Early outcome of interlocking intramedullary nailing of infected tibia fracture nonunions: A report of 2 cases

Abstract

Background: Eradication of infection and fracture union are the two major objectives of treatment of infected non unions. Recent studies indicate that locked intramedullary nailing of tibia fracture non unions provide a  mechanical environment which enhances fracture healing even in the presence of infection. It also allows early weight-bearing without the burden of an external frame making it more acceptable to patients than external fixators.
The Cases: The authors present 2 cases of infected tibia non unions. The first case had segmental fibulectomy, fracture debridement, deep tissue sampling, locked intramedullary nailing, cancellous bone grafting and antibiotic therapy. The second case had segmental fibulectomy, wound and fracture debridement, deep tissue sampling, locked intramedullary nailing, cancellous bone grafting, fasciocutaneous flap wound cover and antibiotic therapy.
Results: The first case had a satisfactory (early) outcome having achieved full weight bearing at 12 weeks with no clinical evidence of infection.  Similarly, the second case had a good outcome having achieved full weight bearing without clinical signs of infection at 12 weeks (although immediate post-op period was complicated by surgical site infection which was effectively managed). Based on these two cases, the importantguiding principles were identified and discussed.
Conclusion: With appropriate surgical technique and strict adherence to surgical principles, the outcome of interlocking intramedullary nailing for infected tibia non unions are satisfactory.

Keywords: Early Outcome, Intramedullary Nailing, Tibia, Fracture Non  unions