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 of
injury and method of treatment. Rate of complications are also high. Locked intramedullary nailing is the preferred
treatment for tibial shaft fractures. When locked proximally and distally, removal of one set of screws, especially in
transverse 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 of
tibial 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 the
tibia were fixed by locking nail without proximal screws. This prospective study was done from June 2009 to July
2014 on 410 patients treated at several hospitals of Faridpur city. All the operations were done in closed method
without any C-Arm monitoring. Patients were allowed to move with crutch and controlled partial weight bearing
within two to four weeks of operation. All patients were followed up for five years. In most cases the nail were
removed in one to two years. Early weight bearing causes compression and intermittent micro movements at the
fracture site. The fractures heal as early as in eight to twelve weeks and no nonunion or implant failure were
encountered. Knee pain was complained by 41 patients (10%), disappeared after removal of the nail. Superficial
infection 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 open
fractures. Although five years period is not enough to comment about development of secondary osteoarthritis, we
encountered 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 interlocking
nailing with distal locking screws only, allows early controlled weight bearing, thereby early fracture healing and less
chance of implant failure.

Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):33-36