Percutaneous interlocking nailing of tibial shaft fractures: Technique and outcomes

ABSTRACT

Closed interlocking tibial nailing is a well accepted method of treating tibial fractures. There are advantages to perfoming surgery via smaller incisions. This study provides a method for percutaneous interlocking nailing of tibial shaft fractures intended to improve the technique, functional results and also reduces the problem of anterior knee pain, by avoiding injury to the infrapatellar nerve and/or iatrogenic trauma to, or dissection around, the patellar tendon. The main difference in the technique is the use of a 6 cm-long k-wire fixed temporarily in the anterior cortex of the tibial tuberosity to indicate the midline for medullary canal opening, a small stab incision of an average length of 2.5 cm reaching the tibial cortex midway between the lower pole patella and tibial tuberosity, an invented bone awl for opening the medultary canal at the entry point [sweet spot], inserting an invented graded guide pin into the medullary channel and Slide an invented sleeve over the guide pin till it hits the entry point to check the actual needed nail length through the graded guide pin [depth gauge]. Between March 2004 and March 2007 a prospective trial on 40 patients with unilateral closed tibial diaphyseal fractures was done at the Orthopaedic Surgery Department of Mansoura University Hospital. All were followed up for one year. There were twenty-five men and fifteen women with a mean age of 40 +/- 9 years, two female patients were excluded from the results because of lost follow up with them shortly postoperative. Early perioperative complications, including compartment syndrome, and pulmonary embolism, were checked, but no patients had such complications. Patients began full weight bearing at an average of 14 +/- 4 weeks postoperatively; the median time for fracture healing was 17 +/- 4 weeks, 34% out of our patients experienced different degrees of anterior knee pain, 2.5% grade zero, 7.9% grade 1, 7.9% grade 2 and 15.8% grade 3 according to the Functional Assessment Score [FAS]. At the time of final follow-up, there were 20 excellent, 16 good results, one fair and one poor result according to Johner and Wruh's Criteria [Johner et al., 1983]. This modified technique and devices for percutaneous interlocking tibial nailing provide significant advantages when compared with the standard technique so that the time to union, the functional outcome and incidence of anterior knee pain,are significantly improved