title: Percutaneous clamping of spiral and oblique fractures of the tibial shaft: a safe and effective reduction aid during intramedullary nailing.
abstract: The reduction of tibial shaft fractures during intramedullary nailing is important if limb alignment is to be restored and successful clinical outcomes are expected. We have used a percutaneously applied (or open) clamp or clamps to achieve and maintain reduction during nailing of all amendable tibial shaft fractures. In this article, we describe the technique and preliminary results comparing closed, simple spiral and oblique tibial shaft fractures (OTA 42-A1 and A2) managed with percutaneous clamp-assisted nailing (CAN) versus nailing using manual reduction (MRN) held by the surgical team. In the MRN group, there were an increased fracture gap (P = 0.04) and trends toward malalignment (P = 0.07) and healing time (P = 0.06) compared with the CAN group. There were also trends in clinical; no wound complications occurred in either group. We have found that percutaneous CAN of closed, simple spiral and oblique tibial shaft fractures seems safe and allows for early predictable union with reproducible alignment compared with nailing using MRN.
authors.affiliation: *Division of Orthopaedic Surgery, Harris Methodist Fort Worth Hospital, Fort Worth, TX; †Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX; ‡University of Tennessee Family Practice Residency, Jackson, TN; and §Division of Orthopaedic Surgery, Peninsula Regional Medical Center, Salisbury, MD.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beltran
authors.forename: Henry A
authors.initials: HA
authors.lastname: Dollahite
authors.forename: Florian G
authors.initials: FG
authors.lastname: Huber
mesh_terms: D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome