Abstract

Introduction: In this modern era of industrialization and mechanization high speed traffic accidents fractures of the tibial shaft are common injuries among the long bones and mainly affect young adults, i.e. individuals at their peak of physical and work capacity. Due to their frequency, topography, mode of injury and sometimes type of treatment, they have become a major source of temporary and permanent disability. In spite of all the advances, fractures of the tibia still pose a challenge to the orthopedic surgeon as non-union and infections are quite common. The optimum management of tibial shaft fracture is not controversial now a days due to advanced techniques like interlocking. Before going into details of different modalities of treatment of tibial shaft fractures, it is necessary to be conversant with the anatomy and the blood supply of the bone.

Material and Methods: The present study was include 60 patients of fracture of tibia who were be admitted in outdoor/emergency in the department of orthopaedics over a period of 2016-2017 in Katihar Medical College.

Type of study:  Prospective study

Inclusion Criteria

Patients with tibial diaphyseal fracture fulfilling the following criteria:

1    Tibial diaphyseal fracture.

2    Skin condition of the operative field Normal.

3    Patients and Party agreeing to have a surgery (after counseling).

4    No neurological deficit. 

Exclusion Criteria are as follows

1. Tibial mal-alignment and shortening.
2. Range of knee motion and extensor lag.
3. Range of ankle motion.
4. Foot Motion.
5. Pain in limb.
6. Swelling.

Duration of the study: 2016 - 2017

Methods: A sequence of methods to be used during this study are  as follows:

Selection of cases.

Based on Medical History (Name, Age, Sex, History with duration of pain and tenderness, history of trauma, history of any pathology etc.)

Examination of diaphyseal tibial fracture: (Gustillo & Anderson method)

To examine attitude, deformity, swelling, tenderness etc.

Relevant laboratory investigation.

Complete Blood count, Haemoglobin estimation, Fasting & Post Prandial Blood Sugar, Blood Urea, Serum Creatinine, bleeding Time, Clotting Time, HIV, HBsAg, Anti HCV etc.

Radiological Study

Plane X-ray of Knee with Ankle of Affected Limb (AP & Lat view)

All the patients selected will then be operated and followed-up after 3 weeks, 5 weeks for at least 6 month with clinical and radiological assessment at each visit. In all the cases a preoperative and post-operative neurological charts will be maintained with regular assessment for proper postoperative recovery assessment.

Implants: Universal Interamedullary Interlocking Nail DCP Plate  

Result: The results are assessed on the basis of Alho and Ekeland criteria’s (Clinical Orthopaedics (231), 205-15 1988). ⁹²

This, criteria considers six aspects:

• Tibial mal-alignment and shortening
• Range of knee motion and extensor lag
• Range of ankle motion
• Foot Motion
• Pain in limb
• Swelling

Summary: The present study consisted of 60 patients with fracture shaft of tibia treated at Katihar medical college katihar, Of these 30 patients were treated by DCP and 30 patients with Interlock nailing and results were compared.

The age of patients ranged from 18-63 years with mean age of 34.07 years. The mean age in DCP group was 36.3 years and of interlock nailing group was 31.87 years.

Majority of patients (81.67%) were males.

Conclusion: We conclude that DCP is a better mode of fixation for proximal and distal tibial facture and interlock nailing is ideal implant in diaphysial and segmental fractures.