The treatment of tibial fractures with unreamed interlocking nails

Abstract

Objectives: We evaluated the clinical and radiographical results of tibial fractures treated with unreamed interlocking nails.
Patients and methods: Thirty-eight tibial fractures of 35 patients (22 males, 13 females; mean age 39 years; range 18 to 74 years) were treated with titanium unreamed interlocking nails. There were nine open fractures (4 G I, 3 G II, 2 G IIIA). Fractures were in the middle 1/3 (n=24, 63.2%), distal 1/3 (n=9, 23.7%), and proximal 1/3 (n=5, 13.2%) of the tibia. The mean time from injury to treatment was 44 hours (range 4 hours to 13 days). The size of the intramedullary nails was 8 mm in 18 fractures, and 9 mm in 20 fractures. The results were evaluated according to the Johner and Wruhs’ criteria. The mean follow-up period was 42 months (range 24 to 55 months).
Results: Union was achieved in 30 fractures (79%) in a mean period of 22 weeks (range 12 to 24 weeks) without any additional surgical intervention. Six fractures (15.8%) required dynamization and one fracture (2.6%) required dynamization and grafting to heal after a mean of 26 weeks. One fracture did not unite despite dynamization and was treated with a reamed nail. Superficial infections detected in four fractures (10.5%) responded well to appropriate treatment. Malunion was encountered in seven fractures (18.4%) and interlocking screws were broken in four fractures (10.5%). The results were excellent in 19 patients (54.3%), good in 10 patients (28.6%), and fair in six patients (17.1%).
Conclusion: Treatment of tibial fractures with unreamed interlocking nails is an appropriate method due to its ease of application, a shorter operation time, and a lower infection rate owing to less traumatic affect on soft tissues.