Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-02-2005 | Original Article

External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients

Authors: Martinus Bråten, Per Helland, Torbjørn Grøntvedt, Arild Aamodt, Pål Benum, Anders Mølster

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2005

Abstract

Introduction

We performed a prospective, randomised study to compare the Ex-fi-re external fixator (EF) with locked intramedullary (IM) nailing in tibial fractures. Only fractures without soft-tissue problems of importance were included.

Materials and methods

Ex-fi-re is a unilateral, dynamic axial fixator with fracture reduction capabilities. The Grosse-Kempf nail was used for nailing. A total of 78 patients with 79 fractures were entered in the study (41 Ex-fi-re, 38 IM nails).

Results

Time to radiographic union and full weight-bearing did not differ significantly, but unprotected weight-bearing was achieved earlier in the IM group (12 vs 20 weeks; p<0.001). There were more reoperations due to secondary dislocation in the EF group. There were no differences in final angulation or shortening. After 6 months and 1 year there were no differences in knee motion, ankle motion, fracture site pain or ankle pain. Some 64% of the nailed patients complained of anterior knee pain after 1 year.

Conclusion

The results were comparable in most respects. Unprotected weight-bearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.

Alho A, Ekeland A, Strømsøe K, Follerås G, Thoresen BO (1990) Locked intramedullary nailing for displaced tibial shaft fractures. J Bone Joint Surg Br 72:805–809

Alho A, Benterud JG, Høgevold HE, Ekeland A, Strømsøe K (1992) Comparison of functional bracing and locked intramedullary nailing in the treatment of displaced tibial shaft fractures. Clin Orthop 277:243–250

Bone LB, Johnson KD (1986) Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg Am 68:877–887

Court-Brown CM, Christie J, McQueen MM (1990) Closed intramedullary tibial nailing. Its use in closed and type I open fractures. J Bone Joint Surg Br 72:605–611PubMed

Court-Brown CM, Wheelwright EF, Christie J, McQueen MM (1990) External fixation for type III open tibial fractures. J Bone Joint Surg Br 72:801–804

Court-Brown CM, McQueen MM, Quaba AA, Christie J (1991) Locked intramedullary nailing of open tibial fractures. J Bone Joint Surg Br 73:959–964

Court-Brown CM, Gustilo T, Shaw AD (1997) Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome. J Orthop Trauma 11:103–105

Court-Brown CM (2004) Reamed intramedullary tibial nailing. An overview and analysis of 1106 cases. J Orthop Trauma 18:96–101CrossRefPubMed

De Bastiani G, Aldegheri R, Brivio LR (1984) The treatment of fractures with a dynamic axial fixator. J Bone Joint Surg Br 66:538–545

10.

Egger EL, Gottsauner-Wolf F, Palmer J, Aro HT, Chao EYS (1993) Effects of axial dynamization on bone healing. J Trauma 34:185–192PubMed

11.

Emami A, Mjøberg B, Karlstrøm G, Larsson S (1995) Treatment of closed tibial shaft fractures with unilateral external fixation. Injury 26:299–303CrossRefPubMed

12.

Goodship AE, Kenwright J (1985) The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg Br 67:650–655

13.

Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of 1025 open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458PubMed

14.

Hammer R, Helland P (1987) Improved external skeletal fixation for unstable fractures. Clin Orthop 217:230–242

15.

Helland P, Bøe A, Mølster AO, Solheim E, Hordvik M (1996) Open tibial fractures treated with the Ex-fi-re external fixation system. Clin Orthop 326:209–220

16.

Hooper GJ, Keddell RG, Penny ID (1991) Conservative management or closed nailing for tibial fractures. J Bone Joint Surg Br 78:83–85

17.

Johner R, Wruhs O (1983) Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop 178:7–25PubMed

18.

Karladani AH, Styf J (2001) Percutaneous intramedullary nailing of tibial shaft fractures: a new approach for prevention of anterior knee pain. Injury 32:736–739CrossRefPubMed

19.

Keating JF, Orfaly R, O’Brien PJ (1997) Knee pain after tibial nailing. J Orthop Trauma 11:10–13

20.

Kenwright J, Richardson JB, Cunningham JL, White SH, Goodship AE, Adams MA, Magnussen PA, Newman JH (1991) Axial movement and tibial fractures. A controlled randomised trial of treatment. J Bone Joint Surg Br 73:654–659PubMed

21.

Kyrö A, Tunturi T, Soukka A (1991) Conservative treatment of tibial fractures. Results in a series of 163 patients. Ann Chir Gynaecol 80:294–300PubMed

22.

Lochner HV, Bhandari M, Tornetta P III (2001) Type-II error rates (beta errors) of randomized trials in orthopaedic trauma. J Bone Joint Surg Am 83:1650–1655

23.

McQueen MM, Christie J, Court-Brown CM (1990) Compartment pressures after intramedullary nailing of the tibia. J Bone Joint Surg Br 72:395–397

24.

Noordeen MHH, Lavy CBD, Shergill NS, Tuite JD, Jackson AM (1995) Cyclical micromovement and fracture healing. J Bone Joint Surg Br 77:645–648

25.

Puloski S, Romano C, Buckley R, Powell J (2004) Rotational malalignment of the tibia following reamed intramedullary nail fixation. J Orthop Trauma 18:397–401CrossRefPubMed

26.

Schandelmaier P, Krettek C, Rudolf J, Kohl A, Katz BE, Tscherne H (1997) Superior results of tibial rodding versus external fixation in grade 3B fractures. Clin Orthop 342:164–172

27.

Toivanen JA, Väistö O, Kannus P, Latvala K, Honkonen SE, Järvinen MJ (2002) Anterior knee pain after intramedullary nailing of fractures of the tibial shaft. A prospective, randomized study comparing two different nail-insertion techniques. J Bone Joint Surg Am 84:580–585

28.

Tornetta P III, Bergman M, Watnik N, Berkowitz G, Steuer J (1994) Treatment of grade-IIIB open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br 75:13–19

29.

Watson JT (1994) Current concepts review. Treatment of unstable fractures of the shaft of the tibia. J Bone Joint Surg Am 76:1575–1584

30.

Whittle AP, Russell TA, Taylor JC, Lavelle DG (1992) Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg Am 74:1162–1171

Title: External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients
Authors: Martinus Bråten
Per Helland
Torbjørn Grøntvedt
Arild Aamodt
Pål Benum
Anders Mølster
Publication date: 01-02-2005
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2005
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-004-0768-0

At a glance: The STEP trials

Springer Medicine

External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients

Abstract

Introduction

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2005

Elbow tuberculosis: an unusual location and diagnostic problem

Biomechanical properties of heat-treated bone grafts

Talonavicular dislocation and nondisplaced fracture of the navicular

Randomization and concealment in surgical trials: a comparison between orthopaedic and non-orthopaedic randomized trials

Endoprosthetic replacement of the humerus combined with trapezius and latissimus dorsi transfer: a report of three patients

Iatrogenic paraplegia in spinal surgery