Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing

Year 2011, Volume: 2 Issue: 2, 168 - 174, 01.06.2011

Abdullah Demirtaş Mehmet Oğuz Durakbaşa İbrahim Azboy Atilla Polat Bekir Yavuz Uçar Yahya Coşar Gürkan Gümüşsuyu

https://doi.org/10.5799/ahinjs.01.2011.02.0233

Abstract

Objectives: The aim of this study was to evaluate the results of reamed and locked intramedullary nailing for tibial di-aphysis fractures. Materials and methods: The study included 38 patients (26 males, 12 females) who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. Fractures were classified according to Gustilo-Anderson classification and functional results were assessed using the Johner-Wrush criteria. Results: The mean age was 36 years (range 18-61). There were 21 AO/ASIF type A, 16 type B, and 1 type C fractures. Twenty-four fracture were closed (63.1%) and 14 (36.9%) were open fractures. According to the Gustilo-Anderson classification, 9 were grade I, 4 patients grade II, and one grade IIIA open fractures. Intramedullary nailing was per-formed following open reduction in 18 patients, and closed reduction in 20. The mean time to surgery was 9.4 days and the mean follow-up was 29 months. Union was achieved in all patients within a mean of 17.6 weeks. Anterior knee pain developed in 18 patients and infection developed in three patients. Angular deformity less than 10º was developed 12 patients (31.6%). There were screw breakacge and synostosis in four and two patients respectively. Ac-cording to the Johner-Wrush criteria, functional results were very good in 23 patients (60.5%), good in 12 patients (31.6%) and fair in 3 (7.9%) patients. Conclusion: Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing gives satisfactory results. It should be considered as first choice in the treatment of these fractures.

Keywords

Tibia shaft fracture, closed-open surgery, intramedullary nail, reamed dynamisation, complication, locking screw.

Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing

Abstract

Amaç: Bu çalışmanın amacı tibia cisim kırıklarının oymalı kilitli intramedüller çiviler ile tedavi sonuçlarını değerlendir-mektir. Gereç ve yöntem: Çalışmaya tibia cisim kırığı nedeniyle oymalı kilitli intramedüller çivi ile tedavi edilen 38 hasta (26 erkek, 12 kadın) alındı. Kırıklar Gustilo-Anderson sınıflamasına göre sınıflandırıldı, fonksiyonel sonuçlar Johner-Wrush değerlendirme kriterlerine göre değerlendirildi. Bulgular: Hastaların yaş ortalama yaşı 36 yıl (18-61 yıl) idi. AO/ASIF sınıflamasına göre kırıkların 21'i (%55.3) Tip A, 16'sı (%42.1) Tip B, 1'i (%2.6) Tip C kırık olarak değerlendirildi. Kırıkların 24'ü (%63.1) kapalı, 14'ü (%36.9) açık idi. Gustilo-Anderson sınıflamasına göre açık kırıkların 9'u (%23.6) Tip 1, dördü (%10.5) Tip 2 ve biri (%2.6) Tip 3A kırık idi. Kırıkların 20'sinde (%52.6) kapalı, 18'inde (%47.3) açık redüksiyon tekniği kullanılarak çivileme yapıldı. Kırık oluşumu ile ameliyat arasında geçen Tüm hastalarda kaynama sağlandı. Ortalama kaynama süresi 17.6 hafta idi. On sekiz has-tada (%47.3) diz önü ağrısı gelişti. Hastalarımızın 6'sında (%15.8) enfeksiyon gelişti. On iki hastada (%31.6) 10° ve altında açısal deformite saptandı. Dört hastada (%10.5) vida kırılması görüldü. Johner-Wrush kriterlerine göre 23 hastada (%60.5) mükemmel, 12 hastada (%31.6) iyi ve 3 hastada (%7.9) orta sonuç elde edildi. Sonuç: Tibia cisim kırıklarının tedavisinde oymalı kilitli intramedüller çivileme yönteminin çok iyi sonuçlar verdiği ve bu kırıkların tedavisinde öncelikli olarak düşünülmesi gerektiği sonucuna varıldı. kırıklarının oymalı kilitli intramedüller çi-viler ile tedavi sonuçlarını değerlendirmektir.

Keywords

Tibia cisim kırığı, kapalı-açık cerrahi, intramedüller çivi, oymalı, dinamizasyon, komplikasyon, kilitleme vidası.

