Treatment of tibial shaft fractures with Kuntscher intramedullary nailing

ABSTRACT

This study had been carried out at Assiut University Hospital, Assiut, Egypt and El-Razi Hospital Kuwait, between the year 1987 and 1989. 60 tibial shaft fractures were included in 56 patients who were treated with Kuntscher intramedullary nailing. There were 14 females and 42 males [75%]. Their ages ranged from 17 years to 65 years, average [38 year]. The majority of the patients were between 21 and 40 years [average 36.2 years]. The patients were followed-up until months]. The majority of these tibial fractures [70%] were caused by motor car accidents. There were 43 closed and 17 open fractures. The majority of open fractures were Grade 1 in 8 cases [13.3%]. In the 60 tibial fractures there were 10 with double fracture making a total of 70 fracture level. Primary railing i.o on some day in [16], early nailing i.e within the 1st week [21], and delayed nailing i.e after 1st week [18]. The average time for radiological union was 18.25 weeks for fractures of junction of upper 1/3rd and middle 1/3rd, but was 18.77 weeks for middle 1/3rd and 21 weeks for junction of middle and lowest 1/3rd and was 17.78 weeks in lower 1/3rd. Closed fractures healed in 17.45 weeks, 15 patients healed within 24.2 weeks. Cases without reaming of medullary canal took longer time to heal [20.7 w] than nails fixed after reaming [17.2 w]. The bigger the diameter of the nail the rapid healing time i.e less than 11 mm the healing time [21 w], more than [11 to 13] the healing time [16.7 w]. The complication were infection of open fracture [17.6%] and 2.3% infection in closed fractures, delayed union in 18 cases [30.3%].There was no non-union, 20% of cases healed with shortening varying between less than 1 cm and 3 cm. 16.4% patients showed mild to moderate limitation of movements of knee joint. 53% of patients complained of knee irritation and pain in kneeling. The final assessment in reaming group were excellent in 63.6%, fair 27.3% and poor 9.1% but in group without reaming showed excellent in 48.5%, fair in 48.5% and poor in 3%