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Nonreamed interlocked intramedullary tibial nailing. One community's experience
P J Duwelius1, A H Schmidt, R A Rubinstein
1Oregon Health Sciences University, Division of Orthopedics and Rehabilitation, Portland 97201-3098, USA.
Clinical Orthopaedics and Related Research
|June 1, 1995
Summary
Unreamed interlocked tibial nails effectively stabilize acute displaced tibial fractures, achieving a 94% healing rate. Adjunctive use of a distractor aids reduction and alignment during intramedullary nailing.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Biomedical Engineering
Background:
- Acute displaced tibial fractures require effective stabilization for optimal healing.
- Management of open and closed tibial fractures presents unique challenges.
- Intramedullary nailing is a common surgical approach for tibial shaft fractures.
Purpose of the Study:
- To evaluate the efficacy of unreamed interlocked tibial nails with a distractor for acute displaced tibial fractures.
- To assess complication rates and outcomes in a cohort of tibial fracture patients.
- To determine the role of static locking and early dynamization in fracture union.
Main Methods:
- A standard operative protocol using a distractor and unreamed interlocked tibial nail was applied to 49 acute displaced tibial fractures.
- Fractures included both closed (31) and open (18) injuries of varying Gustilo-Anderson grades.
- Patient outcomes, healing rates, and complication incidence were prospectively recorded.
Main Results:
- A high healing rate of 94% (46 out of 49 fractures) was achieved.
- Complications included nonunion (6%), deep infection (4%), delayed union (18%), and malunion (8% and 4% for angular and rotatory, respectively).
- Screw failure (bent or broken) occurred in 24% of cases, and 57% required additional surgery, often for dynamization.
Conclusions:
- Unreamed tibial nails offer adequate stabilization for displaced tibial fractures, both open and closed.
- Static locking is crucial for axially unstable fractures.
- Early dynamization, exchange nailing, or bone grafting may be considered to expedite union and prevent hardware failure. Distractors are beneficial for reduction and alignment.