Prospective study of management of close or compound segmental fracture tibia by close reduction and internal fixation with interlocking nail
Journal Title: International Journal of Orthopaedics Sciences - Year 2017, Vol 3, Issue 2
Abstract
Background: Fractures of tibia are rated as one among the list of common and major skeletal injuries as one third of its surface is subcutaneous. Segmental tibial fractures feature a unique fracture type characterized by a completely isolated intercalary osseous fragment separated by at least two different fracture lines. Since tibia is a large bone and one of the principal load bearing bones in the lower extremity, fractures can cause prolonged morbidity, extensive disability unless treatment is appropriate. Treatment of such fractures in adults is a challenge to orthopaedic surgeons due to its poor soft tissue coverage and poor blood supply. Moreover, compartment syndrome, neurovascular injuries and infection might add to the burden. Later non union, delayed union and Mal-union may occur. The acceptable treatment goal for the segmental fracture tibia is union maintaining normal length, normal alignment without rotational deformity, normal joint movements and reduced hospital stay. Interlocking nailing has proven to be the method of choice for fixation of these fractures. The intramedullary nailing under image intensifier fulfills the objective of stable fixation with minimal tissue damage resulting in better and quicker fracture unions. Materials and methods: This study included 51 patients admitted in the Department of Orthopaedics with either open (37) or close segmental tibia fractures with compromised soft tissue (14) and treated with interlocking nail. Anterioposterior and lateral radiograph were done to diagnose fracture type. Routine preoperative investigation was followed. Patients were operated within 48 hours of hospital admission. Patients were followed up periodically on an outpatient basis on 2nd, 4th, 6th, 10th, 14th, 18th week and 6th month. Clinical and radiological assessment was done for pain, deformity, shortening, range of motion of knee, ankle, subtalar joints and radiological union.The final outcome was assessed using Johner and Wruh’s criteria Results and Discussion: In our series, out of 51 cases, 47 (92.15%) had acceptable Johner and wruth's criteria for functional results (sum of excellent and good results). Excellent in 36 (70.59%), good in 11 (21.57%), fair in 3 (5.87%) and poor in 1 (1.97). These results were comparable with results btained by Ekeland and Alho who reported results excellent in 29, good in 13 and fair in 2 and poor in one out of 45 cases. Conclusion: From this study, it was concluded that the preferred method of initial fracture stabilisation is the use of unreamed interlocking inramedullary tibial nail with immediate soft tissue cover whenever possible, this procedure require less surgical time, hospital stay, is cost effective and have minimum complications with good functional outcome.
Authors and Affiliations
Dr. Vivek P Nikumbha, Dr. G Krishna N Goud, Dr. Siddharth Baidya, Dr. Kuldeep Mishra
Keywords
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- EP ID EP502053
- DOI 10.22271/ortho.2017.v3.i2f.53
- Views 99
- Downloads 0
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