A Comparitive study of conservative versus operative management of stable tibia shaft fractures in adults.

Dr. Muni Srikanth; Dr. Sethu Madhav Chebrolu; Dr. Rohit Inuganti; Dr. Yesoph Mungara

Volume : IX, Issue : V, May - 2020

A Comparitive study of conservative versus operative management of stable tibia shaft fractures in adults.

Dr. Muni Srikanth, Dr. Sethu Madhav Chebrolu, Dr. Rohit Inuganti, Dr. Yesoph Mungara

Abstract :

Purpose: To study the short term functional outcome in treatment of stable tibia shaft fractures with casting versus nailing. METHODS: A retrospective type of study conducted in ASRAM Hospital, Eluru from January 2018 to December 2019. A total number of 32 cases who met inclusion criteria were selected and taken into the study group.16 patients were treated with closed reduction and Cast immobilization thereafter were assessed radiologically every month for fracture union.16 patients were treated with intramedullary nail and were assessed clinically and radiologically at 6 weeks, 3 Months, 6 Months to assess the fracture union. Malalignment and malunion was measured with x rays. Knee, ankle, foot range of motion were measured with goniometry. Functional outcome was compared according to Johner and Wruhs criteria. Results: Partial weight–be� was begun at a mean of 12.4 weeks (SD 3.1) in Conservative group and by 9.8 weeks (SD 2.4) in nailing group, the difference being highly significant statistically( P VALUE<0.0049). Time–to–Full weight–be� was at a mean of 19.8 weeks (SD 2.9) in the Conservative group and 15.6 weeks (SD 1.3) in nailing group, the difference of which was very highly significant statistically (P<0.0001). The full range of both knee joint and ankle joint movements were achieved much early in the nailing group (2.7 wks.& 2.5 wks) than in the Conservative group (15.8 wks.& 20.6wks). The mean time–to– Bone union in the Conservative group was 25.8 weeks (SD 1.77), Compared to 20.7 weeks (SD 1.44) in the nailing group. The difference was very highly significant statistically (P<0.0001). Varus or valgus angulations occurred in 5 patients of the Conservative group and 2 patients of nailing group. Anterior or posterior angulations occurred in 4 patients of Conservative group and 1 patient in nailing Group. In the Conservative group 2 delayed union cases , 1 Non union case, 1 case of significant displacement in cast was observed during follow up which were treated by Interlocking nailing .In the nailing group, 1 patient had a superficial infection, and 1 patient had delayed union . 4 of the patients (25 %) in the nailing group developed anterior knee pain. The functional outcome at 6 months follow up was better in the nailing group in which 87.5% of the fractures had an excellent–good outcome and none of the patients had poor outcomes. Compared to nailing group, functional outcome in the Conservative group was excellent–good in only 50% of the patients, 37.5% had a fair outcome and 12.5% had poor outcomes. Conclusion: The treatment of stable fracture shaft of tibia surgically with interlocking nail appears to be an optimal mode of treatment than treatment with cast with better short term functional outcome.