FRACTURE UNION WITH CLOSED INTERLOCKING NAIL IN SEGMENTAL TIBIAL SHAFT FRACTURE
A segmental fracture of the tibial shaft is a major cause of morbidity and mortality in patients with lower extremity injuries. From December 2010 to December 2014, Thirty-four patients (28 males and 6 females) with segmental tibial fractures were recruited from Emergency and outpatient department and compared healing and complications with a matched control group of Thirty-four non-segmental tibial fractures. In follow-up, we determined the time to union, delayed and nonunion and overall complication rates. All patients were followed for twelve months. Majority of the patients had a union in 120 to 180 d with a mean of 160.58. The results were excellent in 79.41 % (27/34) and good in 14.70 % (5/34) patients in segmental fractures and excellent in 91.17 % (31/34) and good in 5.88 % (2/34) patients in non-segmental fractures. 5.88 % (2/34) of our patients was labeled as non-union and14.75 % (5/34) delayed unions in segmental fractures, and 2.94 % (1/34) non-union, and 5.88 % (2/34) delayed union in non-segmental fractures and was treated by bone graft and dynamization. Insignificant limb shortening of less than 1.5 cm was found in both the groups. Majority of the segmental tibial fractures had severe soft tissue injuries and demanded prolonged treatment and with an uncertain clinical and functional outcome.
Keywords: Segmental tibia fracture, intramedullary interlocking nail, Reaming, Nonunion
2. Merianos, K Papagiannakos, E Scretas, P Smyrnis. Ender nails for segmental tibial fracture. Early weight bearing in 22 cases. Acta Orthop Scandanavia 1988;59:297-301.
3. Woll TS, Duwelius PJ. The segmental tibial fracture. Clin Orthop Relat Res 1992;281:204â€“7.
4. Robertson A, Giannoudis PV, Matthews SJ. Maintaining reduction during undreamed nailing of a segmental tibial fracture: the use of a Farabeuf clamp. Injury 2003;34:389-91.
5. Ricci WM, Oâ€˜Boyle M, Borrelli J, Bellabarba C, Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma 2001;15:264-70.
6. Wu CC, Shih CH. Segmental tibial shaft fractures treated with interlocking nailing. J Orthop Trauma 1993;7:468â€“72.
7. MuÂ¨ller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Berlin and Heidelberg, Germany New York: NY, USA, Springer-Verlag; 1990.
8. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg Am 1976;58:453â€“8.
9. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984;.24:742â€“6.
10. Simonis RB. Summary of talk on non-unions for CMS UK annual conference Bristol; 2007. Available from: http://www.cmsuk. org/documents/tmpB6.pdf. [Last accessed 13 May 2012].
11. Sarmiento A, Gersten LM, Sobol PA, Shankwiler JA, Vangsness CT. Tibia1 shaft fracture treated with functional braces. J Bone Jt Surg 1989;71:602-9.
12. Ekeland A, Thoresen B0, Alho A, Stromsoe K, Folleras G, Haukebo A. Interlocking intramedullary nailing in the treatment of tibial fractures-A report of 45 cases. Clin Orthop 1988;231:205-5.
13. Bonnevialle P, Cariven P, Bonnevialle N, Mansat P, Martinel V, Verhaeghe L, et al. [Segmental tibia fractures: a critical retrospective analysis of 49 cases] [in French]. Rev Chir Orthop Reparatrice Appar Mot 2003;89:423â€“32.
14. Kakar S, Tornetta P III. Segmental tibia fractures: a prospective evaluation. Clin Orthop Relat Res 2007;460:196â€“201.
15. Langard O, Bo O. Segmental tibial shaft fractures. Acta Orthop Scand 1976;47:351â€“7.
16. Rommens PM, Coosemans W, Broos PL. The difficult healing of segmental fractures of the tibial shaft. Arch Orthop Trauma Surg 1989;108:238â€“42.
17. Giotakis N, Panchani SK, Narayan B, Larkin JJ, Al Maskari S, Nayagam S. Segmental fractures of the tibia treated by circular external fixation. J Bone Joint Surg Br 2010;.92:687â€“92.
18. Huang CK, Chen WM, Chen TH, Lo WH. Segmental tibial fractures treated with interlocking nails. A retrospective study of 33 cases. Acta Orthop Scand 1997;68:563â€“6.
19. Melis GC, Sotgiu F, Lepori M, Guido P. Intramedullary nailing in segmental tibial fractures. J Bone Joint Surg Am 1981;63:1310â€“8.
20. Ozturkmen Y, Karamehmetoglu M, Karadeniz H, Azboy I, Caniklioglu M. Acute treatment of segmental tibial fractures with the Ilizarov method. Injury 2009;40:321â€“6.
21. Sarmiento A, Latta LL. Functional treatment of closed segmental fractures of the tibia. Acta Chir Orthop Traumatol Cech 2008;75:325â€“31.
22. Zucman J, Maurer P. Two-level fractures of the tibia. Results in thirty-six cases treated by blind nailing. J Bone Joint Surg Br 1969;51:686â€“93.
23. Lam SW, Teraa M, Leenen LP, van der Heijden GJ. Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures. Injury 2010;41:671â€“5.
24. Beardi J, Hessmann M, Hansen M, Rommens PM. Operative treatment of tibial shaft fractures: a comparison of different methods of primary stabilisation. Arch Orthop Trauma Surg 2008;128:709â€“15.
25. Teraa M, Blokhuis TJ, Tang L, Leenen LPH. Segmental tibial fractures: an infrequent but demanding Injury. Clin Orthop Relat Res 2013;471:2790-6.
26. Mohammed AA, Hasan MH, Ahmed R. Minimal fixations for the treatment of closed segmental fractures of tibial shaft in adults. MOJ Orthop Rheumatol 2015;2. Doi:10.15406/ mojor.2015. 02.00067. [Article in Press]
27. Godowsky C, Abrams JS, Godowsky WT. Diagnosing segmental wedge fracture of the tibia before performing intramedullary nailing. Am J Orthop 2013;42:369-71.
28. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop 1983;178:7-25.