“Results of Early Fixation of Open Fracture Shaft of Tibia by Closed Reamed Static Interlocking intramedullary Nail: A study in National Institute of Traumatology and Rehabilitation (NITOR), Dhaka, Bangladesh”

Original Research Article Background: The tibia by its location is exposed to frequent injuries as one third of its surface is subcutaneous. Treatment of tibial fracture in adult is a challenge to orthopaedic surgeons due to poor soft tissue coverage and blood supply. Moreover, compartment syndrome, neurovascular injury and infection might add to this burden. The nail provides good stability against bending forces, while the interlocking screws control axial compression and rotational instability. Closed insertion techniques reduced operating time, causes minimal surgical trauma and consequently fewer postoperative complications like infection. Objectives: The main focus of this current study was to evaluate union and complications like infection, knee pain. Materials and Methods: This prospective study was carried out in the National Institute of Traumatology and Rehabilitation (NITOR), Dhaka, during the period of July 2014 – June 2016. This was an observation study, which included 18 patients aged between 18 to 60 years, all irrespective of sex having open tibial fracture (G-II) treated by closed reamed static interlocking intramedullary nailing within 48 hours of injury. Results: Maximum tibial fracture cases were found in 26-35 years and male was predominant. Motor vehicle accident (MVA) accounted for 72.22%; right side involvement was in 61.11% cases. All cases had mid shaft transverse fracture of tibia and it been stabilized by static nailing. Mean time interval between injury and fixation was 33±7.7 hours. Functional outcomes of patients were based on “Tucker’s criteria”. The duration of hospital stays varied from 5 to 7 days and union time required 14 -27 weeks with mean 19.9 weeks. Post-operative complication was superficial infection in 05.55% cases. After full weight bearing mild pain was found in 05.55%, anterior knee pain was observed in 33.33% cases. There were satisfactory results in 16 cases (88.88%) and unsatisfactory in 2 cases (11.11%). Conclusion: The treatment of open tibial diaphyseal (Gustilo-II) fractures with early closed reamed interlocking intramedullary nailing is effective and safe technique; it combines a satisfactory rate of union with low complication rate and patients can return to work earlier.