Dr Khazi Syed JavidMS;FRCS; FRCSI;FRCS(Tr & Orth)Consultant Orthopaedic Surgeon

Al Hada Military HospitalTaifKSA

Plating for Tibial Shaft Fractures-A Problem or A solution??

Case 2RTA 2/12 earlier

IM NAIL

• Deep infection- 3.5% in type 2 and 3A

and 23% in type 3B

• Time to union: 6/12 in 1, 2, 3A

12/12 in 3B

Problems with Plating

• Plate is a load bearing implant

• Haematoma is removed

• No wt bearing= no compression

• High infection

•Load sharing implant

• Stress shielding is less.

• Peri implant fractures are less.

• Loading can be done early in IM nail,

• IM nail can be done without opening the fracture site,

•The union rate is high, because the fracture hematoma is preserved and the cambium layer of periosteum which is needed for bony healing is preserved.

Advantages with IM Nail

Conclusion

• Plating ×××

• IM nail

• Reamed or unreamed : results

Open and closed tibial fractures - Reamed versus unreamed nailingOrthop. trauma dir. 2009; 04; 15-24SummaryEvidence from one large and three smaller randomized controlled trials suggests that time to union may be faster and the proportion of patients with nonunion lower with the use of reamed compared with unreamed nails. The rate of complications appears to be similar between groups. Rates of reoperation were not statistically different between groups. Additional studies that measure patient function and quality of life could help substantiate these findings and provide more definitive evidence regarding advantages of reamed versus unreamed nailing of tibialfractures.