Journal of Musculoskeletal Trauma

Treatment Using Unreamed Intramedullary Nailing for Open Tibial Fractures: In Heon Park, Ki Byung Lee, Kyung Won Song, Jin Young Lee, Seung Yong Lee; J Korean Soc Fract 1997;10(4):886-891. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.886

Abstract PDF: Intramedullary nailing has become the most popular fixation method in the treatment of the tibial shaft fractures because it affords most rigid fixation of fracture via closed method which makes early rehabilitation possible. Unlearned interlocking nails offer the advantages of loss damage to the intramedullary blood supply, so infectious rate was lower in open fractures compared with reamed nails. We have analyzed 34 cases of 30 patients who performed unlearned interlocking intramedullary nail for open tibial fractures. The results were as follows : 1. The classification of the open fracture was 12 cases Gustilo-Anderson Type I, 20 cases Type II, 2 case Type III. 2. Bony union occured an average of 18 weeks postoperatively. 3. The complication were 4 cases of nonunion, 1 case of deep infection, and 1 case of screw loosening. In conclusion, unlearned intramedullary nailing is a good alternative method for the management of Type I, II open tibial fracture.

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Clinical Results of Locked Unreamed Nailing in Tibial Shaft Fractures: Duck Yun Cho, Hee Chun Kim, Kyung Chul Kim; J Korean Soc Fract 1997;10(3):575-582. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.575

Abstract PDF: We reviewed the results of the treatment of 23 tibial shaft fractures in 22 patients by primary unlearned locked intramedullary nailing. The duration of follow-up was average 10.1 months (range, from 6 to 27 months). The results were as follows : 1. There were 11 open and 12 closed fractures. 2. All fractures united clinically in an average time of 17.9 weeks(range 10 to 26 weeks), and radiologically in an average time of 19.4 weeks (range, 10 to 31 weeks). 3. Complications included 1(4.3%) case with delayed union and 3(13.0%) cases with malunion. 4. No patient had deep infection and there were no broken nails or screws in this series. 5. No fracture refuired an additional procedure before union, such as dynamization or bone graft.

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The Clinical Results of Unreamed Interlocking Intramedullary Nailing for Tibial Fractures: Young Ho Kwon, Hyun Mok Yang; J Korean Soc Fract 1997;10(3):569-574. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.569

Abstract PDF: Recently interlocking intramedullary nailing is used widely for the management of tibial shaft fractures. We evaluated any differences in healing time and complications associated with reamed and unlearned tibial interlocking intramedullary nailing. Between January 1991 and February 1996 we performed a retrospective trial on 62 patients with tibial shaft fractures comparing the reamed with unlearned interlocking nailing. The mean time to union for patients with unlearned intramedullary nail was 18.5 weeks(13 to 32 weeks) which was significantly less(P<0.05) than the 21.7 weeks(16 to 36 weeks) for reamed group. The complications of the reamed interlocking intramedullary nailing were three delayed unions (9.3%), three superficial infections(9.3%), and two cases of knee joint or ankle joint LOM(6.2%). The complications of the unlearned interlocking intramedullary nailing were four delayed unions(13.9%), three angular deformities(10.3%), three screw breakages(10.3%), and one superficial infection(3.4%). Unlearned interlocking intramedullary nailing is better for the tibial shaft comminuted fractures with small diameter, unstable tibial isthmus fractures, pelytraurnatized patient and some type of open fractures.

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Interlocking Intramedullary Nailing in the Treatment of the Tibial Shaft Fractures: Comparative Study between Reamed and Unreamed Nailing: Jae Hoon Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(4):993-1001. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.993

Abstract PDF: Interlocking intramedullary nailing has been popularized by its many advantages in the fracture treatment of long bone compared with the other fixatives. The purpose of this paper was to evaluate the treatment results in the viewpoint of bone union, complication and functional outcomes of the interlocking intramedullary nailing between reamed and unlearned technique in the treatment of tibial shaft fractures. We reviewed 64 tibial shaft fracture that were treated at our hospital from May 1990 to February 1995 with interlorking intramedullary nailing that composed 36 reamed, and 28 unlearned cases. These included 33 open fractures and 34 closed fractures. There was no significant di florences in average prriod of radiologic union, complications and in the functional outcomes between the two treatment grovps(P<0.05). Unlearned interlocking intramedullary nailing in the tibial shaft fractures must be a goof treatment modality by its simplicity, shorter operation time, less probability in pulmonary and throrrlboembolic complications and less comprormised medullary blood supply, especially in patients with multiple trauma or open fractures.

