Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures

Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures Jie Mei, Qiang He, Ying Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2658060/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To investigate and analyze the clinical efficacy of B-ultrasound-guided manipulative repositioning combined with tibial intramedullary nailing in the treatment of Zhang-Hou's (Z-H) fractures. Methods: Fifty-nine patients with Z-H fractures treated surgically in our hospital from January 2019 to December 2022 were selected for retrospective study, and were divided into 31 cases in the observation group (B-ultrasound-guided manipulative repositioning combined with intramedullary nailing of the tibia) and 28 cases in the control group (plate screw internal fixation) according to the surgical method. The general data, surgical indexes, VAS scores at 1, 3, 6 and 12 months after surgery, and the excellent rate of functional rehabilitation at 6 and 12 months after surgery were compared between the two groups. Results: There was no statistical difference between the general data of the two groups (P > 0.05), which was comparable. The observation group had better operating time, intraoperative blood loss, number of intraoperative fluoroscopy, hospital stay and fracture healing time than the control group, and the difference was statistically significant ( P 0.05); whereas the observation group had better VAS scores than the control group at all postoperative time points, and the difference was statistically significant ( P <0.05). The incidence of postoperative complications in the observation group was 6.45% (2/31, cases), which was significantly lower than that in the control group (17.86% (5/28, cases), and the difference was statistically significant ( P <0.05). The excellent functional rehabilitation rate in the observation group was 93.55% (29/31, cases) at 12 months after surgery, which was significantly higher than that in the control group (78.57% (22/28, cases), and the difference was statistically significant ( P <0.05). Conclusions: Compared with conventional plate and screw internal fixation for Zhang-Hou fractures, B-ultrasound-guided manual repositioning combined with intramedullary nailing of the tibia has the advantages of optimizing surgical indexes, reducing postoperative complications, and improving postoperative functional recovery, and also shortens the learning curve of clinicians for intramedullary nailing surgery. Health sciences/Medical research/Pre clinical studies Health sciences/Medical research/Study design Tibial fracture ultrasound TCM manipulation and revision intramedullary tibial nailing Figures Figure 1 Introduction The Zhang-Hou fracture (Z-H fracture for short), which consists of a spiral fracture of the lower 1/3 of the tibia combined with a posterior ankle fracture, is a type of fracture generalized by Academician Zhang Yingze and Professor Hou Zhiyong of the Chinese Academy of Engineering after extensive epidemiological investigations of fractures [1] . In the analysis of academician Zhang Yingze, this type of fracture is mostly caused by the lower limb continuing to move forward and rotate laterally due to inertia during the movement of the patient with the foot and ankle immobilised, resulting in a spiral fracture of the lower 1/3 of the tibia from inferior to superior [2] . In contrast, fractures of the posterior ankle are mainly due to avulsion fractures caused by pulling of the inferior tibiofibular ligament during movement, or fractures caused by shearing of the tibia forward with the talus [3] . The current clinical treatment options for Z-H fractures include: the lower 1/3 of the tibia spiral fracture is mostly treated with intramedullary nailing or plate internal fixation; the posterior ankle independent fracture can be treated with plate internal fixation or hollow nailing. In recent years, there have been fewer clinical reports on Z-H fractures at home and abroad, and there is currently no uniform knowledge on the clinical treatment methods for Z-H fractures. Therefore, in this study, 59 patients with Z-H fractures treated surgically in our hospital from January 2019 to December 2022 were selected for a retrospective study to analyse the clinical efficacy of B-ultrasound-guided manipulative repositioning combined with intramedullary tibial nailing in the treatment of Z-H fractures. 1. Information And Methods 1.1 General information Fifty-nine patients with Z-H fractures treated surgically at our hospital from January 2019 to December 2022 were selected for a retrospective study. Inclusion criteria: (1) patients with unilateral lower 1/3 tibial spiral fractures combined with posterior ankle fractures; (2) patients with fresh fractures; (3) patients with fresh fractures. Exclusion criteria: (1) patients with old fractures (≥14 days of injury), open fractures, pathological fractures, etc.; (2) patients with infectious diseases, coagulation disorders and deep vein thrombosis of the lower limbs; (3) patients with pre-injury lower limb dysfunction; (4) poor compliance or discontinuation during follow-up. According to the different surgical methods, 31 cases were divided into the observation group (B-ultrasound-guided manipulation combined with intramedullary tibial nailing) and 28 cases in the control group (plate and screw internal fixation). In the observation group, the age ranged from 16 to 63 years (mean age 38.25±6.67, years); gender (male/female: 19/12, cases); injured limb (left/right: 14/17, cases), and all had a clear history of trauma. The control group ranged in age from 18 to 61 years (mean age 38.34±6.69, years); gender (M/F: 17/11, cases); injured limb (left/right: 12/16, cases), all with a clear history of trauma. The differences between the two groups were not statistically significant ( P <0.05) in the comparison of general information such as age and gender, and were comparable. The study followed the Declaration of Helsinki (revised in 2013) and the relevant requirements of medical ethics in our hospital, and the patients included gave informed consent to the surgical protocol. 1.2 Method The 59 patients included with Z-H fractures (see Figures 1 and 2 for fracture patterns) were preoperatively completed with positive and lateral tibiofibular + ankle X-ray and CT 3D reconstruction to clarify the fracture staging, and routine investigations such as ECG and coagulation five. This study was approved by the Institutional Review Boards of Nanjing Traditional Chinese Medicine Hospital (No. KY2021059). The protocol of this study adhered to the tenets of the Declaration of Helsinki. Informed consent was waived by the Institutional Review Boards of Nanjing Traditional Chinese Medicine Hospital, in view of the retrospective nature of the study and the de-identifcation of patients’ data. Signed statements of informed consent to publish patient photographs were obtained from all identifable persons. Observation group (B-ultrasound-guided manipulation combined with intramedullary nailing of the tibia): ultrasound exploration of the affected tibia (see Figure 3) and marking of the fracture break. Using Spinal-epidural anesthesia, 0.5% ropivacaine (Specification: 10ml) 1.5~2.5ml was injected into the subarachnoid cavity of the patient. After successful anaesthesia, the patient is placed in the supine position with a balloon tourniquet on the proximal thigh and a disinfected towel is laid. The lower limb was placed in continuous traction and the fractured end was repaired using Chinese orthopaedic techniques under real-time ultrasound guidance. After ideal repositioning, fluoroscopy confirmed that the posterior ankle fracture was undisplaced and the posterior ankle fracture block was cross-fixed by percutaneous drilling of 3 kerf pins. The knee is flexed at 30 degrees and a longitudinal median incision of approximately 3cm is made at the superior pole of the patella, the Kirschner pins are drilled along the sleeve, the entry point is determined by frontal and lateral fluoroscopy, the hole is reamed, the Kirschner pins are withdrawn and the guide pins are