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

Jae-Kwang Hwang; Chung-Hwan Kim; Young-Joon Choi; Gi-Won Lee; Hyun-Il Lee; Tae-Kyung Kim

doi:10.12671/jkfs.2014.27.2.144

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Hwang, Kim, Choi, Lee, Lee, and Kim: Intramedullary Nailing of Distal Tibial Fractures with Percutaneous Reduction by Pointed Reduction Forceps

Original Article

Journal of the Korean Fracture Society 2014; 27(2): 144-150.

Published online: 18 April 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.2.144

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

Jae-Kwang Hwang, M.D., Chung-Hwan Kim, M.D., Young-Joon Choi, M.D., Gi-Won Lee, M.D., Hyun-Il Lee, M.D., Tae-Kyung Kim, M.D.

Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

Address reprint requests to: Chung-Hwan Kim, M.D. Department of Orthopaedic Surgery, Gangneung Asan Hospital, 38 Bangdong-gil, Sacheon-myeon, Gangneung 210-711, Korea. Tel: 82-33-610-3249, Fax: 82-33-641-8050, chkim@gnah.co.kr

Received 30 October 2013 Revised 8 December 2013 Accepted 14 March 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 0.57° and 0.24°, respectively. That of valgus and anterior angulation at bone union was 0.37° and 0.16°, 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.

Keywords: Distal tibial fractures, Intramedullary nailing, Percutaneous reduction

Figures and Tables

Fig. 1

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

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.

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.

Table 1

Fracture Type (AO/OTA Classification)

Table 2

Summary of Results

Trans: Translation, Length: Lengthening, val: Valgus, AA: Anterior apical angulation, PA: Posterior apical angulation.

Notes

Financial support: None.

Conflict of interest: None.

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