Abstract
Purpose: To evaluate the efficacy of intramedullary nailing for the treatment of the fractures of the proximal quarter of the tibia with special respect on the reduction accuracy.
Patients: This is a retrospective study which was conducted in our institution between October 2004 and March 2007. 30 extrarticular proximal tibia fractures were treated with intramedullary nailing. The mean age of the patients was 27 years (19 to 47). Seven fractures (23%) were open – Gustillo grade I-, twelve fractures (12%) had segmental comminution and six (6%) were bifocal fractures. Static intramedullary nailing was chosen in all cases. Distal dynamization was performed routinely in all fractures at an average of 7 weeks (6 to 12 weeks) after the primary operation. Union of the fracture and the accuracy of the reduction were assessed clinically and radiologically.
Results: The average follow up was 16 months (9 to 22). All fractures united without additional procedures. Acceptable alignment was obtained in 28 of 30 fractures (93%). Postoperative angulation was satisfactory (average frontal and sagittal plane deformity of less than 2 degrees) in 26 fractures (87%). Two patients had frontal plane deformities (one 4° varus and one valgus 7°) and two patients had a saaggital plane deformities (7° procuvartum). No significant complication was recorded.
Conclusions: The proximity of the upper tibia fracture to the knee makes the treatment of these fractures more challenging. Closed intramedullary nailing combined with special reduction technique is a safe and effective method of managing of the proximal tibia fractures.
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