placed, the guide pins stop at the proximal end of the fracture, and the distal end of the fracture is adjusted under real-time ultrasound imaging in combination with Chinese orthopaedic manipulation so that the distal and proximal ends of the fracture are free of angular, lateral displacement and the guide pins are gradually passed through the fracture break and approach the distal tibial epiphysis. A small 1-cm incision is made anterior to the ankle joint and a hollow screw is driven through the gristle to fix the fracture. The wound is closed layer by layer and dressed with a sterile dressing. Control group (conventional plate and screw internal fixation):Using Spinal-epidural anesthesia, 0.5% ropivacaine (Specification: 10ml) 1.5~2.5ml was injected into the subarachnoid cavity of the patient.After satisfactory anaesthesia, the patient was placed in a supine position with a balloon haemostasis placed in the upper 1/3 of the thigh and a sterile towel was laid. A small incision of approximately 1 cm in length was made on the anterior aspect of the ankle joint, followed by fixation with a hollow screw via a Kirschner pin. A longitudinal incision of approximately 15 cm in length is made along the anterior lateral tibia of the lower leg, centred on the fracture end of the tibia, and the fracture end is bluntly separated to reveal a spiral fracture in the lower third of the tibia. The tibial fracture is satisfactorily repositioned and the plate and screws are of appropriate length. The wound is closed layer by layer and dressed with aseptic dressings. Both groups of patients were operated on by the same chief surgeon. 1.3 Observed indicators General information for both groups; surgical indicators; (operative time, intraoperative bleeding, number of intraoperative fluoroscopies, length of hospital stay, fracture healing time); pain visual analogue [5] (visual analogue scale ,VAS) scores at 1, 3, 6 and 12 months postoperatively; postoperative complication rate; excellent functional recovery rate (Johner-Wruhs scale of tibial efficacy) at 12 months postoperatively. 1.4 Statistical methods Statistical analysis was performed using SPSS 26.0. All measurement data were expressed by applying (`c±S), and all count data were expressed by applying [n(%)]. t or 2 test was applied for comparison between and within groups, and P <0.05 was statistically significant. 2. Results 2.1 Comparison of surgical indicators between the two groups The observation group outperformed the control group in terms of operative time, intraoperative blood loss, number of intraoperative fluoroscopies, length of hospital stay and fracture healing time, with statistically significant differences ( P <0.05). See Table 1. Table 1. Comparison of surgical indicators between the two groups （`c±S ） Group n Surgery time（min） Intraoperative blood loss（ml） Number of intraoperative fluoroscopies（times） Length of stay in hospital（d） Fracture healing time (weeks) Observation group 31 80.03±9.41 107.44±14.61 31.28±3.62 13.84±2.66 15.41±1.17 Control group 28 133.66±11.52 127.93±13.71 42.45±4.61 17.52±2.58 17.54±2.53 t 9.311 2.738 6.046 2.759 2.780 P ＜0.001 0.033 ＜0.001 0.027 0.023 2.2 Comparison of VAS scores at various postoperative time points between the two groups Compared with the preoperative period, the postoperative VAS scores of both groups decreased significantly at all time points, and the difference was statistically significant ( P 0.05), while the VAS scores of the observation group were better than those of the control group at all postoperative time points, and the difference was statistically significant ( P <0.05). See Table 2. Table 2. Comparison of VAS scores at various postoperative time points between the two groups （`c±S ） Group n Pre-operative 1 month post-operative 3 months post-operative 6 months post-operative 12 months post-operative Observation group 31 6.82±2.19 1.87±0.09* 1.03±0.17* 0.88±0.18* 0.64±0.17* Control group 28 6.88±1.98 2.48±0.32* 1.56±0.28* 1.34±0.22* 1.05±0.23* t 0.018 6.462 5.255 4.589 4.195 P 0.976 ＜0.001 0.003 0.007 0.015 Note: Comparison with Pre-perative，* P ＜0.05。 2.3 Comparison of the incidence of postoperative complications between the two groups In the observation group, there was one case of venous embolism and one case of bone discontinuity each, with a complication rate of 6.45% (2/31, cases); in the control group, there was one case of venous embolism, one case of internal fixation failure, two cases of incision infection and one case of bone discontinuity, with a complication rate of 17.86% (5/28, cases). The incidence of postoperative complications in the observation group was significantly lower than that in the control group, and the difference was statistically significant ( P <0.05). Patients in both groups were cured of venous embolism and incisional infection after symptomatic treatment, and secondary surgical treatment was performed for bone nonunion and failure of the internal fixation. See Table 3. Table 3. Comparison of the incidence of postoperative complications between the two groups [n（%）] Group n Venous embolism Failure of internal fixation Infection of the incision Bone discontinuity Total incidence（%） Observation group 31 1 0 1 0 2（6.45） Control group 28 1 1 2 1 5（17.86） t 10.816 P ＜0.001 2.4 Comparison of excellent functional rehabilitation rates between the two groups at 12 months after surgery The excellent rate of functional rehabilitation in the observation group at 12 months postoperatively was 93.55% (29/31, cases) significantly higher than that in the control group (78.57% (22/28, cases), with a statistically significant difference ( P <0.05). See Table 4. Table 4. Comparison of excellent functional rehabilitation rates between the two groups at 12 months postoperatively [n（%）] Group n Excellent Good Poor Excellent rate（%） Observation group 31 22 7 2 29（93.55） Control group 28 13 9 6 22（78.57） t 15.281 P ＜0.001 3. Discussion Zhang-Hou fractures are rare in clinical practice. The posterior ankle fracture block is often a cleft fracture or a poorly displaced fracture, and the tibial fracture line of this fracture is not continuous with the posterior ankle fracture line. This fracture is not continuous with the posterior ankle fracture line. Because posterior ankle fractures are insidious, they are often missed in clinical practice [4] . In our analysis, we believe that the reasons for the missed diagnosis include the following two points: (1) when young doctors receive patients, they only focus on the pain of the lower limb and neglect the ankle examination due to their lack of experience, which leads to the missed diagnosis of posterior ankle fractures; (2) during the preoperative examination of patients, some doctors only perform X-ray examination of the affected limb and neglect CT and MRI examination of the ankle joint, which also leads to the missed diagnosis of first- and second-degree Zhang-Hou fractures to a certain extent. This may also lead to a certain degree of underdiagnosis of I and II degree Zhang-Hou fractures. However, posterior ankle fractures in I degree Zhang-Hou fractures do not usually require special surgical management in clinical practice [5] . Therefore, MRI of Zhang-Hou fractures is not as important in the preoperative examination. The main clinical methods of fixation of the tibial region for Zhang-Hou fractures are intramedullary nailing and plate and screw fixation. Due to the long fracture line of the tibia, traditional internal fixation with plates exposes a large area of the operative field and requires dissection of the periosteum, which damages the soft tissues and blood flow, making the healing time of the fracture longer and increasing the risk of postoperative wound infection and non-union of the fracture [6-8] . Compared with traditional plate internal fixation, intramedullary nailing is less demanding on soft tissues, more securely fixed, less likely to displace the fracture, and can avoid secondary injuries caused by repeated operations due to poor plate fixation [9-11] . At the same time, intramedullary nailing has obvious biomechanical advantages, patients can recover knee and limb