Results Of Compound Diaphyseal Tibial Fractures Treated By Unreamed Nail

Compound fractures of tibia are one of the commonest fractures seen in clinical practice. Traditionally their treatment involved the application of external fixator and then definitive surgery once the wound has healed. This prospective study of 47 patients was undertaken to evaluate the results of unreamed interlocking nailing in such fractures. They were followed up for an average of 14 months. All the fractures united at an average of 24 weeks and there were no major complications. In our study17 cases (36.7%) had excellent results, 19cases (40.4%) had good results, 11 cases (23.4%) had fair results and none of the cases had poor results as per criteria laid down by Johner and Wruhs (1982) [15]. Our study does suggest that unreamed interlocking nailing is a good method of primary internal fixation of compound (grade I to IIIB) fractures of tibia.

Treatment of Open Tibial Shaft Fractures using Unreamed Nailing

PURPOSE: To report the results of unreamed nailing using a nail with the largest possible diameter for the management of the open tibial shaft fractures. MATERIALS AND METHODS: Nineteen patients with open tibial shaft fractures underwent unreamed nailing with the largest possible diameter according to the isthmic diameter measured on preoperative radiography. There were 1 Grade I, 6 Grade II, 9 Grade IIIa, 3 Grade IIIb open fractures. There were 4 type A, 12 type B, 3 type C fractures according to the OTA classification. Fractures were classified as The nail was introduced after gentle passage of a 7 to 8 millimeter-hand reamer. RESULTS: Union was obtained in all cases. However 9 (47%) fractures required an additional procedures before union. In 6 cases, dynamization was done. Two of them were required exchange nailing for nonunion, 1 of two gained bony union through additional bone graft. Three of the others had gained union through exchange nailing, bone graft, bone transport respectively. There were one rotational malunion, one superfical and one deep infection. Interlocking screw breakage developed only in one patient. CONCLUSION: Our data indicate that unreamed nailing in the management of open tibial fractures is safe and reliable method. Using a tight fitting nail with the largest possible diameter is a safe and effective way to avoid the problems of screw breakage.

Grade III Tibia Open Fractures Treated with Unreamed Tibial Nailing

PURPOSE: This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture. MATERIALS AND METHODS: Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated. RESULTS: Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use. CONCLUSION: In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.

Treatment of open tibia shaft fractures using unreamed intramedullary nail / 中华创伤骨科杂志

Objective To introduce the method,characteristics and indication of unreamed in-tramedullery nailing in treatment of open tibia fractures.Methods 28 cases were classified according to the Gustilo method:18 belonged to type I,8 type II and 2 type III a.26 nails with 8mm in diameter and 2 nails with 7mm in diameter were used.Results All cases were fixed successfully with unreamed nailing without any X-ray aids.All of fractures had no infection,and healed in an average time of 5.6 months.There were no broken nails and screws in this series.Conclusion The unreamed intramedullary nailing is an advantageous therapeutic method with simple management,little trauma and wide indication in management of open tibia fractures.

Antibiotic cement-coated Unreamed nailing for Treatment of Infected Nonunion of Long bone / 대한정형외과학회잡지

PURPOSE: Our study was aim to evaluate the results of treatment by antibiotic cement-coated unreamed nailing for infected nonunion of long bone shaft. MATERIALS AND METHODS: Ten cases of nonunion, 6 femurs and 4 tibias were included in this study. Average age of patients was 38.5 and men were eight. Average follow-up period was 16.4 months (12-35) . Etiologies of infection were open fractures (6 cases) and iatrogenic (4 cases) . Eight cases which had positive antimicrobial sensitivity test preoperatively were used a sensitive, heatstable, and powderform antibiotics. Primary autogenous bone grafting with nailing was perfomed in five cases. Delayed bone grafting after curettage and nailing was done in another five cases in infected by S. aures organism. RESULTS: All of ten cases had bony union. Union time was average 31.5 in femur and 26.4 in tibia. Early weight bearing ambulation and motion of adjacent joint were beneficial. But average 8 mm of shortening was developed and angulation more than 5 degrees occured in one case. CONCLUSION: Antibiotic cement coated-unreamed intramedullay nailing is the recommended treatment of method in infected nonunion of long bone shaft with minimal shortening.

Treatment Using Unreamed Intreamedullary Nailing for Closed and Open Tibial Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this paper was to evaluate the treatment results according to bone union, union time, and complications, including infection of unreamed nailing of tibial fractures between closed and open fractures. MATERIALS AND METHODS: We reviewed 64 tibial shaft fractures that were treated with unreamed tibial nail. These included 42 closed fractures and 22 open fractures. RESULTS: Average union time of closed fractures was 19.8 weeks and that of open fractures was 20.2 weeks, nonunion rate were 4/42 and 3/22 in closed and open fractures. Average union time were 19.2, 20.4, 21.3 weeks in open grade I, II, llla fractures. According to the type of fractures, average union time were 18.5, 20.2, 24.6 weeks and nonunion rate were 2/29, 3/26, 2/9 in type A, B, C fractures. According to the level of fractures, average union time were 20.0, 20.3, 19.4 weeks and nonunion rate were 1/5, 4/37, 2/22 in proximal, middle, and distal fractures. There was no significant differences in average period of radiologic union, infection rate and nonunion rate between closed and open fracture group, but longer union time and higher nonunion rate in complex and comminuted fractures (P<0.05). CONCLUSIONS: We consider unreamed intramedullary nailing in the tibial shaft fractures as a good treatment modality for closed and open grade I, II, IIIa fractures

The Treatment of Fracture of Tibial Shaft with Rush Nailing and Early Weight Bearing / 대한정형외과학회잡지

Twenty nine patients who had fracture of tibial shaft were treated with closed Rush nailing and early weight bearing. 1. The average age was 37.8 years (range from 20 to 65), and 21 were men and 8 women. Eighteen cases were open fractures and 11 closed. 2. The time for clinical union was averaging 15.4 weeks. In some cases callus appeared as early as 3 weeks after nailing and in most cases appeared at 8 weeks. 3. Mild angular and rotational deformity of the fractured shaft were developed as complication but did not present any clinical problems. No deep wound infection and pulmonary embolism were encountered. 4. The nails allowed a certain dynamic controlled motion at the fracture site which was probably beneficial to early callus formation. 5. This type of closed nailing method required no medullary reaming, further periosteal stripping and muscle detachment. The allowance of early knee and ankle movements and early weight bearing after surgery could be listed as the advantage.