Tibial fracture with intact fibula treated by reamed nailing

摘要: PURPOSE OF THE STUDY The main difficulties encountered in the orthopedic treatment of leg fractures with intact fibula are reduction tibial and an unusually high rate varus unions non-unions. aim this retrospective study was to assess outcome after reamed nailing fibula. MATERIAL AND METHOD Between 1986 1997, 38 tibia were treated by first intention centromedullar nailing. There 28 men 10 women, mean age years, a single fracture 25 cases. motor vehicle accidents (17 two-wheel, 8 four-wheel), 5 sports accidents, 2 home falls, 6 others. Fracture diaphysis associated homolateral femoral 7 cases, open (7 type 1, 2, 1 3), abrasive skin lesions. Using AO classification, A 26 B 11, C 1. middle third 21 distal 15 proximal third. Grosse Kempf nails used exclusively. Static 27 dynamic 8, nail not locked 3 Nails diameter 9 13 implanted reaming mm more. RESULTS gap increased during patients; patients had undergo secondary aponeurectomy due postoperative compartment syndrome no further sequela. Consolidation achieved 30 patients, dynamization 6. non-union also successfully managed new dynamization. Delay consolidation 175 days (range 60 - 480). Transverse consolidated more rapidly (mean 122 days). At last follow-up (minimum year), active knee ankle mobility normal all patients. Nineteen complained pain at site insertion, evaluated on 10-point analogie scale them Eight out felt cure been months postoperatively. DISCUSSION These obtained clinical results relatively low (5 p. 100) should be attributed technique. We discuss frequency underlying circumstances. lack patent fibular does signify is intact. Trauma-induced tibio-fibular dislocation (1 case our series) can occur. review literature emphasizes non misalignment treatment. most widely surgical technique This has inconvenience possible insertion which usually disappears ablation where aggravating factor. CONCLUSION Nailing reliable for Weight bearing encouraged as early possible. indication depends anatomic its localization. Immediate weight recommended. Strict surveillance allows fibulotomy late consolidation. Prospective randomized studies comparing other therapeutic methods needed confirm these data.