Application of the multiplanar fracture redactor in the treatment of tibial shaft fractures with intramedullary nails

www.nature.com/scientificreports OPEN Application of the multiplanar fracture redactor in the treatment of tibial shaft fractures with intramedullary nails Kuo Zhao1,2,3, Hongzhi Lv1,2,3, Chun Zhang1,2,3, Zhongzheng Wang1,2,3, Zhiyong Hou1,2,3,4, Wei Chen1,2,3*, Qi Zhang4* & Yingze Zhang1,2,3,4* This prospective study aimed to introduce the application of the multiplanar fracture redactor (MFR) in the treatment of tibial shaft fractures with intramedullary nails (IMNs). From February to June 2018, a total of 18 patients with tibial shaft fractures were recruited. MFR was used to help achieve the reduction of tibial shaft fractures with IMN in all patients. The demographic and fracture characteristics, surgical data, postoperative complications and prognostic indicators of 16 patients were recorded. All operations were performed under closed reduction, excellent radiological and functional outcomes were observed. The average duration of surgery, intraoperative blood loss, intraoperative fluoroscopy times, number of intraoperative assistants, and duration of postoperative hospital stay were 91.2 ± 26.1 min, 95.0 ± 58.3 ml, 19.2 ± 2.3 times, 1 (1–2), and 7.8 ± 2.6 days, respectively. The mean Lysholm Knee Function Score (LKFS), American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores at one year after surgery were 96.8 ± 2.1, 94.8 ± 2.9, and 1 (0–3), respectively. Wound infection, non-union, malunion or complications associated with MFR were not observed in this study. Thus, MFR was a safe and neater method to achieve and maintain the reduction of tibial shaft fractures with IMN. Tibial shaft fracture is one of the most common fractures of long bone, accounting for 24.75% of tibiofibular fractures and 4% of all adult f ractures1, 2. It has been reported that 17 per 10,000 persons suffer tibial shaft fractures annually, the rate of which increases sharply with increasing motorization in low- and middle-income countries3. The occurrence of tibial shaft fractures exhibits a bimodal age distribution with one peak noted in young patients suffering from high-energy injury and another peak noted in geriatric patients undergoing a low-energy i njury4. Intramedullary nailing (IMN), plating and external fixation are available options for the surgical treatment of tibial shaft fracture p atients5. For better biomechanical and biological performances compared with the other alternative fixation methods, IMN has become the preferred method for the surgical treatment of tibial shaft fractures6–9. Patients with tibial shaft fractures demonstrated satisfactory functional outcomes and low levels of complications due to their less invasive nature and potential for earlier weight b earing10, 11. Closed reduction and minimally invasive fixation are the ideal goals for the application of IMN in the treatment of tibial shaft fractures. The process and sustained reduction were critical to the surgery. In contrast to femur shaft fractures, for which the traction bed could be used to achieve reduction, tibial shaft fractures were mainly reduced by manual t raction12, 13. Therefore, open reduction is always required to achieve acceptable reduction in the treatment of tibial shaft fractures with IMN for powerless manual traction, especially for the multi-fragmentary fractures of the tibial shaft14–17. Postoperative malalignment is a common complication in tibial shaft fracture patients fixated by IMN, the incidence of which ranges from 19 to 41% as reported by previous studies18, 19. As a preventable iatrogenic complication, postoperative malalignment could be decreased or avoided if reduction devices exist to achieve and maintain reduction at the insertion of IMN. To resolve these problems, many methods have been proposed in previous studies14. Tubular external fixator as a reduction 1 Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei 050051, People’s Republic of China. 2Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang 050051, Hebei, People’s Republic of China. 3Orthopaedic Research Institution of Hebei Province, Shijiazhuang 050051, Hebei, People’s Republic of China. 4NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People’s Republic of China. *email: ; ; Scientific Reports | (2021) 11:8428 | https://doi.org/10.1038/s41598-021-87913-5 1 Vol.:(0123456789) www.nature.com/scientificreports/ device has been described but was limited to maintaining the reduction of fractures in only one plane20. Blair et al. successfully applied a simple half circular reduction device to achieve the reduction of tibial fractures, but the device was restricted to reduction control in one p lane21. Anton et al. proposed a new surgical technique of fixator-assisted nailing in the treatment of tibial f racture22. The advantages of this technique were that it could control the reduction in the coronal plane and sagittal plane. However, the disadvantages of these methods, including the increased duration of surgery, more difficult surgical techniques and increased medical costs, were not conducive to their popularization. Moreover, most previous studies on reduction devices in the treatment of tibial shaft fractures treated with IMN have primarily concentrated on how to maintain reduction during surgery, and they have limited influence on the reduction of fractures6, 20, 22. To facilitate the closed reduction of tibial shaft fractures and maintain the appreciated alignment on the insertion of the IMN, we designed a multiplanar fracture redactor (MFR) for the treatment of tibial shaft fractures with IMN. The purposes of this study were as follows: (a) to demonstrate the application of MFR in the treatment of tibial shaft fractures with IMN and (b) to assess the outcomes of tibial shaft fractures with IMN facilitated by MFR. Patients and methods This prospective study was conducted at a level I trauma centre in a tertiary university hospital. From February to June 2018, patients with tibial shaft fractures who were hospitalized in our department were included in our research. The exclusion criteria were patients with (a) age < 18 years; (b) multiple fractures or open fractures; (c) old fractures (time from injury to surgery > 21 days); and (d) the follow-up < 1 year. All tibial shaft fractures were fixed by IMN with MFR (Fig. 1), and all operations were conducted by the same team, which consisted of 1 chief physician and 2 attending physicians. The ethical committee of Third Hospital of Hebei Medical University approved this study, and all patients in this study signed informed consent before surgery. The ethical standards of the Declaration of Helsinki were followed in the implementation of this study. Patients characteristics. A total of 16 continuous patients, including 3 females and 13 males, were recruited in the prese (...truncated)