References

• Bhandari M, Guyatt G, Tornetta P, et al. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg 2008;90(2):2567-2578.
• Court-Brown CM. Fractures of tibia and fibula. In: Bucholz RW, Heckman JD, Court-Brown C. Rockwood and Green’s Fractures in Adults. Sixth Edition, Philadelphia, Lippincott Williams and Wilkins 2006;2080-2146.
• Ege R. Tibia ve fibula cisim kırıkları. In: Ege R editör. Trav- matoloji, Kırıklar ve Eklem Yaralanmaları. 4. Baskı. An- kara, Kadıoğlu Matbaası 1989;3:2774-2882.
• Müler ME. The comprehensive classification of fractures of long bones. In: Müler ME, Allgower M, Schneider R, Wil- lenegger H editors. Manual of internal fixation technigues recommended by the AO/ASIF Group. 3rd ed. Berlin, Springer-Verlag 1991;118-150.
• Toivanen JA, Honkonen SE, Koivisto AM, et al. Treatment of the low energy tibial shaft fractures. Plaster cast compared with intramedullary nailing. Int Orthop 2001;25(1):110- 113.
• Russell AT. Fractures of the shaft of the tibia. In: Rock- wood CA, Green DP(eds). Rockwood and Green’s Frac- tures in Adults, 4. ed., Philadelphia: Lippincott Company, 1996;2127-2199.
• Whittle AP, George WW. Fractures of lower extremity, In: S. Terry Canale eds. Campbell’s Operative Orthopae- dics Tenth Edition, Philadelphia, Pennysylvania, Mosby 2003;2725-2872.
• İlizarov GA. The historical background of transosseous oste- osynthesis. In: Green SA eds. Transosseous Osteosynthesis, Berlin, Springer-Verlag 1992;3-62.
• Court-Brown CM, Mc Queen MM, Qubaa AA. Locked in- tramedullary nailing of open tibial fractures. J Bone Joint Surg 1991;73(B):959-964.
• Alho A, Ekeland A, Stromsoe K, et al. Locked intramedul- lary nailing for displaced tibial shaft fractures. J Bone Joint Surg 1990;72(B):805-809.
• Babis GC, Benetos IS, Karachalios T, et al. Eight years clinical experience with orthofix tibial nailing system in the treatment of tibial shaft fractures. Injury 2007;38:227-234.
• Bone LB, Sucato D, Stegeman PM, et al. Displaced isolated fractures of tibial shaft treated with either a cast or intramed- ullary nailing. J Bone Joint Surg 1997;79(A):1336-1341.
• Court-Brown CM, Will E, Christie J, et al. Reamed or un- reamed nailing for closed tibial fractures. J Bone Joint Surg 1996;78(B):580-583.
• Tükenmez M, Perçin S, Öztürk H, et al. İntramedüller çivi ile tedavi edilen tibia kırıklarının değerlendirilmesi. XVI. Milli Türk Ortopedi ve Travmatoloji Kongre Kitabı. Antal- ya, 1999;296-301.
• Keating JF, O’Brien PJ, Blachut PA, et al. Interlocking in- tramedullary nailing of open fractures of the tibia. A pro- spective randomised comparison of reamed and unreamed nails. J Bone Joint Surg 1997;79(A):334-341.
• Keating JF, Olfaly L, O’Brien PJ. Knee pain after tibial nail- ing. J Orthop Trauma 1996;11(1):10-13.
• Court-Brown CM, Gustilo T, Shaw AD. Knee pain after in- tramedullary tibial nailing: Its incidence, etiology and out- come. J Orthop Trauma 1996;11(1):103-105.
• Lefaivre KA, Guy P, Chan H, et al. Long-term follow-up of tibial shaft fractures treated with intramdeullary nailing. J Orthop Trauma 2008;22(8):525-529.
• Vaistö O, Toivanen JA, Paakkala T, et al. Anterior knee pain and thigh muscle strenght after intramedullary nailing of a tibial shaft fracture: An 8 year follow-up of 28 consecutive cases. J Orthop Trauma 2007;21(3):165-171.
• Wiss DA, Stetson WB. Unstabil fractures of the tibia treated with a reamed intramedullary interlocking nail. Clin Orthop 1995;1(1);56-63.
• Milner SA, Davis TR, Muir KR, et al. Long-term outcome after tibial shaft fractures: Is malunion important? J Bone Joint Surg 2002;84(6):971-80.
• Merchant TC, Dietz F. Long-term follow-up after frac- tures of the tibial and fibular shaft. J Bone Joint Surg 1989;71(4):599-606.
• Bridgman SA, Baird K. Audit of closed tibial fractures. What is a satisfactory outcome? Injury 1993;24(2):85-89.
• Gregory P, Sanders R. Treatment of closed unstable tibial shaft fractures with unreamed interlocking nails. Clin Or- thop 1995;315(1):48-55.
• Keating JF, O’Brienn PI, Blauch PA, et al. Reamed inter- locking intramedullary nailing of open fractures of the tibia. Clin Orthop 1997;338(1):182-191.
• Ekeland A, Thoresen BO, Alho A, et al. Interlocking in- tramedullary nailing in the treatment of fractures. A report of 45 cases. Clin Orthop 1988;231(2):205-215.