Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fractures.
BACKGROUND
Almost 9% of tibial shaft fractures occur in the proximal third of the bone. In order to address the problems of mal-alignment and late loss of fixation, all the specific surgical techniques described in the literature were used in nailing these fractures in our study.


METHODS
From December 2001 to December 2003, 45 consecutive patients with fracture of the proximal third of the tibial shaft underwent nailing. The clinico-radiological outcome of these cases and the complications encountered were analysed.


RESULTS
The average time to knee mobilisation and partial weight-bearing walking was 3.2 days. The fractures had united at an average of 4.3 months. At the last follow up, the average lower extremity functional score was 96%. There were seven cases of malunion (15.56%), with three valgus and four apex anterior angulations. Delayed union necessitated open bone grafting in three cases, at an average of 6.3 months. At 8 months, one patient with delayed union experienced nail breakage across the weakest point, i.e. the dynamic screw hole. He underwent reamed exchange nailing and, 3 months later, the fracture had united.


CONCLUSIONS
Meticulous intramedullary nailing of fractures of the proximal third of the tibial shaft, using all current surgical principles and techniques, has excellent clinico-radiological outcome and is relatively safe. We recommend a nail similar to a Sirus nail, but with a more proximal bend of the nail and no dynamic interlocking screw hole.
Vidyadhara
S
S
Trauma and Joint Replacement Services, Department of Orthopaedics, Kasturba Medical College, Manipal 576104, Karnataka, India. vidya007@gmail.com
Sharath
K Rao
KR
D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017759:Fractures, Malunited / Q000000981:diagnostic imaging; D005599:Fractures, Ununited / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D013978:Tibial Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*