경골 근위부 골절 환자에서의 골수강 내 금속정 고정술 시행시 외측 도달법의 유용성

Abstract

Purpose: Medial approach in intramedullary nailing insertion in proximal tibia fracture can result in varus deformity and anterior angulation of proximal fragment. The authors used lateral approach in insertion of intramedullary nailing in proximal tibia fracture and evaluate the efficacy of ioint. Materials and Methods: 10 patients with proximal tibia fracture who were treated with intramedullary nail and were follow up for more than 1 year between January, 2001 to June, 2005 were selected. During operation, knee was flexed at 30 degree and 3-4cm logitudinal incision was done to lateral margin of patella tendon. Patella tendon was distracted to medial side and intramedullary nail was inserted after confirming portal using C-arm. For postoperative evaluation, radiographic angulation, displacement and VAS score of the anterior knee pain was checked. Results: Intramedullary insertion using lateral approach can minimize patella tendon injury and enabled direct insertion to lateral aspect of lateral tibia condyle. Nail insertion was possible in half flexed state. Reduction of fragment and correction of varus and anterior angulation was relatively simple. 9 cases showed no angulation or displacement but 1 case showed postoperative angulation. Conclusion: Lateral approach seem to be efficient method in insertion intramedullary nail of proximal tibia fracture as it minimize soft tissue injury and prevent varus and anterior angulation