Management protocol for unreamed interlocking tibial nails for open tibial fractures

Over a 15-month period, 41 open grade I-IIIA tibia fractures were treated with unreamed interlocking nails. A protocol previously established by the authors to enhance fracture union was followed. The purpose of the study was to determine if union rate for the comminuted statically locked fracture could be reduced through early dynamization, bone grafting, or a combination of both. Of the 41 patients, 15 had grade I wounds, 12 had grade II wounds, and 14 had grade IIIA wounds. Fracture classification using the Orthopaedic Trauma Association Classification showed 19 42A fractures, 15 42B fractures, and seven 42C fractures. Fifteen of the 41 fractures required dynamization for rotational and axial stabilization. Of these 15 patients, five subsequently underwent dynamization only, six underwent autogenous bone grafting, and three underwent both dynamization and bone grafting, one of which also underwent exchange rodding. One patient underwent bone grafting and exchange rodding. Comparing the fractures of these 15 patients to similar fractures previously reported, union rate was reduced from 37 to 24 weeks. This was statistically significant to 0.002. It is the authors' recommendation that statically locked unreamed tibial nails be dynamized and/or bone grafted at 6-8 weeks postinjury to enhance union and reduce the time of fracture healing.