Fixation of Tibial Shaft Fracture by Interlocking Nail without Proximal Screws

Abstract

Tibia is the most commonly fractured long bone. In adults it takes 4 to 6 months to heal depending on the severity ofinjury and method of treatment. Rate of complications are also high. Locked intramedullary nailing is the preferredtreatment for tibial shaft fractures. When locked proximally and distally, removal of one set of screws, especially intransverse and short oblique fractures are required for dynamization before weight bearing. Fail to do this timely,many of these patients present with nonunion and implant failure. The purpose of the study was to enhance healing oftibial shaft fracture by early weight bearing, at the same time minimizing the complications and early return to work.Stable open type- I, II & closed tibial shaft fractures from the isthmus to 4 cm above the distal articular surface of thetibia were fixed by locking nail without proximal screws. This prospective study was done from June 2009 to July2014 on 410 patients treated at several hospitals of Faridpur city. All the operations were done in closed methodwithout any C-Arm monitoring. Patients were allowed to move with crutch and controlled partial weight bearingwithin two to four weeks of operation. All patients were followed up for five years. In most cases the nail wereremoved in one to two years. Early weight bearing causes compression and intermittent micro movements at thefracture site. The fractures heal as early as in eight to twelve weeks and no nonunion or implant failure wereencountered. Knee pain was complained by 41 patients (10%), disappeared after removal of the nail. Superficialinfection developed in 8 cases (1.95%), controlled in 2 to 3 weeks and deep infections were encountered in 8 cases(1.95%) with delaying union but eradicated spontaneously as the fracture healed. Deep infection occurs only in openfractures. Although five years period is not enough to comment about development of secondary osteoarthritis, weencountered no such cases till now. So, closed reduction and internal fixation (CRIF) of stable open type-I, II &closed tibial shaft fractures from the isthmus to 4 cm above the distal articular surface of the tibia by interlockingnailing with distal locking screws only, allows early controlled weight bearing, thereby early fracture healing and lesschance of implant failure. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):33-36