Application of Minimally Invasive Technology in Orthopedic Trauma

The application of minimally invasive technology in orthopedic trauma is one of the thousand promoted technologies.

Under the technical guidance and support of General Hospital of Northern Theater Command, the Second Ward of Orthopedics Department, No. 968 Hospital of Joint Logistic Support Force has gradually mastered this technology and applied it in clinical treatment—minimally invasive closed reduction for tibial fractures.

Fractures of the distal 1/3 of the tibia are one of the most difficult fracture sites to heal. Due to the scarce surrounding soft tissues and poor blood supply (especially the anteromedial tibia, which is only covered by subcutaneous fat and skin), nonunion of fractures, exposure of internal fixation plates, and bone exposure after tibial fractures are troublesome problems for orthopedic surgeons.

Typical Case Analysis

Patient: Male, 46 years old.

Admitted to the hospital 2 hours after falling, with swelling, pain, and deformity of the left lower leg. Physical examination showed no signs of neurovascular injury.

Diagnosis after admission: Left tibiofibular fracture.

Left tibiofibular fracture / Grade 8–10 disability

Surgical Options

Based on the patient’s actual condition and fracture severity, the most suitable surgical plan was discussed:

Plate fixation?

Intramedullary nail fixation?

M1: Plate and Screw Fixation

Under effective anesthesia, the plate and screw fixation method involves incising the skin, subcutaneous tissue, and fat layer, retracting with retractors, bluntly dissecting muscles to the fracture site, excising severely contused tissue at the fracture site, and removing local hematoma. The fracture is manually reduced anatomically and fixed with instruments. The prepared plate and screws are placed on the tension side (not the compression side) according to the fracture position.

After drilling holes with a bone drill, the length of the screws is measured, and each screw is fixed with a screwdriver. After achieving satisfactory fixation, the incision is irrigated and sutured.

M2: Intramedullary Nail Fixation

Intramedullary nail fixation is more beneficial for the recovery of fractures with poor blood supply. Because intramedullary nails do not interfere with the blood supply at the fracture site, cause less damage, and facilitate faster recovery. However, the fixation stability of intramedullary nails is relatively inferior to that of plates, but they allow slight movement of the fracture ends during healing.

Advantages of Intramedullary Nail Fixation

· Central fixation of intramedullary nails conforms to the normal physiological mechanics of the human body, ensuring good stability, while plate fixation is eccentric.

· Intramedullary nail fixation requires no incision or only a small incision at the fracture site, causing minimal damage to local blood supply and favoring fracture healing.

· Plate fixation involves extensive local incision and dissection, resulting in significant secondary damage.

· Patients with intramedullary nail fixation can get out of bed earlier, with higher safety and better promotion of bone healing, compared to later ambulation with plate fixation.

Surgical Treatment Process

Phase 1

Localization under C-arm fluoroscopy, reamer drilling, traction reduction and guide wire insertion, and sequential reaming after opening the medullary cavity at the proximal fracture end.

Phase 2

Insertion of the fixed intramedullary nail, and screwing in all locking nails after measurement.

Phase 3

Intraoperative real-time display of fracture reduction and intramedullary nail fixation effect via C-arm fluoroscopy.

Phase 4

Postoperative limb appearance (only a few small incisions left for intramedullary nail insertion and locking nails on the skin).

Phase 5

Postoperative rest and recovery.

Precautions

After intramedullary nail surgery, the hematoma organization phase begins, with local inflammatory response forming granulation tissue. After intramedullary nail internal fixation, new blood vessels grow at the fracture ends and osteoblasts proliferate in large quantities, promoting the healing and ossification of the fracture ends.

The recovery time after intramedullary nail fixation mainly depends on the speed of bone healing, generally taking 3–6 months. Postoperatively, intensive care of the injured site is required. During bone recovery, patients can take bone healing-aiding drugs as prescribed by doctors, such as Huoxue Zhitong Capsules, Biqi Capsules, Xianling Gubao Capsules, Calcium Carbonate D3 Tablets, and Alfacalcidol Soft Capsules.

The fracture becomes relatively stable only after bone healing. It is important to avoid premature weight-bearing on the injured site and refrain from exercises such as running and deep squats. Normal weight-bearing and physical activity can only be resumed after complete healing of the lesion.