2019, Vol. 3 Issue 3, Part B
Primary interlocking nailing of open fractures of the tibial shaft at a tertiary care hospital
Author(s): Dr. Channabasava Patil and Dr. Srinivas Pandurangiah
Abstract: The use of interlocking nailing for open fractures is controversial. The accepted standard treatment has been External Fixation followed by definitive treatment. This is especially true when there is severe soft tissue injury or severe contamination. Also reaming was considered contraindicated for open fractures. This is because it is thought to destroy the end steal blood supply. Thus it theoretically increases the risks of infection and nonunion. However recent studies have indicated that the results are similar whether nonreamed or reamed technique is used. Patients were excluded if they had a fracture in the proximal fourth of the tibia or a fracture within four centimeters of the ankle, neither of which was judged to be amenable to interlocking nailing; if the patients did not turn for follow up; if the patients had significant medical or surgical disorders to minimize their influence on fracture healing and union; or if they had open growth plates. The average time to union was 26 weeks for type I fractures(fifteen in number), 29 weeks for type II fractures(nineteen in number), 34 weeks for type III A fractures(nine), 38 weeks for type III B fracture (One). There were 2 non-unions (Both Type II), both of them had middle third fractures, for one of them the original nail was replaced with a larger diameter Grosse Kempf nail with reaming and chancellors bone grafting was done, the donor site being the upper end of the contralateral tibia. The other nonunion patient which was infected was treated with removal of the nail, thorough washing with hydrogen peroxide and betadine solution, freshening of the fracture ends, fibular resection and chancellors bone graft application and Ilizarov frame application this united later at about 105 weeks.