Usage of Unreamed Interlocking Nails for the Management of Gustilo Anderson Grade 2 and 3 Open Fractures of Shaft of Tibia – A Prospective Study

Abstract

Long bones fractures are the main emergency procedures in most trauma centers. Tibial fractures are commonly open as described by the Gustilo classification. Grade III fractures of the tibia (diaphysis) are very challenging injuries. Intramedullary nailing is one of the best known treatments for tibial fractures. It’s still being debated which is the most appropriate surgical approach to treat such fractures especially the choice between reamed vs. unreamed nails. This study was designed to determine the outcome of unreamed interlocking nail in open type II and IIIA tibial shaft fractures in terms of infection, bone union, delayed union and nonunion.

Patients and Methods:  It was a prospective, quasi – experimental study, conducted at Department of Orthopedics, Lahore General Hospital/PGMI Lahore upon sixty patients. All subjects with Grade II and III open fractures of shaft of tibia were operated using the unreamed nails. They were followed regularly on 3^rd then 10^th, 20^th, 30^th post-op days. Later a monthly OPD follow up for 9 months was maintained. Records were maintained and analyzed using SPSS 20. Modified Anderson criteria was used to segregate results from poor to excellent.

Results:  Mean age of all patients was 32.82 ± 8.87 years. Fracture geometry shows that 9 patients had transverse, 27 had oblique, 18 had spiral and 6 patients had comminuted fracture. According to the Gustilo – Anderson Classification 43 fractures were Type II and 17 fractures were Type IIIA. Only 9 patients developed infection. Union was seen in 51 (85%) patients and delayed union was observed in 7 (11.66%) subjects. Two patients (3.34%) had nonunion. According to the Modified Anderson grading 47 (78.34%) patients had excellent, 7 (11.66%) patients had good and 6 (10%) patients had poor results.

Conclusion:  On the basis of the results obtained, it was shown that unreamed interlocking nail for treating type II and III A fractures of tibial shaft shows promising and effective results in terms of low rate of infection and bone union. Overall excellent results were seen in 47 (78.34%) patients according to the modified Anderson criteria.