Treatment of Tibial Diaphysis Fractures with Reamed and Locked Intramedullary Nailing

Objectives: We aimed to evaluate the results of reamed and locked intramedullary nailing for tibial diaphysis fractures. Methods: The study included 34 patients (22 males, 10 females; mean age: 34 years; range: 17 - 80 years) who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. There were 20 (59%) AO/ASIF type A, 13 (38%) type B, and 1 (3%) type C fractures. Eight fractures (23%) were open fracture. According to the Gustilo-Anderson classification, 4 patients (12%) had grade I, 3 patients (9%) had grade II, and 1 patient (3%) had grade IIIA open fractures. The fractures involved the proximal, middle and distal tibial diaphysis in 4 (12%), 20 (59%), and 10 (29%) patients, respectively. Intramedullary nailing was performed following open reduction in 22 patients (65%) and closed reduction in 12 patients (35%). The mean time to surgery was 4.6 days (range: 1 - 22 days) and the mean follow- up was 22 months (range: 10 - 35 months). Functional results were assessed using the Johner-Wrush criteria. Results: Union was achieved in all the patients within a mean of 16.8 weeks (range: 9 - 39 weeks). Two patients (6%) required dynamization because of delayed union. Anterior knee pain developed in 12 patients (35%). Superficial infection developed in 2 patients (6%). Limb shortening occurred in 4 patients (12%). Angular deformity <10 degrees developed in 6 patients (18%). Reflex sympathetic dystrophy developed in 1 patient (3%). Joint movement was <= 10 degrees in the proximal and distal fractured extremity in 7 patients (21%). According to the Johner-Wrush criteria, functional results were very good in 22 patients (65%), good in 10 patients (29%) and fair in 3 patients (6%). Conclusion: Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing with appropriate indications provides very good results with low complication rates. It should be considered as the first choice in the treatment of these fractures.