A radiological assessment of tibia shaft fractures stabilised with intramedullary nails by trainee surgeons

Abstract

Background: This retrospective cohort study analysed patient files and radiographs of 158 patients who underwent tibial nail surgery between April 2016 and March 2018 at a level one trauma centre in South Africa. The aim was to evaluate the radiological adequacy of reduction of tibial fractures treated by intramedullary nailing at our institution, and to identify factors associated with poor reduction and the causes of early loss of reduction.

Methods: Demographic and injury data were collected, and radiographs were digitally measured at two time points. The data were analysed to determine the success rate of adequate reductions and identify any factors associated with unacceptable reductions.

Results: Out of 163 tibial fractures, the majority showed adequate reductions that were maintained until follow-up. Motorised vehicle accidents were the most common cause of fracture (64%), and the majority of fractures were closed injuries (60%). A malalignment rate of 32% was found overall, with the bulk of these being minor deviations of a few degrees. Fractures in the proximal third were most likely to be malaligned. However, fractures in the distal third were most likely to displace after surgery. Surgeon level of experience and time of day the surgery occurred were associated with rates of malalignment.

Conclusion: This study demonstrates a high rate of acceptable reduction that is in keeping with international standards. These procedures were commonly performed by trainee orthopaedic surgeons, and the results demonstrate that trainee orthopaedic surgeons can perform tibial nail surgery to an acceptable standard. Factors correlated with poor reductions were proximal third fractures requiring three proximal screws, and complex cases done during daytime hours.

Level of evidence: Level 3