[Closed intramedullary nailing of tibial shaft fractures].

Objective: To assess patient outcome after nailing of the tibial shaft with the unreamed AO/ASIF nail.

Design: A retrospective study of 54 nailed fractures of the tibial shaft treated between 1990 and 1994. Follow-up was done at the outpatient clinic and included measurements of the lower limbs and x-rays.

Setting: The study was conducted at the Hôpital de l'Enfant-Jésus, Québec, a centre specializing in trauma care.

Patients: Fifty-four acute displaced fractures of the tibial shaft occurring in 52 patients were studied.

Intervention: Nailing with the Synthes AO/ASIF unreamed locked nails.

Main Outcome Measures: Time to bone fusion, rate of infection, incidence of deformity and failure rate of the implants, especially the lock screws.

Results: The majority of fractures were associated with a high-speed trauma (40/54 or 74% of cases) and 18 (33%) were open fractures. Osteitis developed in one (1.8%) open type IIIA fracture. Bone fusion was observed clinically and radiologically after 29 weeks on average; none of the fractures presented residual deformity on rotation of more than 5 degrees or a difference in length of more than 1 cm or a frontal or sagittal displacement of more than 10 degrees. A single case of pseudoarthrosis was noted. One or more lock screws became deformed or broke in 16 (34%) tibias; however, this did not lead to any reduction loss. Four compartment syndromes were diagnosed.

Conclusions: Excellent results were obtained with respect to limb alignment and length. Loss of joint mobility was minimal. The number of lock screw failures indicates that a delayed weight bearing could prevent this complication, especially when an interfragment space remains after the nail placement.