Elsevier

Injury

Volume 31, Issue 6, 1 July 2000, Pages 451-459
Injury

The clinical performance of a small diameter tibial nailing system with a mechanical distal aiming device

https://doi.org/10.1016/S0020-1383(00)00024-3Get rights and content

Abstract

We present the clinical and radiographic results of a prospective study with the Orthofix tibial nailing system. The ease and safety of distal locking with the use of an improved targeting system was also evaluated. Sixty fresh tibial fractures in 60 patients with a mean age of 37.3 years (range 17–73 years) were treated. Eighteen of the fractures were grade I open fractures. All operations were performed in a conventional operating theatre on a simple transparent operating table, with reduction of the fracture performed under manual traction and manipulation of the fracture site. Hand reaming was then performed to ensure, where possible, the insertion of a nail of at least 9 mm in diameter. Fracture healing was observed at a mean of 17 weeks (12–28 weeks). No tibial non-unions occurred in our series, and only three fractures, two segmental and one severely comminuted, showed delayed union. No infection, either superficial or deep, was found and no cardio-pulmonary complications were recorded. Following surgery, all patients gained a full range of pain-free movement of the ankle and knee joints and only six patients (10%) complained of mild anterior knee pain. All patients returned to their previous jobs one month after fracture healing had been confirmed clinically and radiographically. Following nailing, no deviation from normal tibial alignment was detected. No mechanical failure of either the nails or the locking screws was recorded. The mean duration of operation (skin to skin) was 30 min (range 20–45 min) and the mean total theatre time was 55 min (range 40–75 min). The mean total intensification time was 5 s. In total, 120 distal locking screws were inserted using the external targeting device. All attempts at distal locking except five (4.2%) were successful with two failures in the same patient being a result of inappropriate use of the system. We conclude that this nailing system is clinically effective and that distal locking can be performed easily, without exposure to radiation.

Introduction

Several effective modes of treatment exist for the management of tibial fractures, including cast bracing, plate fixation, external fixation and intramedullary nailing [1], [2]. The features of the fracture normally determine the type of treatment employed.

In recent years the development of modern intramedullary devices and techniques has facilitated the management of tibial fractures, especially unstable ones, and excellent clinical and radiographic results have been reported by several authors [2], [3], [4]. The availability of appropriate equipment in the operating theatre and technical problems arising during the operation are probably the only constraints to their widespread application [5], [6].

The purpose of this study is to assess the ease and safety of distal locking in tibial nailing, without exposure to radiation, using a new improved targeting system. We also present our initial clinical experience with this new intramedullary tibial nailing system, which has improved technical features.

Section snippets

Patients and Method

In May 1996, a prospective study of tibial nailing for fractures was established in our department in an attempt to test the hypothesis that tibial nailing and distal locking can be easily and safely performed without exposure to radiation in an emergency operating theatre, around the clock, provided the nail has features facilitating insertion of the distal locking screws. For the purposes of the present study, the Orthofix tibial nailing system (Orthofix S.r.l., Verona, Italy) was used.

Results

The mean period of follow-up was 29 weeks (range 16–32 weeks) and no drop outs were recorded. Fracture healing was observed at a mean of 17 weeks (range 12–28 weeks; Fig. 2). No tibial non-unions occurred in our series, and only three fractures showed delayed union, with sound fracture union being achieved by 26, 28 and 28 weeks respectively (Fig. 3). Two of these fractures were segmental and one was severely comminuted. No infection, either superficial or deep, was found and no

Discussion

When treating diaphyseal fractures of the long bones our aim is to relieve the pain caused by the fracture, to restore normal function rapidly and to return the patient to normal life as soon as possible. The mode of treatment chosen must ensure that the bone unites in an optimal mechanical (but not necessarily optimal anatomical) position, and that the natural bone healing process by callus formation is not disturbed. The surgeon’s choice of treatment depends mainly on the features of the

References (30)

  • S. Weller

    Internal fixation of fractures by intramedullary nailing. Intoduction, historical review and present status

    Injury

    (1993)
  • C.M. Court-Brown

    An atlas of closed nailing of the tibia and femur

    (1991)
  • M.P.M. Kempf et al.

    Closed locked intramedullary nailing. Its application to comminuted fractures of the femur

    J. Bone Joint Surg. Am.

    (1985)
  • R.B. Gustillo et al.

    Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones, retrospective and prospective analysis

    J. Bone Joint Surg. Am.

    (1976)
  • M.E. Muller et al.

    The comprehensive classification of fractures of long bones

    (1990)
  • Cited by (33)

    • Insertion-related pain with intramedullary nailing

      2017, Injury
      Citation Excerpt :

      Treatment of symptomatic prominent hardware is generally elective implant removal if the patient decides their pain is substantial enough to warrant the procedure. Pain relief following hardware removal is inconsistent [17,28–31], and causation between prominent hardware and pain remains unclear [4]. Therefore, patients should be made aware preoperatively of the variable success with pain relief after removal.

    • Radiation-free distal locking of intramedullary nails: Evaluation of a new electromagnetic computer-assisted guidance system

      2013, Injury
      Citation Excerpt :

      Concerns about the safety of IMN regarding radiation exposure, as well as the need to ease and lessen the duration of the procedure have led to various alternative distal locking methods for IMNs.1 These include modified freehand techniques with or without use of radiolucent drills and jigs,3–5 mechanical guiding systems that are attached either to the proximal part of the nail6–13 or to the image intensifier14,15 or even to the surgical table16 and computer-assisted navigation systems with or without application of robotics.17–22 Accurate targeting of the distal holes is problematic due to the inevitable deformation of the nail after its insertion to the tibia or the femur23–26 and that is the main cause of failure for many of the aforementioned targeting systems, especially for those that are mounted to the proximal section of the nail.

    • Are there any advantages in using a distal aiming device for tibial nailing? Comparing the Centro Nailing System with the Unreamed Tibia Nail

      2011, Injury
      Citation Excerpt :

      The results of one other large prospective study showed that the OTNS is safe and effective. Further, the time for distal locking was reduced.10–12 The need for fluoroscopy during distal locking could not be eliminated, as fluoroscopy was still demanded during the procedure in half of the cases when using the distal aiming device in our study.

    • Eight years' clinical experience with the Orthofix<sup>®</sup> tibial nailing system in the treatment of tibial shaft fractures

      2007, Injury
      Citation Excerpt :

      One hundred and eighteen tibial fractures in 118 patients were treated with intramedullary nailing and were included in this study. All, but thirty fractures treated in the initial period by Karachalios et al.,18 were operated by the first author (G.C.B.). Inclusion criteria for this prospective study were: skeletal maturity and closed or open 16 types I to IIIa tibial fractures with a distance from the proximal and distal joint line of 7 and 4 cm, respectively.

    View all citing articles on Scopus

    Investigations performed at: Orthopaedic Department, University of Athens, KAT Hospital, Kifisia 14561, Athens, Greece.

    View full text