Open tibial shaft fractures. Treatment with intramedullary nailing after provisional stabilization with non penetrating external fixator

Abstract

Objective To evaluate the incidence of union, nonunion, deep infection and factors influencing the time of bone healing in the treatment of open tibial shaft fractures Gustilo and Anderson types I and II initially treated with a non penetrating external fixator (Pinless ® ) followed by an unreamed intramedullary locked nail (UTN ® ). Methods It is a prospective study of 39 open tibial shaft fractures. According to the AO classification, 16 patients (41.0%) were type A, 17 (43.6%) were type B and six (15.4%) were type C. According to the Gustilo and Anderson classification, 14 patients (35.9%) were type I and 25 (64.1%) were type II. For the definitive stabilization of the fracture were used an unreamed intramedulary locked nail (UTN ® ). Results Bone healing was achieved in 97.4% of the cases, with a mean time of 21.2 weeks, ranging from 12 to 104 weeks. Deep infection was seen in 2.6% patients and malunion were seen in 5.1%. Only the presence of complications were statistically significant to the time of bone healing, with a risk of faster healing in patients without complications of 4.29 times (CI 95%: 1.25–14.71) comparing to patients with complications. Conclusion The treatment of open tibial shaft fractures with unreamed intramedullary locked nail allows high rates of bone healing, low rates of nonunion and deep infection, and only the presence of complications is statistically significant to the time of bone healing.

Open fractures: epidemiological pattern, initial management and challenges in a sub-urban teaching hospital in Nigeria

“…The tibia and the fibula bones were the most frequently involved in open fractures making up about 45% of cases in this series. Several previous studies also reported similar findings [9, 16, 20, 21]. The reason for this observation has been ascribed to the fact that the antero-medial border of the tibia is largely subcutaneous throughout its whole length [5, 20].…”

Comparing Intramedullary Nailing, External Fixation, and External Fixation followed by Intramedullary Nailing as management for open fractures of the tibial shaft: a Systematic Review

“…Park et al [4] did not specify the percentages of superficial and deep infection. In the study of Sakaki et al [17] most infections were deep (10.71%), whereas, in the study of Kaftandziev et al…”

“…Out of the 10 studies on intramedullary nailing as definitive management, only Tielinen et al [18] showed 0%. The other studies on intramedullary nailing presented less than 11% [4, 6, 10, 11, 16,17,19,[20][21][22], except for Sakaki et al [17], Park et al [4], and Kaftandziev et al [11] in which that rate was 17.85%, 22.0%, and 33.3%, respectively. Park et al [4] did not specify the percentages of superficial and deep infection.…”

“…Besides, 10% of the fractures had delayed healing (over 6 months, according the paper), and they had to be dynamized and/or subjected to other procedures (reaming of the shaft, bone graft). In the other studies on IM Nailing as definitive management [2,6,10,11,16,17,19,[20][21][22][23][24] the nonunion rate was between 0% [6] and 11.1% [11].…”

Caracterização dos atendimentos de um serviço de ortopedia e traumatologia em urgência e emergência da cidade de Manaus – Amazonas / Characterization of the treatment of an orthopedic and traumatology service in urgency and emergency of the city of Manaus - Amazonas

“…Das abordagens cirúrgicas, 78,5% foram realizadas nos membros inferiores e desses 65,5% na tíbia, a qual segundo Hungria et al (2013) 18 é o osso longo mais fraturado e que com maior frequência sofre fratura exposta.…”