Abstract: Background and Objectives:
With increasing number of vehicles on the roads in India, complex trauma cases caused by traffic accidents have increased progressively. Fracture Tibia are among the commonest fractures sustained in road traffic accidents due to the subcutaneous nature of the tibia, they are frequently open and contaminated fractures. Due to the poor blood supply and poor soft tissue coverage these fractures are frequently complicated by delayed union, malunion, non-union and infection.
Controversy exists as to the optimal method of stabilization of compound fractures of Tibia. External Fixation devices had been quite popular in the management of these fractures, but lately unreamed intramedullary nail is being used as the initial management of these fractures as external fixation devices are associated with complications such as communition, displacement, soft tissue injury and pin tract infections moreover wound management and skin closing procedures are easier with Intramedullary nailing, Studies have shown that reaming disrupts the cortical blood flow to a greater extent than the Unreamed nails thereby increasing the susceptibility to infection. When comparing the Unreamed IM nail to the Reamed IM nail, the Unreamed nail with interlocking may provide the same stability as a closely fitting tubular nail but without the danger of jamming. Thus considering all these studies, the Unreamed IM Nail can be used for the management of Compound fractures of Tibia.
This study was conducted at the Department of Orthopaedics, Adichunchanagiri institute of medical sciences to evaluate the results of interlocking intramedullary nailing using an unreamed nail in the treatment of the compound fractures of tibia. It was done to compare the advantage of using an interlocking intramedullary nailing without reaming in the treatment of compound fractures of tibia with various studies in terms of time required for union, rate of malunion and malrotation, infection and range of motion of knee and ankle.
Materials and Methods: This study was performed on 50 compound fractures of tibia with an unreamed interlocking intramedullary nail at Adichunchanagiri Institute of Medical Sciences & Research centre after attaining ethical clearance. All the cases selected were fresh fractures and mostly traumatic in nature. The procedure was done as early as possible and the secondary procedures of Dynamisation, skin grafting and musculocutaneous flap were done as and when needed.
The cases were followed up for an average period of 18 months with 4 visits (6 weeks, 3 months, 6 months and 12 months)
Results: Compound fractures of the tibia managed using an unreamed interlocking intra medullary nail gave good functional results and patient satisfaction. It involved minimal surgical trauma and less blood loss. It provides the advantage of early ambulation, lower rates of infection, non-union, mal union and delayed union compared to other treatment modalities. It allows early weight bearing and shorter hospital stay.
Interpretation and Conclusions: It was concluded that early interlocking intra medullary nailing using an unreamed nail with immediate soft tissue coverage resulted in good fracture union and low rates of complications compared to other modalities of treatment. It is cost effective with short hospital stay and facilitates earlier return to work. Over all morbidity is reduced and better patient satisfaction noted.