|Year : 2013 | Volume
| Issue : 3 | Page : 140-142
A prospective study of biological fixation with either plate or interlocking nail on the mean duration of union in diaphyseal fractures of tibia
Rajendra B Uppin, Satish Nesari, Ullas Mahesh
Department of Orthopaedics, KLE University's, J. N. Medical College and Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka, India
|Date of Web Publication||19-Oct-2013|
Rajendra B Uppin
Department of Orthopaedics, KLE University's, J. N. Medical College and Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
Objective: To study the results of Biological plating or Interlocking nail for the closed diaphyseal fracture of the tibia in Department of Orthopedics, KLE University's, Dr. Prabhakar Kore Hospital and Medical Research Center, Belgaum. The aim of this study was the evaluation of the results of biological plating or interlocking nail for closed diaphyseal fractures of the tibia. Materials and Methods: The study included 30 patients. All the patients underwent a comprehensive orthopedic examination and work-up was done to diagnose and classify tibial fractures. The treatment modalities were suggested accordingly. Results: Intramedullary nailing should be the method of choice for treating the closed type of tibial shaft fractures. Biological plating should be considered as an alternative in intramedullary interlocking nail in specific indications. Conclusion: Comprehensive orthopedic examination with detailed study of fracture pattern and type of fracture help to evaluate the different modalities of treatment.
Keywords: Biological fixation, intramedullary interlocking nail, plating, union
|How to cite this article:|
Uppin RB, Nesari S, Mahesh U. A prospective study of biological fixation with either plate or interlocking nail on the mean duration of union in diaphyseal fractures of tibia. J Sci Soc 2013;40:140-2
|How to cite this URL:|
Uppin RB, Nesari S, Mahesh U. A prospective study of biological fixation with either plate or interlocking nail on the mean duration of union in diaphyseal fractures of tibia. J Sci Soc [serial online] 2013 [cited 2020 Apr 8];40:140-2. Available from: http://www.jscisociety.com/text.asp?2013/40/3/140/120056
| Introduction|| |
Fractures of tibial shaft are important as they are common and are controversial. An average of 26 tibial fractures per 100,000 people are common as tibia is subcutaneous by its location. Operative treatment is controversial as good results are achieved with closed reduction, casting and functional brace. 
Internal fixation has gained widespread acceptance in treatment of fracture of tibia, good anatomical reduction, stability of fracture, early mobilization and decrease in post-operative infection.  Biological fixation of fractures is an important advancement in the fracture management in which the utmost respect is given to soft-tissues and vascularity of bone. Fixation maintains fracture alignment without compression. The principles are limited exposure, indirect reduction methods, with vascularity intact. Biological internal fixation can be achieved by three conventional techniques-splinting stabilization with external fixators, intramedullary nails and with the use of the plate and screw as pure splints that is without the additional lag screw effect at the fracture site. ,
Surgical options are intramedullary nailing, plate and screw fixation and external fixation in open fractures. Appropriate treatment is still controversial.
| Materials and Methods|| |
Patients with closed diaphyseal fractures of tibia treated with either plate or intramedullary interlocking nail (IMILN). It's a prospective study, source of data: Patients admitted with closed diaphyseal fractures of the tibia in KLE Hospital, Belgaum. Sample size: 30. Inclusion criteria were: (1) All closed diaphyseal fracture of tibia who were medically fit and indicated for surgery. (2) Patients aged >18 years. (3) In patients where IMILN [Figure 1] wasn't possible such as severe comminuted/segmental fracture, long spiral, vertical split closed diaphyseal fracture, wound over knee were treated with biological plate and screws [Figure 2]. Exclusion criteria were: Fracture upper and lower end of tibia, open fracture of tibia, patients who have concurrent infection or previous local infection, patients who had a previous injury with residual deformity. Patients who had not provided informed consent for participation.
| Results|| |
All patients with biological plating were declared clinically united at 11-20 weeks [Figure 1]. In interlocking nailing group 88.90% fractures united clinically at 11-15 weeks and 1 fracture united clinically at 5-10 weeks [Figure 2]. All patients (100%) with biological plating united radiologically within 21.3 weeks with a mean duration of union of 19.5 weeks (16.6-21.3 weeks). In patients treated with interlocking nail, mean duration of union was 18.1 weeks (13.2-24.6 weeks).
| Discussion|| |
More flexible fixation should encourage the formation of callus while less precise, indirect reduction will reduce operative trauma.  IMILN permits a minimally open approach but its advantages are somewhat offset by extensive damage to intramedullary circulation and local as well as general intra vascular thrombosis due to tissue damage and fat intravasation due to high intramedullary pressure during reaming and insertion of nail  . Minimally invasive technologies of plating are an alternative when biology is the most important concern  . Conventional stable internal fixation with precise reduction, requires fairly extensive surgical approaches to bone. This contributes to increasing necrosis, which has been initially produced by injury. IMILN is preferred method of treatment in diaphyseal fractures, but not always appropriate depending on fracture type and location. IMILN maintain length and prevent rotation, needs special training and costly instrumentation and longer operative time. In IMILN group patients were started on partial weight bearing within 10-20 days and full weight bearing within 5-10 weeks. In plating system first 4 weeks above knee cast, later 2 weeks below knee cast. Allowed partial weight bearing after 6 weeks after removal of the cast and full weight bearing from 16 weeks to 24 weeks depending on union. 
| Conclusion|| |
Biological internal fixation is safe and reliable method for closed diaphyseal fracture of the tibia. IMILN has got a wide range of indications with respect to pattern of fracture and should be the method of choice for closed type of fracture of tibial shaft.  In extensive comminuted type 4 fractures and for vertical split closed fracture of tibia, plate osteosynthesis is a good method of treatment. Plate is used when wound is present at nail insertion site to decrease post-operative infection. Biological fixation promotes early union as it does not disturb anatomy and biology at the fracture site. Plating is easier, has a shorter learning curve and requires minimal instruments. IMILN nail requires greater skills and has got separate set of costly instruments. Biological fixation does not require additional procedure like bone grafting. Advantage of IMLIN is early union, can be achieved with early ambulation of the patient.  Biological fixation causes minimal damage to soft-tissues and vascular supply to long bone. Biological fixation has no risk of infection. Functional recovery with biological internal fixation is early. 
All patients with biological plating were declared clinically united at 11-20 weeks. In interlocking nailing group 88.90% fractures united clinically at 11-15 weeks and one fracture united clinically at 5-10 weeks. All patients (100%) with biological plating united radiologically within 21.3 weeks with a mean duration of union of 19.5 weeks (16.6-21.3 weeks). In patients treated with interlocking nail, mean duration of union was 18.1 weeks (13.2-24.6 weeks).
| References|| |
|1.||Bucholz RW, Heckman JD. Rockwood and Green's Fractures in Adults. 5 th ed. Philadelphia: Lippincott Williams and Wilkins; 2001. |
|2.||Perren SM. Davos Editorial Minimally invasive internal fixation history, essence and potential of a new approach (Editorial). Injury 2001;32:SAI-3. |
|3.||Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P 3 rd , Hanson B, Weaver B, et al. Surgeons' preferences for the operative treatment of fractures of the tibial shaft. An international survey. J Bone Joint Surg Am 2001; 83-A:1746-52. |
|4.||Perren S. Some clinically relevant properties of the intramedullary nail (Editorial). Injury 1999;30:SC2-4. |
|5.||Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: Choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093-110. |
|6.||Schatzker J. Changes in the AO/ASIF principles and methods. Injury 1995;26:S/B56. |
[Figure 1], [Figure 2]