Dynamic osteosynthesis by modified Kuntscher nail for the treatment of tibial diaphyseal fractures

Abstract

Background: We evaluated a series of diaphyseal fractures of the tibia using low-cost, Indian-made modified Kuntscher nail (Daga nail) with the provision of distal locking screw for the management of the tibial diaphyseal fractures.

Materials and methods: One hundred and fifty one consecutive patients with diaphyseal fractures of tibia with 151 fractures who were treated by Daga nail were enrolled. One of the patients who had died because of cancer, and the two patients who were lost to follow-up at 3 months were excluded from the study.Therefore data of 148 patients with one hundred and fortyeight fractures is described. One hundred twenty closed fractures, 20 open Grade I fractures, and eight open Grade II fractures as per Gustilo and Anderson classification were included in this study. One hundred fourteen men and 34 women, with a mean age of 38.4 years, were studied. The result were analysed for Surgical time, duration of hospitalisation, union time, union rate, complication rate, functional recovery and crutch walking time. The fractures were followed at least until the time of solid union.

Results: The follow-up period averaged 15 months (range, 6-26 months). Union occurred in 140 cases (94.6%). The mean time to union was 13 weeks for closed fractures,17.8 weeks for Grade I open fractures, and 21.6 weeks for Grade II open fractures. Compartment syndrome occurred in two patients. Superficial infection occurred in five cases of Grade I and II compound fractures. Three closed fractures and one case of Grade I compound fracture required bone grafting for delayed union. Two cases of Grade II compound fracture with nonunion required revision surgery and bone grafting. Twelve cases resulted in acceptable malalignment due to operative technical error. In four cases, the distal screw breakage was seen, but none of these complications interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or ankle injury.

Conclusion: Unreamed distally locked dynamic tibial nailing (modified Kuntscher nail/Daga nail) can produce excellent clinical results for diaphyseal tibial fractures. It has the advantages of technical simplicity, minimal cost, user-friendly instrumentation, and a short learning curve.

Keywords: dynamic osteosynthesis; intramedullary nail; modified Kuntscher nail; tibial diaphyseal fracture; ‘D’ interlocking nail.

Figure 1

(a) X-ray of right leg lateral and anteroposterior views showing a fracture of both bones of leg, middle third with a butterfly fragment. (b) 6 weeks postoperative (anteroposterior and lateral) radiographs showing early healing, (c) radiograph showing good consolidation at 1 year follow-up.

Figure 2

X-ray of left leg (anteroposterior and lateral views) showing a short oblique diaphyseal fracture of distal one fourth of tibia and fibula, which are inherently unstable. (b) Immediate postoperative (anteroposterior and lateral)radiographs showing good fracture reduction. (c) radiograph showing good consolidation at 9 month follow-up.