gms | German Medical Science

Objectives: To explore methods for rapid and effective judgment to avoid inappropriate closed reduction in treatment of comminuted tibial fractures with supracondylar intramedullary nails when there is no bone anatomy available.

Methods: Twenty-one patients suffering from comminuted tibial fractures and treated with closed reduction from January 2014 to January 2016 with intramedullary nails were selected for prospective research. Consisting of 16 males and 5 females, they aged from 22 to 53, averaging 34.6. All patients underwent frontal and lateral X-ray examination before operation. During operation, the tibial intramedullary nails were inserted and the connecting rods in the front were used as the measuring rod. They were pointed to the second metatarsal for interlocking with adjacent supracondylar intramedullary nails. After operation, a horizontal tibial full-length CT scan was conducted from both sides, and the images at the same level were chosen (Tibial proximal and tibial distal). Then, a tangent was made from the posterior margin of the tibial plateau and the distal end of the tibia respectively. The two planar images collected were measured against the horizontal line for calculating the angular differences of the two tangents. After that, the differences were compared to determine the reliability of the surgery. The functional response index (FIQ) and olerud-molander ankle score (OMAS) were used to assess the functions of the affected knee and ankle joint before injury and during the last follow-up. In addition, the Chinese version of the SF-36 Health Questionnaire was used to assess the quality of life of the patients. Then, the function rating and the patients' self-perception were studied, and found to be indirectly confirming the reliability of the surgery.

Results: After the surgery, the twenty-one patients were followed up for 12 to 24 months (averaging 18.3 months). The healing period for fractures was 3.2 to 6.7 months (averaging 4.5 months). On the 2nd to the 3rd day, the angle between the two tangents on the normal limb was 47.1 ± 2.9 °, while that of the injured limb was 44.8 ± 5.6 °. There was no significant difference between the healthy limb and the affected limb (T = 1.895, P = 0.064). There were no statistically significant differences in the FIQ score, OMAS score and the score of the Chinese version of SF-36 Health Questionnaire for all 21 patients before the injury and during the last follow-up (P> 0.05).

Conclusion: In treatment of comminuted tibial fractures with intramedullary nail fixation, using the connecting rods of tibial intramedullary nails inserted as the measuring rod and pointing them at second metatarsal is a simple and effective way to avoid twist in the distal part of the fracture.