Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2010; 77(3):235-241 | DOI: 10.55095/achot2010/046

Diafyzární zlomeniny bérce - technika a klinické výsledky s použitím Expert Tibial Nail (ETN) v klasických a rozšířených indikacíchPůvodní práce

J. TRLICA¹, T. DĚDEK¹, K. ŠMEJKAL^1,2, J. KOČÍ^1,3, P. LOCHMAN^1,2, M. FRANK¹

¹ Chirurgická klinika FN Hradec Králové

² Katedra válečné chirurgie Fakulty vojenského zdravotnictví Univerzity obrany, Hradec Králové

³ Oddělení urgentní medicíny FN Hradec Králové

PURPOSE OF THE STUDY:
To present the authors' technical experience with the use of the Expert Tibial Nail (ETN) technique and its clinical results.

MATERIAL AND METHODS:
Between December 2005 and the end of 2007, the ETN technique was used in 41 patients to treat 41 diaphyseal tibial fractures. All patients were followed-up prospectively.

RESULTS:
The injury Severity Score (ISS) was in the range of 4 to 25 (average, 5.9). Eight patients suffered multiple trauma, 33 had isolated injuries. Of the 41 fractures, 31 were closed and 10 were open injuries. The fracture types according to the Tscherne classification were as follows: closed 0 type (n=10); closed type I (n=18); closed type II (n=3); open type I (n=3); open type II (n=5); open type III (n=2). The injury-to-surgery interval ranged from 1 h and 50 min to 25 h and 12 min (median, 8 h and 52 min). The operative time ranged from 50 to 170 min (average, 87 min). Infectious complications or a secondary loss of reduction were not recorded. Three cases of insufficient primary reduction underwent repeat surgery during the first stay in hospital. Full weight-bearing with no pain was reported in the range of 10 to 24 weeks (average, 18 weeks) after surgery.

DISCUSSION:
A choice of the nail diameter in relation to the marrow cavity width can be made during surgery with no loss of reduction (guidewire; undreamed/reamed nail). Because of a shorter straight lower part of the nail (compared to a UTN), a very steep position of the nail is necessary at its insertion in a short proximal metaphyseal fragment. The blunt lower ETN end can produce fracture line distraction when an effort is made to drive the nail as deep as possible into the short distal metaphyseal block, if this has not been reamed.

CONCLUSIONS:
The ETN provides sufficient stability of diaphyseal tibial fractures including those involving the metaphysis. However, in some instances, poler screws are still indispensable. Sufficient reduction is necessary before nail insertion.

Klíčová slova: tibial fracture, intramedullary nail

Zveřejněno: 1. červen 2010  Zobrazit citaci