Evaluation of the use of expert tibia nailing in proximal tibia fractures.

Background : For a very long period, open reduction and internal fixation with a plate was the preferred therapy for proximal tibia fractures. Recently, proximal tibia fractures are often treated with expert tibial nail since it has numerous distal and proximal interlocking alternatives. At the distal end, there are four locking choices and five at the proximal end in different lines. As well as it is a less invasive procedure, wound-related problems and post-surgery care duration than plating. Expert tibial nail style helps to achieve stable fixation with interlocking screws. In this study, the effectiveness of expert tibial nail in treating proximal tibia fractures was examined. Aim of the study: to evaluate the postoperative radiological and functional results of using expert tibial nail in the treatment of proximal tibia fractures. Patients: In this study, twenty patients (fourteen males and six females) with upper third tibia fracture were operated by expert interlocking tibial nail at universal health insurance hospitals of Port Said City. Methods: Between August 2021 and August 2022, we prospectively analyzed our cases of proximal third tibia fractures in patients aged 18 to 60 who underwent closed reduction and internal fixation with expert interlocking tibial nail and were observed for at least six months. Each patient was evaluated in term of postoperative radiological and functional outcomes. Results: Patients had no complications were 13 (65%) however, 4 (20%) of the patients had anterior knee pain, 1 (5%) of the patients had infection, 1 (5%) of the patients had DVT and 1 (5%) of the patients had delayed union. Patients were evaluated radiologically for fracture union and alignment, as well as clinically for the knee & ankle joints' range of motion, knee pain, and atrophy of the muscle utilizing the Modified Klemm and Borner Scoring System. The excellent patients results were 13 (65%) and 5 (25%) of patients were good. While only one patient was fair, and one patient was poor. Conclusion: For the management of proximal third tibia fractures, expert tibia nailing is a good therapeutic option because it offers strong angular stability and appropriate fixation, leading to early rehabilitation and union with great functional success and fewer problems. In cases where the surrounding soft tissue is affected, it is also a safer treatment option. weeks. Our results were in line with study of Kadam et al ⁽ ¹ ⁵⁾ as they stated that the patient began full weight bearing walking without support at 7.2 weeks and that the average duration for protected full weight bearing walking was 3.2 weeks. Without dynamization, a 100% union rate was attained with no case of nonunion or delayed union. Patients typically required 18.2 weeks to view the union on an X-ray. Manikandan and Palanikumar ⁽ ¹³ ⁾ demonstrated that all cases achieved union at the end of study for a period of one year with good functional outcome. The present study showed that Thirteen (65%) patients had no complications however, four (20%) patients had anterior knee pain, one (5%) patient had infection, one (5%) patient had DVT and one (5% ) patient had delayed union. Our results were supported by study of Tijoriwala et al ⁽ ¹ ⁴⁾ as they noted that 25% of the patients in that trial experienced anterior knee pain as the most typical acute complication. All of these patients also experienced mild limitations in knee joint range of motion. 15% of nailing patients experienced a superficial wound infection that was treated with a normal dressing. Infections in superficial wounds occurred in 30% of plating patients, of whom 20% recovered with simple dressings and 10% required debridement under anaesthesia. In 10% and 5% of patients, respectively, the fracture did not heal after plating and nailing. Our results showed that 13 (65%) of patients were excellent, and 5 (25%) of patients were good, While only one patient was fair, and one patient was poor. In accordance with our results, study of Kadam et al ⁽ ¹ ⁵⁾ as they reported that out of thirty cases the excellent results were twenty patients (66.67%), eight patients (26.67%) had a good score and only two patients (6.66%) with fair score. Also, et al ⁽ ¹ ⁶⁾ revealed that 71.42% of patients fell into the excellent group, 17.85%