Does the distal nail position impact the rates of misalignment and bone union in distal tibial fractures?
Alignment
Distal tibial fracture
Nail endpoint
Tibia
Journal
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
ISSN: 1432-1068
Titre abrégé: Eur J Orthop Surg Traumatol
Pays: France
ID NLM: 9518037
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
received:
18
03
2023
accepted:
23
04
2023
medline:
16
11
2023
pubmed:
2
5
2023
entrez:
1
5
2023
Statut:
ppublish
Résumé
This retrospective study aimed to assess the impact of distal nail placement on misalignment and healing rates in distal tibial fractures. We reviewed all patients with distal tibial fracture treated with intramedullary nailing between 2015 and 2021, and a minimum follow-up of 12 months. Distal nail positioning was determined according to the Triantafillou zones. We related these positioning zones to misalignments (alignment ≥ 3°) and too bony union disorders (delayed union, non-union). Out of the 62 patients included, 56 (90.3%) show bone union without additional procedure, 3 (4.8%) with dynamization, and 3 (4.8%) showed non-union. Twenty-one (33.8%) presented misalignment, with valgus in the coronal plane being the most frequent (76.19%). In patients with and without misalignment, the most frequent distal nail position was 2-2 in 47.6% and 80.5%, respectively (p = 0.01). In multivariate analysis, distal nail positioning in the 2-2 zone showed a significant protective effect against misalignment (OR 0.18; p = 0.018), while nail positioning in the 3-2 zone generated a significant risk of misalignment (OR 18.55; p = 0.009). In intramedullary nailing of distal tibial fractures, distal positioning of the nail slightly lateral to the center of the talus in the coronal plane and slightly posterior in the sagittal plane (zone 2-2) allows high alignment percentages to be obtained. Positioning medial to this point in the coronal plane (zone 3) is associated with more significant misalignment and should be avoided.
Identifiants
pubmed: 37127816
doi: 10.1007/s00590-023-03566-2
pii: 10.1007/s00590-023-03566-2
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3365-3371Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.
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