2^nd Stage Unreamed Tibial Nailing after Conventional and Pinless Fixex

Abstract

Purpose: Our own results after 2^nd stage unreamed nailing of the tibia are evaluated and correlated with the literature.
Method: External fixation as well as unreamed tibial nailing is an accepted treatment option in lower leg fractures. Intramedullary implants are more comfortable for the patients, but not in every case is a primary nailing advisible. If immediate stabilisation is recommended external fixation is the safest way. On a second stage, after amelioration of local or general conditions, internal stabilisation is better tolerated during rehabilitation. During the last 8 years the AO-UTN (unreamed tibial nail) as method of choice was used in 230 lower leg fractures. A conversion to the UTN from either a pinless fixator (n =10) or a conventional external fixator (n=10) with bicortical Schanz’ screws was performed in 20 cases. Fracture classification according to the AO-classification: Pinless: 3 A, 6 B, 1 C and 3 ap II, 2 ap III and 4 closed soft tissue injuries; Fixex: 7 B, 3 C and 1 ap I, 2 ap II, 3 ap III and 3 closed soft tissue injuries.
Results: In the Pinless group there was a delay of 5.7 and in the Fixex group a delay of 9.9 days between primary fracture stabilisation and definitive treatment. As additional procedures we had in the pinless group: 2 × split skin grafting, 1 × free flap and secondary monorail callus distraction and 1 × exchange nailing after reaming. In the fixex group: 4 × shorthening of 1-2 cm, 1 × monorail callus distraction of 5 cm, 1 local flap and 1 free flap. The overall infection rate was 5 % (in the pinless group without adequate soft tissue reconstruction), whereas in the literature we found a rate up to 44 %. Nailing was performed as a one stage conversion procedure.



Conclusion: The standard external fixator seems to be advantageous concerning additional joint bridging possibilities. Adequate soft tissue repair seems to be much more important than the primary stabilisation method.

Key words

UTN - Unreamed tibial nailing - External fixation - Pinless fixator - Conversion procedure

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