Expandable nailing system for tibial shaft fractures

OBJECTIVE: To evaluate and present our current clinical experience in the treatment of closed and open tibial shaft fractures using the expandable intramedullary nailing system. DESIGN: Prospective study. SETTING: One level-1 trauma centre. PARTICIPANTS: Twenty-six patients with acute tibial shaft fractures with at least 10 cm of intact cortex on both sides of the fracture. INTERVENTION: Internal fixation using the Fixion expandable intramedullary nail (Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel). MAIN OUTCOME MEASUREMENTS: Operative and fluoroscopy time, healing time and perioperative complications were recorded. RESULTS: Twenty-six tibial fractures were treated (OTA classification: 3 type A1, 8 A2, 8 A3, 3 B1, 3 B2, and 1 B3), six of which were open. All fractures healed by week 18.5 with an mean of 12.8+/-3.8 weeks. The operating time ranged from 20 to 50 min with an mean of 40+/-12.17 min. The fluoroscopy time ranged from 6 to 22s with a mean of 10+/-5s. In one case the nail failed to expand, as detected by X-ray control, and had to be exchanged intraoperatively. Two patients reported anterior knee pain during the follow up, but did not wish any further treatment. In a low demanding patient rotational malalignment was noted and no further action needed. CONCLUSION: According to the results of this study, the use of the Fixion nailing system, where indicated, is associated with minimal complications and very good functional outcomes in fractures OTA types A and B. The advantages of the expandable nail include the decrease in the operating and fluoroscopy time and the simplicity of its application.     

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

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.     

Intramedullary nailing of open and closed tibial shaft fractures

The authors present their experience about intramedullary nailing in tibial shaft fractures in a serie of 551 cases. Closed fractures represent 330 cases (60%) and open fractures type I, II, III represent 221 cases (40%). intramedullary nailing had been performed in emergency, especially in open fractures (even type III) associated whenever it was necessary with a plastic procedure in the same operative stage. Patients had been reviewed up to consolidation and the mean follow up date was 20 months. The main complication (6.7%) was infection. The authors noticed an infection rate directly proportional to the open type of fracture. The mean consolidation time based on objective radiologic data was 24 weeks. Other complications were few in particular malunion (3%). The functional results and articular motion were very good. The authors defend intramedullary nailing because of the low rate of complications and the possibility of early mobilisation. Finally, they suggest the possibility of using this technic in emergency in open fractures type III under cover of the management of the cutaneous problem.     

Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing

Introduction The aim of this study was to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of type IIIA open fractures of the tibia. Materials and Methods Sixty-one patients with open type IIIA tibial shaft fractures were treated with an IEF (n = 32) or UTN (n = 29). Both groups were compared for union time, secondary outcomes of nonunion, infections, mechanical failure of the implant, and malunion. Results The average time-to-bone healing was 19 weeks (range 14–23 weeks) for IEF and 21 weeks (range 16–36 weeks) for UTN; it was significantly shorter in the IEF group (P = 0.039). One patient had refracture in the IEF group. Malunion occurred in four patients for each group. Posttraumatic osteomyelitis occurred in two patients in the IEF group and in three patients in the UTN group. In the IEF group, additional surgical procedures were indicated in three cases including sequestrectomy (n = 1), and pin replacement (n = 2). In the UTN group, seven patients needed additional surgery including bone grafting (n = 3), nail exchanged (n = 1), and posttraumatic osteomyelitis (n = 3). Conclusion The results of the current study showed that IEF technique had a notable incidence of pin-tract infection, joint contracture, and shorthening related to treatment of the delayed union. The UTN technique had the disadvantage of a posttraumatic osteomyelitis and delayed union requiring additional surgery. We believe that the decision to use IEF or UTN should be made on a case-by-case basis.     

