Study of the Healing of Tibial Fractures Treated with Dynamic Intramedullary Nailing
,
Abstract
Introduction and Aims: Dynamic nailing (IMN) by placing only one screw on one side of the nail, shortens the surgical time and reduces the complications during surgery and secondary dynamization, so we decided to investigate the healing of dynamic IMN of tibial fractures.
Material and Methods: This cross sectional study was done on 67 patients with dynamic IMN in Fifth Azar Hospital, Gorgan in 2015-2018. Complications, union time, RUST score and Johner-Wruhs criteria were analyzed based on their grouping in AO classification.
Results: The average age of the patients was 33.2±13 years. Most of the fractures were closed type (71.6%), type C (43.4%). The mean healing time was 14.62±4.38 weeks and RUST score was 8.9±1.26. There was no significant difference between locations of fracture and the healing time or RUST score (P> 0.05). The healing time in the comminuted fractures (e.g, type C) and open tibial fractures were statistically longer than the simpler type (e.g, type A or B) and the mean radiological score in type C fractures was significantly lower (P<0.05). The mean Johner-Wruhs Criteria score of fractures was 46.31±4.49, so that 61 patients had excellent results, four patients had good results, and two patients had fair results.
Conclusion: Dynamic IMN of closed and middle third tibial fractures and simpler types of fractures (e.g, type A or B) have faster healing. Anyway, it is better to be more cautious for fixation of open or comminuted fracture (e.g, type C).
Keywords: leg, tibia fracture, healing, Dynamic, intramedullary nail
1.Șerban Al, Botnaru V, Turcu R, Obadă B, Anderlik St. Fractures of the tibia shaft treated with locked intramedullary nail. ARS Medica Tomitana. 2013; 4(75): 197-201. doi: 10.2478/arsm-2013-0035
2. Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma. 2010; 68(3): 629-32. doi:10.1097/TA.0B013e3181a7c16d
3. Whatling G, Nokes LD. Literature review of current techniques for the insertion of distal screws into intramedullary locking nails. Injury. 2006; 37(2): 109-19.doi:10.1016/j.injury.2005.09.009
4. Lam SW, Teraa M, Leenen LPH, van der Heijden GJMG. Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures. Injury. 2010; 41(7): 671-5. doi:10.1016/j.injury.2010.02.020.
5. Busse JW, Morton E, Lacchetti C, Guyatt GH, Bhandari M. Current management of tibial shaft fractures: a survey of 450 Canadian orthopedic trauma surgeons. Acta Orthopaedica. 2008; 79(5): 689-94. doi:10.1080/17453670810016722
6. Lefaivre K, Guy P, Chan H, Blachut P. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. Journal of Orthopaedic Trauma. 2008; 22(8): 525-9. doi:10.1097/BOT.0b013e318180e646
7. Andre JWL, James RO, Jason H, Iswadi D. Comparison of dynamic versus static fixation of intramedullary nailing in tibial diaphyseal fractures: A systematic review and meta-analysis. Journal of Clinical Orthopaedics and Trauma. 2022; 32: 1019-41. doi:10.1016/j.jcot.2022.101941.
8. Roux A, Bronsard N, Blanchet N, de Peretti F. Can fluoroscopy radiation exposure be measured in minimally invasive trauma surgery?. Orthopaedics & Traumatology, Surgery & Research. 2011; 97(6): 662-667. doi: 10.1016/j.otsr.2011.03.024.
9. Somani AM, Saji MA, Rabari YB, Gupta R, Jadhao AB, Sharif N. Comparative study of static versus dynamic intramedullary nailing of tibia. International Journal of Orthopaedics Sciences. 2017; 3: 283-286. doi:10.22271/ORTHO.2017.V3.I3E.52
10. Lee YS, Lo TY, Huang HL. Intramedullary fixation of tibial shaft fractures: a comparison of the unlocked and interlocked nail. International Orthopaedics 2008; 32(1): 69-74. doi: 10.1007/s00264-006-0271-z
11. Mohammed A, Saravanan R, Zammit J, King R. Intramedullary tibial nailing in distal third tibial fractures: distal locking screws and fracture non-union. International Orthopaedics. 2008; 32(4): 547-9. doi: 10.1007/s00264-007-0356-3
12. Hernández-Vaquero D, Suárez-Vázquez A, Iglesias-Fernández S, García-García J, Cervero-Suárez J. Dynamisation and early weight-bearing in tibial reamed intramedullary nailing: its safety and effect on fracture union. Injury. 2012; 43: S63-S67. doi:10:1016/S0020-1383(13)70182-7
13. Kreb DL, Blokhuis TJ, van Wessem KJ, Bemelman M, Lansink KW, Leenen LPH, et al. Intramedullary nailing without interlocking screws for femoral and tibial shaft fractures. Arch Orthop Trauma Surg 2013; 133(8): 1109-13. Doi:10.1007/s00402-013-1775-9
14. Omerovic D, Lazovic F, Hadzimehmedagic A. Static or dynamic intramedullary nailing of femur and tibia. Medical Archives. 2015; 69(2): 110-13. doi: 10.5455/medarh.2015.69.110-113
15. Gadegone W, Salphale Y, Lokhande V. Results of Dynamic Interlock Nailing in Distal Tibial Fractures. Surgical Science. 2015; 6(7): 317-26. doi: 10.4236/ss.2015.67048
16. Saruhan CS, Algün R, Barış B, Budak K. [Unlocked using of interlocked intramedullary nails in tibial shaft fractures]. Joint disease &related surgery. 2013; 24(1): 23-9. doi: 10.5606/ehc.2013.06.[Article in Turkish]
17. Kreb DL, Blokhuis TJ, van Wessem KJP, Bemelman M, Lansink KWW, Leenen LPH. Intramedullary nailing without interlocking screws for femoral and tibial shaft fractures. Archives of orthopaedic and trauma surgery. 2013; 133(8): 1109–1113. doi: 10.1007/s00402-013-1775-9
| Files | ||
| Issue | Vol 10 No 2 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i2.15516 | |
| Keywords | ||
| leg, tibia fracture, healing, Dynamic, intramedullary nail | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
