Use of a Minimally Invasive Traction Repositor versus Conventional Manual Traction for the Treatment of Tibial Fractures: A Comparative Study from a Tertiary Hospital in China

Figures & data

Figure 1 The general view of minimally invasive traction repositor (MITR).

Figure 2 Diagram of device application.

Figure 3 Intraoperative view of minimally invasive traction repositor (MITR) application. A 20-year-old female patient with comminuted fracture of the left tibia. (A) Anteroposterior view. (B) Lateral view. A 48-year-old male patient with distal third fracture of the right tibia. (C) The MITR is connected and applied to the affected limb. (D) The minimally invasive incision for closed reduction of the tibia fracture and intramedullary nail insertion.

Figure 4 Anteroposterior and lateral X-ray films of a 20-year-old female patient with comminuted fracture of the left tibial. (A) Before surgery. (B) Immediately after surgery. (C) 1 month after surgery. (D) 3 months after surgery. (E) 6 months after (F) 12 months after surgery.

Table 1 Comparisons of Patient Demographics and Injury-Related Data Between Two groups^§

Characteristics	Group A With MITR (n=32)	Group B With Manual Traction (n=87)	P value*
Age, years	53.2 ± 18.8	48.5 ± 19.0	0.230
Gender, no. (%)			0.173
Male	19 (59.4%)	63 (72.4%)
Female	13 (40.6%)	24 (27.6%)
BMI group, no. (%)			0.859
Normal (BMI<24 kg/m2)	11 (34.4%)	34 (39.1%)
Overweight (24 ≤ BMI < 28 kg/m2)	18 (56.3%)	44 (50.6%)
Obesity (BMI ≥ 28 kg/m2)	3 (9.4%)	9 (10.3%)
Residence, no. (%)			0.269
Rural	18 (56.3%)	39 (44.8%)
Urban	14 (43.8%)	48 (55.2%)
Smoking history, no. (%)			0.349
Yes	20 (62.5%)	46 (52.9%)
No	12 (37.5%)	41 (47.1%)
Drinking history, no. (%)			0.110
Yes	12 (37.5%)	47 (54.0%)
No	20 (62.5%)	40 (46.0%)
Injury mechanism, no. (%)			0.591
Low-energy fracture	17 (53.1%)	51 (58.6%)
High-energy fracture	15 (46.9%)	36 (41.4%)
AO/OTA classification, no. (%)			0.760
A	18 (56.3%)	55 (63.2%)
B	10 (31.3%)	24 (27.6%)
C	4 (12.5%)	8 (9.2%)
ASA, no. (%)			0.423
1	18 (56.3%)	37 (42.5%)
2	8 (25.0%)	31 (35.6%)
3	5 (15.6%)	12 (13.8%)
4	1 (3.1%)	7 (8.0%)
Method of anesthesia type, no. (%)			0.488
Regional anesthesia	21 (65.6%)	51 (58.6%)
General anesthesia	11 (34.4%)	36 (41.4%)
Surgical delay	2.5 (1, 4)	4 (2, 4)	0.257

Notes: ^§Values are presented as the number (%). Age is presented as the mean ± standard deviation. Surgical delay is presented as the median and interquartile range (IQR). *The differences between the groups were not statistically significant for all parameters.

Abbreviations: MITR, minimally invasive traction repositor; BMI, body mass index; ASA, American Society of Anesthesiologists.

Table 2 Comparisons of Operation-Related Data and Outcomes Between Two groups^§

Characteristics	Group A With MITR (n=32)	Group B With Manual Traction (n=87)	P value
Operation time, (min)	67.0±12.2	72.7±13.4	0.039*
Fracture reduction duration, (min)	10.9±2.7	19.3±6.3	<0.001*
Intraoperative blood loss, (mL)	200 (100, 200)	400 (200, 500)	<0.001*
Fluoroscopy time, (min)	15.4±3.7	20.9±5.5	<0.001*
Times of fluoroscopy	14.0±2.6	23.1±7.6	<0.001*
VAS	1.8±0.8	2.6±1.5	<0.001*
HSS	90.8±2.3	86.4±3.8	<0.001*
Fracture healing time, (week)	19.8±3.8	19.8±3.9	0.968
Postoperative complications
Bone nonunion, no (%)	0 (0.0%)	3 (3.4%)	0.563
Implant failure, no (%)	1 (3.1%)	2 (2.3%)	1.000
Infection, no (%)	1 (3.1%)	3 (3.4%)	1.000

Notes: ^§Values are presented as the mean ± standard deviation. Postoperative complications are presented as the number (%). Intraoperative blood loss is presented as the median and interquartile range (IQR). *P<0.05, statistical significance.

Abbreviations: MITR, minimally invasive traction repositor; VAS, visual analog scores; HSS, Hospital for Special Surgery score.