Abstract
The purpose of this study was to evaluate the role of locked intramedullary nailing without reaming for the treatment of open tibial and femoral shaft fractures that has recently been widely used all over the world, and recently evaluated.
Seventy open femoral and tibial shaft fractures were treated by meticulous wound excision and early inter-locking nailing without reaming between 1996 and 1999 in our department. The average follow-up of the patients was 20.2 (12–36) months. Thirty-six were fractures of the tibia, and 34 of the femur. Ten (14.3%) were classified as Grade I., 32 (45.7%) as Grade II, and 28 (40%) as grade III according to Gustilo-Anderson. Most of the fractures were the result of high-energy trauma.
In patients fixed with locked intramedullary nails due to no immobilisation, rehabilitation began just after the operation. Hip, knee and ankle functions were regained rapidly. All fractures were united in an average of 17.1 (10.1–36.6) weeks. There were six (8.6%) delayed unions and four superficial infections (5.7%). One patient developed deep infection (1.4%) and required further surgical treatment. Locking screws broke in one tibia (1.4%) and two femurs (2.8%), but the breakage did not result in loss of reduction. Although there was no nail breakage observed, two (2.9%) had between eight and twelve degrees external rotation, four (8.5%) shortening of 1.1 to 2.5 cm., and three (4.3%) valgus seven to ten degrees. Of the seventy fractures, 52 (74.2%) were classified according to Folleras as excellent, 8 (11.4%) as good, 6 (8.5%) as fair and 4 (5.7%) as poor.
Early unreamed intramedullary interlocking nailing is a very effective and safe treatment method for open tibial and femoral shaft fractures.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