function faster and better after surgery, can shorten the time to get out of bed after surgery, and can improve the fracture healing rate and reduce the occurrence of postoperative complications by virtue of the autologous bone graft effect [12-14] . Although intramedullary nailing has many advantages over plate fixation, it is a closed repositioning procedure, which is almost a "hidden operation" and requires a high level of skill and a learning curve, and the procedure is more dependent on the C-arm machine [15-16] . However, there are obvious shortcomings of the C-arm machine. Firstly, some primary or remote hospitals are unable to use C-arms for reasons such as cost or operating theatre equipment failing to meet radiation protection standards; secondly, the ionising radiation from C-arms can cause varying degrees of dysfunction in human tissues and organs, and repeated fluoroscopy can cause certain damage to the body; furthermore, C-arms are large in size and weight and cannot be moved over long distances, so they lack convenience in use [17-18] . In contrast, ultrasound currently has unique advantages in the diagnosis and treatment of fractures in clinical practice by virtue of its non-invasive, non-ionizing radiation and real-time imaging characteristics [19] . ultrasound machines are relatively inexpensive, lightweight and more convenient, and do not cause harm to the body, which can compensate for the shortcomings of C-arm machines to a certain extent. Secondly, ultrasound can clearly show the nerve and vascular path around the fracture during fracture reduction, which can effectively reduce the damage to the nerve and blood vessels during intraoperative fracture reduction[20]. More importantly, the real-time imaging feature of ultrasound can not only make the fracture end repositioning more accurate and fast, but also help the intramedullary nail guide pin to pass through the fracture end more accurately and quickly, which greatly shortens the operation time and reduces the risk of surgery. The real-time guidance of the ultrasound makes the tibial intramedullary nailing procedure relatively 'visual' and shortens the learning curve for the clinician. Although ultrasound has not yet been able to replace the role of the C-arm in tibial intramedullary nailing, as ultrasound continues to be updated, ultrasound-guided tibial intramedullary nailing will be used in more patients. In this study, patients who underwent intramedullary nailing surgery had shorter operative time, hospital stay, fracture healing time, less intraoperative bleeding and less postoperative pain compared to plate and screw internal fixation surgery, indicating that intramedullary nailing surgery in the treatment of Zhang-Hou fractures has the advantages of less surgical trauma and blocky postoperative recovery; and with the help of real-time ultrasound guidance, the operative time and the number of intraoperative fluoroscopies were greatly reduced. At 12 months after surgery, the excellent functional rehabilitation rate of the observation group was 93.55% (29/31, cases) significantly higher than that of the control group (78.57% (22/28, cases). We analyzed that the function of the affected limb was poorer in patients with plate internal fixation surgery than in patients with intramedullary nailing surgery, considering that the reason was that patients with plate surgery had a longer recovery time after surgery and were unable to walk and exercise on the ground in the short term, which would cause joint stiffness The reason for this is that patients with plate surgery have a longer recovery time and are unable to walk and exercise for a short period of time. The patients in the observation group had no significant post-operative complications, while the patients in the control group developed post-operative incisional infection, mainly because the plate group had a large surgical trauma and long intraoperative exposure time, which increased the probability of post-operative infection; secondly, bone nonunion occurred, which was considered to be due to the patients' premature weight-bearing walking before the fracture healed and the disruption of peripheral blood flow by intraoperative periosteal stripping, resulting in post-operative bone nonunion. In conclusion, in the clinical treatment of Zhang-Hou fractures, B-ultrasound-guided manipulative revision combined with intramedullary tibial nailing has the advantages of short operative time, minimal intraoperative trauma, rapid postoperative recovery and few complications. It can also greatly reduce the number of intraoperative fluoroscopies, make intramedullary nailing surgery and TCM manipulative revision visualized, and shorten the learning curve of clinicians for intramedullary nailing surgery, which is worthy of clinical promotion. Declarations Data availability The datasets generated during and/or analyzed during the current study are available from the corresponding authors on reasonable request. References Zhang Yingze, Hou Zhiyong, Zhang Qi, et al. Injury types and grading of lower 1/3 spiral fractures of the tibia combined with posterior ankle fractures[J]. Hebei Medicine, 2007(12):1337-1338. Zhang Yingze, Hou Zhiyong, Zhang Qi, et al. Study on the relationship between lower 1/3 spiral fracture of the tibia and ankle injury[J]. Journal of Hebei Medical University, 2007(05):364-365+402. Wang Yanzi, Huang Changhong, Feng Yang, et al. Comparison of the efficacy of hollow screws and "L"-shaped plates in the treatment of mid-lower 1/3 spiral fractures of the tibia combined with posterior ankle fractures[J]. Chinese and Foreign Medicine, 2019, 38(33):36-38. YE Zhiyang, Huang Danlei, Wang Jun, et al. Efficacy of semi-extension intramedullary nailing with hollow screw fixation in the treatment of lower 1/3 tibial spiral fractures combined with posterior ankle fractures[J]. Modern Biomedical Progress, 2022, 22(13):2509-2513. Zhang Yingze, Hou Zhiyong, Zhang Qi, et al. Injury types and grading of lower 1/3 spiral fractures of the tibia combined with posterior ankle fractures[J]. Hebei Medicine, 2007(12):1337-1338. Guo Fengbo. Clinical analysis of tibial intramedullary nailing and anatomical locking splints in the treatment of lower and middle tibial fractures[J]. Journal of Shandong Medical College, 2022, 44(01):40-42. Schaffer NE, Wilson JL, Yee MA, et al. Intramedullary Nail for a Distal Tibia Fracture[J]. J Orthop Trauma, 2020,34(02):37-38. Cheng L, Li YH, Chu Y, et al. Intramedullary nailing via suprapatellar approach versus locked plating of proximal extra-articular tibial fractures: a randomized control trial[J]. Int Orthop, 2021, 45(6):1599-1608. Franke J, Hohendorff B, Alt V, et al. Suprapatellar nailing of tibial fractures-Indications and technique[J]. Injury, 2016, 47(2):495-501. Zhang H R, Sun Y G, Cao L Chao. Effect of internal fixation with suprapatellar approach tibial intramedullary nailing on postoperative pain visual analog scale scores and knee function in patients with middle and lower tibial fractures[J]. China Medical Engineering, 2022, 30(02):123-125. Ringenberg JD, Tobey JL, Horinek JL,et al. Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature[J]. OTA Int, 2022, 5(1):196. Chen JC, Ye JC, Wu SJ, et al. Study on the effect of suprapatellar approach to tibial intramedullary nailing in the treatment of tibial stem fractures[J]. Heilongjiang Medicine, 2022, 35(03):656-658. Yang L, Sun Y, Li G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shafa'a'at fractures: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2018, 13(1):146. Zamora R, Wright C, Short A, et al. Comparison between suprapatellar and parapatellar approaches for intramedullary nailing of the tibia[J]. Injury, 2016, 47(10):2087-2090. Zhou D, Guo W C, Su Y, et al. A comparative study of interlocking intramedullary nailing and percutaneous minimally invasive locking plate internal fixation for the treatment of middle and lower tibial fractures[J]. Jilin Medicine, 2018, 39(09):1757-1759. Charak SS, Chib MS, Darokhan Maud, et al. Radiation-free Insertion of Interlocked Intramedullary Tibial Nail in Closed Extra-articular Displaced Tibial Shaft Fractures in an Emergency Setup[J]. Ortop Traumatol Rehabil, 2021, 23(6):427-431. Zheng Y, Yang X, Rong CH. Radiation damage of mobile C-arm machine and protective countermeasures[J]. Journal of North China Coal Medical College, 2011, 13(02):178-179. Williamson M, Iliopoulos E, Williams R, et al. Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing vers with infrapatellar tibial nailing[J]. Injury, 2018, 49(10):1891-1894. Shen SH, Wang XA, Fu Z. Ultrasound-guided closed reduction minimally invasive fixation for metacarpophalangeal fractures[J]. China Medical Imaging Technology, 2018, 34(02):293-296. Xiong GA, Fu WT. Clinical application effect of ultrasound in closed reduction intramedullary nailing for internal fixation of extremity fractures[J]. Chinese contemporary medicine, 2018, 25(35):41-43. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2658060","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":188322463,"identity":"c24ad1db-f6a6-4d1a-aad8-8ab0dabc686f","order_by":0,"name":"Jie Mei","email":"","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Mei","suffix":""},{"id":188322464,"identity":"1696b887-9e04-47fb-91b9-18ed29c33e24","order_by":1,"name":"Qiang He","email":"","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qiang","middleName":"","lastName":"He","suffix":""},{"id":188322465,"identity":"045a1ad2-b0f3-4fdc-aa89-a2c553c80eef","order_by":2,"name":"Ying Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBACfmbmgw8+GNjIsfE3HyBOi2R7W7LhjIo0Yz6JYwnEaTE4c0ZNmufM4cR5DDkGRLrsRg6zMW9bmjEbw5mPN94w2MnpNhDQwTgj9+DDuW1AvzD3bracw5BsbHaAgBZmibxkg7dgW85uk+ZhOJC4jZAWNokcMwnetsOJbQw5z4jTwsNzxkwS5H2gFjbitEiwQwOZTeKYseUcAyL8Yn8YGpXy/c0Pb7ypsJMjqAXVSh5iowZJC6k6RsEoGAWjYEQAAETuQ7fE5onFAAAAAElFTkSuQmCC","orcid":"","institution":"Shandong University of Traditional Chinese Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2023-03-05 17:44:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2658060/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2658060/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":35294668,"identity":"4599c4ab-d0bd-4869-922e-57a43a69826b","added_by":"auto","created_at":"2023-04-04 22:10:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":577637,"visible":true,"origin":"","legend":"\u003cp\u003e1-2:X-ray presentation of Zhang-Hou fracture: spiral fracture of the lower 1/3 of the tibia with independent fracture of the posterior ankle (without significant displacement). 3: Spiral fracture of the lower 1/3 of the tibia on B-ultrasound imaging.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-2658060/v1/2ea91671b59a4a18206c2c96.png"},{"id":56592728,"identity":"0e288e4d-9429-40ea-9865-7f6d94919c0f","added_by":"auto","created_at":"2024-05-16 09:36:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":923106,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2658060/v1/256042ba-d368-4614-b774-956f0b5f8d4a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Zhang-Hou fracture (Z-H fracture for short), which consists of a spiral fracture of the lower 1/3 of the tibia combined with a posterior ankle fracture, is a type of fracture generalized by Academician Zhang Yingze and Professor Hou Zhiyong of the Chinese Academy of Engineering after extensive epidemiological investigations of fractures \u003csup\u003e[1]\u003c/sup\u003e. In the analysis of academician Zhang Yingze, this type of fracture is mostly caused by the lower limb continuing to move forward and rotate laterally due to inertia during the movement of the patient with the foot and ankle immobilised, resulting in a spiral fracture of the lower 1/3 of the tibia from inferior to superior \u003csup\u003e[2]\u003c/sup\u003e. In contrast, fractures of the posterior ankle are mainly due to avulsion fractures caused by pulling of the inferior tibiofibular ligament during movement, or fractures caused by shearing of the tibia forward with the talus \u003csup\u003e[3]\u003c/sup\u003e. The current clinical treatment options for Z-H fractures include: the lower 1/3 of the tibia spiral fracture is mostly treated with intramedullary nailing or plate internal fixation; the posterior ankle independent fracture can be treated with plate internal fixation or hollow nailing. In recent years, there have been fewer clinical reports on Z-H fractures at home and abroad, and there is currently no uniform knowledge on the clinical treatment methods for Z-H fractures. Therefore, in this study, 59 patients with Z-H fractures treated surgically in our hospital from January 2019 to December 2022 were selected for a retrospective study to analyse the clinical efficacy of B-ultrasound-guided manipulative repositioning combined with intramedullary tibial nailing in the treatment of Z-H fractures.\u003c/p\u003e"},{"header":"1.\tInformation And Methods","content":"\u003cp\u003e\u003cstrong\u003e1.1 General information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFifty-nine patients with Z-H fractures treated surgically at our hospital from January 2019 to December 2022 were selected for a retrospective study. Inclusion criteria: (1) patients with unilateral lower 1/3 tibial spiral fractures combined with posterior ankle fractures; (2) patients with fresh fractures; (3) patients with fresh fractures. Exclusion criteria: (1) patients with old fractures (\u0026ge;14 days of injury), open fractures, pathological fractures, etc.; (2) patients with infectious diseases, coagulation disorders and deep vein thrombosis of the lower limbs; (3) patients with pre-injury lower limb dysfunction; (4) poor compliance or discontinuation during follow-up. According to the different surgical methods, 31 cases were divided into the observation group (B-ultrasound-guided manipulation combined with intramedullary tibial nailing) and 28 cases in the control group (plate and screw internal fixation). In the observation group, the age ranged from 16 to 63 years (mean age 38.25\u0026plusmn;6.67, years); gender (male/female: 19/12, cases); injured limb (left/right: 14/17, cases), and all had a clear history of trauma. The control group ranged in age from 18 to 61 years (mean age 38.34\u0026plusmn;6.69, years); gender (M/F: 17/11, cases); injured limb (left/right: 12/16, cases), all with a clear history of trauma. The differences between the two groups were not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05) in the comparison of general information such as age and gender, and were comparable. The study followed the Declaration of Helsinki (revised in 2013) and the relevant requirements of medical ethics in our hospital, and the patients included gave informed consent to the surgical protocol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 59 patients included with Z-H fractures (see Figures 1 and 2 for fracture patterns) were preoperatively completed with positive and lateral tibiofibular + ankle X-ray and CT 3D reconstruction to clarify the fracture staging, and routine investigations such as ECG and coagulation five.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Boards of Nanjing Traditional Chinese Medicine Hospital (No. KY2021059). The protocol of this study adhered to the tenets of the Declaration of Helsinki. Informed consent was waived by the Institutional Review Boards of Nanjing Traditional Chinese Medicine Hospital, in view of the retrospective nature of the study and the de-identifcation of patients\u0026rsquo;\u0026nbsp;data. Signed statements of informed consent to publish patient photographs were obtained from all identifable persons.