Use of Fibular plating as supplementary technique in static intramedullary interlocking nailing for distal both bone fractures of leg: A Prospective study

Selva Renga Raju, R (2010) Use of Fibular plating as supplementary technique in static intramedullary interlocking nailing for distal both bone fractures of leg: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Treatment of distal both bone fractures of leg remains a challenge. The goals of surgical management include correction and maintenance of sagittal and coronal alignment, establishment of length and rotation and early functional range of movements of knee and ankle. Treatment options include medullary implants, half pin, thin wire or hybrid external fixation, plate fixation or combination techniques. Interlocking nailing of tibial fractures are desirable because this technique allow some load sharing , spares extraosseous blood supply, avoids extensive soft tissue dissection and is familiar to most surgeons. Nailing of distal tibial fractures with short distal fragment is associated with an increase in malalignment particularly in coronal plane, non union and need for secondary procedures to achieve union. The cause has been attributed both to displacing muscular forces and residual instability. As there is a mismatch between the diameters of the nail and the medullary canal, with no nail-cortex contact, the nail may translate laterally along coronally placed locking screws and increased stress in placed on the locking holes to maintain fracture alignment after surgery. Various techniques have been recommended to improve nailing the distal both bone fractures of leg including fibular plating (distal third fractures), temporary unicortical plating, different nail design with different proximal bends (proximal third fractures) and blocking screws (poller screws). AIM: To evaluate the clinical use of fibular plating as a supplement to stability in addition to intramedullary nailing in distal both bone fractures of leg. MATERIALS AND METHODS: This was a prospective study of 20 cases of distal both bone fractures of leg treated with statically locked intra medullary nailing with supplementary fibular plating between march 2008 and September 2009 at Kilpauk Medical College, Chennai. Inclusion Criteria - Displaced distal third both bone fractures of leg in adults treated with intramedullary nailing were included in this study . The fractures included were acute fractures and delayed union. Exclusion Criteria - Distal tibial fractures with articular extension (pilon fractures) Comminuted fibular fractures. RESULTS: All the relevant data were analysed. All the fractures eventullay united in a mean period of 11.7 weeks (95% LCL 10.19 weeks and 95% UCL 11.98 weeks). Karlstrom-Olerud score was excellent in 12 fractures (60%), good in 5 patients (25%) and fair in 2 patients(10%) and poor in 1 patient (5%). Radiologically the mean post operative varus/valgus alignment was +1.6 degrees (95% LCL 0.6 degrees and 95% UCL 2.8 degrees) when compared to the mean preoperative varus/valgus alignment of + 10.2 degrees (95% LCL 8.1 degrees and 95% UCL 12.6 degrees). The alignment was maintained till union with the mean remaining the same in the coronal plane. CONCLUSION: We conclude that fibular plating, when supplemented the intramedullary nailing of distal both bone fractures of leg, 1. Were effective in achieving the fracture alignment especially in fresh fractures. 2. Improves not only angular stability but also rotational stability. 3. Maintained the fracture alignment till uni. 4. on, preventing loss of initial reduction.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Fibular plating ; supplementary technique ; static intramedullary interlocking nailing ; distal ; bone fractures of leg ; prospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 18:29
Last Modified: 17 Sep 2017 17:21
URI: http://repository-tnmgrmu.ac.in/id/eprint/2985

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