Prospective study of the clinico-radiological outcome of interlocked nailing in proximal third tibial shaft fractures

Background: Almost 9% of tibial shaft fractures occur in the proximal third of the bone. In order to address the problems of mal-alignment and late loss of fixation, all the specific surgical techniques described in the literature were used in nailing these fractures in our study. Methods: From December 2001 to December 2003, 45 consecutive patients with fracture of the proximal third of the tibial shaft underwent nailing. The clinico-radiological outcome of these cases and the complications encountered were analysed. Results: The average time to knee mobilisation and partial weight-bearing walking was 3.2 days. The fractures had united at an average of 4.3 months. At the last follow up, the average lower extremity functional score was 96%. There were seven cases of malunion (15.56%), with three valgus and four apex anterior angulations. Delayed union necessitated open bone grafting in three cases, at an average of 6.3 months. At 8 months, one patient with delayed union experienced nail breakage across the weakest point, i.e. the dynamic screw hole. He underwent reamed exchange nailing and, 3 months later, the fracture had united. Conclusion: Meticulous intramedullary nailing of fractures of the proximal third of the tibial shaft, using all current surgical principles and techniques, has excellent clinico-radiological outcome and is relatively safe. We recommend a nail similar to a Sirus nail, but with a more proximal bend of the nail and no dynamic interlocking screw hole.