- Post-Procedure: Intramedullary Interlocking Nails
- Post-Procedure: Fine-Wire Fixation
Post-Procedure: Intramedullary Interlocking Nails
POST-PROCEDURE CARE
- IM nailing: apply removable splint with a patellar tendon-bearing brace or orthosis if additional support is needed.
- External fixator: instruct patients on careful pin site care.
- Therapy: begin knee and hip range-of-motion and isometric quadriceps exercises.
- Weight-bearing: restrict for 4 to 6 weeks and then progress as tolerated.
- Fixator removal: if the foot was included, remove the foot pins when soft-tissue healing is adequate. Delay this if there is an unstable ankle injury. Monitor healing and pin sites every 4 to 6 weeks.
- Nail removal: usually not necessary; delay until 12 to 18 months if symptomatic.
COMPLICATIONS
- Compartment syndrome
- Neurovascular injury
- Delayed union or nonunion
- Infection
- Hardware failure
ANALYSIS OF RESULTS
Intramedullary nailing for tibial shaft fractures has been shown to have excellent success with a high union rate and low complication rate. The most common complication has been infection, which most frequently occurs in severely comminuted open fractures.
OUTCOMES AND EVIDENCE
- Bone et al compared IM nailing with casting and found significantly fewer nonunions in the IM nailing group. The casting group had significantly higher rates of malalignment and fracture shortening.
- Puno et al also compared IM nailing with closed reduction and casting. The IM nailing group had 98% union, 3.3% infection, and no malalignment. The casted group had 90.1% union, 1.4% infection, and 4.5% malalignment.
- Hooper et al found significantly better outcomes with IM nailing than with casting for closed or grade I open tibial fractures with at least 50% displacement or 10 degrees of angulation.
- Klemm and Borner reported 94% excellent to good results with interlocking IM nails with an infection rate of 2.2%.
- Keating et al found no statistically significant differences in outcomes with reamed or unreamed nailing for open fractures but found a higher rate of screw breakage in the unreamed group.
- Ali et al: good to excellent results in 85% of complex proximal tibial fractures treated with beam-loading ring fixation
- Roberts et al compared commonly used hybrid and ring fixators and showed that the most common error in all systems is undertensioning.
- Adair et al reported that Ilizarov complication rate was 34%, with 6.6% infection, 14% malunion or nonunion, 4% nerve injury, 6.9% joint stiffness, 0.3% patient depression, 1% pain requiring referral to pain management, and 1% wire breakage.
Procedure: Intramedullary Interlocking Nails
Post-Procedure: Fine-Wire Fixation
POST-PROCEDURE CARE
- IM nailing: apply removable splint with a patellar tendon-bearing brace or orthosis if additional support is needed.
- External fixator: instruct patients on careful pin site care.
- Therapy: begin knee and hip range-of-motion and isometric quadriceps exercises.
- Weight-bearing: restrict for 4 to 6 weeks and then progress as tolerated.
- Fixator removal: if the foot was included, remove the foot pins when soft-tissue healing is adequate. Delay this if there is an unstable ankle injury. Monitor healing and pin sites every 4 to 6 weeks.
- Nail removal: usually not necessary; delay until 12 to 18 months if symptomatic.
COMPLICATIONS
- Compartment syndrome
- Neurovascular injury
- Delayed union or nonunion
- Infection
- Hardware failure
ANALYSIS OF RESULTS
Intramedullary nailing for tibial shaft fractures has been shown to have excellent success with a high union rate and low complication rate. The most common complication has been infection, which most frequently occurs in severely comminuted open fractures.
OUTCOMES AND EVIDENCE
- Bone et al compared IM nailing with casting and found significantly fewer nonunions in the IM nailing group. The casting group had significantly higher rates of malalignment and fracture shortening.
- Puno et al also compared IM nailing with closed reduction and casting. The IM nailing group had 98% union, 3.3% infection, and no malalignment. The casted group had 90.1% union, 1.4% infection, and 4.5% malalignment.
- Hooper et al found significantly better outcomes with IM nailing than with casting for closed or grade I open tibial fractures with at least 50% displacement or 10 degrees of angulation.
- Klemm and Borner reported 94% excellent to good results with interlocking IM nails with an infection rate of 2.2%.
- Keating et al found no statistically significant differences in outcomes with reamed or unreamed nailing for open fractures but found a higher rate of screw breakage in the unreamed group.
- Ali et al: good to excellent results in 85% of complex proximal tibial fractures treated with beam-loading ring fixation
- Roberts et al compared commonly used hybrid and ring fixators and showed that the most common error in all systems is undertensioning.
- Adair et al reported that Ilizarov complication rate was 34%, with 6.6% infection, 14% malunion or nonunion, 4% nerve injury, 6.9% joint stiffness, 0.3% patient depression, 1% pain requiring referral to pain management, and 1% wire breakage.
Procedure: Fine-Wire Fixation
