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Objective To study the stability of plate-assisted intramedullary nailing for fixing proximal third tibiafractures, compare and observe biomechanical characteristics of anterolateral or posteromedial plate-assisted intramedullary nailing after fixation of proximal third tibia fractures. Methods Eight artificial tibia of 4th-generation sawbones were divided into two groups based on location of the assisted plate, namely, anterolateral plate group and posteromedial plate group, with 4 specimens in each group. Each two locking bolts were fixed to theintramedullary nail proximally and distally, and each three bicortical screws were fixed to the plate proximally and distally. The specimens were osteotomized with a 10-mm defect which located 0. 5 cm to the proximal locking bolt of intramedullary nail or 5-6 cm distally to the knee joint line, in order to simulate an AO/ OTA 41-A2 type proximal third tibia fracture after fixation of intramedullary nail. After osteotomy was finished, axial compression test, three point bending test, cyclic loading and overstress test were conducted by mechanical testing machine. The results of axial stiffness and three-point stiffness between two groups were compared and analyzed. Results Axial compression test showed that the average axial stiffness in posteromedial plate group was lower than that in anterolateral plate group, but no significantly statistical differences were found between the two groups. Three point bending test showed that the average bending stiffness in posteromedial plate group was significantly higher than that in anterolateral plate group when stimulating either varus stress (plate located at pressure side of the fracture, t = 3. 679, P<0. 05) or valgus stress (plate located at tension side of the fracture, t = 8. 975, P<0. 05). Conclusions Plate-assisted intramedullary nailing for fixation of proximal third tibia fractures can minimize the angulation malalignment, improve the stability of nailed proximal tibial fragment and allow the early weight bearing. Both anterolateral and posteromedial plate-assisted intramedullary nail can provide satisfactory axial stability for proximal third tibia fractures, while posteromedial plate-assisted intramedullary nail shows better bending stability than anterolateral plate in countering varus or valgus stress deformity. This study provides an essential basis for clinical decision making about plate-assisted intramedullary nailing for fixing proximal third tibia fractures.
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Objective To define the peroneal nerve’ s safety zone and study its clinical value in treatment of MIPPO for proximal tibia fracture. Methods The peroneal nerve’ s safety zone was defined according to dead body anatomy. Patients with proximal tibia fracture were divided into traditional therapy group ( control group) and peroneal nerve’ s safety zone therapy ( observation group) . The curative effects and complications were compared. Results The peroneal nerve’s safety zone of R1 was (45. 30 ± 1. 55) mm,R2 was (45. 61 ± 1. 40) mm,R3 was(45. 42 ± 1. 62) mm,angle A was(33 ± 2. 1)°,angle B was(97 ± 2. 3)°. The operating time,bleeding volume,hospitalization time and fracture time in observation group were significantly lower than those in the control group,but there was no siginificant difference in post-ther-apy infection,delayed healing and other complications. Conclusion The curative effects according to peroneal nerve’ s safety zone are better than traditional MIPPO in proximal tibia fracture.
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Objective To investigate the clinical application of minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates. Methods The clinical data of 38 patients with minimally invagive fixation of complex proximal tibia fractures by uniaxial(n=21)and polyaxial(n=17)locking plates from January 2008 to June 2009 were retrospectively analysed,and the union rates and function recovery were compared between groups.Results All patients were followed up for 3 to 20 months,with an average of 12 months.All patients had bone union.The time of fracture union for fixation by uniaxial locking plates was 10 to 20 weeks,with an average of 14 weeks;and that for fixation by polyaxial locking plates was 11 to 18 weeks,with au average of 13 weeks.Evaluated by Johner-Wruhs method, there were 14 "excellent" cases,5 "better" eases,2 "good" cases and 0 "poor" case for fixation by uniaxial locking plates (rate of "excellent and better",90.4%),and there were 11 "excellent" cases,5 "better" cases,1 "good" cage and 0 "poor" case for fixation by polyaxial locking plates (rate of "excellent and better",94.1%). Conclusion Minimally invagive fixation of complex proximal tibia fractures by uniaxial and polyaxial locking plates is stable,has less effects on bone blood supply,high bone union rate and favourable function recovery,and is an effective way in the treatment of complex proximal tibia fractures.Fixation by uniaxial locking plate has a better mechanical intensity,while fixation by polyaxial locking plate can adjust the screw angle according to fracture situation,which can be clinically applied accordingly.
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PURPOSE: To find out the efficiency of two staged operation of patients with high energy proximal tibia fracture with severe soft tissue damage, the first step being external fixation, and the second, internal fixation with plates. MATERIALS AND METHODS: The study group was the 42 patients who had followed for one year out of a group of 56, performed the first step external fixation and the second step internal fixation with plates retrospectively, from March 2003 to March 2007. The average age of the study group was 51.4, 26 men, and 16 women participating in this study. The average time of follow up was 32 months. In the final follow up, investigations of the radiological assessments and functional abilities of the bony fusion were carried out along with the complications of the soft tissue. RESULTS: The duration after the first step external fixation until second step internal fixation to be performed was 14.9 (6~40) days in average. The final bone fusion took about 15 weeks, and according to the final follow up, the range of motion of the knee was around 110.8 degrees (6.2~117 degrees). In 31 cases, only the internal fixation was performed, while in 11 cases, soft tissue reconstruction was carried out with the internal fixations. As for the complications there were 2 cases of deep soft tissue infection, 2 cases of nonunion, 1 case of malunion and 1 case of knee joint stiffness. CONCLUSION: In cases of proximal tibia fracture with severe soft tissue damage, external fixation was important to secure the safety of the fracture, carry forward the anatomical alignment, plan the soft tissue safety and manage the wound to decrease the number of microbial in the next operation, which is the internal fixation with plates.
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Female , Humans , Male , External Fixators , Follow-Up Studies , Knee , Knee Joint , Range of Motion, Articular , Resin Cements , Retrospective Studies , Soft Tissue Infections , Soft Tissue Injuries , TibiaABSTRACT
Objective To introduce and investigate internal-fixtion with outboard proximal tibia anatomic plates through cut of anterolateral aspect of the leg.Methods 56 cases fracture of proximal tibia were fixed with outboard proximal tibia anatomic plates.Results All cases were followed up ranging from 5～18 months,with an average of 9 months.The excellent and good rate was 94.6% on Merchant grading system.Conclusions Internal-fixtion with outboard proximal tibia anatomic plates for the fracture of proximal tibia is an effective and reliable operation.
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OBJECTIVES: To evaluate the results and its efficacy of double plating for proximal tibial fractures using minimally invasive percutaneous osteosynthesis (MIPO) technique. MATERIAL & METHODS: Twenty-three fractures, followed-up more than 1 year, were included in this retrospective study. There were 18 men and 5 women, and the mean age was 53.5 years-old. According to the AO-OTA classification, five were 41A, 13 were 41C, and 5 were 42. There were four open fractures (grade I- three, grade III A-one case). The plates were fixed on the medial and lateral sides of tibia with MIPO technique. Functional and radiographic results were evaluated by the modified Rasmussen system. RESULTS: All fractures healed without bone graft, and the mean period for fracture healing was 19.3 weeks (range, 10~32 weeks). All other patients had excellent or good clinical or radiological results, except for two patients of a fair clinical result after a combined injury. Complications included one case of shortening (1 cm) and two cases of mal-alignments (varus less than 10 degrees). There was one case of superficial infection, but no patient showed deep infection. CONCLUSION: Double plating using MIPO technique can provide favorable results in the treatment of proximal tibial fractures.