TIBIAL FRACTURES WITH BONE LOSS TREATED BY PRIMARY REAMED INTRAMEDULLARY NAILING

We reviewed the results of the treatment of 30 tibial fractures with m inor to severe bone loss in 29 patients by early soft-tissue and bony debridement followed by primary locked intramedullary nailing, Subsequ ent definitive closure was obtained within the first 48 hours usually with a soft-tissue flap, and followed by bone-grafting procedures whic h were delayed for six to eight weeks after the primary surgery, The t ime to fracture union and the eventual functional outcome were related to the severity and extent of bone loss. Twenty-nine fractures were s oundly united at a mean of 53.4 weeks, with delayed amputation in only one patient, Poor functional outcome and the occurrence of complicati ons were usually due to a departure from the standard protocol for pri mary management, We conclude that the protocol produces satisfactory r esults in the management of these difficult fractures, and that intram edullary nailing offers considerable practical advantages over other m ethods of primary bone stabilisation.