Double Segmental tibia fracture treated with intramedullary nail using multiple clamps technique to hold reduction: A case report and surgical technique
Main Article Content
Abstract
Segmental tibial fractures are considered to be a severe injury associated with high complication rate. This type is not common in clinical practice. This pattern is generally caused by a high-energy trauma associated with severe soft tissue injury, potentially leading to compromised circulation to the underlying bone. It is potential to have complication during surgical procedures and it is possible to have rotational displacement during reaming. This report presents a case of a male patient who had a closed fracture with double segmental pattern on right tibia treated by percutaneously open reduction and intramedullary nail fixation using multiple clamps technique for holding the reduction. The united fracture was occurred at twenty weeks and the patient regained full weight bearing. Radiographic healing was revealed at twenty weeks. Multiple clamps technique is able to reduce and maintain all segment to prevent rotational displacement before reaming and nailing, which could decrease complication during the procedure.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
2. Corey RM, Park NK, Cannada KL. Segmental tibia fractures: an analysis of complication and healing rates. J Orthop Trauma. 2018;32:296–300.
3. McMahon SE, Little ZE, Smith TO el al. The management of segmental tibial shaft fractures: A systematic review. Injury. 2016;47:568–573.
4. Rommens PM, Coosemans W, Broos PL. The difficult healing of segmental fractures of the tibial shaft. Arch Orthop Trauma Surg. 1989;108: 238–242.
5. Woll TS, Duwelius PJ. The segmental tibial fracture. Clin Orthop Relat Res. 1992;281:204–207.
6. Giannoudis PV, Hinsche AF, Cohen A, et al. Segmental tibial fractures: an assessment of procedures in 27 cases. Injury. 2003;34:756– 762.
7. Beardi J, Hessmann M, Hansen M, et al. Operative treatment of tibial shaft fractures: a comparison of different methods of primary stabilisation. Arch Orthop Trauma Surg. 2008;128:709–715.
8. Teraa M, Blokhuis TJ, Tang L, et al. Segmental tibial fractures: an infrequent but demanding injury. Clin Orthop Relat Res. 2013; 471:2790–2796.
9. Robertson A, Giannoudis PV, Matthews SJ. Maintaining reduction during unreamed nailing of a segmental tibial fracture: the use of a Farabeuf clamp. Injury. 2003; 34:389–39.
10. Boyd HB, Lipinski SW. Causes and treatment of nonunions of the shafts of the long bones, with a review of 741 patients. Instr Course Lect 1960;17:165–72.
11. Wu CC, Shih SH. Segmental tibial shaft fractures treated with interlocking nailing. J Orthop Trauma 1993;7:468–72.
12. Rommens PM. The significance of soft tissue trauma for fracture healing: prospective study on 70 tibial shaft fractures. Acta Chir Belg 1992;92:10–8.
13. Reynders P. Open acute segmental tibial fracture fixation using the Less Invasive Stabilisation System (LISS): Study of 23 consecutive cases. Injury. 2009;40:449–454.
14. Öztürkmen Y, Karamehmetoglu M, Karadeniz H, et al. Acute treatment of segmental tibial fractures with the Ilizarov method. Injury. 2009;40:321–326.
15. Kakar S, Tornetta P III. Segmental Tibia Fractures: a prospective evaluation. Clin Orthop Relat Res. 2007;460:196–201.
16. Hoon S, Jun Y, Hyung KS. Analysis of complications and clinical outcomes in the treatment of segmental tibial fractures according to the method of internal fixation. Asian Journal of Surgery. 2019; 42:740e745.
17. Yoon RS, Bible J, Marcus MS, et al. Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: a multi-centre study. Injury. 2015;46:1097–1101.
18. Court-Brown C, Pennig D. Tibia and fibula. Oxford, Boston, Singapore: Butter- worth-Heinemann; 1997.
19. Schütz M, Kääb MJ, Haas N. Stabilization of proximal tibial fractures with the LISS system: early clinical experiences in Berlin. Injury 2003;34:S30–5.
20. Brooks M, Revell WJ. Blood supply of bone; scientific aspects. London: Springer- Verlag; 1998.
21. Kamal B, Kumar V, Sandeep P, et al. Double segmental tibial fractures - an unusual fracture pattern. Chinese Journal of Traumatology. 2011;14(4):247-249.
22. Mateen HA, Brendan S, Elizabeth OP, et al. Does it really spin? Intra-medullary nailing of segmental tibial fractures—A cadaveric study. Injury. 2015; 46:643–648.