We conducted random effects meta analysis to evaluate risk of nonunion or delayed union, wound complications and superficial infection, deep infection, and. Recently, suprapatellar nailing in the semiextended position has been suggested as a safe and effective surgical technique. Trigen metanail instrumentation bmt medical devices. Intramedullary nailing versus external fixation in gustilo type iii open. Open tibial shaft fractures are the most common of longbone open. The trigen meta nail tibial nail is the latest addition to the trigen family of intramedullary nails. Threaded screw holes and polyethylene bushings reduce angular instability.
In the unreamed nailing group, the surgeon inserted the nail, without reaming, across the fracture site, with particular attention being paid to the prevention of overdistraction and the achievement of cortical contact of the fracture ends. To compare the clinical outcomes of external fixator ef and intramedullary nails in in the treatment of open tibial fractures. Effects of intramedullary nail removal after tibial. Trigen meta nail tibial the tibia nail is a comprehensive approach to the treatment of tibial fractures. Complications associated with the metanail tibial nail end cap. Since its introduction 10 procedures using this device have been performed. Optimal surgical approach for tibial shaft fractures remains controversial. One nail was prominent on anterior nail distance and the other on superior nail. The meta nail tibial nail continues to offer the highest proximal bend on the market, allowing for easier insertion into he t canal space wh it less isk r. Magnetic navigation meta nailing for tibial fractures via.
Numerous reduction techiques are available to achieve an anatomic. The new trigen semiextended instrumentation facilitates intramedullary nailing procedures of the tibia with less flexion of the knee joint. Expert tibial nail surgical technique depuy synthes 7 indications t he expert tibial nail is indicated for fractures in the tibial shaft as well as for metaphyseal and certain intraarticular fractures of the tibial head and the pilon tibiale. Outcomes and complications following flexible intramedullary. Pdf complications associated with the metanail tibial nail end. Before the improvements mentioned above came into being, plating was considered the best choice for proximal tibial. Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on youtube. The trigen metanail tibial nail is indicated for fractures of the proximal and distal third of the tibia, including the shaft, stable and unstable fractures, non. The nail has multiple screw holes in the proximal body to allow surgeons to.
The center point of the portal is located slightly medial to the lateral tibial spine as visualized on the ap radiograph and immediately adjacent and anterior. Attach the anterior drop 71654501 to the drill guide and verify targeting accuracy by inserting a gold 9. Unreamed intramedullary nailing is a better alternative. Effect of minimally invasive percutaneous plates versus. Bone morphogenetic protein for the healing of tibial. Enhanced fixation via threaded screw holes and polyethylene bushings offer better solutions for the fixation of complex fractures. Searches using medline, embase, and cochrane library. Establishing an appropriate starting point is a crucial part of the surgical procedure. One common compression screw to close the fracture site, and end caps in eight sizes are available to provide an improved fit for every indication. Can you align a tibia using finesse, and not force. A more distal entry point may result in damage to the posterior cortex during nail insertion. This allows access to the optimal starting point for nail insertion.
Semiextended intramedullary nailing of the tibia using a. Magnetic navigation metanail interlocking intramedullary nailing for tibial shaft. The meta nail system allows for up to 7mm of compression while keeping the guide attached. Based on the data presented above, minimally invasive percutaneous plates could decrease the rates of pain and delayed union compared with interlocking intramedullary nailing for tibial shaft fracture fixation. Visual analog scale vas was used to assess pain in the knee and ankle before the operation, 6 weeks after the operation, and at the last followup. Expert nailing system titanium cannulated tibial nail. Previous studies and clinical practice suggest that a 12.
External fixation versus unreamed tibial intramedullary. External fixation versus unreamed tibial intramedullary nailing for open tibial fractures. Combinations of these fractures for these indications the expert tibial nail should be used in combination with other implants not shown in the illustra note. The cause of knee pain is multifactorial, possibly includingstretchingthe tendon intraoperatively and injury to the infrapatellar nerve. Surgical treatment options include reamed or unreamed nailing, plating, ender nails, ilizarov. Tibial shaft fractures are the most common type of long bone fracture. Comparing intramedullary nailing and plate fixation for. The tibial nail is designed to help treat various fractures of the tibia. Trigen meta nail tibial nail specifications driving end of nail all knee and distal tibial top view of nail nondriving end of nail ml view ap view set does not include all sizes. Insert the nail until it is at or below the tibial opening.