\u003c/p\u003e\n\u003cp\u003eObservation group (B-ultrasound-guided manipulation combined with intramedullary nailing of the tibia): ultrasound exploration of the affected tibia (see Figure 3) and marking of the fracture break. Using Spinal-epidural anesthesia, 0.5% ropivacaine (Specification: 10ml) 1.5~2.5ml was injected into the subarachnoid cavity of the patient. After successful anaesthesia, the patient is placed in the supine position with a balloon tourniquet on the proximal thigh and a disinfected towel is laid. The lower limb was placed in continuous traction and the fractured end was repaired using Chinese orthopaedic techniques under real-time ultrasound guidance. After ideal repositioning, fluoroscopy confirmed that the posterior ankle fracture was undisplaced and the posterior ankle fracture block was cross-fixed by percutaneous drilling of 3 kerf pins. The knee is flexed at 30 degrees and a longitudinal median incision of approximately 3cm is made at the superior pole of the patella, the Kirschner pins are drilled along the sleeve, the entry point is determined by frontal and lateral fluoroscopy, the hole is reamed, the Kirschner pins are withdrawn and the guide pins are placed, the guide pins stop at the proximal end of the fracture, and the distal end of the fracture is adjusted under real-time ultrasound imaging in combination with Chinese orthopaedic manipulation so that the distal and proximal ends of the fracture are free of angular, lateral displacement and the guide pins are gradually passed through the fracture break and approach the distal tibial epiphysis. A small 1-cm incision is made anterior to the ankle joint and a hollow screw is driven through the gristle to fix the fracture. The wound is closed layer by layer and dressed with a sterile dressing.\u003c/p\u003e\n\u003cp\u003eControl group (conventional plate and screw internal fixation):Using Spinal-epidural anesthesia, 0.5% ropivacaine (Specification: 10ml) 1.5~2.5ml was injected into the subarachnoid cavity of the patient.After satisfactory anaesthesia, the patient was placed in a supine position with a balloon haemostasis placed in the upper 1/3 of the thigh and a sterile towel was laid. A small incision of approximately 1 cm in length was made on the anterior aspect of the ankle joint, followed by fixation with a hollow screw via a Kirschner pin. A longitudinal incision of approximately 15 cm in length is made along the anterior lateral tibia of the lower leg, centred on the fracture end of the tibia, and the fracture end is bluntly separated to reveal a spiral fracture in the lower third of the tibia. The tibial fracture is satisfactorily repositioned and the plate and screws are of appropriate length. The wound is closed layer by layer and dressed with aseptic dressings.\u003c/p\u003e\n\u003cp\u003eBoth groups of patients were operated on by the same chief surgeon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Observed indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGeneral information for both groups; surgical indicators; (operative time, intraoperative bleeding, number of intraoperative fluoroscopies, length of hospital stay, fracture healing time); pain visual analogue [5] (visual analogue scale ,VAS) scores at 1, 3, 6 and 12 months postoperatively; postoperative complication rate; excellent functional recovery rate (Johner-Wruhs scale of tibial efficacy) at 12 months postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 Statistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 26.0. All measurement data were expressed by applying (`c\u0026plusmn;S), and all count data were expressed by applying [n(%)]. t or 2 test was applied for comparison between and within groups, and \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 was statistically significant.\u003c/p\u003e"},{"header":"2. Results","content":"\u003cp\u003e\u003cstrong\u003e2.1 Comparison of surgical indicators between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe observation group outperformed the control group in terms of operative time, intraoperative blood loss, number of intraoperative fluoroscopies, length of hospital stay and fracture healing time, with statistically significant differences (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). See Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Comparison of surgical indicators between the two groups\u0026nbsp;（`c\u0026plusmn;S\u0026nbsp;）\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"794\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.7783375314861463%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003eSurgery time（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.624685138539043%\"\u003e\n \u003cp\u003eIntraoperative blood loss（ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.670025188916878%\"\u003e\n \u003cp\u003eNumber of intraoperative fluoroscopies（times）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003eLength of stay in hospital（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003eFracture healing time (weeks)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003eObservation group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.7783375314861463%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003e80.03\u0026plusmn;9.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.624685138539043%\"\u003e\n \u003cp\u003e107.44\u0026plusmn;14.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.670025188916878%\"\u003e\n \u003cp\u003e31.28\u0026plusmn;3.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e13.84\u0026plusmn;2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e15.41\u0026plusmn;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"3.7783375314861463%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003e133.66\u0026plusmn;11.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.624685138539043%\"\u003e\n \u003cp\u003e127.93\u0026plusmn;13.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.670025188916878%\"\u003e\n \u003cp\u003e42.45\u0026plusmn;4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e17.52\u0026plusmn;2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e17.54\u0026plusmn;2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"16.750629722921914%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003e9.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.624685138539043%\"\u003e\n \u003cp\u003e2.738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.670025188916878%\"\u003e\n \u003cp\u003e6.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e2.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e2.780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"16.750629722921914%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.972292191435768%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.624685138539043%\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.670025188916878%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.4911838790932%\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Comparison of VAS scores at various postoperative time points between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompared with the preoperative period, the postoperative VAS scores of both groups decreased significantly at all time points, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). There was no statistically significant difference between the preoperative VAS scores of the two groups (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05), while the VAS scores of the observation group were better than those of the control group at all postoperative time points, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). See Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison of VAS scores at various postoperative time points between the two groups\u0026nbsp;（`c\u0026plusmn;S\u0026nbsp;）\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"765\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.594771241830065%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.143790849673203%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.07843137254902%\"\u003e\n \u003cp\u003ePre-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.26143790849673%\"\u003e\n \u003cp\u003e1 month post-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.986928104575163%\"\u003e\n \u003cp\u003e3 months post-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.294117647058824%\"\u003e\n \u003cp\u003e6 months post-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640522875816993%\"\u003e\n \u003cp\u003e12 months post-operative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.594771241830065%\"\u003e\n \u003cp\u003eObservation group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.143790849673203%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.07843137254902%\"\u003e\n \u003cp\u003e6.82\u0026plusmn;2.