Session V - Knee / Tibia

Fri., 10/11/13 Knee/Tibia, PAPER #62, 3:04 pm OTA 2013

Intramedullary Nailing With an Internal Compression Device for Transverse Tibial Shaft Fractures Decreases Time to Union When Compared to Traditional “Backslapping” and Dynamic Locking

Michael J. Beltran, MD; Christopher R. James, MD; H. Claude Sagi, MD;
Florida Orthopaedic Institute, Tampa, Florida, USA

Purpose: This study was conducted to compare the time to union and union rate for transverse tibial fractures treated with compression applied through the intramedullary rod or traditional technique of compression by “backslapping” and dynamic locking.

Methods: This was a retrospective analysis of skeletally mature patients with a transverse diaphyseal tibial fracture (OTA 42-A3) managed at a single institution between 2005 and 2012. Group 1 consisted of 22 patients managed with an intramedullary nail having the ability to apply controlled fracture compression using an internal compression device. Group 2 consisted of 32 patients managed with traditional “backslapping” and use of a single interlocking screw placed in the dynamic mode. All patients were permitted immediate weight bearing as tolerated. Inpatient and outpatient charts as well as complete radiographs were reviewed to determine patient demographics, injury characteristics, and time to radiographic and clinical union. Union was defined as the presence of bridging bony callus on at least three cortices and pain-free full weight bearing. Patients were excluded from analysis if they had inadequate follow-up, incomplete radiographs, or the mode of compression could not be ascertained from operative reports.

Results: Both groups were similar with respect to age, gender, fracture location and soft-tissue injury, use of bone stimulators, patient comorbidities, and weight-bearing allowance. The time to radiographic and clinical union was 103 days for group 1 versus 148 days for group 2 (P = 0.018). When patients treated with bone stimulators and/or bone morphogenetic proteins were excluded, the time to union was 88 days for group 1 versus 143 days for group 2 (P = 0.002). The incidence of nonunion was 0% in group 1 versus 9% (3 patients) in group 2; this difference was not statistically significant due to insufficient power.

Conclusion: Transverse tibial shaft fractures treated with an intramedullary rod with an internal compression device have a significantly shorter time to union and may have an overall lower nonunion rate compared to traditional intraoperative “backslapping” and dynamic locking.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.