Effect of using a trephine to extract bone at the insertion point of the intramedullary nails and graft bone at the fractured ends in the treatment of tibial shaft fractures with intramedullary nail

Abstract

Objective: To explore the effect of using a trephine to extract bone at the insertion point of the intramedullary nails (IMN) and graft bone at the fractured ends in the treatment of tibial shaft fractures with IMN.

Methods: In this single-center retrospective study, patients who underwent treatment for tibial shaft fracture using IMN between January 2016 and December 2019 at Fudan University Jinshan Hospital were retrospectively analyzed. There were two groups. In the study group, a trephine was used to extract bone chips at the insertion point of the IMN, which were grafted at the fractured ends. The control group comprised sex- and age-matched patients with similar fracture location and classification, but without bone graft at the fractured ends. The surgery time, fracture healing time, and frequency of IMN dynamic surgery were compared between the two groups. Furthermore, the Johner-Wruhs score, WHO-QOL score, and knee joint range of motion at six and 12 months after surgery were compared.

Results: Both groups had 99 matched patients (69 male and 30 female). The median healing time was significantly shorter in the study group (z=-2.86, p=0.004). Five cases (5.05%) in the study group and 10 cases (10.10%) in the control group underwent IMN dynamic surgery; the between-group difference in this respect was not statistically significant (c²=1.803, p=0.179). There was no significant between-group difference regarding the other parameters.

Conclusions: The surgical technique can promote healing of tibial shaft fractures with no adverse effect on postoperative functional recovery.

Keywords: Bone grafting; Intramedullary nail; Tibial shaft fracture.

Fig.1

A trephine