The management of segmental tibial shaft fractures: A systematic review

IntroductionSegmental tibial fractures are complex injuries associated with significant soft tissue damage that are difficult to treat. This study aimed to identify the most effective method of treating segmental tibial fractures.MethodA PRISMA compliant systematic review was conducted. Studies investigating the management of segmental tibial fractures with intramedullary nail fixation (IMN), open reduction and internal fixation (ORIF) or circular external fixation (CEF) were included for review. The primary outcome measure was time to fracture union. Secondary outcomes were complications and functional outcome. A narrative analysis was undertaken as meta-analysis was inappropriate due to heterogeneity of the data.ResultsThirteen studies were eligible and included. No randomised controlled trials were identified. Fixation with an intramedullary nail provided the fastest time to union, followed by open reduction and internal fixation and then CEF. The rate of deep infection was highest after IMN (5/162 [3%]), followed by open reduction and internal fixation (2/78 [2.5%]) and CEF (1/54 [2%]). However, some studies reported particularly high rates of infection following IMN for open segmental tibial fractures. There was limited reporting of postoperative deformities. From the studies that did include such data, there was a higher rate of deformity following ORIF (8/53 [15%]), compared to IMN (13/138 [9%]), and CEF (4/44 [9%]). Three studies, not including IMN, described patient reported outcome measures with results ranging from ‘excellent’ to ‘fair’.DiscussionThe available evidence was of poor quality, dominated by retrospective case series. This prevented statistical analysis, and precludes firm conclusions being drawn from the results available.ConclusionIMN has the fastest time to fracture union, however there are concerns regarding an increased deep infection rate in open segmental tibial fractures. In this subgroup, the data suggests CEF provides the most satisfactory results. However, the available literature does not provide sufficient detail to make this statement with certainty. We recommend a randomised controlled study to further investigate this challenging problem.     

The risk of post-operative infection after reamed intramedullary locked nailing of tibial fractures. A review of 730 cases

Summary 730 consecutive acute reamed intramedullary locked nailing of tibial fractures were studied, according to Gustilo’s classification of soft tissue lesions for the open fractures. There is a significant increase of post-operative infection rate if the tibial fracture is open, and the relative risk increases with the severity of soft tissue lesions. The comparison of these figures with those of other methods of treatment and the mechanical and clinical advantages of nailing leads us to propose this method for treatment of grade I, II and IIIa open fractures, while external the fixator seems better adapted for IIIb and c open fractures. European Bone and Joint Infection Society Meeting, München, Germany, October 7–9, 1993     

Eight years' clinical experience with the Orthofix tibial nailing system in the treatment of tibial shaft fractures

Intramedullary nailing has become a popular and effective procedure for the treatment of most tibial fractures. However, concerns regarding difficulties with reduction, the use and extent of intramedullary reaming, and hardware failure are probably the only constraints to its widespread use. In this prospective study, we present the clinical and radiographic results of the Orthofix tibial nailing system used in the treatment of tibial shaft fractures. One hundred and fifteen fresh tibial fractures in the same number of patients with a mean age of 37.5 years (17-85 years) were treated with operative stabilisation using the Orthofix tibial nailing system. All of the operations took place in a conventional operating theatre, on a simple tranlucent operating table and with manual reduction of the fracture. In the majority of the cases closed reduction and conventional reaming were performed and the mean duration of the operation was 38 min. Fracture healing occurred at 16 weeks (11-30 weeks) and was confirmed both clinically and radiographically. In six cases (two severely comminuted and four segmental fractures) delayed union occurred, however there were no tibial non-unions necessitating re-operation. There were no substantial differences in time to fracture union or in the rate of complications related to minimal open reduction. In addition, there seem to be more benefits than risks in the use of power intramedullary reaming during intramedullary fixation of tibial shaft fractures. In conclusion, most tibial shaft fractures can effectively and safely be treated using this type of locking intramedullary nailing device, with relatively few complications, and with satisfactory long-term clinical results.     

Suprapatellar versus infrapatellar nailing for tibial shaft fractures: A comparison of surgical and clinical outcomes between two approaches

