EFFECTIVENESS COMPARISON OF DIFFERENT OPERATIVE METHODS IN TREATMENT OF CLOSED FRACTURE OF TIBIAL SHAFT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANHongkai ¹ ,  HUANGJincheng ²

1. Department of Orthopedics, the First People's Hospital of Zhengzhou, Zhengzhou Henan, 450000, P. R. China;
2. Graduate School of Southern Medical University;

Corresponding?author：

HUANGJincheng, Email: drlaohuang@163.com

Keywords：

Tibial shaft fracture; Locking plate; Minimally invasive internal fixation; Intramedullary nail

DOI：

10.7507/1002-1892.20150231

Video：

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Objective To explore the effectiveness of three different operative methods in the treatment of closed fracture of the tibial shaft. Methods Between January 2012 and May 2014, 94 patients with closed fracture of the tibial shaft were treated, and the clinical data were retrospectively analyzed. Fracture was fixed with locking plate (external fixation) in 25 cases (group A), with intramedullary nail in 34 cases (group B), and with minimally invasive locking plate in 35 cases (group C). There was no significant difference in gender, age, reasons of injury, fracture types, and time from injury to operation among groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency during operation, fracture union time, and complications were recorded. The effectiveness was evaluated according to Johner-Wruhs criteria. Results The operation time and fluoroscopy frequency during operation in groups A and C were significantly less than those in group B (P<0.05), but there was no significant difference between groups A and C (P>0.05). The intraoperative blood loss in groups A and C was significantly less than that in group B (P<0.05), and the blood loss in group A was significantly less than that in group C (P<0.05). All patients were followed up 15.61 months on average (range, 12-41 months). There was no significant difference in fracture union time among 3 groups (F=1.712, P=0.186). The excellent and good rates of groups A, B, and C were 92.00%, 88.24%, and 91.43% respectively according to Johner-Wruhs criteria at 12 months after operation, showing no significant difference (χ²=0.301, P=0.860). At 12 months after operation, the complication incidences of groups A (12.00%, 3/25), and C (15.55%, 5/35) were significantly lower than that of group B (44.12%, 15/34) (P<0.017), but no significant difference was found between groups A and C (P>0.017). Conclusion Using locking plate as external fixation and minimally invasive locking plate internal fixation are better than intramedullary nail fixation in treating closed fracture of tibial shaft because of less injury and lower complication incidence, and locking plate as external fixation is better than minimally invasive locking plate internal fixation because of less injury.

Citation： LIANHongkai, HUANGJincheng. EFFECTIVENESS COMPARISON OF DIFFERENT OPERATIVE METHODS IN TREATMENT OF CLOSED FRACTURE OF TIBIAL SHAFT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1067-1071. doi: 10.7507/1002-1892.20150231 Copy

