[Closed intramedullary nailing of tibial shaft fractures].

OBJECTIVE

To assess patient outcome after nailing of the tibial shaft with the unreamed AO/ASIF nail.

DESIGN

A retrospective study of 54 nailed fractures of the tibial shaft treated between 1990 and 1994. Follow-up was done at the outpatient clinic and included measurements of the lower limbs and x-rays.

SETTING

The study was conducted at the Hôpital de l'Enfant-Jésus, Québec, a centre specializing in trauma care.

PATIENTS: Fifty-four acute displaced fractures of the tibial shaft occurring in 52 patients were studied.

INTERVENTION: Nailing with the Synthes AO/ASIF unreamed locked nails.

MAIN OUTCOME MEASURES: Time to bone fusion, rate of infection, incidence of deformity and failure rate of the implants, especially the lock screws.

RESULTS

The majority of fractures were associated with a high-speed trauma (40/54 or 74% of cases) and 18 (33%) were open fractures. Osteitis developed in one (1.8%) open type IIIA fracture. Bone fusion was observed clinically and radiologically after 29 weeks on average; none of the fractures presented residual deformity on rotation of more than 5 degrees or a difference in length of more than 1 cm or a frontal or sagittal displacement of more than 10 degrees. A single case of pseudoarthrosis was noted. One or more lock screws became deformed or broke in 16 (34%) tibias; however, this did not lead to any reduction loss. Four compartment syndromes were diagnosed.

CONCLUSIONS

Excellent results were obtained with respect to limb alignment and length. Loss of joint mobility was minimal. The number of lock screw failures indicates that a delayed weight bearing could prevent this complication, especially when an interfragment space remains after the nail placement.