[Osteosynthesis by Unreamed Interlocking Nail UTN of the Tibial Shaft Fractures Caused by High Energy Injuries.].
The authors present their own two-year experience with osteosynthesis of 54 fractures of the diaphysis of the leg in 51 patients, using a UTN nail without predrilling, at the Orthopaedic Clinic of the Institute for Postgraduate Medical Training in Prague Bulovka Hospital. After a one-year interval they included in the group 28 complicated fractures of the leg in 26 patients where the fractures were caused by a high energy impact. In nine instances (34.6 %) the fracture was in a polytraumatized patient and in eight patients (50,8 %) with multiple injuries. There were 14.3 % grade 1 open fractures (four fractures) and 21.4 % (four fractures) were grade 2 fractures. The other fractures were closed with major soft tissue contusion. In 11 instances (42.9 %) a secondary operation had to be performed: in 9 instances dynamization, in one instance a supplementary spongioplasty, in one case dynamization combined with osteotomy of the fibula and in one instance a rotational malposition was corrected. In three cases UTN osteosynthesis was supplemented by plaster fixation. Full burdening was possible after an average period of three months. Healing was recorded after an average period of 6.4 months, i.e after 27.7 weeks. As to complications, in one instance an infection was recorded, three times instability of the short proximal fragment, twice Sudeck's algoneurodystrophy, twice neurological complications and once a dry dermal necrosis at the site of the surgical wound. The authors did not record thromboembolic disease or compartment syndrome. As to subjective symptoms oedema and intermittent pain on burdenig were most frequent (32.1 %). Fracture of the nail did not occur. Breaking of the supporting screws was found in 17.9 % (20 screws). In the investigated group of patients the authors evaluated the results in 21 patients (80.8 %) as excellent or good. Satisfactory results were recorded in 11.5 % (3 patients). Unsatisfactory results were recorded in two patients (7.7 %) where surgical revision was necessary because of infection and fifteen degree valgus malposition. In the discussion the authors compare their results with patient groups selected according to similar criteria and they confirm the conclusions of indication of UTN in all fractures of the diaphysis of the leg caused by high energy of violence, incl. grade 1 and 2 open fractures according to Gustil's classification. Key words: unreamed interlocking nailing of the tibial shaft fractures, UTN, fractures of the tibial shaft caused by high energy injury.
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Ortopedická klinika IPVZ, FN Praha - Bulovka.
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