COMPARISON OF TWO TECHNIQUES OF INTERLOCKING INTRAMEDULLARY NAILING IN FRACTURES OF TIBIA

Aim: To compare the results of reamed and unreamed interlocking intramedullary nailing in fractures of tibia in terms of their advantages and disadvantages, fracture stabilization, maintenance of alignment, complications and functional outcome.

Design: A Prospective comparative study

Place and Duration: The study was conducted at the Department of Orthopedic Surgery at Mayo Hospital Lahore for one-year duration from April 2019 to April 2020.

Patients and Methods: A total of 40 patients having closed or grade1 open fractures of tibia that presented within 12 hours of injury were admitted through emergency department. The detailed history was taken. The patients were evaluated both clinically and radiologically. Complete physical and systemic examination was performed to rule out associated injuries. The laboratory investigations were carried out and surgery was planned. Long leg splint was applied. By random selection Unreamed interlocking intramedullary nailing was performed in one group of 20 patients and in the 2nd group intramedullary interlocking nailing was done after reaming of the medullary cavity. Patients were informed about the nature, cost, advantages and limitations of the procedure.

Results: The patients treated by the unreamed method of interlocking intramedullary nailing had better results regarding the rehabilitation, functional outcome, as scored by the evaluation criteria and radiological union time in comparison with the reamed method of interlocking intramedullary nailing which in relation to patients rehabilitation, functional outcome residual deformities, and post-operative complications, scored less. There were no cases of nonunion resulting from either technique. Two patients developed superficial wound infection, both treated by the reamed method of intramedullary nailing but none developed chronic osteomyelitis

Conclusion: In the case of tibial shaft fractures, Unreamed interlocking nailing is a better solution, as it is associated with fewer complications, better rehabilitation, fewer cases of residual deformity, and thus a better functional outcome.

Keywords: reamed, untreated, intramedullary, nail