Browsing by Subject "Fracture Fixation, Intramedullary"
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Item How Do Open Distal Tibia Fractures Differ from Open Tibial Shaft Fractures?(2018-01-23) Nguyen, Ivy; Ho, Christine AnnPURPOSE: The purpose of this study was to compare a cohort of open distal tibia fractures to open tibial shaft fractures in regards to injury severity, method of fixation, and outcomes. METHODS: This is a retrospective review of 49 open distal tibia fractures (group D) with a mean age of 8.7years and 56 open tibia shaft fractures (group S) with a mean age of 8.6years, treated from 2007-May2017 at a single level 1 pediatric trauma center. Mann Whitney test was used to compare means between groups. RESULTS: Extremely high energy trauma (ATV, GSW, vehicular collision, lawnmower, crush, fall >8 feet) was the mechanism of injury in 90% (44/49) in group D and 77% (43/56) in group S (p=0.119). Mean AIS lower extremity scores were significantly higher in group S compared to group D (2.74 vs 2.55, p=0.043), as were mean Injury Severity Scores (13.10 vs 9.36, p=0.053). There were more Gustilo type II fractures in group S (42% vs. 35%), and more Gustilo type III fractures in group D (51% vs 39%) which trended towards significance (p=0.0622). 88% (43/49) of open distal tibia fractures had ipsilateral fibular involvement, compared to 71% (40/56) of open tibial shaft fractures (p=0.054). Tibial fixation methods were statistically different between the 2 groups (Table 1, p=0.0377), but incidence of fibular fixation was not statistically different (group D-12% vs group S-5%, p=0.4348). While surgical time and fluoroscopy times were not significantly different between the two groups, group D had longer mean length of hospitalization (8.44vs6.36 days, p=0.006), mean duration of immobilization (135vs100 days, p=0.033), and longer mean time to full weight bearing (77vs40 days, p=0.006). Rate of hardware removal (group D-49%, group S-52%) and radiographic angulation at final follow-up were not statistically significantly different between the two groups (p>0.05). Mean time to union was prolonged for both groups (178 days group D-178 days, group S-139 days, p=0.231). CONCLUSIONS: Open distal tibia fractures are significant for extremely high energy of injury. Alternate methods of fixation for open distal tibia fractures such as external fixation, K wires, and ORIF are more likely to be utilized than flexible intramedullary nailing. Open distal tibia fractures have longer hospital stays, immobilization, and time to full weightbearing but radiographic outcomes and time to union are comparable. SIGNIFICANCE: This study increases awareness of the difference in injury severity, fixation methods, and clinical course between open distal tibia and open tibial shaft fractures.Item Lateral Patient Positioning and Central Lag Screw Placement in Geriatric Cephalomedullary Nailing(2023-01-31) Peters, Albert W., V; Harris, Timothy J.; Rinehart, Dustin B.; Sohn, Garrett H.; Sanders, Drew T.Hip fracture is a debilitating condition in the elderly. Cephalomedullary nails are commonly used to achieve internal fixation in these injuries. Proper screw placement within the femoral head (central or inferior in the coronal plane, central in the lateral plane) lowers the risk of the screw cutting out of the femoral head post-operatively. Traditionally, these nails have been implanted with the patient positioned supine, but some surgeons prefer a lateral patient position. This lets adipose tissue fall away from the incision site, potentially improving the surgeon's ability to achieve a desired nail starting point. Lateral nailing also theoretically provides more control over the aiming arm by preventing its rotation due to gravity. Because relatively little research exists comparing these methods, the purpose of this study was to investigate if lateral patient positioning may be associated with higher rates of central lag screw placement than traditional supine nailing. Patients aged 60 or older receiving a cephalomedullary nail for an intertrochanteric femur fracture between June 2009 and April 2022 were identified via a medical records query of three hospitals (n=465). Lateral intra-operative fluoroscope images were for each patient were de-identified and exported to Microsoft PowerPoint, where a custom overlay was applied to divide each femoral head into perfect thirds. The lag screw tip was determined by inspection to reside in the Anterior, Middle, or Posterior third of the head. Cases in which the minor diameter of the screw was touching the line between thirds were considered Junction Anterior-Middle or Junction Posterior-Middle. To prevent bias, the surgical record was accessed last to determine the position of each patient. Compared to supine positioning, lateral positioning was associated with a 0.493 relative risk of placement not fully within the middle region (p=0.004) and a 0.244 relative risk of placement in extreme anterior and posterior regions (p=0.056). Multivariate linear regression analysis revealed that central screw placement was associated with the following: lateral positioning (p=0.030), older patient age (p=0.009), and larger screw diameter (p=0.014). Analysis of only patients receiving 11mm screws (n=346) produced broadly similar results. We conclude that in geriatric intertrochanteric cephalomedullary nailing, lateral positioning of the patient may be associated with higher rates of central screw placement on the lateral fluoroscopy view. Prospective study design is needed to reduce the influence of confounding variables on these results, including varying levels of surgeon experience with this procedure.