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Comparison of Reamed and Unlearned type Intramedullary Interlocking Nail in Treatment of Tibia Shaft Fracture: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Kim, Soo Gon Kim; J Korean Soc Fract 1995;8(3):572-577. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.572

Abstract PDF: The authors analyzed 41 cases of fresh diaphyseal fracture of tibia who were treated with intramedullary interlocking nail between Oct. 1991 to Oct. 1993. in Hae-Dong hospital and followed up for 12 months or more. Among 41 cases, 18 cases were treated with reamed nailing method, and the others with unlearned method. The authors compared the results of 2 type of nailing method and obtained the following results. 1. Most of the cases(63%) had injury in their third and forth decade. Male was 31 cases. 2. The most common cause of injury was traffic accident(61%). 3. The mean bony union time was 16.5 weeks in reamed case, and 15.6 weeks in unlearned case. 4. The patients were judged to have good or excellent result in 89% of reamed cases and 87% of unlearned cases according to functional result by Klemm and Borner. The merits of unlearned intramedullary interlocking nail were relatively easier in procedure, short operation time, and less bleeding. So the authors concluded that unlearned intramedullary interlocking nail is useful method to treat the tibial diaphyseal fractures, especially in open fracture, elder patient and complicated patient.

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A Treatment of Unreamed Intramedullary Nailing of Open Fracture of the Tibia: Keun Kwon Kang, Jang Jung Kim, Kun Yung Lee, Myung Kon Nam, Myung Sik Park; J Korean Soc Fract 1995;8(3):551-556. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.551

Abstract PDF: The tibial fracture was the most common fracture of the long bone fractures, especially there were many controversies in the treatment of open fracture by high energy injury. The authors analyzed retrospectively 32 patients of tibial open fracture who underwent unlearned intramedullary nailing at the Department of Orthopedic Surgery, Lee-Rha general hospital from September 1992 to August 1994 with minimal 1 year follow up. In 32 cases, the average age was 37.5 years old and the most common injury was traffic accident(25 cases,78%). Twenty seven cases were male(84.4%) and 5 cases female(15.5%). There were 17 cases of Type A fracture(53%),12 cases Type B(37.5%) and 3 cases Type C(19.5%) by A-O classification, and 11 cases were Type I open fracture(34%) by Gustilo - Anderson classification, 15 cases, Type B (47%) and 6 cases, Type III (19%). The average bone union time was 14.8 weeks except one case of infected non-union. We concluded that unlearned intramedullary nailing is recommended for the compatible treatment metnod of tibial open fractures.

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Application of Unlearned Interlocking Nailing for Tibial Shaft Fractures: Hee Kwon, Kyoung Dae Min, Jong Suk Park, Jae Uk Kwon, Soo Byoon Rah, Chang Uk Choi; J Korean Soc Fract 1995;8(1):292-299. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.292

Abstract PDF: Intramedullary nails may be divided into two categories: unlearned and reamed. reaming effectively lengthens the isthmus of the tibia and thereby extends the number of fractures amenable to this technique, but other studies showed that union impairement and infection rates were relatively high because of reaming destroyed the endosteal blood supply, especially open fractures. Unlearned interlocking nails in open fractures offer the advantage of less damage to the intramedullary blood supply Also lower infection rates have been reported in open fracture when compared with reamed nails. We analysed 22 cases of tibial shaft fractures managed with interlocking nailing without reaming and experienced treatment of complications since September 1992. Average follow-up period was 13 months ranged 5 to 17 months and results were as follows: 1) We used an unlearned interlocking nails for tibial open fractures, 14 cases(Gustilo-Anderson type: I.3 cases, II.5 cases, III a 4 cases, III b.2 cases)and closed fractures asscciated with combined injuries, 8 cases. 2) Union occurred an average of 5.2 months postoperatively with a range from three to 14 months. 3) The complications were 2 cases of superficial infection and 5 cases of nonunion(3 cases among the 8 cases of closed fracture and 2 cases among the 14 cases of open fracture. 4) The treatment of nonunion was successful with bone graft, additional screw fixation and reinsertion of reamed nail. 5) We concluded that unlearned interlocking nailing was useful method to treat the open tibial shaft fractures in the selected cases, but undesirable to treat closed tibial shaft fractures because considered less mechanical stability.

