Résumé
Background: Although the tibia is one of the most commonly fractured long bones in the body, there are two accepted management techniques: reamed and unreamed nailing. There is not a general consensus as to which technique is more advantageous to the patient. Patients and methods: This was a single centre prospective randomized trial of 38 adults with a tibial shaft fracture who were treated with either reamed or unreamed nailing. Results: Overall fracture healing time was 23 weeks in the reamed group and 25 weeks in the unreamed group. Differences in rate of clinical union, clinical outcome, time for weight bearing and complications in both the groups were not statistically significant. Conclusion: There are no clear indications or contraindications to favour either reamed or unreamed nailing over the other. Technique, fracture union, functional outcome and complications are similar in both groups. Considering the ease of technique application and the decreased operative time, unreamed interlocking nailing has an edge over reamed interlocking nailing.
Résumé
After the stabilization using unreamed intramedullary interlocking nails for the management of fractures of the tibial shaft, a large percentage of patients whose fractures would proceed to delayed bony union may be subject to secondary surgical procedure. The purpose of this study is to determine whether ultrasound, through its potential early assessment of the presence or absence of callus at the fracture site, can be used to predict the need for secondary surgical procedure. Fourteen tibial fractures (5 open, 9 closed) were treated with unreamed interlocking intramedullary nailing. Radiographs were obtained to monitor the maintenance of reduction and fracture healing. The results of ultrasound studies were obtained at two-week intervals for 10 weeks postoperatively and read by a radiologist. In prospective study of 14 patients, tibial fractures treated with unreamed interlocking intramedullary nailing were analyzed from June 1995 to February 1997 and following results were obtained. 1. Ultrasound correctly predicted fracture healing in all 10 fractures that subsequently progressed to fracture union. 2. Of the 4 fractures that did not heal, ultrasound was able to predict delayed union before it was radiographically evident. 3. Ultrasound predicted fracture healing at an average of 42 days (range, 22-70 days). In comparison, the plain radiographs showed fracture healing at an average of 126 days (range, 70 - 180 days). In conclusion, the tibia was ideal for ultrasound study because of the thin overlying soft tissue. Furthermore, the presence of the intramedullary nail facilitated evaluation of the intervening tissue. And there were several advantages of ultrasound over other imaging modalities. It was noninvasive, easy to use, and painless method of evaluation that does not use ionizing radiation.