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Tibial Fractures

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Location: http://www.medscape.com/viewarticle/444926_9

Description: 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)

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Added: Tue Apr 11 2006
Last Modified: Fri Apr 04 2008