1.	Sohn OJ, Kang DH. Staged protocol in treatment of open distal tibia fracture:using lateral MIPO. Clin Orthop Surg, 2011, 3(1):69-76.
2.	Tong DK, Ji F, Cai XB. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures. Chin J Traumatol, 2011, 14(4):233-236.
3.	Lindvall E, Sanders R, Dipasquale T, et al. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures:comparison of 56 cases. J Orthop Trauma, 2009, 23(7): 485-492.
4.	馬敏, 蔡俊豐, 尹峰, 等. 兩種術式治療脛骨中段閉合性骨折的療效比較. 中國矯形外科雜志, 2012, 20(18):1661-1664.
5.	肖志林, 周明昌, 馮經旺, 等. 微創經皮鋼板接骨術結合鎖定加壓鋼板與切開復位解剖型鋼板內固定治療脛骨遠端骨折的療效比較. 中華創傷骨科雜志, 2014, 16(1):91-92.
6.	布金鵬, 謝新敏, 張太元, 等. 微創帶鎖髓內釘治療脛骨骨折兩種方法療效分析. 中國矯形外科雜志, 2010, 18(10):867-869.
7.	楊林, 趙新建, 張毅, 等. 專家型脛骨髓內釘與鎖定鋼板治療脛骨干骺端骨折的療效比較. 中華創傷骨科雜志, 2014, 16(6):547-549.
8.	田文, 王富明, 黃儉, 等. 髓內釘、鎖定加壓鋼板內固定術治療脛骨下段骨折療效比較. 山東醫藥, 2013, 53(31):53-56.
9.	Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178):7-25.
10.	Stannard JP, Wilson TC, Volgas DA, et al. Fracture stabilization of proximal tibial fractures with the proximal tibial LISS:early experience in Birmingham, Alabama (USA). Injury, 2003, 34 Suppl 1: A36-42.
11.	李瑩, 張力丹, 王滿宜, 等. 經皮微創內固定與切開復位內固定治療脛骨干遠1/3骨折的比較研究. 中華創傷骨科雜志, 2010, 12(7): 642-646.
12.	陳剛, 錢明權, 朱國興, 等. 經皮閉合復位鎖定鋼板和交鎖髓內釘及切開復位鋼板置入修復脛骨中下段骨折:生物穩定性比較. 中國組織工程研究, 2014, 18(44):7151-7156.
13.	Greiwe RM, Archdeacon MT. Locking plate technology:current concepts. J Knee Surg, 2007, 20(1):50-55.
14.	張洪, 葉茶花, 于虎, 等. 不同固定方法治療96例脛骨骨折的病例對照研究. 中國骨傷, 2012, 25(3):198-201.
15.	Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178):7-25.
16.	Giannoudis PV, Snowden S, Matthews SJ, et al. Temperature rise during reamed tibial nailing. Clin Orthop Relat Res, 2002, (395):255-261.
17.	Klein MP, Rahn BA, Frigg R, et al. Reaming versus non-reaming in medullary nailing:interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg, 1990, 109(6):314-316.
18.	仲飆, 潘垚, 羅從風, 等. 脛骨干骨折髓內釘治療后膝關節痛的臨床研究. 中華創傷骨科雜志, 2004, 6(10):1109-1111.
19.	黃鵬, 唐佩福, 姚琦, 等. LCP鋼板和帶鎖髓內釘治療新鮮脛骨干骨折的對比分析. 中國修復重建外科雜志, 2007, 21(11):1167-1170.
20.	Forman JM, Urruela AM, Egol KA. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures. Acta Orthop Belg, 2011, 77(6):802-808.
21.	Guo JJ, Tang N, Yang HL, et al. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg (Br), 2010, 92(7):984-988.
22.	查國春, 陳澤林, 齊小波. 經皮微創鎖定加壓鋼板內固定治療脛骨骨折. 中國修復重建外科雜志, 2008, 22(12):1448-1450.
23.	Apivatthakakul T, Sananpanich K. The locking compression plate as an external fixator for bone transport in the treatment of a large distal tibial defect:a case report. Injury, 2007, 38(11):1318-1325.
24.	Ma CH, Tu YK, Yeh JH, et al. Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures. J Trauma, 2011, 71(3):614-619.
25.	Woon CY, Wong MK, Howe TS. LCP external fixation-external application of an internal fixator:two cases and a review of the literature. J Orthop Surg Res, 2010, 5:19.
26.	Ma CH, Wu CH, Yu SW, et al. Staged external and internal lessinvasive stabilisation system plating for open proximal tibial fractures. Injury, 2010, 41(2):190-196.
27.	Kloen P. Supercutaneous plating:use of a locking compression plate as an external fixator. J Orthop Trauma, 2009, 23(1):72-75.
28.	顧紹飛, 李永成, 劉道聲, 等.骨質正常的簡單脛骨骨折應用LCP 固定較LC-DCP或是一種過度治療的對比研究. 中國醫藥指南, 2013, 11(31):63-64.

