Outcomes Related to Closed Interlocking Intramedullary Nailing for Segmental Tibia Fracture

ABSTRACT

PURPOSE: To evaluate the outcomes of twenty-six cases of segmental tibia fracture that were treated by closed interlocking intramedullary nailing. MATERIAL AND METHODS: All cases were followed up for at least 1 year (average 14.3 months). Clinical results were evaluated by Klemm & Borner's scale. We analyzed the average range of the motion of the ankle and knee joint, atrophy of quadriceps muscle and angular deformity at the last follow up. We evaluated complications (new fracture of the tibia, infection, compartment syndrome, nonunion, delayed union, angular deformity and pain of ankle and knee joint). RESULTS: Results were excellent in 4 cases (15.4%), good in 18 cases (69.2%), fair in 3 cases (11.5%), and poor in 1 case (3.9%). Union was obtained in 25 cases (96.1%) over an average period of 23.3 weeks. Nine cases showed intra-operative or post-operative complications new fracture of the proximal tibia on the posteromedial side (2 cases), local infection at an entry point (2 cases), compartment syndrome (1 case), deep infection (1 case), and delayed union (3 cases). At the last follow up, angular deformity was found in 4 cases (mean of all deformities, 6 degrees) 3 cases at the proximal fracture site (2 cases of valgus deformity 5 and 8 degrees and 1 case of varus deformity 7 degrees) and the other case in the distal fracture site (valgus 5 degrees). Average postoperative range of motion of the knee joint was 123.7 degrees (80~135 degrees). Knee pain or limited motion occurred in 4 cases. The average range of the motion of the ankle joint was 68.1 degrees (60~70 degrees). Limited motion occurred in 4 cases (average, 10 degrees) but no case showed ankle pain. CONCLUSION: Closed interlocking intramedullary nailing for segmental tibia fracture often results in complications. To minimize these complications, comprehensive evaluation of the fracture, and careful surgical treatment are required.