Angle Stable Interlocking Intramedullary Nails for Tibial Plateau Fractures

Abstract

Objective: Angle stable interlocking intramedullary nail (ASIN), a novel technique, has rarely been used for treatment of tibial plateau fractures (TPF). This retrospective study was designed to introduce this novel technique, ASIN, as well as to describe the initial experience and verify the effectiveness when ASIN was used for the management for TPF.

Methods: A cohort of 19 cases with closed TPF aged from 18-70 years with at least 23 months follow-up from November 2008 to September 2013 was analyzed retrospectively. All patients underwent the ASIN procedure, which was performed by the same group of surgeons. Perioperative and postoperative parameters like the measurement of radiographic pictures, surgical data, and clinical function were recorded including the changes in treatment. A modified Hohl-Luck radiological and functional score combined with the Hospital for Special Surgery (HSS) score were applied to evaluate the final results and to provide reliable data through the whole procedure when applying the ASIN procedure.

Results: The patients were followed up regularly for an average of 26.3 (range, 23-34) months. All patients achieved a bony union at an average of 15.1 weeks with no incidences of malunion, nonunion, or infection. Anatomical reduction of the articular surface was obtained in 16 patients. No secondary failure of fixation occurred. The mean postoperative knee flexion was 122.9°. The modified Hohl-Luck radiological and functional score was excellent and good, respectively, in 16 patients. The mean HSS score was 89.4.

Conclusion: The angle stable interlocking intramedullary nail system turned out to be a viable alternative protocol in the treatment of tibia plateau fractures and provided satisfactory results, with good fracture reduction, biomechanical fixation, low rates of complications, and passable postoperative knee function.

Keywords: Intra-articular fracture; Intramedullary nailing; Plateau fracture; Tibia.

Figure 1

Multiple locking options in different planes and locking screws at the proximal end of angle stable interlocking intramedullary nail (ASIN). a Restrictive screws cancellous bone locking screws with a gentle slope. b Restrictive screws cancellous bone locking screws with higher thread.

Figure 2

Diagram of reduction and internal fixation of C‐type tibial plateau fractures. (A–C) Preoperative morphology of C‐type tibial plateau fracture (A: C1‐type, B: C2‐type, C: C3‐type). (D, E) After reduction and leveling of tibial plateau fracture, the front (D) and upper (E) view of internal joint fracture were fixed by a “raft” type of cancellous screw, turning C‐type fracture into A‐type fracture. (F) Installation of angle stable interlocking intramedullary nail (ASIN), enabling the fixation of large fracture pieces with restrictive cancellous tension nailing while supporting the non‐restrictive cancellous pull screw. The main nail of ASIN, the restrictive high thread locking nail, the restrictive cancellous bone tension locking nail and the unrestrictive cancellous bone tension screw together form the jail technique 3‐D fixation.