Closed Intra-medullary Interlocking Nailing Closed or Type-1 Open (Gustiloanderson) Tibial Diaphyseal Fractures Under Simple X-ray Control.
SUMMARY: This is a descriptive study, designed to evaluate the feasibility and outcome of closed intramedullary interlocking nailing for closed and type-1 open (Gustilo Anderson) tibial diaphyseal fractures under simple X-ray control in place of image intensifier, because image intensifier is no...
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| Format: | Book |
| Language: | English |
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c2010.
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| Summary: | SUMMARY: This is a descriptive study, designed to evaluate the feasibility and outcome of closed intramedullary interlocking nailing for closed and type-1 open (Gustilo Anderson) tibial diaphyseal fractures under simple X-ray control in place of image intensifier, because image intensifier is not available in most of the hospitals of Nepal. It was conducted at the department of Orthopaedics, Bir hospital during the period of February 2008 to January 2010. Initially 35 patients were included in this study but 2 patients were lost to follow up and 3 were excluded because they required open reduction and internal fixation due to technical problems. Thus remaining 30 patients were included in the study to analyze the functional outcome. Mean age of the patients was 36.47years ranging from 21-66 years. Male and female were 21(70%) and 9 (30%) respectively. The road traffic accident (16 patients, 53.3%) was the commonest mode of injury followed by fall from the height (11 patients, 36.7%). Twenty one patients (70%) were of closed fractures whereas 9 patients (30%) were type 1 open fractures. Most commonly encountered fractures were of oblique type i.e., 10 (33.33%), whereas 9 (30%), 8 (26.7%) and 3 (10%) with minimal comminuted, transverse and spiral types of fractures respectively. Seventeen patients (56.7%) had fracture of middle third, the remaining 10 (33.3%) and 3 (10%) patients had distal third and proximal third fractures respectively. In 5 patients (17%), only tibia was involved whereas remaining 25 patients (83%) had fractured both tibia and fibula. Majority were operated within a week of admission with a mean time delay of 9.50 days (range 4 to 20 days). After strict aseptic precaution, under spinal or general anaesthesia, patients underwent closed intramedullary interlocking nailing under simple portable X-rays control and were regularly followed up for a period of 9 months. In each follow up, every patient was assessed clinically and radiologically. The mean duration of operation was 153.50 minutes (range 120 to 180 minutes). Majority of the patients, i.e. 14 (46%) patients, needed two attempts of closed reduction for the guide wire insertion. All the fractures were statically locked with 2 distal & 2 proximal screws. Ten (33.3%) patients needed direct visualization technique for distal locking screws, rest all 20 (66.7%) were successful with the external jig. Dynamization was done accordingly after a mean period of 10.17 (range 6 to 25 weeks) after visible bridging callus on the radiographs. The overall mean time to union was 20.77 weeks with the mean time to union in closed fracture group (21 patients) was 20.48 weeks whereas 21.44 weeks in type-1 open fracture group (9 patients). The ROM of knee, ankle and subtalar joints measured at 6weeks, 3 months, 6 months and 9 months after the surgery showed gradual increased from 6 weeks to 9 months follows up which were nearly equal to that of uninjured side. Four patients had lost 15-25° of arc of knee movement, 2 patients lost 10° dorsiflexion, 3 patients lost 10° plantarflexion, 3 patients lost 15° of inversion and 2 patients lost 5° of eversion at 9 months follow up. The mean time to return to previous occupation was 18.07 weeks (range- 12-32 weeks). Only one (3.3%) patient had developed superficial infection with no evidence of deep infection in all our patients. None of the patients developed compartment syndrome after the surgery. Malunion and delayed union was found in 9 (29.7%) and 2 (6.7%) cases, respectively. No one had developed nonunion and shortening of the limb. The mean VAS at 6 weeks, 3 months, 6 months and 9 months was 4.6, 2.67, 1.87 and 1.3 respectively, showing the gradual decline in the intensity of anterior knee pain at final follow up, but 5 (16.5%) among 30 patients had continued anterior knee pain of 5/10 mm in VAS score, at the 9 months follow up. The overall result was found comparable with the most of the other similar studies done elsewhere. The unique difference of this study from the other similar studies was the use of portable X-ray in place of image intensifier. |
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| Item Description: | Thesis Report. |
| Physical Description: | 84p. |