Comparative Study of Treatment in Open Tibia Fracture Treated with Jugdesh-Awais Solid Tibial Nail (JA-STN) and AO External Fixator
Introduction: The tibia is most commonly fractured long bone in the body, as it has poor soft tissue coverage, medial surface is completely subcutaneous. The optimum method for skeletal stabilization of open fractures of the tibial shaft remains controversial. In recent years, unreamed intramedullary nailing has become an increasing attractive treatment method for tibial fractures. Due to high price of imported unreamed tibial nail (UTN), therefore we first designed the nail according to the measurement of our tibia, and then manufactured the solid UTN nail from 316L steel and inserting instrument from stainless steel. Two average size i.e. 350 mm and 330 mm in length and 9 mm diameter after analyzing the measurements of tibia in 20-40 years old male population of tibia of 50 healthy males by using CT scan. The sizes of long bones are slightly different in Western and Asian societies.
Aims and Objectives: (1) The Development of solid intramedullary nail for tibia shaft; (2) to evaluate efficacy of internal fixation and external fixation for treatment of open type IO1 and IO2 fractures of tibia (3) to evaluate the time required for healing of fracture and soft tissues, and return to the function with each method of treatment and (4) to observe and compare the rate of complications in both procedures.
Material and Method: This study was carried out in the Department of Orthopaedic Surgery, Mayo Hospital, Lahore between June 1995 to June 1998. This study was carried out in three phases: Phase I - collection of data regarding measure-ments of tibia in 20-40 years old male population by using CT scan, Phase II - designing and manufacturing of solid tibia nail alongwith inserting and interlocking instruments and Phase III - comparative study of treatment of 40 open fractures (IO1 and IO2) 50% treated with solid unreamed interlocking nail and 50% with the AO external fixators.
Results: The duration of hospital stay between 3-8 days, 85% patients in unreamed tibial nail (group A) and 30% in external fixation (group B), statistically the difference is highly significant (P<0.0001). The average time off work in group A was 13.9 weeks while 21.19 weeks in group B, P<0.05 (significant). The average time to union was 21 weeks in group A and 24.3 weeks in group B, statistically the difference is not significant (P>0.05). Full weight bearing without support 75% patients in 11-20 weeks in group A and 40% patients in group B, statistically the difference is very highly significant (P<0.0001). The average wound healing time was 2.8 weeks in group A and 5.4 weeks in group B. Wound infection develop in 2 patients (10%) in group A and 4 patients (20%) in group B. Breakage of distal locking bolts in 2 patients but no breakage of nail and Schawnz screw in group A and B respectively. Two patients (10%) develop infection at distal locking bolt site in group A and 10 patients (50%) got pin tract infection in group B.
Conclusion: This study supports the use of the URTN over external fixation in the treatment of severe open tibial fractures.
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