LIMITED REAMED INTRAMEDULLARY NAILING AS THE SOLUTION OF THE PROBLEM OF UNION FOR OPEN TIBIAL SHAFT FRACTURES

Abstract

Open tibial shaft fractures are the most frequent in whole skeletal trauma and the way of their treatment cause determined hesitations. Open tibial fractures present complex surgical problem on account of their cure which needs reachable approach, because of the complications which aren’t rare, and because of their influence of the final outcome. Lately, as an alternative method of the standard intramedulary nailing, limited reamed technique was established as a concept which has to minimize the negative effect of reaming and also to provide a biomechanical stability to prevent the problems of union.

The main purpose of this study is to evaluate the clinical results and complications, especially the problems of union, after limited reamed fixation of grade II and III open fractures of the tibial diaphysis.

Clinical material from the Traumatology clinic, Medical Faculty Skopje is used in the study, which is divided into two groups according the grade of injury (using modified Gustilo classification). 56 patients were examinated. The most frequent mechanism of injury was high energy trauma (80,2%). 38 patients were treated in group A and 18 in group B. The examinations were performed following the determined criteria. At all of the patients the exact protocol were conducted which included preoperative, operative (consist of two different parts: primary surgical treatment of traumatized soft tissue and bone stabilization) and postoperative part. Few parameters were examinated in the study such as: radiological evaluation (new bone formation, time of union, problems of union – delayed, male and nonunion), infection, other complications in connection with the operative treatment, additional surgical procedures and functional outcome.

Follow up period was et least 12 months.

The results from the study showed main time of union of 27,5 weeks in Group A and 32 weeks in Group B. Concerning the problems of union, delayed union was noticed at 2 (5,26%), male union at 2 (5,26%) and non-union at 1 (2,6%) patient in Group A. In Group B delayed union at 4 (22,2%), male union at 2 (11,1%) and non-union at 2 (11,1%). Superficial infection at 6 (15,7%) and deep at 2 (5,2%) patients in Group A. In Group B superficial at 4 (22,2%), deep infection at 3 (16,6%) and fistula at 1 patient. Other complications such as compartment syndrome, DVT and problems of the implants was noticed. Additional surgical procedures were performed at 11 patients in A and at 16 in B.

Functional outcome showed great percent of excellent results in both groups.

Limited reamed intramedulary fixation is safe and effective method for operative treatment of open tibia shaft fractures (especially Gr. II according Gustilo), with relatively small percent of complications particularly concerning the problems of union and excellent functional outcome.