Evaluation of functional result in different grades of compound tibial fractures by intramedullary nail

Abstract

Background: The purpose of the present study was to evaluate the outcomes of compound fractures of tibia shaft managed by interlocking intramedullary nailing. Methods: This is a retrospective study of 20 patients with open fractures of tibia shaft operated primarily by tibia interlocking nail. Results: In Our Study we had 20 patients with open tibial fractures. Majority of patients in our series were under 40 years of age with an average age of 28.6 years. The youngest patient was 17 years old and the eldest patient was 55 years. Majority (80%) of our cases sustained Tibial shaft fracture in road traffic accidents. Out of 20 cases in our series in 7 cases (35%) middle 3rd of tibia was involved and in 9 cases (45%) it was lower 3rd. Most common radiological pattern of fracture in our series was transverse (55%) followed by oblique in 30% and communited in 15%. In Patel series most common pattern was oblique 50%, transverse in 31% and communited in 19%. In our study, 70% cases were operated within 2 weeks of injury. Earliest case was operated on 3rd day of injury. Supplementary / secondary procedure required in our series were dynamization (required in 15% of our cases) and bone grafting (5%), none of our cases required nail removal with plating and bone grafting or exchange nailing. One patient required nail removal as he developed deep infection. 75% of our patients were ambulatory within 2 weeks of operation in the form of non weight bearing crutch walking. Of the remaining 5 patients 2 had shaft Femur fracture, one had contralateral both bone leg, one had surgical neck of Humerus with undisplaced Tibial plateau and last one had wound complication. In our series 75% cases showed signs of satisfactory radiological union by 20 weeks. In 50% of our cases clinical and radiological union occurred in 20 weeks’ time. There was no incidence of non union in our series. Our series did not include compound grade III fracture rest all series mentioned here included this in their study. Average time of union came out to be 24.8 weeks with minimum of 16 weeks and maximum of 30 weeks. In 10 patients union occurred in >20 weeks (delayed union). 2 were those patients who underwent dynamization, one had underwent bone grafting, one patient had contralateral both bone leg and one patient was 55 years old. In rest 5 patients no obvious cause was found. Delayed union was more in distal1/3rd fracture due to precarious blood supply. In our study out of 20 patients operated by Tibia interlocking nail 4 (20%) excellent, 6(30%) Good, 10(50%) fair functional results. Conclusions: Treatment of open tibial fracture remains controversial. But the early debridement, primary wound closure and interlock nail is a good option in compound tibia fractures.