HEALING PATTERN OF THE INTERLOCKING INTRAMEDULLARY NAILED CLOSED TIBIAL SHAFT FRACTURES — EFFECT OF AGE, IM NAIL AND FIBULA ON CALLUS FORMATION

Abstract

Objectives: To assess the healing pattern of the fractured tibial shaft with or without fibula fracture, fixated with locked intramedullary (IM) standard cannulated titanium nail in a group of patients in each decade; nonosteonal versus osteonal. Summary of background data: Up to now there have been many previous clinical studies on the nailed tibial shaft fractures. However, only a few animal experiments dealt with the callus type in healing, and a little human researches on the effect of the age and fixation device on callus formation in tibia at the two bone level of the lower limb were carried out. Material and Methods: 135 out of 168 patients with normally united closed tibial shaft fractures, fixated with titanium cannulated nail which showed good quality radiograms, were subjected to this study: 10 patients at minimum in each decade from late teens to 8th decade being regularly and radiographically followed were selected. Results: The nailed fractures united primarily by periosteal callus in the teenagers, while in the patients over third decade the fractures united by the intercortical uniting callus (osteonal). Conclusion: It was found that nail in tibia could not suppress the periosteal reparative reaction in the late teenagers which was suppressed in the adults. Union of the titanium nail-fixated adult tibial shaft fractures had to be depended primarily on osteonal healing because of the suppressed reparative periosteal reaction.