Tibia is one of the most commonly fractured bone. Proximal third tibial fracture account for 5% to 11% of tibial shaft fracture. Treatment of proximal third fracture tibia is complex and problematic. Techniques include plate fixation, external fixation and intramedullary nailing. Purpose of this paper is to review and compare IM Interlock nailing technique in treatment of fracture proximal third tibia with other available techniques.
Materials and Methods: Study involved 33 patients (24 male and 9 females) operated between year 2012 and 2016 in SRTR Medical College and rural hospital, Ambajogai. An age between 18-70 year was selected for the study. Male to female ratio was 3:1. There were 27 simple fractures and six had open injury (4 with gustillo1 and 2 with gustillo 2). Fractures were classified on basis of fracture pattern as simple undisplaced, displaced, comminuted, and segmental. Fractures extending into articular surface were excluded from our study. Patient was in supine position with knee in figure of four posture. A 4 cm vertical midline incision was taken on patellar tendon. Patellar tendon was retracted medially. Entry made just in front of inter meniscus ligament with curved awl, after removal of piece of infrapatellar pad. Entry point was much higher than techniques described in other interlocking nailing. Tibia IM interlock nail of suitable size was inserted with manual rotation and proximal and distal locking done with locking screw. Polar screw and reaming was not used in our cases. In the case of nonunion, broken implants were removed and nail used, bone graft was done. In the case of hypertrophic nonunion IM nail was used and 1cm fibula excision. Post operatively patients were ambulated with crutches NWB and later PWB to FWB as per the pain threshold of the patient. Follow-up of patients were done at regular intervals and final angulations in four planes were studied. Reduction greater than 5 degree in any plane was considered as mal reduction
Results: The average hospital stay was 3-7 days. There was only one postoperative superficial infection, which healed with antibiotics and dressing. No patient had deep infection, neurovascular injury, implant failure or screw loosening. Union time was average 16 weeks with union rate of 94%. Majority of the patient with fractures (88%) shows painless wt bearing and radiological evidence of healing between 12-16 weeks. About 91% pt. showed more than 120-degree knee range of motion at final follow up. The nonunion cases took 16-20 wks for union. Postoperative angulations were within five degree in all planes, and no secondary procedure was required to achieve union or correct malunion.
Conclusion: Tibia IM intramedullary nailing is a safe and effective technique of fixation with good outcome. Alignment can be well maintained despite short proximal segment because the interlock IM nail, triple diameter screw that provides better stiffness and stability in axial and rotatory plane.