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Intramedullary nailing of open and closed tibial shaft fractures

Enclouage centro-médullaire des fractures ouvertes et fermées de jambe. A propos de 551 cas

A report of 551 cases

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Abstract

The authors present their experience about intramedullary nailing in tibial shaft fractures in a serie of 551 cases. Closed fractures represent 330 cases (60%) and open fractures type I, II, III represent 221 cases (40%). intramedullary nailing had been performed in emergency, especially in open fractures (even type III) associated whenever it was necessary with a plastic procedure in the same operative stage. Patients had been reviewed up to consolidation and the mean follow up date was 20 months. The main complication (6.7%) was infection. The authors noticed an infection rate directly proportional to the open type of fracture. The mean consolidation time based on objective radiologic data was 24 weeks. Other complications were few in particular malunion (3%). The functional results and articular motion were very good. The authors defend intramedullary nailing because of the low rate of complications and the possibility of early mobilisation. Finally, they suggest the possibility of using this technic in emergency in open fractures type III under cover of the management of the cutaneous problem.

Résumé

Les auteurs présentent leur expérience de l'enclouage centro-médullaire des fractures de jambes à propos d'une série de 551 cas. Les fractures fermées représentaient 330 cas (60 %) alors que les fractures ouvertes de type I, II et III représentaient 221 cas (40 %). L'enclouage a été réalisé en urgence et tout particulièrement dans les fractures ouvertes (y compris pour les fractures de type III) avec quand cela était nécessaire des gestes de couverture dans le même temps opératoire. Les patients ont été suivis jusqu'à consolidation avec un recul moyen pour la série de 20 mois.

La principale complication (6,7 %) était l'infection. Les auteurs ont noté un taux d'infection croissant en fonction du type d'ouverture. La moyenne de consolidation sur des critères objectifs radiologiques était de 24 semaines. Les autres complications étaient très faibles avec en particulier un taux de cals vicieux de 3%. Les résultats fonctionnels et la mobilité articulaire étaient très bons. Les auteurs défendent la technique de l'enclouage centro-médullaire en raison du faible taux de complication et de la possibilité de mobilisation précoce. Enfin, ils suggèrent la possibilité d'utilisation de cette technique en urgence dans les fractures ouvertes de type III sous réserve d'une maîtrise dans le même temps opératoire des problèmes de couverture.

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Authors and Affiliations

  1. Department of Orthopaedic Traumatologic and Plastic Surgery, University Hospital Jean Minjoz, F-25030, Besançon, France

    P. Garbuio, F. Gérard, P. E. Ridoux, Y. Tropet & Ph. Vichard

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  1. P. Garbuio
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  2. F. Gérard
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  3. P. E. Ridoux
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Garbuio, P., Gérard, F., Ridoux, P.E. et al. Intramedullary nailing of open and closed tibial shaft fractures. Eur J Orthop Surg Traumatol 7, 153–157 (1997). https://doi.org/10.1007/BF00579277

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