Tibial fractures can be classified into many types based on their location, severity, and the fracture's complexity. Typically, surgical interventions are required in treating most tibial fractures.
A common surgical option for tibial fractures is the locked intramedullary nailing procedure. The procedure has been widely adopted by orthopedic surgeons for treating tibial fractures because of its numerous benefits.
This blog post will provide a comprehensive guide on locked intramedullary nailing in tibial fractures, other surgical interventions available, and the benefits of using this procedure.
Locked Intramedullary Nailing
Locked intramedullary nailing is a surgical procedure for treating tibial fractures that involve the insertion of a metal nail rod into the tibia. The metal rod is inserted into the medullary cavity of the tibia, which is the inner space inside the bone.
The locking mechanism of the nail enables it to provide stability and support to the fractured bone while also promoting the healing process. The external fixation process, which requires the surgical implantation of metal plates and screws to support the broken bone, has been frequently replaced by locked intramedullary nailing.
In the procedure, the surgeon makes an incision above the knee joint and passes the nail into the medullary cavity of the bone. The nail is then fixed to the bone using locking screws, which are inserted through the bone and the nail, thus offering rigid fixation for the fracture.
This surgical approach has become a standard treatment for tibial fractures because of its multiple advantages, such as allowing early motion and weight-bearing, increased biological healing, lower infection rates, and shorter hospital stays.
Intramural nails come in various sizes, and the length and diameter of the rod to be used will depend on the size of the bone and the fracture itself. Patients who undergo locked intramedullary nailing will be monitored in the hospital until the bone has fully healed and the patient regains full mobility and they can resume their daily activities.
Other Surgical Options
Although locked intramedullary nailing is the standard treatment for tibial fractures, other surgical interventions are available depending on the type and the severity of the fracture.
External fixation is one alternative surgical method that is frequently used in severe tibial fractures, particularly when there is an open wound over the broken bone. During this surgery, the bone segments are aligned, and metal screws and pins are inserted into the bone on either side of the fracture to keep the bone fixed in place.
Nonetheless, external fixation is now rarely used frequently as its success rate is considerably lower than locked intramedullary nailing. Additionally, it tends to cause discomfort, longer healing time, and possible infections.
Traditional open reduction and internal fixation (ORIF) is another surgical approach for tibial fractures that involve making an incision over the fractured bone, aligning it, and then using plates and screws to fix the bone segments back in place. ORIF is utilized for the more complex fractures, and it provides good healing and recovery rates, but it necessitates a longer hospitalization period than locked intramedullary nailing.
Benefits of Locked Intramedullary Nailing
The primary advantage of locked intramedullary nailing in tibial fractures is its rapid healing and recovery period. The locking mechanism of the nail provides significant stability to the bone, allowing it to heal more rapidly.
Another significant advantage of locked intramedullary nailing is that it reduces the chance of wound infection. Since the procedure is minimally invasive, there is a lower risk of hospital-acquired infections and the risk of wound-site infection related to ORIF or external fixation.
The procedure also enables earlier weight-bearing activities, providing promoting mobility to the patient and reducing the recovery time. Additionally, the use of intramedullary nails reduces the likelihood of a malunion (incorrect healing of the bones), as the stability provided by the nail limits the bones' movement.
Conclusion
Locked intramedullary nailing is a common surgical solution for treating tibial fractures. Its benefits include early mobility, shorter hospitalization periods, greater healing rates, and lower risk of infection. However, external fixation and open reduction and internal fixation are still viable options, but usually used in specific cases. As with any surgical procedure, the surgeon will consider the patient's medical history, the type and severity of the fracture, and the methods available to determine the best approach.
In general, who are struggling with tibial fractures should consult an orthopedic surgeon to discuss the ideal plan of care for their situation.