J Korean Fract Soc.  2014 Apr;27(2):144-150. 10.12671/jkfs.2014.27.2.144.

Intramedullary Nailing of Distal Tibial Fractures with Percutaneous Reduction by Pointed Reduction Forceps

• Hwang JK
• Kim CH
• Choi YJ
• Lee GW
• Lee HI
• Kim TK

• KMID: 1703113
• DOI: http://doi.org/10.12671/jkfs.2014.27.2.144

Abstract

PURPOSE
The purpose of this study is to analyze the radiographic and clinical results of intramedullary nailing after percutaneous reduction using pointed reduction forceps for spiral or oblique fractures of the distal tibia. The benefit of percutaneous reduction using pointed reduction forceps in anatomical reduction and maintenance was assessed.
MATERIALS AND METHODS
From January 2005 to December 2009, 47 cases of distal one-third tibial fracture were managed by intramedullary nailing using pointed reduction forceps. Thirty-eight cases were spiral fracture and nine cases were oblique fracture. In all cases, the percutaneous reduction was achieved using pointed reduction forceps under fluoroscopy control. While maintaining the reduction with the pointed reduction forceps, the intramedullary nail was inserted. The pointed reduction forceps were removed after insertion of proximal and distal inter-locking screws. Alignment was evaluated with anterior-posterior and lateral radiographs taken immediately post-operation and at the time of union.
RESULTS
At immediate post-operation, the mean displacement of valgus and anterior angulation was 0.57degrees and 0.24degrees, respectively. That of valgus and anterior angulation at bone union was 0.37degrees and 0.16degrees, respectively. The average duration of bone union was 16.1 weeks.
CONCLUSION
Intramedullary nailing with percutaneous reduction using pointed reduction forceps for distal tibial fractures was an easy and effective method for achievement of accurate alignment intra-operatively. Accurate alignment was successfully maintained until bone union.

Keyword

Distal tibial fractures; Intramedullary nailing; Percutaneous reduction

MeSH Terms

Fluoroscopy
Fracture Fixation, Intramedullary*
Surgical Instruments*
Tibia
Tibial Fractures*

Figure

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  Fig. 1 Photograph of pointed reduction forceps (ECT; Zimmer, USA).

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  Fig. 2 (A) The radiographs show a spiral right distal tibia fracture. (B) Fractures are reduced using three forceps under fluoroscope. (C) Intramedullary nail is inserted while maintaining the reduction with forceps. (D) Immediate postoperative radiographs show the accurate reduction and alignment of the tibial fracture. (E) At postoperative 20 weeks, radiographs show maintenance of alignment and union of the fracture.

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  Fig. 3 (A) The radiographs show right distal tibial and fibular fractures. (B) Immediate postoperative radiographs show a tibial fracture with intramedullary nailing and concomitant fibular plating. (C) Radiographs at postoperative 21 weeks show maintenance of alignment and union of fractures.

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