Tibial shaft fracture is a common clinical injury. Intramedullary nail internal fixation has the biomechanical advantages of minimally invasive and axial fixation, making it a standard solution for surgical treatment. There are two main nailing methods for tibial intramedullary nail fixation: suprapatellar and infrapatellar nailing, as well as the parapatellar approach used by some scholars.
For fractures of the proximal 1/3 of the tibia, since the infrapatellar approach requires knee flexion, it is easy to cause the fracture to angle forward during the operation. Therefore, suprapatellar approach is usually recommended for treatment.
▲Illustration showing the placement of the affected limb through the suprapatellar approach
However, if there are contraindications to the suprapatellar approach, such as local soft tissue ulceration, the infrapatellar approach must be used. How to avoid angulation of the fracture end during surgery is a problem that must be faced. Some scholars use small-incision steel plates to temporarily fix the anterior cortex, or use blocking nails to correct the angulation.
▲ The picture shows the use of blocking nails to correct the angle.
To solve this problem, foreign scholars adopted a minimally invasive technique. The article was recently published in the magazine "Ann R Coll Surg Engl":
Select two 3.5mm leather screws, close to the tip of the broken end, insert one screw forward and backward into the bone fragments at both ends of the fracture, and leave more than 2cm outside the skin:
Clamp the reduction forceps to maintain the reduction, and then insert the intramedullary nail according to conventional procedures. After the intramedullary nail is inserted, remove the screw.
This technical method is suitable for special cases where suprapatellar or parapatellar approaches cannot be used, and is not routinely recommended. The placement of this screw may affect the placement of the main nail, or there may be a risk of screw breakage. It can be used as a reference in special circumstances.
Post time: May-21-2024
