Functional Outcome Of Metaphyseal And Diaphyseal Fractures Of Tibia Treated With Expert Tibial Interlocking Nail- A Prospective Study

Abstract

Background and objectives: Tibia is the most commonly fractured bone due to road traffic accidents, and other high-energy trauma and usually associated with severe soft-tissue injury. Surgical management is required for most of these fractures, with either internal or external fixation. Even though wide variety of treatment options are present for treating these fractures is still a challenge because of its wide associated complications like infection at the operated site , delayed union or non-union. Locked intramedullary nailing has been widely accepted as a satisfactory treatment of tibial fracture. However, in patients with tibial fractures, there is a risk that the fracture will propagate into the knee / ankle or that the nail will fail because of inadequate fixation of the small distal fragment. The indications of their use have been extended to fracture closer to proximal / distal fragments with introduction of expert tibial nail. It is a new kind of low, multidirectional lock tibial intramedullary nail .Its interlocking system was developed to attain increased angular stability and to enhance the axial and lateral stability of fracture fragments. In this study we would like to find out the functional outcome and complications associated with expert tibial nailing. Methods: Thirty patients with fresh tibial metaphyseal/diaphyseal fractures are treated surgically with expert tibial nail between October 2016- March 2018 Results: Among 30 patients treated with expert tibia nail for metaphyseal/diaphyseal tibial fractures the average time taken for union was 21.8 weeks, Closed fractures and type 1 fractures united earlier (average time 18.66 weeks and 21.75 weeks respectively ) compared to type 2 open fractures (average of 25 weeks)The incidence of closed fractures is 60% and those with open fractures were 40% (Gustilo Anderson type 1 and 2), Gustilo Anderson type 3 were excluded from the study. Complications arising from expert tibia nailing in our study is malunion in one patient (3.33%), superficial wound infection in four cases (13.33%), anterior knee pain in ten patients (30%), shortening in two patients (6.67%), delayed union in 3 patients( 10%) and two patients had ankle pain (6.67 %). Functional results were graded according to the criteria by Johner and Wruh's Criteria79. 43.33 % of patients achieved excellent results, 33.33 % of patients achieved good results, 16.67 % fair results were obtained and in two patient, the functional results were poor(6.67%). 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 metaphyseal/diaphyseal fractures of tibia. Locking options in different planes, provide a better stabilization of small proximal and distal fragments and achieve a higher stability of the bone implant construct. Good functional results and union rates were achieved with cautious preoperative planning and considering the principles of intramedullary interlocking nailing technique. Hence we suggest the use of expert tibial nail in metaphyseal /diaphyseal fractures of the tibia.