The treatment of tibia fractures by intramedullary nails at Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Background: Tibial shaft fractures are the most common long bone fractures in young adults, and intramedullary nailing of these fractures consumes a considerable amount of theatre resources at Charlotte Maxeke Johannesburg Academic Hospital. Although there is substantial international literature on the accuracy of this treatment method, no prior study has been conducted at this institution to determine whether our results are comparable with international norms. We conducted this study to assess whether tibial fractures are being treated appropriately with intramedullary nails at Charlotte Maxeke Johannesburg Academic Hospital, with adequate reductions that do not undergo early loss of reduction. Methods: A retrospective review of patient files and radiographs was done on patients who received a tibial nail between 01 April 2016 and 31 March 2018. Demographic and injury data were collected from the files. Radiographs were measured digitally at two time points, immediately post-operatively and after the six weeks’ follow-up. The data were analysed to determine whether these fractures were adequately reduced at both time points. We then conducted a statistical analysis to ascertain if there were any factors that were correlated with unacceptable reductions. Results: There were 158 patients with 163 tibial fractures that met our inclusion criteria. The majority of tibial fractures occurred in young male patients (65.82%) and the most common mechanism of injury was a pedestrian vehicle accident (49.69%). The majority of these fractures were closed injuries involving the midshaft of the tibia (42.33%). Surgeon experience was shown to be significant both for theatre time usage and also for the adequacy of reduction, although this did not follow a linear pattern. Multiple procedures done in one sitting were also associated with a longer surgical time, but not with the quality of the reduction. There were 46 (22.28%) patients who were identified to have inadequate reductions at follow-up, 15 (9.20%) of whom had lost reduction from their initial post-operative measurements. Malalignment was most common in fractures of the proximal third of the tibia. Conclusion: The majority of patients had adequate reductions that were maintained until follow-up. The rate of unacceptable reductions is in keeping with the international data