DIAPHYSEAL TIBIAL FRACTURES;

CLOSED INTRAMEDULLARY INTERLOCKING NAILING

Abstract

Objective: To determine the outcome and consequences of close intramedullary
interlocking nailing in diaphyseal tibial fractures and to observe the hospital stay & complications
in this method of treatment. Place & Duration: The study was conducted in department of
orthopaedic unit-I at Liaquat University Hospital Jamshoro/Hyderabad during Jan 2011 to June
2012. Patients & Method: The present study constituted on 43 patients, 3 cases were dropped
during follow up and the rest 40 cases completed 1 year post operative follow up. After having
routine laboratory investigations and necessary x – rays, the stable patients were operated for
intramedullary interlocking nailing on routine operating days. The patients were assessed
according to the criteria mentioned in follow up proforma from date and time of arrival to final visit
in review clinic and results were tabulated. Results: Among 40 patients, 38 (95%) were males and
02 (5%) females. The age ranges from 17 to 50 years with mean age of 32.23 years. There were 25
close fractures (62.5%) 15 open fractures (37.5%), among these 13 (32.5%) were Gustilo type I
and 2 (5%) were of type II. The mode of injury in majority (75%) of cases was road traffic accident.
Good union achieved in 39 cases (97.5%) in 17.53 weeks. But only 1 (2.5%) case unfortunately
went in infected non union and was converted into Illizarove external Fixation. The main
complication observed after surgery was loosening of screw in 3 (7.5%) cases. Deep infection
was observed in the medullary cavity in 3(7.5%) cases (table-V). It has been observed in
analyzing the functional outcome of these patients that majority (80%) of cases was able to sit on
bed in 12-24 hours and was able to stand in 24-48 hours. In next 24 hours after surgery 75% of
patients were pain free. The mean hospital stay in these cases was 8.53 days and by the 48th
week all of cases were able to join their job except one case in which non union observed due to
infection. Conclusions: The data from the current study reveals that intramedullary interlocking
nailing of closed and open grade I and II fractures is a safe technique. It combines a high rate of
union with a low complication rate, less hospitalization and early return to job.