Unreamed solid interlocking nail for the management of compound tibial diaphyseal fracture? A prospective study

Abstract

Background: Compound tibial fractures have always been a challenge to the orthopedic fraternity. Goals of treating these fractures are preventing infection, restoring soft-tissue vitality, achieving union, and instituting early joint motion and rehabilitation. Aim: The aim was to evaluate the rate of union, infection rate, post-union deformity, and the functional outcome following unreamed solid interlocking nailing in compound tibial diphyseal fracture of Gustilo–Anderson Grade I to IIIB. Materials and Methods: Twenty patients presenting to the emergency orthopedic department with compound tibial fractures, between 2014 and 2016, were included in the study. This was a hospital-based, prospective study. The fractures were classified according to Gustilo–Anderson classification, and the final outcome was measured by Johner and Wruh's criteria with modification. Results: We had more cases of male patients than females (75% vs. 25%) in the age group of 20–60 years (average 37.10). Road traffic accident was the most common cause in our study (75%) followed by fall from height (25%). Gustilo and Anderson classification was used, and 10% were Grade I, 20% were Grade II, 65% were Grade IIIA, and 5% were Grade IIIB. The average time to union was 22.53 weeks and the average time to start full weight bearing was 11 weeks with a standard deviation of 1.38 weeks. Complications such as delayed union (10%), nonunion (5%), shortening (5%), superficial infection (10%), gait disturbance (5%), and angulation (10%) were found; 5% had more than 25° of restriction of ankle rom and 5% had more than 10° of restriction of knee rom. Final outcome was excellent results in 65%, good in 20%, fair in 10%, and poor in 5% of cases. Conclusion: The present study demonstrates that unreamed solid interlocking nailing is considered a good option for the management of compound tibial fractures (Grade I–IIIB) as it allows early weight bearing, early rehabilitation with high union rate, and low complication rate.