Functional outcome of metaphyseal and diaphyseal fractures of tibia treated with expert tibial interlocking nail: A prospective study

Abstract

Introduction: Tibia is the most commonly fractured bone due to road traffic accidents and other high-energy trauma and surgical management is required for most of these fractures, with either internal or external fixation. Locked intramedullary nailing has been widely accepted as a satisfactory treatment of tibial fracture. The indications of their use have been extended to fractures closer to proximal / distal fragments with introduction of expert tibial nail. It is a new kind of low, multidirectional locking tibial intramedullary nail developed to attain increased angular stability and to enhance the axial and lateral stability of fracture fragments.Aim: To study the functional outcome and duration of union of metaphyseal and diaphyseal fractures of tibia treated with expert tibial interlocking nail.Methodology: Study was done in 30 patients with fresh tibial metaphyseal/diaphyseal fractures treated surgically with expert tibial nail between October 2016- March 2018. Patients were followed up at 6 weeks, 3 months, and 6 months. The intra-operative blood loss, duration of surgery, intra operative complications, post-operative complication, and duration of hospital stay were studied. Functional outcome was assessed based on Johner and Wruh's Criteria.Results: Among the 30 patients treated with expert tibia nail for metaphyseal/diaphyseal tibial fractures, 25 were male and 5 were females. Most of patients were in the age group ranging from 20-30 years with a mean age group of 40.1 years. The mode of injury for 24 patients was road traffic accidents which accounted for about 80 %, 5 were due to fall which accounted for 16.67 % and 1 was due to assault which accounted for 3.33 %.16 cases sustained right side tibia fracture and 14 cases sustained left side tibia fracture. The average period of commencement partial weight bearing was 7 weeks and full weight bearing was 13.43 weeks. Excellent results were seen in 43.33% cases, Good results were seen in 33.33%, Fair results in 16.67 %, poor results in 6.67% according to Johner and Wruh's Criteria.Conclusion: Our results with expert tibial interlocking nailing are encouraging and demonstrate the benefits of new nailing system. Changes in the design of the nail for improved proximal and distal locking enables it to use in metaphyseal/diaphyseal fractures of tibia. A better stabilization of small fragments has been achieved by the availability of locking option in three planes, thus providing a higher stability of the bone implant construct. Complications were comparable to other studies.

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