Retrospective study of results of closed tibial diaphyseal fractures treated by closed interlocking nail by subjective and objective parameters

Abstract

Background: Intramedullary nailing of tibia fulfills the objective of stable fixation with minimal tissue damage resulting in early fracture union. However, it is accompanied by its own set of complications. Materials and Methods: Study area: Burdwan Medical College and Hospital. Study population: Patients attending emergency room and outpatient department 18 years with closed tibial diaphyseal fractures. Sample size: Fifty patients. Study Design: This study was an institution-based retrospective, observational study. Parameters to be Studied: (1) Subjective parameters: (A) resumption of activities of daily living, (B) pain-free movement and walking, and (C) squatting and sitting cross-legged. (2) Objective parameters: (A) clinical (i) weight-bearing time (partial/complete), (ii) clinical union time, (iii) range of motion of knee and ankle, (iv) limb length discrepancy, (v) neurovascular damage, (vi) infection, and (vii) need for second surgery: (a) dynamization, (b) exchange nailing, (c) bone grafting, and (d) ORIF with plate and bone grafting. (B) radiological: (i) radiological union, (ii) varus/valgus, (iii) procurvatum/recurvatum, (iv) rotational malalignment, and (v) implant failure. Results: Final outcome was measured using Johner and Wruhs' Criteria with modification, and excellent result was achieved in 48% patients, good in 34% patients, fair in 12% patients and poor in 6% patients. Conclusion: Closed interlocking nail for closed tibial diaphyseal fractures of tibia is not a “full-proof” technique. Advantages over conservative methods and it's complications, both should be explained, and an informed consent taken before “interlocking” a closed tibial diaphyseal fracture.