Volume 29, Issue 3
DOI: 10.24205/03276716.2020.939
Conditions for Early Application of Interlocking Intramedullary Nails for Closed Tibial Shaft Fractures in Severe Polytrauma Patients
Abstract
Objective: To investigate the conditions for the early application of interlocking intramedullary nails in closed fractures of the tibial shaft in patients with severe polytrauma, by comparing with classic external fixators.
Methods: A retrospective analysis was done on 33 cases of closed fracture of the tibial shaft in severe polytrauma patients. The patients had the following characteristics: New Injury Severity Score (NISS) <50; no shock; and no condition of the lethal triad: acidosis, body temperature <35.0ï‚°C, or coagulopathy. All cases were divided into two groups and compared with each other (intramedullary nail group [18 cases] and external fixator group [15 cases]).
Results: The follow-up time was 6–24 months. The interlocking intramedullary nail group showed better results than the external fixator group in bony callus time (4.7 ± 0.8 vs. 5.5 ± 0.5 weeks, P < 0.05) and bony union time (13.2 ± 1.4 vs. 15.4 ± 2.0 weeks, P < 0.05); however, they showed a much longer operation time (52.8 ± 11.3 vs. 40.7 ± 11.0 min, P < 0.05) and higher blood loss (239.4 ± 69.1 vs.139.3 ± 82.2 mL, P < 0.05). The preoperative and postoperative pH, temperature, prothrombin time, and activated partial thromboplastin time were not significantly different between the two groups. There were also no statistically significant differences in complications, mortality, and Johner-Wruhs score between the two groups.
Conclusion: In severe polytrauma patients with NISS <50, no shock, and no condition of the lethal triad, better effects can be achieved with interlocking intramedullary nails than with external fixators in closed tibial shaft fractures.
Keywords
conditions; intramedullary nail; severe polytrauma; tibia fracture