Closed and Open Grade I and II Tibial Shaft Fractures Treated by Reamed Intramedullary Nailing

Abstract

Objective: To evaluate the results of closed and open grade I and II tibial shaft fractures treated by reamed nail and unreamed nailing. Subjects and Methods: Between 1997 and 2000, 119 patients with tibial shaft fractures were treated with reamed tibial nails. Postoperatively 96 patients (70 closed and 26 grade I and II open fractures) were followed clinically and radiologically for up to 18 months. The nail was inserted either by patellar tendon splitting or by nonsplitting technique. The nail was inserted after overreaming by 1.5 mm. Postoperatively, patients with isolated tibial fracture were mobilized by permitting partial weight bearing on the injured leg for 6 weeks. Patients with associated ankle fractures were allowed to walk with a Sarmiento cast. Results: Postoperatively, 6 (6.3%) patients developed a compartment syndrome after surgery. In 48 (50%) cases, dynamization of the nail was carried out after a mean period of 12 weeks for delayed union. Overall, a 90.6% union was obtained at a mean of 24 weeks without difference between closed or open fractures. Two (2.1%) patients with an open grade II fracture developed a deep infection requiring treatment. A 9.4% rate of malunion was observed. Eight (8.3%) patients developed screw failure without clinical consequences. At the last follow-up, 52% of patients with patellar tendon splitting had anterior knee pain, compared to those (14%) who did not have tendon splitting. Conclusion: Reamed intramedullary nail is a suitable implant in treating closed as well as grade I and II open tibial shaft fractures.

The Severity and Prediction of Anterior Knee Pain Post Tibial Nail Insertion

“…The transpatellar approach causes anterior knee pain more frequently. 12,24,25 However, these findings have been disputed. 9,26 Meta-analysis was inconclusive in this area.…”

Comparing Intramedullary Nailing, External Fixation, and External Fixation followed by Intramedullary Nailing as management for open fractures of the tibial shaft: a Systematic Review

“…Out of the 10 studies on intramedullary nailing as definitive management, only Tielinen et al [18] showed 0%. The other studies on intramedullary nailing presented less than 11% [4, 6, 10, 11, 16,17,19,[20][21][22], except for Sakaki et al [17], Park et al [4], and Kaftandziev et al [11] in which that rate was 17.85%, 22.0%, and 33.3%, respectively. Park et al [4] did not specify the percentages of superficial and deep infection.…”

“…Besides, 10% of the fractures had delayed healing (over 6 months, according the paper), and they had to be dynamized and/or subjected to other procedures (reaming of the shaft, bone graft). In the other studies on IM Nailing as definitive management [2,6,10,11,16,17,19,[20][21][22][23][24] the nonunion rate was between 0% [6] and 11.1% [11].…”

The healing stages of an intramedullary implanted tibia: A stress strain comparative analysis of the calcification process

“…In fact, it is well-known that the mechanical conditions during the early phase of bone healing modify the course of healing and the quality and quantity of callus formation. 46,47 Moreover, the differences observed in shear interfragmentary strains may also delay the fracture healing process. 48 This is especially relevant in distal and mid-diaphyseal fractures stabilized by an unreamed intramedullary nail, where differences up to 50% were found.…”