Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.
Recently intramedullary nailing has become the most common method treating tibial fractures.
Reamed intramedullaiy nailing technique leaves the problem of destorying the endosteal blood supply, which associated with delayed union and postoperative infection. Recent reports have shown excellent rate of union and low rate of intection with unlearned interlocking intramedullary nail.
Author reviewed 58 cases of tibia shaft fractures that were treated with unrealned interlocking nail from Feb. 1992 to Feb. 1994.
1. Furty nine fractures were closed and 9 were open (Gustilo-Andersonl;3,II;5, IIIa;1). Thrity one fractures involved the distal portion, 19 fractures the middle portion, 6 fractures tile proximal portion and 2 fractures were segmental.
2. Thirty six cases were male and 22 were female. The most common age was 3rd decade (25.8%).
3. The most common caute was traffic accident.
4. Average interval from injury to operation were 5.7 days in close fracture and 11.3 days in open fracture.
5. The mean duration of bone union were 15.7 weeks in closed fracture and 19.5 wreks in open fracture.
6. Complications include 1 case of delayed union, 1 case of joint stiffness and 1 case of screw failure.
7. According to the functional results by Klemm and Borner, 42 cases were excellent, 15 cases were good and 1 was fair.