Flexible intramedullary nail is still a cost-effective, minimally invasive treatment for stable tibial diaphyseal fracture - A large scale study

KR Gowtham, MR Nambiar

African Journal of Trauma 2017 6(1):1-5

Background: Many times, we come across patients who ask for conservative line of treatment either because of lower socioeconomic status or many people are unable to stay in the hospital for various reasons. Being orthopedicians, mere treatment of fracture should not be our only aim. Our aim also should be to treat patient as a whole. In country like India, especially in rural set-up, economy plays a major role. Hence, we conducted a study to evaluate the cost-effectiveness of flexible unreamed nailing, using Ender nails for the most common long bone fracture, i.e., tibia. Materials and Methods: Nearly 590 patients with diaphyseal fractures were fixed with Ender nails from September 2002 to September 2016. The mean age of the patients was 39 years (range 18–65 years). Inclusion criteria were closed fractures and type 1 compound fractures with relative stable configuration. Exclusion criteria were long oblique and spiral fractures; type 2 and type 3 open fractures. Two Ender nails of 4.5 mm each were passed across the fracture site into the distal fragment. The mean follow-up was 16 months. Results: Average time to fracture union was 11 weeks (range 8–14 weeks). Average peri-operative blood loss was <10 ml and operative time was about 20 min. Average radiation exposure was six shoots. Range of knee movement achieved in most of the cases was >120°. Conclusions: Ender nailing in cases of tibial diaphyseal fractures could achieve reliable fracture stability, better union with least complications. Advantage of low-cost intramedullary device, its easy removal, and less hospital stay makes this even more attractive for the poor patients.

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