Clinical and radiological outcome of proximal third tibia fractures treated with intramedullary nailing

Abstract

Introduction. Extra articular proximal tibia fractures represent about 5-11% of all tibia fractures, and usually exhibit complex fracture patterns with moderate to severe soft tissue damage and deforming forces. No fracture arose more controversy regarding the best method of treatment, common methods of fixation of proximal tibia fractures with intramedullary nailing and minimally invasive plating widely in these fractures. The open reduction or minimally invasive plating of these fractures is widely used plates do not provide axial and varus stability and nail being load sharing device can provide both axial and varus stability, while the nail being a load sharing device can provide both axial and varus stability with minimal soft tissue handling. However, the nailing of extraarticular proximal tibia fractures is associated with malunion. This current study aims to analyse the outcome of proximal third fractures treated with nailing. Material and methods. Thirty consecutive patients with fracture of the proximal third of the tibia shaft underwent nailing and were followed for up to 2 years. The clinical and radiological outcome of these cases and the complications encountered were analysed according to modified Klemm and Borner scoring system. Results. Our study comprised of patients in the age group 19-80 years, average being 40.5 years. Average time of partial weight bearing in the present study was 7.9 weeks (range 6-18 weeks). The average time for full weight bearing was 13 weeks (range 10-24 weeks). The mean time for radiological union was 24.6 weeks (range 20-32 weeks). Fourteen had excellent result, 10 patients had good, 4 patients had fair results and 2 patients had poor results according to Klemm and Borner functional criteria. Conclusions. Intramedullary nailing of proximal third tibia fractures when used with proper reduction technique using reduction clamps, k-wires, poller screws or unicortical plating in semi extended position for nailing is an effective, stable and successful method of treatment for proximal third fractures of tibia.