The authors suggested that rhbmp2 added to intramedullary nail fixation of open tibial fractures could reduce the rate of surgical revisions and total health care costs. Open tibial fractures otf are often associated with severe bone and soft. Bone morphogenetic protein for the healing of tibial fracture. Percutaneous reduction, intramedullary nailing in, fractures, meta analysis introduction reamed, locked in is a commonlyused treatment for isolated fractures in the femoral shaft. Minimally invasive percutaneous plate osteosynthesis. Studies of parallel group design comparing plate or nail fixation for distal tibial fractures. Medline and embase databases were searched from date of inception to 10th april 2017. Data from the sprint trial 2 and the recent meta analysis 3 demonstrated that no significant differences were viewed comparing reamed and unreamed nailing in patients with open tibial fractures. The neogeon tibia knee nail system designed with a hybrid bow to allow. Prevent the ball tip guide rod recession, use the end or the tip of cleaning stylet 607852 against the ball tip guide rod. Apr 01, 2014 this meta analysis has shown that reamed intramedullary nailing significantly reduced the risks of nonunion and screw failure without increasing the rates of infection and compartment syndrome. Tibial nails would be associated with more knee pain, and plates would be associated with pain from implant prominence.
Randomized trial of reamed and unreamed intramedullary. We used locked intramedullary nailing for the treatment of tibial fractures via a suprapatellar approach in this study. Locked meta intramedullary nailing fixation for tibial. Currently, the most common technique and position used are infrapatellar nailing with the knee in a fully flexed position. An upper diameter limit of 10 mm and a nail measuring at least 2. Meta analysis, open tibial fractures, reamed and unreamed intramedullary nailing introduction tibial fractures are one of the most common long bone fractures. The 8mm t2 tibial nail can only be locked distally with 4mm fully threaded screws. Request pdf outcomes and complications following flexible intramedullary nailing for the treatment of tibial fractures in children. Orthopaedic implant design from concept to commercialization.
The use of a cannulated expert tibial nail with a large. Nailing versus plating in the management of proximal extra. Research article open access metaanalysis of reamed versus. Gentamicincoated tibia nail in fractures and nonunion to.
Background open tibial shaft fractures are one of the most devastating orthopaedic injuries. Intramedullary tibial nailing reduces the attachment area and. Tibial bone transport overan intramedullary nail using cable andpulleys march 28, 2018 volume 8, issue 1 e9 3. Comparison of suprapatellar and infrapatellar intramedullary. Controversies in the intramedullary nailing of proximal and distal.
A metaanalysis of suprapatellar versus infrapatellar. Intramedullary nailing versus minimally invasive plate. We perform a meta analysis from randomized controlled trials rcts to compare the clinical efficacy and prognosis between infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures. Expert tibial nail surgical technique depuy synthes 1. However, the ideal treatment for extraarticular tibial fractures remained controversial. With a full range of sizes, the tibial nail is a comprehensive approach to the treatment of tibial fractures.
May 01, 2018 intramedullary nailing versus plating for extraarticular distal tibial metaphyseal fracture. Enhanced fixation via threaded screw holes and polyethylene bushings offer excellent solutions for the fixation of complex fractures. Randomized controlled trials rcts comparing mippo with im nail. The trigen meta nail tibial nail system is designed specifically to repair fractures of the proximal and distal thirds of the tibia. Pdf complications associated with the metanail tibial nail. It is composed of a titanium alloy and is available in 4 diameters 8. Final tightening of the screws should always be under manual control. Complications associated with the metanail tibial nail end. Contact a supplier or the parent company directly to get a quote or to find out a price or your closest point of sale. Oneyear postoperative knee pain in patients with semi. Review article comparison of intramedullary nailing and plate. Trigen metanail nail semiextended instrument set surgical.
