Functional outcome of primary unreamed interlocking intramedullary nailing in open tibial fractures

Abstract

Background & Objectives: Open tibial fracture management is a major challenge to orthopedic surgeons globally. Successful treatment of open tibial fractures aims at bony union’ soft tissue healing and functional improvement to premorbid state. The management protocol for open tibial fracture still remains to be controversial as there is difference in opinion regarding type of implant and method of surgery (reamed or unreamed). Soft tissue injury because of high energy injury and infection makes treatment more challenging. The aim of our study was to evaluate the functional outcome of primary undreamed interlocking intramedullary nailing in open tibial fractures. Materials & Methods: 50 patients presenting to casualty, Govt. Medical College, Kozhikode between Januvary2015-March 2016 with open tibial fractures in the age group 18- 60 amenable to ILN was selected. All patients were treated with thorough wound debridement and skeletal stabilization with undreamed interlocking nail in first 24 hours. In all cases, proper soft tissue coverage was attained. Post operatively functionally assessed with modified Johner-Wruhs criteria. Results & Discussion: Majority of the patients was less than 40 years and 94% were males. In 84% of cases mode of injury was Road Traffic Accidents.98% involved middle and distal third fractures.68% of cases were AO group A type and had good outcome.86% cases were type 1&2 open and had good outcome. Average time for bony union was 21.4weeks.There was no case of knee stiffness and ankle stiffness was 4%.46% of cases was associated with anterior knee pain.76% had good outcome and only 6% was associated with poor outcome. There was three case of deep infection, 2 cases of nonunion, 1 case of malunion, 8cases of delayed union, 3cases of shortening and cases of distal screw breakage. Conclusion: Primary undreamed interlocking intramedullary nailing as an ideal method for treatment of open tibial fractures type 1, 2 and 3A. Unreamed nails provide a stable fixation preserving the soft tissues sleeve around the fracture site and maintaining the cortical blood flow. Other potential advantages include shorter operative time, less blood loss, early mobilization, shorter hospital and early weight bearing. Complications like infections malunion, nonunion and implant failure is also less. Intial wound management and soft tissue coverage is of paramount importance in the management of open tibial fractures. The nailing procedure is simple and fast and is easily reproducible by an average surgeon with a short learning curve.