Outcome of Interlocking Intramedullary Nailing in the Treatment of Diaphyseal Tibial Fractures

Abstract

Introduction: Fracture of the tibia is one of the commonest musculoskeletal injuries. The current practice is a locked intramedullary nailing of these fractures. This retrospective study aims to review the use of, and assess the clinical outcome of reamed locked antegrade intramedullary nailing of the tibia.
Material and Methods: All tibia fractures fixed with intramedullary nailing between January 2009 and December 2011 were included. Cases of fractures in the proximal 4th or within 4cm of ankle joint, fractures in tibiae with open growth plates and Gaustilo type IIIc fractures were excluded. Open fractures were further classified using the Gaustilo-Anderson classification. A reamed interlocking nail was inserted under an image intensifier. All nails were statically locked both proximally and distally. An initial thorough debridement was done for all open fractures. All wounds were then allowed to heal secondarily. Outcome of surgery was assessed using the modified ketenjinan's criteria. The outcome was then classified into excellent, good, fair or poor. Nail width used and fracture type (closed or open) were each correlated with the outcome of surgery.
Results: Twenty cases which fulfilled the inclusion criteria were reviewed. Most of the patients were males and young adults (65% and 63% respectively). Motor vehicular accidents constituted 85% of the cause of the injury while 15% resulted from assaults and falls from height. The commonest fracture configuration observed was oblique (45%) with most fractures located in the middle-third of the diaphysis. Sixty-five percent of the fractures were closed and the remainder open. Except in cases of non-unions, malunion and a case of a closed fracture presenting 3weeks post-injury, all fractures were reduced closed under imaging. Reaming as well as proximal and distal locking was done in all cases. There was a case of breakage of proximal screw, two cases of deep infection. Outcome of surgery at the time of full weight-bearing was evaluated according to the modified Ketenjinan's criteria. Results were good to excellent in 85% cases, and poor to fair in 15% cases.
Conclusion: Antegrade locked intramedullary nailing of tibia fractures offers a satisfactory functional outcome in our local environment. The ultimate width of the nail used when reaming and locking at both ends is done does not significantly affect the outcome of surgery.

Keywords: Tibia, Fracture, Intramedullary nail, Open and closed fractures, outcome.