Chinese Journal of Reparative and Reconstructive Surgery
Supervisor： National Health Commission of the People's Republic of ChinaSponsor： Chinese Association of Rehabilitation Medicine , Sichuan University Editor-in-chief：Bin Shen Publishing period：
Monthly
ISSN：1002-1892CN：51-1372/R
Objective To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation.Methods The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness.Results Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction (P<0.05). Incision infection occurred in 1 case (3.03%) of the trial group and 3 cases (6.67%) of the control group after operation. The difference in the incidence of infection was significant (χ2=0.139, P=0.045). The incisions of other patients healed by first intention. X-ray film reexamination showed that the fractures of the two groups healed. The fracture healing time of the trial group was (5.30±1.33) months, while that of the control group was (5.98±1.80) months, with no significant difference (t=?1.815, P=0.073). There was no significant difference in VAS score, Harris scores of knee joint and ankle joint between the two groups before operation and at 3, 6, and 12 months after operation (P>0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant (P<0.05).Conclusion Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.
Citation：LUO Xiande, DUAN Kuan, QIN Renlei, ZHANG Yisheng. Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1101-1105. doi: 10.7507/1002-1892.202002101Copy
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1. Shi X, Liu H, Xing R, et al. Effect of intramedullary nail and locking plate in the treatment of proximal humerus fracture: an update systematic review and meta-analysis. J Orthop Surg Res, 2019, 14(1): 285.
2. Collinge C, Sanders R, DiPasqnale T. Treatment of complex tibial periaricular fractures using percutaneous techniques. Clin Orthop Relat Res, 2000, 375: 69-77.
3. Turhan S. Finite element analysis of the effect of intramedullary nail compression amount on fracture union in distal tibial diaphyseal fractures. Ulus Travma Acil Cerrahi Derg, 2019, 25(3): 293-297.
4. Barcak E, Collinge CA. Metaphyseal distal tibia fractures: a cohort, single-surgeon study comparing outcomes of patients treated with minimally invasive plating versus intramedullary nailing. J Orthop Trauma, 2016, 30(5): e169-e174.
5. Josten C, Marquass B, Schwarz C, et al. Intramedullary nailing of proximal tibial fractures. Complications and risk factors. Unfallchirurg, 2010, 113(1): 21-28.
6. Jankovic A, Korac Z, Bozic NB, et al. Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing. Injury, 2013, 44 Suppl 3: S33-S39.
7. Lu K, Wang HZ, Shan HQ, et al. Intramedullary nailing of tibial shaft fractures in the semi-extended position using a suprapatellar approach: A retrospective case series. Injury, 2019, 50(11): 2140-2141.
9. Harly E, Angelliaume A, Lalioui A, et al. Divergent intramedullary nailing (DIN): a modified intramedullary nailing technique to treat pediatric distal tibial fractures. J Pediatr Orthop, 2019, 39(10): e773-e776.
10. Inci F, Yildirim AO, Ciliz DS, et al. Intraoperative rotation control in closed intramedullary nailing in tibia diaphyseal fractures: a prospective, randomised study. Acta Orthop Belg, 2018, 84(4): 461-468.
11. Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instr Course Lect, 2004, 53: 441-454.
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Citation：LUO Xiande, DUAN Kuan, QIN Renlei, ZHANG Yisheng. Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(9): 1101-1105. doi: 10.7507/1002-1892.202002101
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