BackgroundTibial shaft fractures are a relatively common injury and contemporary treatment includes on-axis fixation with a locked intramedullary nail in the majority of cases. The conventional technique is via an infrapatellar approach but currently there is a trend towards the use of a suprapatellar approach. We compared key variables including operative time, radiation exposure and early patient reported outcomes when adopting a suprapatellar approach to tibial nailing in our unit versus our previous experience of infrapatellar tibial nailing.MethodTwenty-eight consecutive patients with tibial fracture underwent tibial nailing via the suprapatellar (SPN) approach. Six patients in the study group were excluded due polytrauma and need for dual orthopaedic and plastic surgery management. We compared outcomes with our most recent 20 consecutive patients who had undergone tibial nailing via an infrapatellar (IPN) approach. Primary surgical outcomes were: operative time, radiation exposure and accuracy of entry point of the nail on both anteroposterior and lateral radiographs. Clinical outcomes included time to weightbearing, time to radiographic union and patient-reported outcome score (Lysholm score).ResultsForty-eight consecutive patients underwent intramedullary nail fixation for tibial shaft fractures and 42 were eligible for inclusion in our study (22 SPN vs 20 IPN). There were no significant differences in patient demographics or injury patterns between the two groups. Operative time and radiation exposure were significantly lower in the SPN group when compared to the IPN group (115 min vs 139 min ± 12.5) (36 cGY/cm² vs 76.33 cGY/cm² +/- 20.1). Furthermore, patients in the SPN group reported superior outcome scores at a mean follow up of 3 months (8–24 weeks) There were no observed differences in complication rate between groups and time of final clinical follow up at a minimum of 6 months.ConclusionOur study shows that adoption of the SPN approach requires minimal learning curve, and has the potential benefits of reduced operative time, radiation exposure and superior patient reported outcomes when compared to the conventional infrapatellar approach.     

Elastic stable intramedullary nailing of tibial shaft fractures in children

Purpose  

Tibial fractures in the skeletally immature patient are usually treated without surgery. Elastic stable intramedullary nailing (ESIN) is commonly used for other diaphyseal fracture locations. Its advantages are minimally invasive surgery with a short hospitalisation duration, primary bone union and early weight bearing. The purpose of this study was to assess the use of ESIN in displaced tibial fractures in children over 6 years old and in cases of polytrauma.     

Operative treatment of tibial shaft fractures: a comparison of different methods of primary stabilisation

INTRODUCTION: Segmental fractures of the tibial shaft (AO type 42-C2) often occur after a high energy direct trauma with consecutive severe soft tissue injury and a high rate of open fractures. The blood supply of the intermediate bone fragment can be severely disturbed and therefore operative treatment is demanding. In this retrospective study, we compared three different methods of stabilisation. MATERIALS AND METHODS: We reviewed the clinical charts and postoperative problems of 26 patients in a ten year period. Sixteen (62%) fractures were stabilised with an intramedullary nail, five (19%) fractures by plate osteosynthesis and five (19%) fractures with an external fixator. RESULTS: Bony consolidation was obtained in all patients after an average time of 11.4 months. In 17 patients (65.4%) a second operative procedure had to be performed. Pseudarthrosis was seen in 11 fractures (40%), three times in the proximal and eight times in the distal fracture. In the intramedullary nailing group, pseudarthrosis occurred in nine patients. In the group treated with an external fixator, pseudarthrosis was seen three times. After changing to a different implant bony consolidation was achieved in every patient. CONCLUSION: Conventional intramedullary nailing is not suitable for stabilisation of segmental fracture types with a short metaphyseal fracture fragment. New nails with proximal and distal interlocking in three different planes offer better stability. Bone vascularisation should not be endangered by the stabilisation procedure and optimal reduction of the fracture is an important prerequisite for uneventful fracture healing, especially in this difficult fracture configuration.     

胫骨干骨折髓内钉治疗后膝关节痛的临床研究

目的 通过对胫骨干骨折髓内钉内固定治疗后膝关节痛的临床观察，探讨膝关节痛的发生和病因。方法 回顾性研究我院1997年1月～2002年12月应用髓内钉内固定治疗胫骨干骨折的1332例病例。所有病例在骨折愈合后均有一次以上随访，平均随访时间为27个月。结果 共有409例胫骨干骨折术后发生患侧膝关节痛；经髌韧带入路组膝关节痛发生率为31.9％，髌韧带旁入路组为28.9％。结论 髌韧带旁入路不能减少胫骨干骨折髓内钉治疗术后膝关节痛的发生。     

Operative fixation for complex tibial fractures

INTRODUCTION

The management of open tibial shaft fractures remains challenging. Intramedullary nailing and external fixation are the most commonly used fixation techniques although the optimal fixation technique remains unresolved. In this article the outcomes of these two surgical techniques are compared.

METHODS

A comprehensive literature search was conducted through MEDLINE^® using Ovid^® and MeSH (Medical Subject Heading) terms for articles published in the English literature between 1999 and 2009. The outcome measures compared were time to fracture union, infection rates and complications.

RESULTS

Forty-one studies were identified, of which only three met the inclusion criteria. The average time to union was variable. Delayed union and non-union appeared to be more prevalent in the external fixator group although this was not statistically significant. Both techniques were associated with secondary procedures as well as infection.

CONCLUSIONS

The current literature indicates little evidence to suggest the superiority of one fixation technique over another for open tibial fractures.     

医用机器人及计算机辅助导航手术系统在胫骨髓内钉手术中的设计与应用

目的以胫骨骨折闭合复位、带锁髓内钉手术为研究对象，开发医用机器人及计算机辅助导航手术系统，总结该系统的临床应用经验，优化系统的结构设计，评价系统的临床应用效果。方法应用机器人双目视觉空间定位技术，进行医用机器人的模块化、小型化、实用化结构设计，开发医用机器人及计算机辅助导航手术系统；对胫骨骨折进行机器人辅助复位、计算机辅助导航定位髓内钉置入；临床应用于30例闭合胫、腓骨骨折（胫骨中1／3骨折8例、胫骨中下1／3骨折17例、胫骨远1／3骨折5例；其中斜螺旋骨折16例，蝶形骨折5例，粉碎、多段骨折9例）。受伤至手术的平均时间为36h。记录总手术时间、系统连接建立时间、骨折闭合复位所需X线透视时间（C型臂透视次数）、每个远端锁定螺钉置入所需要的透视时间（C型臂透视次数）。髓内钉型号大小8／310～11／330。结果30例手术均按照机器人及计算机导航系统的预定程序，规划完成，但关键的操作（髓内钉入点置入、远端锁钉锁孔）是在机械臂精确定位的辅助下，由术者亲自完成。总手术时间平均为77min（46～110min）；系统连接建立时间5min（3～7min）；骨折闭合复位所需X线透视时间10．1s（7．0～18．0s），C型臂透视次数12次（9～21次）；每个远端锁定螺钉置入所需的透视时间2．9s（2．2～6．9s），C型臂透视次数7次（5～16次），并且所有远端锁孔均一次锁定成功。结论医用机器人及计算机辅助导航手术系统设计合理，系统的基本功能可满足胫骨带锁髓内钉手术中骨折闭合复位、锁钉准确置人、患肢牢靠固定的要求；系统结构安装简便、易于掌握，人机接口方便、安全，对于未来在创伤骨科发展智能化、微创化、数字化手术具有重要意义。     

Risk factors for deep infection in secondary intramedullary nailing after external fixation for open tibial fractures

BACKGROUND: Risk factors for deep infection in secondary intramedullary nailing (IMN) after external fixation (EF) for open tibial fractures were investigated by multivariate analysis following univariate analyses. METHODS: Forty-two open tibial fractures were treated with secondary IMN after EF. The open tibial fractures were classified according to the criteria proposed by Gustilo et al.: type II, 11; type IIIA, 8; type IIIB, 22 and type IIIC, 1. Locked IMNs with limited reaming were performed in 27 patients, and locked IMNs without reaming in 15 patients. The following factors contributing to deep infection were selected for analysis: age, gender, Gustilo type (II or III), fracture grade by AO type (A or B+C), fracture site, existence of multiple trauma (Injury Severity Score, ISS<18 or ISS> or = 18), existence of floating knee injury, debridement time (< or = 6 h or > 6 h), reamed (R) versus unreamed (UR) nailing, duration of external fixation (< or = 3 weeks or >3 weeks), interval between removal of EF and IMN (< or = 2 weeks or >2 weeks), skin closure time (< or = 1 week or >1 week), existence of superficial infection (+ or -) and existence of pin tract infection (+ or -). The relationship between deep infection and the above factors was evaluated by univariate analyses. RESULTS: Seven (16.7%) of the 42 open tibia fractures developed deep infections. All deep infections occurred in Gustilo type III (22.6%, 7/31). Only the skin closure time was a significant factor affecting the occurrence of deep infection on the present analysis (p = 0.006). CONCLUSION: The present evaluation showed that early skin closure within 1 week is the most important factor in preventing deep infections when treating open tibial fractures with secondary IMN after EF.     