1. Sohn OJ, Kang DH. Staged protocol in treatment of open distal tibia fracture:using lateral MIPO. Clin Orthop Surg, 2011, 3(1):69-76.
2. Tong DK, Ji F, Cai XB. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures. Chin J Traumatol, 2011, 14(4):233-236.
3. Lindvall E, Sanders R, Dipasquale T, et al. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures:comparison of 56 cases. J Orthop Trauma, 2009, 23(7): 485-492.
4. 馬敏, 蔡俊豐, 尹峰, 等. 兩種術式治療脛骨中段閉合性骨折的療效比較. 中國矯形外科雜志, 2012, 20(18):1661-1664.
5. 肖志林, 周明昌, 馮經旺, 等. 微創經皮鋼板接骨術結合鎖定加壓鋼板與切開復位解剖型鋼板內固定治療脛骨遠端骨折的療效比較. 中華創傷骨科雜志, 2014, 16(1):91-92.
6. 布金鵬, 謝新敏, 張太元, 等. 微創帶鎖髓內釘治療脛骨骨折兩種方法療效分析. 中國矯形外科雜志, 2010, 18(10):867-869.
7. 楊林, 趙新建, 張毅, 等. 專家型脛骨髓內釘與鎖定鋼板治療脛骨干骺端骨折的療效比較. 中華創傷骨科雜志, 2014, 16(6):547-549.
8. 田文, 王富明, 黃儉, 等. 髓內釘、鎖定加壓鋼板內固定術治療脛骨下段骨折療效比較. 山東醫藥, 2013, 53(31):53-56.
9. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178):7-25.
10. Stannard JP, Wilson TC, Volgas DA, et al. Fracture stabilization of proximal tibial fractures with the proximal tibial LISS:early experience in Birmingham, Alabama (USA). Injury, 2003, 34 Suppl 1: A36-42.
11. 李瑩, 張力丹, 王滿宜, 等. 經皮微創內固定與切開復位內固定治療脛骨干遠1/3骨折的比較研究. 中華創傷骨科雜志, 2010, 12(7): 642-646.
12. 陳剛, 錢明權, 朱國興, 等. 經皮閉合復位鎖定鋼板和交鎖髓內釘及切開復位鋼板置入修復脛骨中下段骨折:生物穩定性比較. 中國組織工程研究, 2014, 18(44):7151-7156.
13. Greiwe RM, Archdeacon MT. Locking plate technology:current concepts. J Knee Surg, 2007, 20(1):50-55.
14. 張洪, 葉茶花, 于虎, 等. 不同固定方法治療96例脛骨骨折的病例對照研究. 中國骨傷, 2012, 25(3):198-201.
15. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res, 1983, (178):7-25.
16. Giannoudis PV, Snowden S, Matthews SJ, et al. Temperature rise during reamed tibial nailing. Clin Orthop Relat Res, 2002, (395):255-261.
17. Klein MP, Rahn BA, Frigg R, et al. Reaming versus non-reaming in medullary nailing:interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg, 1990, 109(6):314-316.
18. 仲飆, 潘垚, 羅從風, 等. 脛骨干骨折髓內釘治療后膝關節痛的臨床研究. 中華創傷骨科雜志, 2004, 6(10):1109-1111.
19. 黃鵬, 唐佩福, 姚琦, 等. LCP鋼板和帶鎖髓內釘治療新鮮脛骨干骨折的對比分析. 中國修復重建外科雜志, 2007, 21(11):1167-1170.
20. Forman JM, Urruela AM, Egol KA. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures. Acta Orthop Belg, 2011, 77(6):802-808.
21. Guo JJ, Tang N, Yang HL, et al. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg (Br), 2010, 92(7):984-988.
22. 查國春, 陳澤林, 齊小波. 經皮微創鎖定加壓鋼板內固定治療脛骨骨折. 中國修復重建外科雜志, 2008, 22(12):1448-1450.
23. Apivatthakakul T, Sananpanich K. The locking compression plate as an external fixator for bone transport in the treatment of a large distal tibial defect:a case report. Injury, 2007, 38(11):1318-1325.
24. Ma CH, Tu YK, Yeh JH, et al. Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures. J Trauma, 2011, 71(3):614-619.
25. Woon CY, Wong MK, Howe TS. LCP external fixation-external application of an internal fixator:two cases and a review of the literature. J Orthop Surg Res, 2010, 5:19.
26. Ma CH, Wu CH, Yu SW, et al. Staged external and internal lessinvasive stabilisation system plating for open proximal tibial fractures. Injury, 2010, 41(2):190-196.
27. Kloen P. Supercutaneous plating:use of a locking compression plate as an external fixator. J Orthop Trauma, 2009, 23(1):72-75.
28. 顧紹飛, 李永成, 劉道聲, 等.骨質正常的簡單脛骨骨折應用LCP 固定較LC-DCP或是一種過度治療的對比研究. 中國醫藥指南, 2013, 11(31):63-64.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON OF DIFFERENT OPERATIVE METHODS IN TREATMENT OF CLOSED FRACTURE OF TIBIAL SHAFT

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