TITLE:
Results of Dynamic Interlock Nailing in Distal Tibial Fractures
AUTHORS:
Wasudeo Gadegone, Yogesh Salphale, Vijayanand Lokhande
KEYWORDS:
Distal Tibial Fractures, Interlocking Nail, Dynamic Osteosynthesis, Poller Screws, Screw Intramedullary Nail
JOURNAL NAME:
Surgical Science,
Vol.6 No.7,
July
22,
2015
ABSTRACT: A study was
performed in adults to determine the efficacy of closed reduction and
intramedullary nailing in dynamic mode on union, implant failure and incidence
of malalignment in patients who sustained an extra-articular fracture of the
distal tibia. Methods: Between January 2007 and December 2013, one hundred and
twelve patients of distal tibia that involved the distal 6 cm of the tibia were
treated at our hospital with reamed intramedullary nailing with use of two
distal interlocking screws and one proximal screw in dynamic mode. The
augmentation was done with poller screws whenever it was necessary. The nailing
of fibular fractures was done in 27 cases. There were 85 males and 27 females
with a mean age of 30.9 (range: 20 to 72). Eighty fractures were closed whereas
32 were grade 1 open fractures. Results: The average time to union of the
closed fracture was 15.4 weeks (range: 12 – 28 weeks). The healing times for
the primarily nailed compound Grade I averaged 17.8 (range: 15 - 34 weeks).
After minimum follow-up of one year, rate of primary union was in 97.32%. One
case of broken nail required revision surgery. There were three cases of
delayed union and two cases of non union. In one case there was deep infection
which required exchange nailing with antibiotic impregnated nail. There was
breakage of interlocking screws in three cases but fracture had united. In
twenty two cases acceptable malalignment of the tibia was observed after union.
The outcome was determined at a minimum of one year in our study based on the
criteria of Johner and Wruhs. Out of 112 patients, 79 patients had excellent
results, 29 had good results and 4 had fair results. Conclusions: The dynamic
osteosynthesis of distal tibia by interlocking nail and judicious use of poller
screws is an effective alternative for the treatment of distal metaphyseal
tibial fractures.