CLOSED INTRAMEDULLARY NAILING OF TTBIAL SHAFT FRACTURES A Comparison with Conservatively Treated Cases

Bnr P. SLKTIS and P. ROKKANEN Received 18.1.67 Intramcdullary nailing in the treatment of fractures of the long bones was technically developed and popularized by Kiintscher in the 1940’s (Kiintscher 1940). The method was widely adopted for a variety of orthopaedic conditions, but in the treatment of tibial shaft fractures the stability achieved with the original medullary nail was inadequate. Likewise, in open reductions the simultaneous severance of the medullary and periosteal nutrient systems frequently resulted in failure. The principles and results of the method were criticized by several authors (Bauer 1943, Palmer 1951, Trueta C Cavadias 1956, L. Bohler 1957, Lunge 1962) and regarded by many as unsuitable for the treatment of tibial shaft fractures. Two recent technical improvements have revived interest in intramedullary nailing. Firstly, the introduction of the clover-leaved nail, combined with the principle of reaming out the medullary cavity (Kiintscher 1958, 1959), in some cases made rigid fixation possible in the strict sense of the word. Secondly, the use of TV image intensifiers has made it possible to use a closed technique as a routine procedure. Closed intramedullary nailing, with minor technical modifications, has been practised by Alms (1962), J. Bohler (1963, 1965) and Zucman & Maurer (1965) with encouraging results. The value of the method is still debated, however, and comparative studies including selected series treated by other methods are lacking. In this paper an attempt is made to assess the value of primary intramedullary nailing of tibial shaft fractures by comparing the early and