Zentralbl Chir 2011; 136 - V_44
DOI: 10.1055/s-0031-1289009

The T2 intramedullary compression tibia nailing: Comparison of fracture table and manual traction, a prospective multicenter international clinical study

R Jairam 1, 2, JP Stahl 1, P de Lucas 3, K Westermann 4
  • 1Klinikum Dortmund, Klinikzentrum Nord/Unfallklinik, Dortmund, Germany
  • 2Vrije Universiteit Medisch Centrum Amsterdam, Department of General and Trauma-Surgery, Amsterdam, Netherlands
  • 3Hospital Universitario Ramn y Cajal Madrid, Department of Othopaedic and Trauma-Surgery, Madrid, Spain
  • 4Klinikum Nordstadt, Unfallklinik, Hannover, Germany

Introduction: The aim of this study was to see if there is any difference between manual traction and fracture table regarding: operation time, fluoroscopy time, bloodloss, complications and functional results.

Material and methods: Three European level 1 Traumacentres were involved in this study. Between January 2003 and December 2004, 102 patients with tibia fractures were treated with a reamed T2 nail, 48% of the patients without traction and 18% with traction. In 34% of the patients this result was missing. The follow-up was 4–6 weeks, 4 months and 12 months.

Results: Peroperative results: P value for fluoroscopy time (traction versus no traction) P=0,068. P value for operation time (traction versus no traction) P<0,001. P value for bloodloss (traction versus no traction) P<0.001. P value for tourniquet (traction versus no traction) P<0,001. Functional results: Bone healing (4–6 weeks, 4 and 12 months) in patients without traction and with tractions. 4–6 weeks P=0.005, 4 months P=0.562, 12 months P=N/A (constant). Deviation (axial/rotational) of the legs in patients without and with traction 4–6 weeks P=1.000, 4 months P=0.289, 12 months P=0.604. Leg length difference in patients without and with traction 4–6 weeks P=0.497, 4 months P=1.000, 12 months P=0.486. Full weight bearing in patients without and with traction, 4–6 weeks P=0.383, 4 months P=0.277, 12 months P=N/A (constant). Returning to fulltime work in patients without and with traction 4–6 weeks P<0.001, 4 months P<0.001, 12 months P=0.133.

Complications as infections, heterotopic bone, M. Sudeck and foot pain are more seen in patients without traction. Patella pain and compartment syndrome are more seen in patients with traction.

Conclusions: Patients without traction had significantly shorter operation time, less bloodloss and longer fluoroscopy time. In this group of patients there was also significantly more use of tourniquet. There are no significant differences in functional results in both groups, except for the patients in returning to fulltime work after 4–6 weeks and 4 months (P<0.001). Patients with traction had more patella pain and those without traction had more foot pain.

Reference:

Stephen DJG et al. Femoral intramedullary nailing: comparison of fracture table and manual traction. J Bone Joint Surg 2002;84:1514–21.