Comparison of dynamic versus static fixation of intramedullary nailing in tibial diaphyseal fractures: A systematic review and meta-analysis

IntroductionTibial fractures are common long bone injuries, often surgically fixed with intramedullary nails. Modern intramedullary tibial nails allow for two different fixation modes, namely static and dynamic modes. While studies have demonstrated benefits of using either fixation modes, there has been no consensus as to which fixation mode would produce better outcomes and less complications. This systematic review and meta-analysis aims to compare the efficacy and safety of dynamic versus static fixation of intramedullary nails in the operative fixation of tibial diaphyseal fractures.MethodsA meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on April 15, 2021. Data from all published literature meeting inclusion criteria were extracted and analysed with fixed- and random-effects models.Findings/results: A total of 478 statically fixed and 234 dynamically fixed patients were included in this meta-analysis. Dynamically fixed patients had a significantly shorter mean time to union (mean difference, MD = 5.18 weeks, 95%CI: 1.95–8.41 weeks, p = 0.002) and reoperation rates (OR = 0.21, 95%CI: 0.10–0.47, p < 0.001) than statically fixed patients. No significant difference was found between both groups in terms of malrotation (OR = 0.57, 95% CI: 0.07–4.41, p = 0.59), non-union (OR = 1.10, 95% CI: 0.24–5.05, p = 0.91), delayed union (OR = 1.15, 95%CI: 0.19–7.17, p = 0.88) and malunion (OR = 2.73, 95% CI: 0.29–25.26, p = 0.38).ConclusionWhile acknowledging that there is widespread surgeon preference to dyanamise or statically fix intramedullary nails in certain tibial fracture configurations, primary dynamic fixation of intramedullary tibial nails demonstrated significantly shorter times to bony union and less complications than static nailing in our meta-analysis. Further research on identifying patient factors and fracture patterns that would best benefit from dynamic fixation is required.     

Treatment of distal tibial metaphyseal fractures: Plating versus shortened intramedullary nailing

BACKGROUND: Fractures in the distal tibial metaphysis are more complicated to treat than diaphyseal fractures. We compared treatment with plating to treatment with shorted intramedullary (IM) nailing. METHODS: Patients with AO type 43A fractures were treated with plate fixation (group A, n=14) or shortened IM nailing (group B, n = 13). We compared postoperative radiographic deformities, functional results (Iowa ankle scores), and symptoms (Olerud and Molander ankle scores). RESULTS: All fractures had healed at final follow-up (mean, 33 month). Mean union times were 27.8 week (range, 18-36 week) in group A and 22.6 week (range, 18-30 week) in group B (P<0.05). Mean postoperative valgus angulations were larger in group B (3.7 degrees ) than in group A (0.5 degrees ) (P<0.05). However, malunions did not differ between groups (P<0.05). Functional results and postoperative symptoms were similar. CONCLUSIONS: Both plate fixation and shortened IM nailing were effective for treating distal tibial metaphyseal fractures.     

Incidence of infection after early intramedullary nailing of open tibial shaft fractures stabilized with pinless external fixators

Background:

A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This disadvantage is overcome by the AO pinless fixator, in which the trocar points are clamped onto the outer cortex without penetrating it. This study was designed to evaluate the role of AO pinless fixators in primary stabilization of open diaphyseal tibial fractures that received staged treatment because of delayed presentation or poor general condition. We also analyzed the rate of infection on early conversion to intramedullary nail.

Materials and Methods:

This study is a retrospective review of 30 open diaphyseal fractures of tibia, which were managed with primary stabilization with pinless fixator and early exchange nailing. Outcome was evaluated in terms of fracture union and rate of residual infection. The data were compared with that available in the literature.

Results:

All the cases were followed up for a period of 2 years. The study includes Gustilo type 1 (n=10), 14 Gustilo type 2 (n=14), and type3 (n=6) cases. 6 cases (20%) had clamp site infection, 2 cases (6.7%) had deep infection, and in 28 cases (93%) the fracture healed and consolidated well.

