Short Term Outcomes of Distal Tibia Fractures Treated with Closed Reduction and Reamed Intramedullary Interlocking Nail in A Tertiary Care Center in North India.

Abstract

Objectives: This study aimed to analyze functional and radiological outcomes of distal tibia fractures treated with closed reduction and reamed intramedullary interlocking nailing.

Material and methods: A prospective study was conducted on 25 patients that fitted the inclusion criteria and underwent closed reduction and intramedullary interlocking nailing. All patients were reviewed at 6, 12, 18 and 24 weeks post-operative and were assessed for clinical and radiological signs of union, time of union, complications and functional score using the Olerud and Molander ankle score. (OMAS)

Results: In our study, there were 18 males(72%) and 7 females (28%) with mean age of 34.16±10.99 years.18 patients (72%) had closed fractures and 7 patients had open fracture (28%). According to the AO classification, 11patients (44%) had AO 43A1, 9 patients (36%) had AO 43A2 and 5 patients (20%) had AO 43A3 fractures. Bony union was seen in 21 patients (84%) at 3months (12^th week) of follow-up. 4 patients (16%) had delayed union eventually uniting by 6 months. (24 weeks) Mean union time was 15.17±7.20 weeks.  4 patients with delayed union was seen more in cases of open fracture (3 patients) compared to closed fracture. (1 patient) which was statistically significant. (p=0.0023) Using the OMAS, We observed a significant increase in the overall functional score over the follow up interval from 6 weeks to 24 weeks. Overall functional outcomes at 24 weeks revealed that 14 patients (56%) had excellent functional score, 7 patients (28%) had good functional score, and 4 patients (16%) had fair functional score. OMAS in different age groups showed that functional outcomes was higher during all follow up intervals in younger age groups (20-29 years) as compared with to older age groups. (50-59 years) Complications were noted in 2 patients (8%) who developed superficial infections, both of which were open fractures.1 patient (4%) had pain over the distal screw region due to screw prominence which needed removal.

Conclusions: We conclude that intramedullary nailing is a better way to treat distal extra-articular fractures of the tibia with early bony union rate, lesser incidence of infection and implant irritation and functional scores ranging from excellent to fair outcomes. We recommend that intraoperative reduction should be as near anatomic as possible and maintained while passing guide wire, reaming and inserting nail to prevent any mal angulation.