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.26143790849673%\"\u003e\n \u003cp\u003e1.87\u0026plusmn;0.09*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.986928104575163%\"\u003e\n \u003cp\u003e1.03\u0026plusmn;0.17*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.294117647058824%\"\u003e\n \u003cp\u003e0.88\u0026plusmn;0.18*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640522875816993%\"\u003e\n \u003cp\u003e0.64\u0026plusmn;0.17*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.594771241830065%\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.143790849673203%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.07843137254902%\"\u003e\n \u003cp\u003e6.88\u0026plusmn;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.26143790849673%\"\u003e\n \u003cp\u003e2.48\u0026plusmn;0.32*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.986928104575163%\"\u003e\n \u003cp\u003e1.56\u0026plusmn;0.28*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.294117647058824%\"\u003e\n \u003cp\u003e1.34\u0026plusmn;0.22*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640522875816993%\"\u003e\n \u003cp\u003e1.05\u0026plusmn;0.23*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"19.73856209150327%\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.07843137254902%\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.26143790849673%\"\u003e\n \u003cp\u003e6.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.986928104575163%\"\u003e\n \u003cp\u003e5.255\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.294117647058824%\"\u003e\n \u003cp\u003e4.589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640522875816993%\"\u003e\n \u003cp\u003e4.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"19.73856209150327%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.07843137254902%\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"20.26143790849673%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.986928104575163%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.294117647058824%\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.640522875816993%\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote: Comparison with Pre-perative，*\u003cem\u003e\u0026nbsp;P\u003c/em\u003e＜0.05。\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Comparison of the incidence of postoperative complications between the two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the observation group, there was one case of venous embolism and one case of bone discontinuity each, with a complication rate of 6.45% (2/31, cases); in the control group, there was one case of venous embolism, one case of internal fixation failure, two cases of incision infection and one case of bone discontinuity, with a complication rate of 17.86% (5/28, cases). The incidence of postoperative complications in the observation group was significantly lower than that in the control group, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Patients in both groups were cured of venous embolism and incisional infection after symptomatic treatment, and secondary surgical treatment was performed for bone nonunion and failure of the internal fixation. See Table 3.\u003c/p\u003e\n\u003cp\u003eTable 3. Comparison of the incidence of postoperative complications between the two groups \u0026nbsp;[n（%）]\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"718\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.934631432545201%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.292072322670375%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.325452016689846%\"\u003e\n \u003cp\u003eVenous embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.411682892906814%\"\u003e\n \u003cp\u003eFailure of internal fixation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.795549374130736%\"\u003e\n \u003cp\u003eInfection of the incision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.411682892906814%\"\u003e\n \u003cp\u003eBone discontinuity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.82892906815021%\"\u003e\n \u003cp\u003eTotal incidence（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.934631432545201%\"\u003e\n \u003cp\u003eObservation group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.292072322670375%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.325452016689846%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.411682892906814%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.795549374130736%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.411682892906814%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.82892906815021%\"\u003e\n \u003cp\u003e2（6.45）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.934631432545201%\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.292072322670375%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.325452016689846%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.411682892906814%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.795549374130736%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.411682892906814%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.82892906815021%\"\u003e\n \u003cp\u003e5（17.86）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"23.259052924791085%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" rowspan=\"2\" valign=\"top\" width=\"59.88857938718663%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.852367688022284%\"\u003e\n \u003cp\u003e10.816\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"57.986111111111114%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.013888888888886%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Comparison of excellent functional rehabilitation rates between the two groups at 12 months after surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe excellent rate of functional rehabilitation in the observation group at 12 months postoperatively was 93.55% (29/31, cases) significantly higher than that in the control group (78.57% (22/28, cases), with a statistically significant difference (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). See Table 4.\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison of excellent functional rehabilitation rates between the two groups at 12 months postoperatively \u0026nbsp;[n（%）]\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.7028%;\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.7139%;\" width=\"11.195158850226928%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.2299%;\" width=\"15.582450832072617%\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8343%;\" width=\"16.792738275340394%\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0653%;\" width=\"14.674735249621785%\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.4417%;\" width=\"27.68532526475038%\"\u003e\n \u003cp\u003eExcellent rate（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.7028%;\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003eObservation group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.7139%;\" width=\"11.195158850226928%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.2299%;\" width=\"15.582450832072617%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8343%;\" width=\"16.792738275340394%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0653%;\" width=\"14.674735249621785%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.076%;\" width=\"27.68532526475038%\"\u003e\n \u003cp\u003e29（93.55）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8.7028%;\" width=\"14.069591527987898%\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.7139%;\" width=\"11.195158850226928%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.2299%;\" width=\"15.582450832072617%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.8343%;\" width=\"16.792738275340394%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0653%;\" width=\"14.674735249621785%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.076%;\" width=\"27.68532526475038%\"\u003e\n \u003cp\u003e22（78.