Surgical Management of Isolated Tibial Shaft Fractures with Closed Intramedullary Interlocking

Abstract

Background: Tibial diaphyseal fractures are one of the most common long bone fractures encountered by most of the orthopedic surgeons. The tibial shaft fractures with intact fibula had difficulties in the orthopedic treatment of leg fractures such as reduction of the tibial and an unusually high rate of varus malunion, delayed union, and non-union. Fractures of tibial diaphysis associated with an intact fibula have always interested orthopedic surgeons; there has been debate as to whether the intact fibula was associated with an improved or worse prognosis. Materials and Methods: A total of 30 patients with isolated tibial diaphyseal fractures (21 closed fractures, 4 Type I open fractures, and 5 Type II open fractures) were operated with closed intramedullary interlocking nailing. This prospective study was done over a period of 2 ½ years with regular follow-up. Results: Postoperatively following 6 months, excellent functional results were obtained in 70% of cases. Good functional results were obtained in 14%, fair functional results in 3%, and poor functional results in 13%. According to Johner and Wruh’s criteria, the percentage of union rate in our study was 87%. The time for union ranged from 4 to 9 months with an average of 5 months, 17 fractures healed before 5 months (20 weeks), 7 fractures healed between 5 and 8 months (20 to 32 weeks), and 4 fractures had gone into non-union. Conclusion: Intramedullary interlocking nailing is the reliable and effective treatment for undisplaced and minimally displaced closed isolated tibial shaft fractures, also in open Type I tibial shaft fractures. Closed minimal and undisplaced fractures have united well. Displaced, comminuted fractures of tibial shaft with intact fibula are prone to delayed union and non-union. Intramedullary interlocking nailing minimizes the hospital stay and reduces the economic burden and enhances the early return to work.

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