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Intramedullary nailing after external fixation of the tibia
1University Hospital of Brooklyn, Department of Orthopedics, NY 11203, USA.
Bulletin (Hospital for Joint Diseases (New York, N.Y.))
|January 1, 1995
Summary
Sequential intramedullary nailing after external fixation is safe and effective when performed by protocol. Reconstructive nailing has strict contraindications, but can succeed with proper soft tissue healing and antibiotic use.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
Background:
- External fixation of tibia fractures can lead to high complication rates, including nonunion and infection.
- Secondary intramedullary nailing is a potential treatment option, but indications require refinement.
Observation:
- The study differentiates between sequential secondary nailing (protocol-driven) and reconstructive secondary nailing (non-protocol).
- Sequential nailing involves a short external fixation period, a planned interval before nailing, and specific exclusion criteria.
- Reconstructive nailing is typically for prolonged external fixation and addresses complications like delayed union, nonunion, malunion, and infected nonunion.
Findings:
- Protocol-driven sequential intramedullary nailing is deemed safe and effective.
- Reconstructive intramedullary nailing has contraindications including active infection, open wounds, or sequestra.
- Successful reconstructive nailing requires complete soft tissue healing, preoperative antibiotics, and non-reamed nail insertion.
Implications:
- Refined indications for secondary intramedullary nailing can improve outcomes for tibia fractures.
- Sequential nailing offers a safer, planned approach compared to reconstructive nailing.
- Careful patient selection and surgical technique are crucial for successful reconstructive intramedullary nailing.