autor: | Rafael Serrano, Roy W. Sanders, Darryl A. Auston, David T. Watson, Michael J. Beebe, Jonathan H Quade, Michael Morwood, Hassan R. Mir |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Nonunion Bone Nails law.invention Intramedullary rod Weight-Bearing 03 medical and health sciences Fixation (surgical) Young Adult 0302 clinical medicine law medicine Humans Orthopedics and Sports Medicine Aged Retrospective Studies Aged 80 and over Fracture Healing 030222 orthopedics biology business.industry Trauma center Implant failure 030208 emergency & critical care medicine Level iv General Medicine Middle Aged medicine.disease biology.organism_classification Surgery Fracture Fixation Intramedullary Tibial Fractures Valgus Treatment Outcome Female Implant business |
| Zdroj: | Journal of orthopaedic trauma. 33(8) |
| ISSN: | 1531-2291 |
| Popis: | Objectives To determine whether immediate weightbearing after intramedullary (IM) fixation of extra-articular distal tibial fractures (OTA/AO 43-A) results in a change in alignment before healing. Design Retrospective review. Setting Level 1 trauma center. Intervention IM nailing of distal tibial fractures. Patients/participants Fifty-three patients with 54 fractures, all of whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 43-A1, 20 OTA/AO 43-A2, and 16 OTA/AO 43-A3; 20 fractures were open. Main outcome measurements Change in fracture alignment or loss of position. Results Average change from initial angulation at final follow-up was 0.52 ± 1.49 degrees of valgus and 0.48 ± 3.14 degrees of extension. Final alignment was excellent in 14, acceptable in 28, and poor in 12; 2 fractures went from acceptable initial alignment to poor final alignment; and 2 fractures went from excellent to acceptable alignment. Seven fractures had an improvement in alignment over time. Two fractures required free-flap coverage and 4 required staged grafting because of bone loss. Ten fractures had an unplanned return to the operating room (5 for infected nonunion requiring implant exchange, 3 for infection requiring debridement without implant revision, and 2 for aseptic nonunion). No patient had revision for implant failure. Conclusions Immediate weightbearing after IM fixation of extra-articular distal tibial fractures (OTA/AO 43-A) led to minimal change in alignment and seems to be safe for most patients. Complications were consistent with those reported in previous non-weightbearing cohorts. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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