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.3178%;\" width=\"25.264750378214828%\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 26.0039%;\" valign=\"top\" width=\"48.56278366111952%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.747%;\" width=\"16.944024205748864%\"\u003e\n \u003cp\u003e15.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 16.3178%;\" width=\"49.11764705882353%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.747%;\" width=\"32.94117647058823%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eZhang-Hou fractures are rare in clinical practice. The posterior ankle fracture block is often a cleft fracture or a poorly displaced fracture, and the tibial fracture line of this fracture is not continuous with the posterior ankle fracture line. This fracture is not continuous with the posterior ankle fracture line. Because posterior ankle fractures are insidious, they are often missed in clinical practice \u003csup\u003e[4]\u003c/sup\u003e. In our analysis, we believe that the reasons for the missed diagnosis include the following two points: (1) when young doctors receive patients, they only focus on the pain of the lower limb and neglect the ankle examination due to their lack of experience, which leads to the missed diagnosis of posterior ankle fractures; (2) during the preoperative examination of patients, some doctors only perform X-ray examination of the affected limb and neglect CT and MRI examination of the ankle joint, which also leads to the missed diagnosis of first- and second-degree Zhang-Hou fractures to a certain extent. This may also lead to a certain degree of underdiagnosis of I and II degree Zhang-Hou fractures. However, posterior ankle fractures in I degree Zhang-Hou fractures do not usually require special surgical management in clinical practice \u003csup\u003e[5]\u003c/sup\u003e. Therefore, MRI of Zhang-Hou fractures is not as important in the preoperative examination.\u003c/p\u003e\n\u003cp\u003eThe main clinical methods of fixation of the tibial region for Zhang-Hou fractures are intramedullary nailing and plate and screw fixation. Due to the long fracture line of the tibia, traditional internal fixation with plates exposes a large area of the operative field and requires dissection of the periosteum, which damages the soft tissues and blood flow, making the healing time of the fracture longer and increasing the risk of postoperative wound infection and non-union of the fracture \u003csup\u003e[6-8]\u003c/sup\u003e. Compared with traditional plate internal fixation, intramedullary nailing is less demanding on soft tissues, more securely fixed, less likely to displace the fracture, and can avoid secondary injuries caused by repeated operations due to poor plate fixation \u003csup\u003e[9-11]\u003c/sup\u003e. At the same time, intramedullary nailing has obvious biomechanical advantages, patients can recover knee and limb function faster and better after surgery, can shorten the time to get out of bed after surgery, and can improve the fracture healing rate and reduce the occurrence of postoperative complications by virtue of the autologous bone graft effect \u003csup\u003e[12-14]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAlthough intramedullary nailing has many advantages over plate fixation, it is a closed repositioning procedure, which is almost a \u0026quot;hidden operation\u0026quot; and requires a high level of skill and a learning curve, and the procedure is more dependent on the C-arm machine \u003csup\u003e[15-16]\u003c/sup\u003e. However, there are obvious shortcomings of the C-arm machine. Firstly, some primary or remote hospitals are unable to use C-arms for reasons such as cost or operating theatre equipment failing to meet radiation protection standards; secondly, the ionising radiation from C-arms can cause varying degrees of dysfunction in human tissues and organs, and repeated fluoroscopy can cause certain damage to the body; furthermore, C-arms are large in size and weight and cannot be moved over long distances, so they lack convenience in use \u003csup\u003e[17-18]\u003c/sup\u003e. In contrast, ultrasound currently has unique advantages in the diagnosis and treatment of fractures in clinical practice by virtue of its non-invasive, non-ionizing radiation and real-time imaging characteristics \u003csup\u003e[19]\u003c/sup\u003e. ultrasound machines are relatively inexpensive, lightweight and more convenient, and do not cause harm to the body, which can compensate for the shortcomings of C-arm machines to a certain extent. Secondly, ultrasound can clearly show the nerve and vascular path around the fracture during fracture reduction, which can effectively reduce the damage to the nerve and blood vessels during intraoperative fracture reduction[20]. More importantly, the real-time imaging feature of ultrasound can not only make the fracture end repositioning more accurate and fast, but also help the intramedullary nail guide pin to pass through the fracture end more accurately and quickly, which greatly shortens the operation time and reduces the risk of surgery. The real-time guidance of the ultrasound makes the tibial intramedullary nailing procedure relatively \u0026apos;visual\u0026apos; and shortens the learning curve for the clinician. Although ultrasound has not yet been able to replace the role of the C-arm in tibial intramedullary nailing, as ultrasound continues to be updated, ultrasound-guided tibial intramedullary nailing will be used in more patients.\u003c/p\u003e\n\u003cp\u003eIn this study, patients who underwent intramedullary nailing surgery had shorter operative time, hospital stay, fracture healing time, less intraoperative bleeding and less postoperative pain compared to plate and screw internal fixation surgery, indicating that intramedullary nailing surgery in the treatment of Zhang-Hou fractures has the advantages of less surgical trauma and blocky postoperative recovery; and with the help of real-time ultrasound guidance, the operative time and the number of intraoperative fluoroscopies were greatly reduced. At 12 months after surgery, the excellent functional rehabilitation rate of the observation group was 93.55% (29/31, cases) significantly higher than that of the control group (78.57% (22/28, cases). We analyzed that the function of the affected limb was poorer in patients with plate internal fixation surgery than in patients with intramedullary nailing surgery, considering that the reason was that patients with plate surgery had a longer recovery time after surgery and were unable to walk and exercise on the ground in the short term, which would cause joint stiffness The reason for this is that patients with plate surgery have a longer recovery time and are unable to walk and exercise for a short period of time. The patients in the observation group had no significant post-operative complications, while the patients in the control group developed post-operative incisional infection, mainly because the plate group had a large surgical trauma and long intraoperative exposure time, which increased the probability of post-operative infection; secondly, bone nonunion occurred, which was considered to be due to the patients\u0026apos; premature weight-bearing walking before the fracture healed and the disruption of peripheral blood flow by intraoperative periosteal stripping, resulting in post-operative bone nonunion.\u003c/p\u003e\n\u003cp\u003eIn conclusion, in the clinical treatment of Zhang-Hou fractures, B-ultrasound-guided manipulative revision combined with intramedullary tibial nailing has the advantages of short operative time, minimal intraoperative trauma, rapid postoperative recovery and few complications. It can also greatly reduce the number of intraoperative fluoroscopies, make intramedullary nailing surgery and TCM manipulative revision visualized, and shorten the learning curve of clinicians for intramedullary nailing surgery, which is worthy of clinical promotion.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are available from the corresponding authors on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhang Yingze, Hou Zhiyong, Zhang Qi, et al. Injury types and grading of lower 1/3 spiral fractures of the tibia combined with posterior ankle fractures[J]. Hebei Medicine, 2007(12):1337-1338.