Effect of dynamization in delayed union tibia shaft fracture

Introduction: Tibial shaft fracture is among the most common long bone fracture encountered, open fractures are more common in the tibia because one third of the Tibial surface is subcutaneous throughout most of its length, and the blood supply to the tibia is more precarious than that of bones enclosed by heavy muscles. Whenever open fractures occur in the tibia they are more commonly type IIIB. Objective: To study delayed union, non-union and infection are relatively common complications of tibial shaft fracture functional outcome & effect of dynamization in closed Intra-medullary Interlocking nailing for closed and open (Gustilo & Anderson Type I to Type IIIb) Tibial diaphyseal fractures. Material and Methods: Total of 56 skeletally mature patients diagnosed as Tibial diaphyseal fracture included closed & open (Gustilo type I to IIIb). Treated with intramedullary interlocking nail. Observation & Results: The age distribution was 42.9% in 21-40 years age group & 41.1% in 41-60 years age group with mean age 39.32 ± 14.85. Majority of fractures occurred in male i.e. 76.8%. Road traffic Accidents were found to be the main culprit as it contributed to 83.9% of total cases, other includes the fall from height (12.5%) & slip at home (3.6%). Among 56 tibia fractures 51.8 % were the lower 1/3rd shaft of tibia. 31.5% were middle 1/3rd shaft of tibia fracture. 1.8% upper 1/3rd shaft of tibia fracture. 8.9% are segmental fracture. In 33 cases which is more commonly i.e. 58.9% & Right side was involved in only 23 cases i.e. 41.1% of total cases. 80.4% of total cases (45) were closed tibia fractures. Dynamization increases the rate of callus formation with mean time to union post dynamization is 6.86 weeks. We evaluated patient using Lysholm score at 3 months and we found that mean Lysholm score was 75.54, which has increased in 6 months to 87.84. At the end of the study we found score further increased to 95.39. Final result in 56 case of tibia shaft fractures treated with intramedullary interlocking nail, 39 case (69.6%) result was “Good to excellent”, in 13 patient (23.2%) results were “Excellent”. 3 patients (5.4%) had “fair to good “result. 1 patient had “fair” result. We found no case with poor results. Conclusion: Dynamization increases the pace of fracture healing in delayed uniting fracture. Intramedullary interlocking nails shows good to excellent results in the treatment of diaphyseal fractures. Distal tibia shaft fracture are more common followed by middle 1/3rd.