PRELIMINARY EXPERIENCES WITH UNREAMED TIBIAL NAIL (UTN)

During a one-year period starting January 1991, 17 tibial shaft fractu res have been treated with the new AO unreamed tibial nail in a prospe ctive study. Fractures were classified according to the AO classificat ion: 10 type A, 6 type B, one type C. 7 fractures were closed. Out of those 3 showed marked soft tissue contusions and 2 required a fascioto my because of a concomitant compartment syndrome. The open fractures w ere classified according to the Gustilo classification: 3 grade I, 5 g rade II, 1 grade III B and 1 grade III C injury. There were 5 polytrau matised patients (ISS 27-34). The nailing procedure was preformed on t he day of admission in 11 cases and in a delayed fashion (2-14 days af ter the accident) in 6 cases. There were no specific technical problem s encountered intraoperatively. The only perioperative complication co nsisted of 1 case of fat embolism syndrome. 1 fracture required second ary plate osteosynthesis because of a unacceptable valgus deformity 6 weeks postoperatively. There was 1 too long nail implanted at the init ial surgery, which then had to be changed during the rehabilitation pe riod because of pain in the region of the knee. In 3 cases the interlo cking bolts broke and 3 other cases required secondary dynamisation. T here was a complete follow-up in all cases of at least 6 months. There were no infections. All fractures are healed. Full weight bearing was allowed at a mean of 10 weeks for closed fractures and 14 weeks for o pen fractures, respectively. All but one fracture (valgus 8-degrees) h ealed in a correct axial alignment without shortening. Based on our ex perience in this small series, we conclude that the UTN is a valuable alternative to the external fixator in open tibial shaft fractures as well as an alternative to reamed IM nails in selected cases of closed fractures.