Fixator-assisted nailing of tibial fractures: New surgical technique and presentation of first 30 cases.
BACKGROUND
Intramedullary nailing is considered a "gold standard" for treatment of tibial shaft fractures. However, some types of fractures are typically considered as "difficult for nailing". This group includes the periarticular fractures, fractures of both bones at the same level, comminuted and segmental fractures of the tibia. Fixator-assisted nailing (FAN) is an effective method treatment of these types of fractures. The main requirements for the ideal reduction device are an ease of its installation and an ability of multiplanar fracture reduction. Fixator-assisted nailing (FAN) with the use of two perpendicular to each other monolateral tubular frames perfectly meets these requirements. In this study we present this new surgical technique and the analysis of first 30 cases.


METHODS
A prospective analysis was conducted for 30 patients with "difficult for nailing" tibial fractures treated with fixator-assisted nailing in our institution between September 1st, 2017, and March 1st, 2018. The duration of surgery and its different stages, the time of fluoroscopy, difficulties encountered during surgery, were analyzed. Clinical and radiological methods were used to evaluated reduction quality.


RESULTS
In all 30 cases the acceptable reduction was achieved. The mean duration of the surgical procedure was 73.7 ± 3 min. The mean duration of fluoroscopy 85.9 ± 4.8 s. In 7 cases we faced with technical difficulties, which were successfully addressed.


CONCLUSION
The described technique of FAN is an effective method for the treatment of "difficult for nailing" tibial fractures. Future multi-centered studies with a larger number of patients are needed to validate our results.
['Semenistyy|Anton A|AA|', 'Litvina Ea|Elena A|EA|', 'Fedotova|Anna G|AG|', 'Gwam|Chukwuweike|C|', 'Mironov|Andrey N|AN|']
D000328:Adult D000368:Aged D005260:Female D005471:Fluoroscopy D005594:Fracture Fixation, Intramedullary D017102:Fracture Healing D006801:Humans D057072:Intra-Articular Fractures D008297:Male D008875:Middle Aged D011446:Prospective Studies D013978:Tibial Fractures D016896:Treatment Outcome
Fixator-assisted nailing Tibial fracture Intramedullary nailing Periarticular fracture Segmental fracture FAN Fracture reduction Comminuted fracture External fixator