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Treatment with Unlearned Locked Intramedullary Nail for Open Tibial Fractures: Sang Soo Kim, Byung Chang Lee, Dae Moo Shim, Jae Hoon Shin; J Korean Soc Fract 1995;8(1):284-291. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.284

Abstract PDF: Open fractures of the tibia remain a formidable injury. Which the need for stabillization of open tibial fractures is accepted, the method of fracture stabilization is still controversial because of unacceptable infection rate. External fixation has been the routine and safe procedure for open tibial fractrues. However, this is not without significant complications such as pin tract infection and delayed or nonunion due to insufccient stability. We reviewed the records of 29 patients who underwent immediate unlearned locked intramedullary nailing for open tibial fractures. The average time between injury and operation was 2.4days. The classification of the open fractures was; fifteen Grade I, nine Grade II , and five Grade II a. There was no superficial infections, but one of type III a patient developed deep infection. Skin graft or rotational flap to cover the soft tissue defect were performed. All cases were treated by primary intramedullary nailing without a change of the fixator. So, we think unlearned locked intramedullary nailing is a good alternative method for the management of Grade I, II, III a open tibial fractures.

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Treatment of the Tibia Shaft Fractures with Unreamed Intramedullary Interlocking Nail: Ki Chan Ahh, Seung Seok Seo, Hyun Duek Yoo, Jang Seok Choi; J Korean Soc Fract 1994;7(1):95-104. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.95

Abstract PDF: In general, blood supply of the long bones contributes three ways-nutrient, metaphyseal and periosteal vessels. Its vascular damage is caused by major trauma or extensive soft tissue det-achment. When the diaphysis of long bone is reamed, endosteal blood supply is eliminated. In our hospital, 23 selected cases of the diaphyseal fracture of tibla have been treated by manipulative reduction, unlearning of the medullary canal and fixation of fracture fragments with an Interlocking intramedullary nail for preserration its vascularity as possible. We analized the patients from Jan. 1992 to May 1993, who were followed up for a mean 12 months. Most of cases were acute, 18 of these cases were open fracture and main cause of the injury was traffic accidents. Overall, 90% of the patients were judged to have good or excellent result based on both clinical and radiological parameters, and the average bony union time was 17 weeks. The complications were mainly infection(3 cases), loosening or breakage of the locking screws(3 cases) and delayed union(1 case). The merits of unlearned interlocking nailing were relatively easy procedure, short operation time, decreased complcations, rigid fixation and early rehabilitation. We concluded that unlearned intramedullary interlocking nailing is a useful method to treat the tibia shaft fractures, especially open type.

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Treatment of the Tibia Fractures with Unreamed Intramedullary Interlocking Nailing: Jae Won You, Dong Min Shin, Young Bne Pyo; J Korean Soc Fract 1992;5(2):282-288. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.282

Abstract PDF: The intramedullary interlocking nailing for the fractured tibia has been used in selected cases of fresh diaphyseal fracture, but the indication has been expended considerably with modern technical improvement. The authors analyzed 28 cases of fresh fractures of the tibia, who were treated with unlearned intramedullary interlocking nailing in out hospital between May 1990 to Oct. 1991, average follow-up was 12 months ranged from 8 to 22 months and we obtained the following results. 1. The most common causes of the injury were traffic accident(19 cases). 2. Mostly associated injury was ipsilateral fibular fracture(24 cases). 3. We used unlearned intramedullary interlocking nail in all cases and dynamic and static interlocking were done in 12 cases and 16 cases respectively. 4. The average bony union was demonstrated radiographlcally at 16 weeks. 5. The complications were deep infection(1 case), delayed union(2 cases), angular deformity (4 cases), superficial infection(3 cases), limitation of knee joint ROM(3 cases) and shorte ning of leg length(2 cases). 6. In case of the treated for method of unlearned nailing, it is not difficut to insert the nail, and we obtained good bony union, decresed operation time and bleeding. The authors concluded that unlearned intramedullary interlocking nailing is useful method to treat the tibla fracture.

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