Extreme Nailing: Is It Safe to Allow Immediate Weightbearing After Intramedullary Nail Fixation of Extra-articular Distal Tibial Fractures (OTA/AO 43-A)?极限髓内钉固定：胫骨远端关节外骨折（OTA/AO 43-A）髓内钉固定后即刻负重安全吗？ abstract： :To determine whether immediate weightbearing after intramedullary髓内的 (IM) fixation of extra-articular关节外 distal tibial fractures (OTA/AO 43-A) results in a change in alignment对线（骨折线） before healing. :Retrospective review回顾性研究. :Level 1 trauma center. :IM nailing of distal tibial fractures. :Fifty-three patients with 54 fractures, all of whom could bear weight as tolerated postoperatively. Eighteen fractures were OTA/AO 43-A1, 20 OTA/AO 43-A2, and 16 OTA/AO 43-A3; 20 fractures were open. :Change in fracture alignment or loss of position. :Average change from initial angulation at final follow-up was 0.52 ± 1.49 degrees of valgus外翻（ varus内翻） and 0.48 ± 3.14 degrees of extension. Final alignment was excellent in 14, acceptable in 28, and poor in 12; 2 fractures went from acceptable initial alignment to poor final alignment; and 2 fractures went from excellent to acceptable alignment. Seven fractures had an improvement in alignment over time. Two fractures required free-flap 游离皮瓣coverage and 4 required staged grafting分期移植 because of bone loss. Ten fractures had an unplanned return to the operating room (5 for infected nonunion requiring implant exchange, 3 for infection requiring debridement清创术 without implant revision, and 2 for aseptic无菌的 nonunion). No patient had revision for implant failure. :Immediate weightbearing after IM fixation of extra-articular distal tibial fractures (OTA/AO 43-A) led to minimal change in alignment and seems to be safe for most patients. Complications were consistent with 一致those reported in previous non-weightbearing cohorts队列，军团. 百度翻译： 摘要： 目的：探讨胫骨远端关节外骨折（OTA/AO 43-A）髓内固定（IM）后即刻负重是否会导致骨折愈合前对线的改变。 设计：回顾性研究。 单位：创伤中心一级。 干预：胫骨远端骨折的IM钉治疗。 患者/参与者：53例54处骨折，均能承受术后耐受的体重。18例为OTA/AO 43-A1、20例为OTA/ao43-A2、16例为OTA/ao43-A3，20例为开放性骨折。 主要观察指标：骨折对线改变或位置丢失。 结果：术后平均外翻角度为0.52±1.49度，伸直角度为0.48±3.14度。最终对中优14例，可接受28例，差12例；2例骨折由可接受的初始对中转为差的最终对中；2例骨折由优对中转为可接受的对中。随着时间的推移，7处骨折的对位有了改善。2例骨折需要游离皮瓣覆盖，4例因骨丢失需要分期移植。10例骨折意外返回手术室（5例感染性骨不连需换植体，3例感染性骨不连需清创，2例无菌骨不连）。没有一个病人因植入失败而进行了翻修。 结论：胫骨远端关节外骨折（OTA/AO 43-A）经IM内固定后即刻负重，可使骨折的对线发生微小改变，对大多数患者来说是安全的。并发症与以前非负重队列的报道一致。 |
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