A Novel Technique Of Interlocking Nailing In Compound Fractures Of The Tibia Without Image Intensifier By Nail Overlapping Technique

摘要

Locked intramedullary nailing is currently considered the treatment of choice for most type I, II and IIIa open and closed tibial shaft fractures. Intramedullary nailing preserves the soft tissue sleeve around the fracture site and allows early motion of adjacent joints. Unreamed medullary nails are used mostly in Gustillo's types II and III. Tibial intramedullary nailing is now regarded as an emergency procedure for stabilisation of compound fractures to allow early return of function and ambulation. It has replaced external fixator which serves as a temporary means to stabilise compound fractures in the present scenario. Interlocking nailing allows early healing of the wound with permanent stabilisation of the fracture thereby preventing the need for secondary procedure.We hereby describe a technique of intramedullary locked nailing for compound fractures of tibia without X-ray image intensifier by nail overlapping technique. We have applied this technique in 30 cases of compound type II and III fractures of tibia and could be very useful procedure in underdeveloped countries and in rural hospitals where facilities of image intensifier are not available in emergency departments where these patients first land up. Technique The patient is prepared and draped in a standard manner as for routine interlocking procedure of tibia. Wound is debrided and irrigated. Preoperatively nail length is measured by tibial tubercle medial malleolar distance (TMD) and nail diameter is measured on a lateral radiograph at the level of isthmus. The tibia is approached via patellar tendon splitting approach and entry portal is properly identified (Fig.1).