24.
Early results of tibial nailing with Angular Stable Locking Screws
(
ASLS)
Peter Kraglund, Jesper Schønnemann, Søren Kring, Michael Brix
Orthopaedic Odense University Hospital; Orthopaedic, Odense University
Hospital; Orthopaedic, Odense University Hospital; Orthopaedic, Odense
University Hospital
Background:
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Purpose / Aim of Study:
To present experiences and early results of tibial
nailing combined with angular stable locking screws (ASLS) in distal tibial
fractures (AO 42 and AO 43).And whether this provides stable conditions, as
shown in biomechanical studies.
Materials and Methods:
From September 2009 to May 2011, a consecutive
series of 51 patients were treated with Synthes Expert nail including distal
ASLS. All fractures but 11 were preoperatively CT scanned analysing fracture
patterns, and preoperative planning. The patients were followed every 6 weeks
until healing. All 51 were followed for minimum 1 year. 39 patients were
available for 1 year postoperative control with clinical examination, x-ray and
functionality scores (EQ5D, pain score and Olerud Molander).
Findings / Results:
In average, all 51 healed in 4,8 months. None had
secondary loss of reduction. 4 ptt. were reoperated because of complications:
One had dynamisation (healed in 8 months), one had implant removal because
of anterior knee pain, one had autologous bone grafting because of bone defect
occurring during the primary reaming, and one had implant removed because
of suspicion of infection (not found). Two patients had malunion (6 and 18
degrees valgus). 23 fractures were intraarticular. 37% altered AO classification
after CT scan. Mean EQ5D was 12.8 and Olerud Molander was 78.3. Self
reported health state after one year was 8,4 (VAS 0- 10). After 1 year resting
and walking pain score were 0.7 and 1.0, respectively.
Conclusions:
Tibial nailing combined with ASLS in AO 42 and AO 43 seems
to be a safe method with few complications. 100% union and a low rate of
reoperation, indicate that this could be a possible treatment in the future for the
distally placed fractures, where traditional methods (plating and ex-fix) have
shown high rates of reoperations and complications.
