Objective To evaluate the safety and efficacy of expert type intramedullary nail (expert tibial nail, ETN) in the treatment of open distal tibial fracture.
Methods Total 22 cases of open distal tibial fractures in our hospital between March, 2013 and September, 2014 were enrolled into this study. There were 14 males and 8 females, with a mean age of 40.4 (from 22-56) years old, including 10 Gustilo type Ⅰ, 8 type Ⅱ and 4 type ⅢA. All patients were debrided and close reducted and fixed with ETN in the emergency treatment. The duration of surgery, blooding volume, time for clinical heal of the wound and fracture, and incidence of complications were analyzed. All patients were followed up by periodic X-ray examination. Functional outcomes were evaluated according to the Johner-Wruhs standard one year after surgery.
Results All 22 patients were followed up for 9-24 months (average 16.4 months). The mean time of surgery was 75 mins (55-110 mins). The intraoperative bleeding volume was 65ml (40-100 ml). Superficial infection occurred in 2 cases with Gustilo typeⅡand healed by dressing. Two cases of type ⅢA fractures were necrotic and covered with skin flap, with deep infection in 1 case. The fractures healed 4.8 months (from 3.5-13.6 months)after surgery, Anatomical or functional reduction were achieved and maintained in all cases. Two fractures of delayed union healed by dynamization through removing the proximal locking nail. The nonunion of bone occurred in 1 case, which healed by replacing the larger diameter nail and bone graft. No nail breakage, malunion or limb shorting occurred. By Johner-Wruhs criteria, the final outcomes were excellent in 12 cases, good in 7 cases and fair in three. The good rate was 86.4%.
Conclusion Expert Tibial Nail has the advantages of minimally invasive trauma, stronger fixation, better functional recovery for the treatment of open distal tibial fractures. It is safe and effective in the treatment of Gustilo type Ⅰ, Ⅱ fractures with low incidence of complications. But it is less effective for type ⅢA fractures with serious tissue injury.
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