Tibial Fractures Treated With Interlocking Nail(Report Of 33 Patients)

This study focuses on these common topics: selection of indications,specialties of closed and open fractures, its application in delayed unions,nonunions and complications of interlocking nail in tibial fracturs.1 Material and method1.1General informationThirty-three tibial fractures were treated with interlocking nails fromFeb.1998 to May.2000 in our department. There were 26 males and 7females, mean 35.3 years old(18-72); 22(66.7%) closed and ll(33.3%)open fractures; 31 fresh and 2 old fractures, 9(27.3%) with multipleinjuries. According to AO classifications, 9 Grade A(27.3%), 10 GradeB(30.3%) and 14 Grade C(42.4%). And open fractures, according toGustilo classifications, 7 TyPe I (63.6%) and 4 Typeâ…¡(36.4%). Sixfractures occurred in proximal ends, 11 in intermediate shaft, 15 in distalends and 1 in multisegmental shaft.1.2 Surgical methodThe surgery was performed with the help of fluoroscopy Fracturesites need not to be incised, except in infrequent open fractures andreduction troublesome ones.1.3 aftreatmentThose with stable fractures were suggested to leave bed as early aspossible, but weigh beedng was retatded to 6-8 weeks after surgeryThose with unstable fractures or fixed by static interlocking nails begintheir weight beearing after callus formation confirmed by X-ray films.2 ResultsThe mean folloWUP time was l7.9 months of 27 patients, 6 lostfolloWUP. At final followUP, 22 healed, 1 delayed union, l distal lockingscrew broken, 3 still no longer than 6 months. Evaluated byJolmer-Wruhs' criterion, of the siXteen patients, ll(68.75%) wereexcellent, 4(25%) good and l(6.25%) well.3 Discussion3.1 SeIection of surgical timeThere are tWo opinions with regard to SUrgical time, including eary ordelayed oPeration. Our eXPerience is that early operation does notincrease risk. For multiple injuries, eary operation to stabilize fractureends favodring disPosing severe injuries.3.2 SeIection of indicationsTibial fractUres from tUbercle to distal end are indications ofinteriocking nail. It should be prudent Wth fractUres in prokimal l/3,because valgus and onward angulation deformity are very conunonwhen using interiocldng nail.3.3 Reaming or notMamed interiocking nail has a high comPlication rate in closefractUres, but it is wise to use unreamed one When dealing with oPenfracthes.3.4 beatment of open fracturesCovering the woUnds should be placed as first steP When dealing withopen fraMes and unreaxned interlocldng nail is preferable to reduceinfection rate and imProve healing rate.3.5 inatment of delayed union or nonunionWhen treating delayed union or nonunion, reaming is reconunended.For those suffered frOm severe soft tissue damage, 8-l2 weeks afterinsertion of unreamed interiocldng nail, change a reamed one wouldavoid delayed union effectively3.6 Complications after nailingAmong such a good many comPlications, infecton and malunion arethe commonest. Eary debridement and wound coverage are validmanagemeni to prevellt infection. The key to preven malunion arecorrect selection of indicBtions and acctal management.Conclusion Interlocldng nail has a distinCt advantae in treating tibialfractUres, especially those with multiple injuries, severe open fractUres,delayed union and nonunions. If only select the righ surgical time andindications, the interlocking nail would bring good prognosis.