OTA 1997 Posters - Tibia Fractures

Prospective Study of Open and Closed Diaphyseal Segmental Tibia Fractures Treated with Intramedullary Nailing

Alexandra Schmitt, MD, Vincent Green, BS, Daniel M. Zinar, MD

UCLA, Torrance, California, USA

Hypothesis: A prospective study of 21 diaphyseal segmental tibia fractures treated with intramedullary nailing was performed over a five year period. The goal of this series is to evaluate the outcomes of intramedullary fixation for segmental tibia fractures. Variables such as initial fracture pattern, bone loss, and distraction after nailing would also be examined.

Methods: Twenty-nine segmental tibia fractures were treated by the senior author over a five year period. One patient was excluded as she refused surgery and was treated in a long leg cast. Seven patients had fractures located within 8 cm from either articular surface and were therefore treated with an external fixator. Twenty-one patients were treated with intramedullary nails. Of the nine open fractures, eight were Gustilo grade IIIA and one was grade IIIB. Twelve were closed fractures. Average follow up was nine months.

Results: Out of the 21 segmental tibia fractures treated with intramedullary nails, there were three (14%) delayed unions. The delayed union occurred at the distal fracture in all three; one also had a delayed union at the proximal fracture site. Two out of three (67%) of the delayed unions occured at an open fracture site. One out of three (33%) occured in a closed fracture. One of the open fractures with delayed union was treated with an exchange nailing, the other two delayed unions were treated with dynamization of the rod. All three delayed unions progressed to healing after the above treatments. There were no deep infections.

Discussion: There are few studies regarding segmental tibia fractures. Prior series cite 2 - 30% nonunion rates with intramedullary nailing of segmental tibia fractures and 40% nonunion rates with external fixation. These, however, did not differentiate between fractures involving the metaphysis versus diaphysis. This study addresses solely segmental tibia fractures located greater than 8 cm from either the knee or ankle joints.

Results: In this series of 21 diaphyseal segmental tibia fractures treated with intramedullary nailing, the delayed union rate was 14%.

There were no deep infections. The distal fracture site was involved in all cases of delayed union.

Conclusion: In conclusion, when used for the treatment of segmental tibia fractures located greater than 8 cm from either articular surface, intramedullary nailing is associated with an 86% union rate. The intramedullary device eliminates possible complications associated with external fixation such as pin site infection and eliminates the extensive soft tissue stripping often associated with open reductions.