Comparison of retrograde and antegrade tibial intramedullary nail in the treatment of extra-articular distal tibial fractures.

IF 2 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2025-01-01 Epub Date: 2024-10-12 DOI:10.1007/s00264-024-06348-5

Hui Liu, Weibin Lin, Weizhen Xu, Yuanfei Xiong, Jinhui Zhang, Jin Wu

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Abstract

Purpose: The aim of this study was to compare the effectiveness of retrograde and antegrade intramedullary tibial nails (RTN and ATN) in managing extra-articular distal tibial fractures, addressing current controversies in surgical approaches.

Patients and methods: A retrospective analysis included 56 patients treated between December 2019 and August 2022 with either RTN (n = 23) or ATN (n = 33). Data on baseline characteristics, operative specifics, fluoroscopy usage, hospitalization duration, fracture healing times, time to full weight-bearing, distal tibial alignment, American Orthopedic Foot and Ankle Society (AOFAS) scores at final follow-up, and complications were evaluated and compared.

Results: Baseline characteristics were generally comparable and no significant differences except for fracture line lengths (RTN: 6.1 ± 1.9 cm vs. ATN: 7.8 ± 1.6 cm) were observed. Follow-up ranged from 12 to 20 months. No significant differences were observed in operative duration, hospital stays, coronal angulation of the distal tibial joint surface, or AOFAS scores at final follow-up. Intraoperative fluoroscopy was more frequent in the ATN group (9.5 ± 1.5) compared to RTN (8.3 ± 1.1) (P = 0.001). RTN showed shorter healing times (9.6 ± 1.2 weeks) and quicker return to full weight-bearing (12.9 ± 1.3 weeks) than ATN (10.6 ± 1.2 weeks and 13.9 ± 1.7 weeks, respectively). RTN complications included one delayed union, one superficial infection, and two ankle pain, while ATN complications comprised one delayed union, one superficial infection, seven anterior knee pain, and one malalignment. Despite higher complication rates with ATN, the differences were not statistically significant.

Conclusion: For the treatment of extra-articular distal tibial fractures, both RTN and ATN are effective approaches. RTN may offer benefits such as reduced fluoroscopy use, accelerated healing, and earlier return to full weight-bearing compared to ATN.

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逆行和逆行胫骨髓内钉治疗胫骨远端关节外骨折的比较。

目的：本研究旨在比较逆行和逆行胫骨髓内钉（RTN和ATN）治疗胫骨远端关节外骨折的有效性，解决当前手术方法中存在的争议：回顾性分析纳入了2019年12月至2022年8月期间接受RTN（23例）或ATN（33例）治疗的56例患者。对基线特征、手术规格、透视使用、住院时间、骨折愈合时间、完全负重时间、胫骨远端对位、最终随访时美国骨科足踝协会（AOFAS）评分以及并发症等数据进行了评估和比较：除骨折线长度（RTN：6.1 ± 1.9 cm vs. ATN：7.8 ± 1.6 cm）外，基线特征基本相似，未发现明显差异。随访时间从 12 个月到 20 个月不等。在手术时间、住院时间、胫骨远端关节面的冠状角度或最终随访时的AOFAS评分方面均无明显差异。ATN组术中透视（9.5 ± 1.5）比RTN组（8.3 ± 1.1）更频繁（P = 0.001）。与 ATN（分别为 10.6 ± 1.2 周和 13.9 ± 1.7 周）相比，RTN 的愈合时间更短（9.6 ± 1.2 周），恢复完全负重的时间更快（12.9 ± 1.3 周）。RTN并发症包括1例骨结合延迟、1例表皮感染和2例踝关节疼痛，而ATN并发症包括1例骨结合延迟、1例表皮感染、7例膝前疼痛和1例错位。尽管ATN的并发症发生率较高，但两者之间的差异并无统计学意义：结论：对于关节外胫骨远端骨折的治疗，RTN和ATN都是有效的方法。与ATN相比，RTN可能具有减少透视使用、加速愈合和更早恢复完全负重等优点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.