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Critical analysis of tibial fracture healing following unreamed nailing

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Abstract

Purpose

Unreamed nails have revolutionised the treatment of tibial shaft fractures. Many authors, however, have reported increasing bone healing complications with these implants. Unfortunately, few studies have addressed the factors affecting bone healing after unreamed tibial nailing.

Methods

One-hundred and sixty tibial fractures in 158 patients (mean age 39.5 years) fixed using unreamed nails were reviewed. There were 78 AO type-A, 65 type-B and 17 type-C fractures (115 closed and 45 open fractures). Twelve patient, injury and surgery variables were analysed for their influence on fracture healing.

Results

Union occurred in all fractures after a mean time of 24.3 weeks. Additional surgery to achieve union, apart from dynamisation, was done in nine (6%) cases. The most important variables affecting healing were the mechanism of trauma (p = 0.005), fracture site gap (p = 0.01), degree of comminution (p = 0.0003), associated soft tissue injuries (p = 0.02) and the time to dynamisation (p = 0.0001).

Conclusions

High-energy trauma and fracture comminution have a negative impact on bone union and require close follow-up. It is essential to avoid distraction over three millimetres with unreamed nailing. Dynamisation is advised within ten weeks in axially stable fractures to encourage bone healing and avoid failure of the locking screws.

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Disclosure

The author did not receive any outside funding or grants in support of the research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Kasr El-Aini Street, 11562, Cairo, Egypt

    Khaled Hamed Salem

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  1. Khaled Hamed Salem
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Correspondence to Khaled Hamed Salem.

Additional information

Investigation performed at the Department of Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University, Germany

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Salem, K.H. Critical analysis of tibial fracture healing following unreamed nailing. International Orthopaedics (SICOT) 36, 1471–1477 (2012). https://doi.org/10.1007/s00264-012-1505-x

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  • DOI: https://doi.org/10.1007/s00264-012-1505-x

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