Conclusion:

This study has highlighted the valuable role of pinless external fixator in the management of open tibial fractures in terms of safety and ease of application as well as the advantage of early conversion to intramedullary implant without the risk of deep infection.     

The nail-insertion point in unreamed tibial nailing and its influence on the axial malalignment in proximal tibial fractures

The consequence of choosing a point of insertion for the nail (i.e. medial or lateral of the lig. patellae) in unreamed tibial nailing (AO unreamed tibial nail, UTN) was studied in 22 formaldhyde-fixed tibiae. A lateral osteotomy at the transition from the first to the second fifth of the tibia was used as a model for the fracture. A nail insertion point medial of the lig. patellae caused a valgus deformity, combined with a shift of the distal fragment to the medial side. A lateral point of entry resulted in a varus deformity, together with a lateral shift of the distal fragment. Our results show that the insertion point of the nail is important for the alignment of the axis. Choosing a different point for the insertion of the nail can be useful in operative correction of malalignment of the tibia. Received: 8 December 1999     

胫骨新型动力型Hoffmann外固定器的研制与应用

目的探讨自行研制的胫骨新型动力型Hoffmann外固定器(NDHEF)生物力学性能和临床应用效果。方法将15根成人尸体胫骨标本,随机分为3组,制成胫骨中段短斜形骨折模型,分别采用NDHEF、改良型Hoffmann外固定器(IHEF)和多功能外固定器(MEF)固定,进行轴向压缩、弯曲和扭转载荷以及应力遮挡的生物力学测试。自1995～2004年128例胫腓骨开放性骨折分别采用NDHEF和IHEF治疗,随访并评估其临床疗效。结果生物力学实验结果表明在轴向压缩、弯曲和扭转刚度方面,NDHEF与IHEF相似,但均明显强于MEF,差异有显著性意义(P＜0．05)；应力遮挡方面,NDHEF明显小于IHEF和MEF,差异有显著性意义(P＜0．05)。临床应用NDHEF治疗开放性胫腓骨骨折患者40例,并与应用IHEF治疗的88例开放性胫腓骨骨折患者进行比较,经12～36个月(平均16．8个月)随访,骨折完全愈合时间：NDHEF平均22．3周,IHEF平均26．8周,两组问差异有显著性意义(P＜0．05)；延迟愈合和畸形愈合率：NDHEF均为7．5%,IHEF分别为15．9%和4．5%,两组比较差异均无显著性意义(P＞0．05)。结论新型动力型Hoffmann外固定器具有较大的生物力学优越性,临床应用可减少应力遮挡、促进骨折愈合,是一种较好的治疗胫骨骨折的外固定器；固定后再移位倾向可以通过辅助措施加以克服。     

单臂外固定架和锁定加压钛板治疗胫骨远端骨折的比较

目的 比较单臂外固定架和锁定加压钛板固定胫骨远端骨折的效果.方法 对2001年1月至2007年1月分别采用外固定架治疗和锁定钛板(LCP)治疗的胫骨远端骨折并获得随访的51例患者的病例资料进行总结,记录固定时间和骨折愈合时间,并按照美国骨科协会足踝外科分会(AOFAS)的标准评价踝关节功能,比较两组的治疗效果. 结果 外固定架组24例获得随访,骨折愈合时间120～276止平均160 d,按照AOFAS标准进行评分:优11例,良8例,可4例,差1例,优良率79.1%,并发症发生率12.5%;LCP组27例获得随访,骨折愈合时间95～184 d,平均143 d,按照AOFAS标准进行评分:优20例,良4例,可3例,优良率88.8%,并发症发生率11.0%,经统计学处理骨折愈合时间两组差异有统计学意义(t=2.561,P=0.014),并发症发生率和功能优良率差异无统计学意义(P＞0.05). 结论 外固定架和锁定钛板都是治疗胫骨远端骨折常用的有效固定方式,关键是遵循微创原则.实现胫骨骨折局部复位,骨缺损处植骨,胫骨支撑固定和腓骨骨折的复位固定,采取上述两种同定方式均可取得良好效果.