A Novel Reduction Support Frame for Management of Unstable Tibial Fractures with Intramedullary Nail: Preliminary Report

BACKGROUND: Management of unstable tibial fractures (UTF) can be challenging due to widening of the proximal and distal metaphyseal zone, soft tissue problems, and poor vascularity. We aimed to compare the effect of novel tibial orthopedic reduction support (TORS) frame constructed by re-used tubular external fixator systems and manual traction with regard to the quality of reduction, and fracture healing. METHODS: A total of 65 patients who were admitted with UTF and underwent intramedullary nailing were assessed; 43 patients underwent manual traction technique, and 22 patients underwent TORS technique. The sagittal and coronal plane angulations were evaluated in initial postoperative radiographs, and radiologic union scores for tibial fractures (RUST) were compared at follow-up X-rays. RESULTS: The mean age of patients was 43.49 +/- 19.09 years in the manual-traction group and 43.41 +/- 16.8 years in the TORS group. The mean coronal plane angulation was 1.84 +/- 3.16 in the manual traction group and 1.86 +/- 4.21 in the TORS group. The mean sagittal plane angulation was 1.19 +/- 1.93 in manual traction group and 0.32 +/- 0.65 in the TORS group. The number of coronal and sagittal plane angulations >5 degrees was higher in manual traction group than TORS group. The mean RUST was significantly higher in the TORS group than in the manual traction group at 6th, 9th, and 12th -month controls. The union rates were also higher in the TORS group at 9th and 12th-month controls. CONCLUSION: TORS frame is a simple and cheap technique and should be considered as reduction support in the management of UTF by intramedullary nailing.