Review Of The Results Of V – Nailing Vs Interlocking Nailing For Displaced Fractures Of Tibial Diaphysis In Adults.

摘要

This study was conducted on 50 patients with closed and grade I compounded fractures of tibia who attended department of orthopaedics, Government Medical College Jammu, for a period of 2 years. Out of these, 25 patients were treated with interlocking nail and 25 were treated with primary intramedullary V-nailing. The patients were followed after every three weeks for three months; and six weekly till study was completed. The study shows that there is no significant difference in the results of V-nail and Interlocking nail so it is concluded that V-nail in places where C-arm is not available appeals to be an effective modality of treatment in unstable tibial diaphyseal fractures. Introduction Tibia is one of the largest and strongest bones of the body and one of the main weight bearing bone in the lower extremity. Its fracture may result in prolonged and extensive disability unless treatment is appropriate. This study was conducted on 50 patients with closed and grade I compounded fractures of tibia who attended department of orthopaedics, Government Medical College Jammu, for a period of 2 years. Out of these 25 patients were treated with interlocking nail and 25 were treated with primary intramedullary V-nailing. Aims and objectives To compare the result of V-nailing and interlocking nailing in the treatment of closed and type-1 compound fractures of shaft of tibia.To evaluate the complications of each modality of treatment. Materials and methods This study was conducted on 50 patients with closed and grade I compounded fractures of tibia who attended department of orthopaedics, Government Medical College Jammu, for a period of 2 years. Out of these 25 patients were treated with interlocking nail and 25 were treated with primary intramedullary V-nailing. Criteria for selection of patients Age: All the patients in the age group of 16 years and above with fresh fractures of tibial shaft were taken up for study.Type of fracture: Simple tibial fractures and type 1 compound fractures were included in the study.Radiologically all types were taken up.Fractures at least 3 inches from knee and ankle joint. Criteria for exclusion of patients The following fractures were excluded from the study:Compound fractures – type 2 and 3.Fractures in children.Pathological fractures.The patients after admission in the hospital were provided first aid treatment, splintage of the part and other necessary resuscitative measures. Detailed history, general physical examination, systemic and local examination was recorded. In case of compound fractures thorough wound debridement anddressing were done and broad spectrum antibiotics started after sending the material for culture and sensitivity. Interlocking The interlocking nailing was carried under general or spinal anaesthesia depending upon the choice of anaesthetist. The patient was placed supine on the normal operation table with knee flexed and affected leg hanging vertically down. An image intensifier was used to assess the reduction, to check the position of the guide wire and nail and for locking.The insertion point is slightly offset medially, slightly proximal to the tibial tuberosity and sufficiently below the tibial intercondylar area to avoid damage to the joint. The 6cm incision was made medial to the patellar ligament and the tendon was retracted 2cm laterally. The awl was used to open the thin cortex at the point of insertion. Guide wire was introduced into the medullary cavity and pushed into the distal fragment. The position of guide wire was confirmed with image intensifier. After reaming the medullary canal the nail was then inserted through the entry portal into medullary canal. Insertion was aided by gentle blows with hammer. Position of nail was checked with image intensifier. Postoperatively Quadriceps exercises, knee bending exercises and ankle movement were started soon after the patients were comfortable. Partial weight bearing and full weight bearing was started according to