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Outcome of Open Diaphyseal Tibial Fracture Managed with Intra Medullary Inter Locking Nail
Keywords:
Tibia , open diaphysial fracture, static interlocking nail, non unionAbstract
Objectives: To evaluate the outcome of open tibial diaphyseal fracture managed by intra medullary inter locking nail in terms of frequency of union, range of knee motion and absence of infection.
Study Design: Descriptive case series
Place and duration of study: Department of Orthopedics, Jinnah Post Graduate Medical Centre, Karachi from June 2009 to December 2009
Patients and Methods: Patients with open tibial diaphysial fracture Gustilo-Anderson I-III A type managed by intramedullary static inter locking nail were included while patients with co morbids, previous knee or ankle disease with restricted movement and Gustilo-Anderson type III B-C were excluded. Patients were evaluated clinically and radiologically for union of fracture, infection and knee range of motion on monthly interval for 6 months and documented on proforma. SPSS-15.0 was used for statistical analysis.
Results: 92 patients aged 18 – 60 years were selected. 71 (77.2%) were males and 21 (22.8%) females. Mean age was 31.96 ± 8.86. Gustilo-Anderson type I fracture was found in 77 (83.7%) patients, type II fracture in 11 (12%) and type III-A in 4 (4.3%) patients. Sixty-one (66.3%) patients treated within 6 hours of injury while 31 (33.7%) patients treated between 6 - 12 hours. Superficial infection was found in 11(12%) patients during initial follow up. 30 patients needed dynamization 6th week visit. On last follow up at 6 months, 3 (3.3%) patients had deep infection and 89 (96.7%) remained infection free. Three (3.3%) patients had non-union. Majority (96.7%) had range of motion 0 to 1350. Overall outcome of the patients showed 90.2% success and 9.7% failure.
Conclusion: Intramedullary static Interlocking Nail is the treatment of choice in open tibial diaphyseal Gustilo-Anderson Type I-III A fractures, as it provides early mobilization of the patient, decreases hospital stay, prevents complications, improving functional outcome, thus total cost of treatment is reduced.
References
2. Whittle AP, Wood II GW. Fractures of Lower Extremity. In: Canale ST. Campbell’s Operative Orthopedics. 10th Edition. USA. Mosby, 2003: 2725-2872
3. Gustilo RB, Anderson JT. Prevention of Infection in the Treatment of 1,025 open fractures of long bones JBJS 58-A: p 453-458, 1976
4. Merchant TC, Dietz FR. Long-term follow-up after fractures of the tibial and fibular shafts. J Bone Joint Surg Am. Apr 1989; 71: 599-606.
5. Kazmi TH, Omair A, Inam SN, Shaikh I, Jamali S. Spectrum of injuries at the emergency department of a tertiary care hospital. J Coll Phy Surg Pak. 2004;14:61.
6. Luby S, Hassan I, Jahangir N, Rizvi N, Farooqi M, Ubaid S, et al. Road traffic injuries in Karachi: the disproportionate role of buses and trucks. Southeast Asian J Trop Med Public Health 1997;28:395-8.
7. Mohammed A, Saravanan R, Zammit J, King R. Intramedullary tibial nailing in distal third tibial fractures: distal locking screws and fracture non-union. International Orthopaedics 2008;32:547–9.
8. Blachut PA, O'Brien, PJ, Meek RN, Broekhuyse HM. Interlocking Intramedullary Nailing with and without Reaming for the Treatment of Closed Fractures of the Tibial Shaft. A Prospective, Randomized Study. J Bone Joint Surg 1997; 79-A; 640-6
9. Vineet J, Aggarwal A, Methani A, Jain P, Dhaon BK. Primary Unreamed intramedullary locked nailing in open fractures of tibia. Indian J Orthop: 2005;39:30-2.
10. Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing J Bone Joint Surg. 1986; 68 :877-8.
11. Blachut PA, O'Brien, PJ, Meek RN, Broekhuyse HM. Interlocking Intramedullary Nailing with and without Reaming for the Treatment of Closed Fractures of the Tibial Shaft. A Prospective, Randomized Study. J Bone Joint Surg 1997; 79-A; 640-6
12. Freedman EL, Johnson EE. Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop. 1995; 315:25-33.
13. Yokoyama K, Itoman M, Uchino M, Fakushima K, Nitta H, Kajima Y. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing. http// www,ijoonline.com on October 26, 2009.
14. Djahangiri A , Garofalo R , Francios C, Pierre-Francios L, Michael W, Elyazid M. Closed and open grade I and grade II tibial shaft fractures treated by reamed intramedullary nailing. Med P Practice 2006;15: 293-8.
15. Giri SK, Adhikari BR, Gurung GB, RC DR, Bajracharya AR, K Khatri. Mini-open reduction and intramedullary interlocking nailing of fracture shaft of tibia without an image intensifier. Nepal Med Coll J 2008; 10 (2): 123-5.
16. McQueen MM, Christie J, Court-Brown CM. Compartment pressures after intramedullary nailing of the tibia. J Bone Joint Surg Br. 1990; 72:395-7.
