Early Outcome of Open Locked Intramedullary Sign Nail in Closed Tibial Diaphyseal Fracture

Abstract

Background: Fracture of the tibial shaft is a major cause of morbidity and mortality in patients with lower extremity injuries and it is especially  prevalent in the economically active age group 3. The treatment of tibial shaft fracture has always been a focus of interest and has undergone significant evolution over the past century. Currently, interlocking intramedullary nail has emerged as the treatment of choice for tibial shaft  fractures. Open locked intramedullary nailing with the aid of an external jig (without the use of an image intensifier) is increasingly being used in
resource poor countries like ours. The study was aimed at evaluating the early outcome of tibial shaft fracture treated by open method of locked intramedullary SIGN nailing.

Patients and Methods: The study was carried out in National Orthopaedic Hospital, Igbobi Lagos (NOHIL) from July 2015 to July 2016. A prospective, interventional study was carried out on skeletally mature patients or age = 18 years, with unilateral closed tibial shaft fractures. Seventy six patients, who met the inclusion criteria and completed a minimum of 24 weeks of follow up, participated in the study. A structured questionnaire was used to interview the participants. Data was analysed with regards to the clinical and radiological outcome to evaluate the effectiveness, outcome and morbidity associated with the procedure

Results: The peak age was 25-34 years. Male to female ratio was 2:1. Road traffic accidents were the most common (86.9%) mechanism of injury.  Most of the fractures were comminuted (40.8%), the fractures were mostly located in the distal third (32%). The SIGN nail with its external jig
system (without the aid of image intensification) was utilized in all cases. The patients were followed up for 24 weeks. During follow up visits, the state of the wound, limb length discrepancy, malrotation deformity, range of motion of the knee joint and rate of fracture union were assessed. The
mean time to fracture union was 17.5±4.8 weeks. Fracture union was achieved in all the patients though there was delayed union in 15 (20%) cases. There was no incidence of nonunion, malunion, broken implant or screw loosening. Only two patients had superficial wound infection, no patient
had deep wound infection. Eighty four percent of our patients were satisfied with the outcome of treatment, using the Johner and Wruhs' outcome measure.

Conclusion: Open locked intramedullary SIGN nail is a safe  and effective treatment modality for closed tibial shaft fractures in developing countries where image intensifiers and fracture tables are not readily available.

Keywords: Tibial Fracture, Locked intramedullary nail, SIGN nail, Johner and Wruhhs outcome measures