\u003c/li\u003e\n \u003cli\u003eZhang Yingze, Hou Zhiyong, Zhang Qi, et al. Study on the relationship between lower 1/3 spiral fracture of the tibia and ankle injury[J]. Journal of Hebei Medical University, 2007(05):364-365+402.\u003c/li\u003e\n \u003cli\u003eWang Yanzi, Huang Changhong, Feng Yang, et al. Comparison of the efficacy of hollow screws and \u0026quot;L\u0026quot;-shaped plates in the treatment of mid-lower 1/3 spiral fractures of the tibia combined with posterior ankle fractures[J]. Chinese and Foreign Medicine, 2019, 38(33):36-38.\u003c/li\u003e\n \u003cli\u003eYE Zhiyang, Huang Danlei, Wang Jun, et al. Efficacy of semi-extension intramedullary nailing with hollow screw fixation in the treatment of lower 1/3 tibial spiral fractures combined with posterior ankle fractures[J]. Modern Biomedical Progress, 2022, 22(13):2509-2513.\u003c/li\u003e\n \u003cli\u003eZhang Yingze, Hou Zhiyong, Zhang Qi, et al. Injury types and grading of lower 1/3 spiral fractures of the tibia combined with posterior ankle fractures[J]. Hebei Medicine, 2007(12):1337-1338.\u003c/li\u003e\n \u003cli\u003eGuo Fengbo. Clinical analysis of tibial intramedullary nailing and anatomical locking splints in the treatment of lower and middle tibial fractures[J]. Journal of Shandong Medical College, 2022, 44(01):40-42.\u003c/li\u003e\n \u003cli\u003eSchaffer NE, Wilson JL, Yee MA, et al. Intramedullary Nail for a Distal Tibia Fracture[J]. J Orthop Trauma, 2020,34(02):37-38.\u003c/li\u003e\n \u003cli\u003eCheng L, Li YH, Chu Y, et al. Intramedullary nailing via suprapatellar approach versus locked plating of proximal extra-articular tibial fractures: a randomized control trial[J]. Int Orthop, 2021, 45(6):1599-1608.\u003c/li\u003e\n \u003cli\u003eFranke J, Hohendorff B, Alt V, et al. Suprapatellar nailing of tibial fractures-Indications and technique[J]. Injury, 2016, 47(2):495-501.\u003c/li\u003e\n \u003cli\u003eZhang H R, Sun Y G, Cao L Chao. Effect of internal fixation with suprapatellar approach tibial intramedullary nailing on postoperative pain visual analog scale scores and knee function in patients with middle and lower tibial fractures[J]. China Medical Engineering, 2022, 30(02):123-125.\u003c/li\u003e\n \u003cli\u003eRingenberg JD, Tobey JL, Horinek JL,et al. Suprapatellar versus infrapatellar approach for intramedullary nail fixation of tibial shaft fractures: a review of the literature[J]. OTA Int, 2022, 5(1):196.\u003c/li\u003e\n \u003cli\u003eChen JC, Ye JC, Wu SJ, et al. Study on the effect of suprapatellar approach to tibial intramedullary nailing in the treatment of tibial stem fractures[J]. Heilongjiang Medicine, 2022, 35(03):656-658.\u003c/li\u003e\n \u003cli\u003eYang L, Sun Y, Li G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shafa\u0026apos;a\u0026apos;at fractures: a systematic review and meta-analysis[J]. J Orthop Surg Res, 2018, 13(1):146.\u003c/li\u003e\n \u003cli\u003eZamora R, Wright C, Short A, et al. Comparison between suprapatellar and parapatellar approaches for intramedullary nailing of the tibia[J]. Injury, 2016, 47(10):2087-2090.\u003c/li\u003e\n \u003cli\u003eZhou D, Guo W C, Su Y, et al. A comparative study of interlocking intramedullary nailing and percutaneous minimally invasive locking plate internal fixation for the treatment of middle and lower tibial fractures[J]. Jilin Medicine, 2018, 39(09):1757-1759.\u003c/li\u003e\n \u003cli\u003eCharak SS, Chib MS, Darokhan Maud, et al. Radiation-free Insertion of Interlocked Intramedullary Tibial Nail in Closed Extra-articular Displaced Tibial Shaft Fractures in an Emergency Setup[J]. Ortop Traumatol Rehabil, 2021, 23(6):427-431.\u003c/li\u003e\n \u003cli\u003eZheng Y, Yang X, Rong CH. Radiation damage of mobile C-arm machine and protective countermeasures[J]. Journal of North China Coal Medical College, 2011, 13(02):178-179.\u003c/li\u003e\n \u003cli\u003eWilliamson M, Iliopoulos E, Williams R, et al. Intra-operative fluoroscopy time and radiation dose during suprapatellar tibial nailing vers with infrapatellar tibial nailing[J]. Injury, 2018, 49(10):1891-1894.\u003c/li\u003e\n \u003cli\u003eShen SH, Wang XA, Fu Z. Ultrasound-guided closed reduction minimally invasive fixation for metacarpophalangeal fractures[J]. China Medical Imaging Technology, 2018, 34(02):293-296.\u003c/li\u003e\n \u003cli\u003eXiong GA, Fu WT. Clinical application effect of ultrasound in closed reduction intramedullary nailing for internal fixation of extremity fractures[J]. Chinese contemporary medicine, 2018, 25(35):41-43.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Tibial fracture, ultrasound, TCM manipulation and revision, intramedullary tibial nailing","lastPublishedDoi":"10.21203/rs.3.rs-2658060/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2658060/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eTo investigate and analyze the clinical efficacy of B-ultrasound-guided manipulative repositioning combined with tibial intramedullary nailing in the treatment of Zhang-Hou's (Z-H) fractures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Fifty-nine patients with Z-H fractures treated surgically in our hospital from January 2019 to December 2022 were selected for retrospective study, and were divided into 31 cases in the observation group (B-ultrasound-guided manipulative repositioning combined with intramedullary nailing of the tibia) and 28 cases in the control group (plate screw internal fixation) according to the surgical method. The general data, surgical indexes, VAS scores at 1, 3, 6 and 12 months after surgery, and the excellent rate of functional rehabilitation at 6 and 12 months after surgery were compared between the two groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere was no statistical difference between the general data of the two groups (P \u0026gt; 0.05), which was comparable. The observation group had better operating time, intraoperative blood loss, number of intraoperative fluoroscopy, hospital stay and fracture healing time than the control group, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The difference was not statistically significant when comparing the preoperative VAS scores of the two groups (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05); whereas the observation group had better VAS scores than the control group at all postoperative time points, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The incidence of postoperative complications in the observation group was 6.45% (2/31, cases), which was significantly lower than that in the control group (17.86% (5/28, cases), and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The excellent functional rehabilitation rate in the observation group was 93.55% (29/31, cases) at 12 months after surgery, which was significantly higher than that in the control group (78.57% (22/28, cases), and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Compared with conventional plate and screw internal fixation for Zhang-Hou fractures, B-ultrasound-guided manual repositioning combined with intramedullary nailing of the tibia has the advantages of optimizing surgical indexes, reducing postoperative complications, and improving postoperative functional recovery, and also shortens the learning curve of clinicians for intramedullary nailing surgery.\u003c/p\u003e","manuscriptTitle":"Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-04 22:10:09","doi":"10.21203/rs.3.rs-2658060/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1c9dd97a-1984-468f-9419-acf0a957eba5","owner":[],"postedDate":"April 4th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":20378475,"name":"Health sciences/Medical research/Pre clinical studies"},{"id":20378476,"name":"Health sciences/Medical research/Study design"}],"tags":[],"updatedAt":"2024-05-16T09:36:34+00:00","versionOfRecord":[],"versionCreatedAt":"2023-04-04 22:10:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2658060","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2658060","identity":"rs-2658060","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}