Management of closed tibal shaft fractures with reamed inter locking nail

ABSTRACT

The objective of the study was to evaluate the results of closed reamed interlocking nail in the management of closed tibial shaft fractures. Descriptive Observational study Place and Duration This study was conducted in the Department of Orthopedic, Khyber Teaching Hospital Peshawar, from Jun 2007 to December 2008. A total of 32 patients above the age of 18 years were included in the study. Patients were admitted through accident and emergency department. Written informed consent was obtained from all patients. Detailed history was asked, every patients was assessed clinically and radiographycally. Reamed interlocking intramedullary nailing was done as per protocol. Patients were followed for 1 year, and were evaluated for union, infection, range of motion of knee and ankle and implant problems. 2 patients were lost to follow up and the study was completed on 30 patients. All the fractures united without any need for bone graft. Simple fractures united in average period of 12.5 weeks while comminuted and segmental fractures took longer by four weeks, and united in an average of 16.5 weeks. Two patients developed superficial infection at the site of screws which were treated accordingly with drainage and antibiotics and removal of the distal screw. All the patients had full range of knee movement while 28 patients had full range of ankle movements. The remaining two patients had 15-20 degree loss of ankle dorsiflexion. Nail breakage was not observed in any patient while two had breakage of the proximal and two had breakage of distal screws. We concluded that closed intra medullary nailing for closed diaphyseal fracture of the tibia is a safe and rewarding technique which has high rate of union and relatively low complications rate, there is early return to activities