Volume 9, 2023
|Number of page(s)||9|
|Published online||11 August 2023|
Effect of fracture level on the residual fracture gap during tibial intramedullary nailing for tibial shaft fractures
University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology, 34470 Istanbul, Turkey
2 Private Safa Hospital, Department of Orthopaedics and Traumatology, 34194 Istanbul, Turkey
3 Bahçeşehir University, Vm Medical Park Maltepe Hospital, 34846 Istanbul, Turkey
4 University of Missouri, Department of Orthopaedics, Columbia, MO 65201, USA
5 Professor, University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology, 34470 Istanbul, Turkey
* Corresponding author: firstname.lastname@example.org
Accepted: 21 July 2023
Introduction: The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. Material and method: A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. Results: The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001). Discussion: Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates.
Key words: Tibia shaft fractures / Fracture gap / Intramedullary nailing / Union / Fracture level
© The Authors, published by EDP Sciences, 2023
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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