Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures

Sang Soo Park; Jun-Young Lee; Sang-Ho Ha; Sung-Hae Park

doi:10.12671/jkfs.2013.26.4.275

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Park, Lee, Ha, and Park: Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures

Original Article

Journal of the Korean Fracture Society 2013; 26(4): 275-283.

Published online: 18 October 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.4.275

Outcomes and Analysis of Factors Affecting Bone Union after Interlocking Intramedullary Nailing in Segmental Tibia Fractures

Sang Soo Park, M.D., Jun-Young Lee, M.D., Sang-Ho Ha, M.D., Sung-Hae Park, M.D.

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Jun-Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leejy88@chosun.ac.kr

Received 18 January 2013 Revised 25 July 2013 Accepted 7 August 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the radiological results and complications of interlocking intramedullary nailing for segmental tibia fractures.

Materials and Methods

Twenty-six patients (26 cases) who underwent interlocking intramedullary nailing for segmental tibia fractures between January 2003 and May 2011 were followed for more than one year. We evaluated the complications and statistically analyzed the factors influencing bone union, including open fracture, fracture site, reaming, postoperative angulation, and postoperative fracture gap.

Results

Nineteen cases (73%) achieved bone union with one operation at an average of 7 months (range, 5 to 11). Seven cases had secondary procedures before achieving union. Complications included 7 cases of nonunion, 3 cases of incomplete peroneal nerve injury, 2 cases of superficial infection, 1 case of compartment syndrome. Factors showing statistically significant differences were open fracture, postoperative angulation, and postoperative fracture gap. Factors showing no statistically significant difference were fracture site and reaming.

Conclusion

Nonunion is the most common complication in interlocking intramedullary nailing for segmental tibia fractures. To minimize this complication, comprehension of surgical techniques to reduce anatomically and careful evaluation of the fracture are required.

Keywords: Tibia, Segmental fracture, Intramedullary nailing

Figures and Tables

Fig. 1

(A, B) Preoperative radiographs of a 56-year-old man show a tibia segmental fracture classified as AO/OTA type 43-C2.

(C, D) The segmental tibia fracture was stabilized with intramedullary interlocking nailing using reaming.

(E, F) Postoperative radiographs show complete bone union with good alignment at 14 months after surgery.

Fig. 2

(A) Intraoperative C-arm image using the blocking screw technique in the proximal portion of segmental tibia fracture.

(B) Intraoperative C-arm image shows good alignment and reduction after intramedullary nailing with a blocking screw on the tibia proximal portion.

Fig. 3

(A, B) Preoperative radiographs of a 47-year-old man show a tibia segmental fracture classified as AO/OTA type 43-C2.

(C, D) Postoperative radiographs show good alignment and reduction after intramedullary interlocking nailing with additional plating on the tibia proximal portion.

Fig. 4

(A, B) Preoperative radiographs of a 51-year-old man show a tibia segmental open fracture classified as AO/OTA type 43-C2.

(C, D) Initial clinical photo shows Gustilo-Anderson classification IIIA open wound, exposing the bone and muscle.

(E, F) Segmental tibia fracture was stabilized with intramedullary interlocking nailing using unreaming.

(G, H) Follow up x-ray at 16 months after surgery shows nonunion in the proximal and distal sites.

(I) Reoperation has been done with exchange nailing. Postoperative radiographs show complete bone union at 28 months after primary surgery.

Table 1

Demographic Data of the Patients

Values are presented as number or median (range). F/U: Follow up, G-A: Gutilo-Anderson Classification of Open Fractures.

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