PDF(Pubmed)
Abstract：
There has been increasing interest in the use of hindfoot tibiotalocalcaneal (TTC) nails to treat ankle and distal tibia fractures in select patient populations who are at increased risk for soft tissue complications after open reduction and internal fixation with traditional plate and screw constructs. We describe a technique which uses a retrograde femoral nail as a custom length TTC nail. By using a simple modification of the insertion jig, we are able to achieve safe screw trajectories that allow for robust distal interlocking fixation. Review of implantation in multiple cadaveric specimens demonstrates safe placement of distal screw fixation in the calcaneus without risking injury to important neurovascular structures. Because of the 2-cm incremental length options of this particular device, we are able to achieve supraisthmal fixation in the tibia which may lessen the risk for fracture that may be more likely to occur at the tip of a short TTC nail option. Furthermore, a custom length TTC nail is more costly and also requires advanced notice to acquire for the case; retrograde femoral nails are readily stocked and accessible at our level 1 trauma center. This TTC technique offers anatomic restoration while also offering convenience, instrument familiarity, cost savings, and increased patient safety.
摘要：
在使用传统的钢板和螺钉结构进行切开复位和内固定后，软组织并发症风险增加的部分患者人群中，对使用后足胫骨骨（TTC）钉治疗踝关节和胫骨远端骨折的兴趣越来越大。我们描述了一种使用逆行股骨钉作为自定义长度TTC钉的技术。通过使用插入夹具的简单修改，我们能够实现安全的螺钉轨迹，允许坚固的远端互锁固定。对多个尸体标本的植入回顾表明，远端螺钉固定在跟骨中的安全放置，而不会损害重要的神经血管结构。由于该特定设备的2厘米增量长度选项，我们能够在胫骨中实现超固定，这可能会减少在短TTC钉选项的尖端更可能发生骨折的风险。此外，自定义长度的TTC钉成本更高，并且还需要提前通知才能获得这种情况；逆行股骨钉很容易在我们的1级创伤中心储备和访问。这种TTC技术提供解剖恢复，同时也提供了方便，仪器熟悉度,节省成本,增加患者安全。
