Médecine

Paramédical

Autres domaines


S'abonner

Segmental tibia fractures: a critical retrospective analysis of 49 cases - 06/05/08

Doi : RCOE-09-2003-89-5-0035-1040-101019-ART1 

P. Bonnevialle [1],

P. Cariven [1],

N. Bonnevialle [1],

P. Mansat [1],

V. Martinel [1],

L. Verhaeghe [1],

M. Mansat [1]

Voir les affiliations

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Abstract

Segmental tibia fractures: a critical retrospective analysis of 49 cases

Purpose of the study

Segmental tibia fracture is defined by the presence of two distinct fracture lines separating the cortical and completely isolating an intermediary segment of the tibia. Little work has been published on this clinical entity. We report a retrospective analysis of 49 patients treated in one center for segmental tibia fracture in order to determine more precisely the indications for three surgical techniques: locked intramedullary nailing with or without reaming, and external fixation.

Material and methods

The series included 34 men and 15 women, mean age 40.8 years. All patients had traffic accident: 25 had multiple fractures, 17 had multiple organ injury, and 9 had floating knees. There were 30 open fractures; 2 patients developed compartment syndrome. The segments were: distal-proximal metaphyso-metaphyseal (n = 1), proximal diaphyso-metaphyseal (n = 17), diaphyso-diaphyseal (n = 27), and distal diaphyso-metaphyseal (n = 4). The mean length of the intermediary segment was 14.1 cm. The emergency procedure involved intramedullary nailing with reaming (Grosse-Kempf nail) in 32 patients, intramedullary nailing without reaming in 7 patients (Collin nail in 5 and UTN in 2) and external fixation with non-transfixing pins in 10 patients (Orthofix). External fixation was converted early to intramedullary nailing in three patients (Grosse-Kempf nail in 2 and Collin nail in 1).

Results

Three patients were excluded: 2 underwent amputation after failure of vessel repair and 1 developed septic necrosis of a free latissimus dorsi flap; 1 patient died from multiple organ failure. Outcome at at least 18 months was known for 42 patients (4 patients lost to follow-up). There were 4 cases of post-nailing compartment syndrome; one case of deep infection on a Grosse-Kempf nail was treated by external fixation. Among the 27 patients with segment tibia fractures finally stabilized with a Grosse-Kempf nail, nonunion developed in 8; mean time to bone healing was 10 ± 4.8 months (with dynamization in 13 patients). For the 7 external fixations, nonunion developed in 2; mean time to bone healing was 9.2 ± 2.9 months. For the 8 nailings without reaming, nonunion developed in 2; mean time to bone healing was 9.5 ± 2.5 months. Bone healing was not simultaneous in the two foci in more than half of patients. Two patients developed clinical sequelae of their compartment syndrome with deficient knee flexion in two. The 12 cases of aseptic nonunion were successfully treated by nailing with reaming and early weight bearing.

Discussion

Comparing our results with the therapeutic modalities used in published reports on segmentary tibia fractures showed that time to bone healing and the rate of nonunion were generally greater than in our series. A critical analysis of these results allows us to propose a more interventionalistic attitude before the development of late healing. We also propose a classification of segmental tibia fractures and a decisional tree for choosing between the three techniques based on the presence of soft tissue damage, the presence of compartment syndrome (nailing without reaming), and the presence of proximal or distal metaphyseal fractures (distal locked nail). Nailing with moderate reaming remains the preferred method.

Keywords: Segmental tibia fracture , intramedullary locking nail , external fixation , reaming


Plan



© 2003 Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 89 - N° 5

P. 423-432 - septembre 2003 Retour au numéro

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement ou un achat à l’unité.

Déjà abonné à cette revue ?

;

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.