The expert tibial nail is indicated for fractures in the tibial shaft as well as for metaphyseal and certain intraarticular fractures of the tibial head and the pilon tibiale. The use of a cannulated expert tibial nail with a large diameter offering more stability associated with. Which surgical treatment for open tibial shaft fractures. Pdf complications associated with the metanail tibial. Russell, md, mba university of mississippi medical center treatment goals shaft fracture. The trigen meta nail tibial nail is indicated for fractures of the proximal and distal third of the tibia, including the shaft, stable and unstable fractures, non. Tibial fractures, intramedullary nail, knee pain, vas scores introduction common long bone fracture 1. Verify and confirm location under biplanar fluoroscopic guidance. Complications associated with the metanail tibial nail.
As with all diameters of t2 tibial nails, the proximal screws are 5mm. They can be either closed fractures, where the skin remains intact, or open fractures accounting for 25% of all tibial shaft fractures where the skin is broken. Research article open access a metaanalysis of external. A metaanalysis of reamed versus unreamed intramedullary. The nails have been designed for specific applications to help restore the shape of the fractured bone to its natural, preinjured state. The trigen meta nail tibial nail with a full range of sizes, the tibial nail is a comprehensive approach to the treatment of tibial fractures. Open access original research the economic burden of. The present meta analysis aims to compare the clinical outcomes following mippo and im nail. A femoral distractor was usedto obtainand maintainappropriate alignment priorto insertionof the tibial nail. One nail was prominent on anterior nail distance and the other on superior nail distance both by 3 mm. Dec 12, 2015 statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures.
Review article comparison of intramedullary nailing and. Intramedullary tibial nailing reduces the attachment area. Comparison between nailing and plating in the treatment of. Both antegrade and retrograde femoral nailing provide reliable healing and allow for immediate postoperative weightbearing 1, 2. Review article a meta analysis of suprapatellar versus infrapatellar intramedullary nailing for the treatment of tibial shaft fractures heng xua, fushun gub, jindang xinb, chengguang tianc, fei chenc a department of orthopaedics, zhejiang veterans hospital, no. Expert tibia nail depuy synthes pdf catalogs technical. Tibial nail designed to treat a variety of tibial shaft fractures and help reduce soft tissue irritation 10 herzog bend located 67mm from the proximal end of the nail for optimal fit implant overview locking screws headless screws to help reduce tissue irritation standard and headless locking screws 4.
The tibial nail ex is intended to stabilize fractures of the proximal and distal tibia and the tibial shaft, open and closed tibial shaft fractures, certain pre and postisthmic fractures, and tibial malunions and nonunions. The intramedullary nail imnfixationisreported to be a successful surgical procedure for the. Length alignment rotation mobile joint mobile joint wb extremity when to nail gold standard for tibial shaft fractures possible in proximal and distal tibial fractures with appropriate technique. This leads to more control of the reduction and easier, reproducible outcomes. A meta analysis of external fixator versus intramedullary nails for open tibial fracture fixation xian xu, xu li, lin liu and wei wu abstract background. Screws are placed through the nail to secure the implant in place and maintain length and alignment while healing occurs. Unreamed intramedullary nailing is a better alternative than. Tibial shaft fractures, infrapatellar, suprapatellar, intramedullary nail, meta analysis background tibial shaft fracture is common and comprises about 2% of workload in all fractures in adult 1, 2. Effects of intramedullary nail removal after tibial fracture.
They can be classified into open and closed tibial fractures according to soft tissue injuries 1. Features enhanced multiplanar proximal locking hole configuration for optimal fixation threaded screw holes and. Expert tibial nail with expandable bioresorbable sleeves for enhanced fixation. Instructional course lecture controversiesintheintramedullary. The trigen meta nail tibial nail is indicated for fractures of the proximal and distal third of the tibia, including the shaft, stable and unstable fractures, nonunions, malunions, and for the prophylactic nailing of impending pathological fractures.
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