EXTRAARTICULAR DISTAL TIBIAL FRACTURES – LCP VERSUS INTRAMEDULLARY NAILING, part I.
Authors:
Vojtěch Pokorný
Authors‘ workplace:
Fakultní nemocnice BrnoBohunice, Klinika úrazové chirurgie, Jihlavská
20
Published in:
Úraz chir. 20., 2012, č.3
Category:
Theoretical contemplation
Overview
BACKGROUND:
The management of extraarticular distal tibial fractures remains challenging. A variety of treatment methods have been suggested for these injuries, including nonoperative treatment, external fixation, intramedullary nailing, and plate fixation.
DISCUSSION:
Nonoperative treatment may be complicated by loss of reduction and subsequent malunion. This method is currently used exceptionally. Similarly external fixation may result in insufitient reduction, malunion and pin tract infection. External fixation is indicated for fractures associated with extensive soft tissue damage, in polytraumatized patients and in therapy of infection. Intramedullary nailing can be considered the best method for the treatment of tibial midshaft fractures, but there are concerns about their use in distal tibial fractures. This is because of technical difficulties with distal nail fixation, the risk of nail propagation into the ankle joint and the discrepancy between the diaphyseal ane metaphyseal diameter of intramedullary canal. The benefit of new nails is in upgraded options of distal locking. Open reduction and internal plate fixation have an advantage in control of alignment, but results in extensive soft tissue dissection and may be associated with wound complications and infections. Minimally invasive LCP osteosynthesis avoids complications associated with conventional ORIF.
CONCLUSION:
In distal tibial metaphyseal fractures, indications for osteosynthesis using nails or plates overlap. Intramedullary nailing have an advantage in reduced wound complications, plate fixation can better restore alignment. Both LCP fixation and intramedullary nailing may at present be considered standard procedures, with a place in treatment of distal tibial metaphyseal fractures.
KEY WORDS:
fracture, distal tibial metaphysis, plate, nail.
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