Interlocking Intramedullary Nailing for the Treatment of Segmental Tibial Shaft Fractures

Song, Kyung Jin; Lee, Young Keun; Kim, Jeong Yeul; Hwang, Byung Yun

Abstract

The treatment of segmental tibial shaft fractures poses many problems because of the serious damage to the surrounding soft tissue that usually occurs from the high-energy trauma, and the results are often unsatisfactory following lots of complications like non-union, delayed union, malunion, and infection We studied to evaluate the treatement results of interlocking intramedullary nailing for the segmental tibial shaft fractures. Twenty-two cases of segmental tibial shaft fractures were reviewed and we analyzed the results of surgical treatement in the viewpoint of bony union times, complication and its final outcome. The range of follow-up was 12 months to 68 months with mean 38 months follow-up. Most of the patients were between forty and sixty years, and average age was 47 years. Associated injury was incurred in nineteen cases with various musculoskeletal symptoms and signs. According to Meils classification, 8 were Type I, 1 was Type II and 3 were Type IV of the 12 closed fractures. Of the 10 open fractures, 4 were Type, 2 were Type II, 3 were Type IV, and 1 demonstrated multisegmental fractures. All of the closed fractures were united well except only one infected nonunion. The average time to union was 21.6 weeks with range from 16 to 26 weeks. The healing was tlowest in Type IV and fastest in Type I fractures. There was no significant difference in the healing time between the distal and proximal fractures. Of the 10 open fractures, each one of open type I fracture and open type II fractures did not united because of infected nonunion. The average time to union was 26.4 weeks with range from 16 to 38 weeks for the remaining 8 open fractures. The healing was slowest in Type IV and fastest in Type I fractures. There were 3 cases of infected nonunion, 1 case of delayed union of the proximal fracture and 1 case of valgus deformity of distal fracture. The infection was controlled and bone union obtained with removal of the nail and reaming, curettage and antibiotic bead wire, and plating with bone graft. We recommand that wherever poslible, interlocking intramedullary nailing can be used for the closed or open type I and II segmental tibial shaft fractures. And a high rate of union and a low rate of complication can be expected with this treatment modality.