Combined intra-and extramedullary fixation for the treatment of tibial shaft fractures invol-ving the ankle joint

Wang Zhaohui; Cao Shujie; Liu Jianwei; Zhang Liang; Liu Congwei; Xiong Jingzhi

doi:10.3969/j.issn.1009-4237.2024.11.007

Abstract：Objective To investigate the clinical effect of concomitant tibial shaft and ankle fractures by suprapatellar intramedullary nailing combined with extramedullary cannulated screws or plate.Methods From Jan.2018 to Jan.2023,37 patients with concomitant tibial shaft and ankle fractures treated in the Department of Ortho-paedic Trauma,the First People's Hospital of Chenzhou,Affiliated to Hengyang Medical School,University of South China,were retrospectively evaluated,including 23 males and 14 females aged 18-71(mean 45.1)years.Among them,there were 21 falls,13 road traffic injuries,and 3 crash injuries;32 were closed fractures and 5 were open;26 cases had ipsilateral distal tibia fractures;18 ankle fractures were occult on X-ray films.Of the patients,16 were managed by suprapatellar intramedullary nailing combined with plates or cannulated screws(combined fixation group),and the other 21 by locking plates(locking plate group).The interval time from injury to surgery,operation time,intraoperative blood loss and frequency of fluoroscopy,complications,fracture union time,and functional out-comes by AOFAS ankle-foot score were analyzed.Results All patients were followed up for 12-34(mean 20.1)months.Fracture union was observed in all of them in 3-8(mean 4.8)months.Compared with the locking plate group,the combined fixation group showed longer operation time(min,93.8±15.1 vs.79.5±13.3)and more fre-quent intraoperative fluoroscopy(times,15.1±2.4 vs.6.6±1.7),but shorter injury to surgery time(d,4.9±1.4 vs.7.2±1.3)and intraoperative blood loss(mL,86.3±15.9 vs.118.1±30.6,all P＜0.05).The fracture union time,incidence of complications,and AOFAS ankle-foot score at the last follow-up revealed no significant difference be-tween the two groups(P＞0.05).Conclusion Suprapatellar intramedullary nailing combined with extramedullary cannulated screws or plates for the treatment of tibial shaft fractures involving the ankle joint is simple,minimally in-vasive,safe,and effective;the shortcoming is need of more intraoperative fluoroscopy.