For Orthopedic doctors and nurses

1. Dr Khazi Syed Javid
MS;FRCS; FRCSI;FRCS(Tr & Orth)
Consultant Orthopaedic Surgeon
Al Hada Military Hospital
Taif
KSA

2. Plating for Tibial Shaft Fractures-
A Problem or A solution??

12. Case 2
RTA 2/12 earlier

18. IM NAIL
• Deep infection- 3.5% in type 2 and 3A
and 23% in type 3B
• Time to union: 6/12 in 1, 2, 3A
12/12 in 3B

21. Problems with Plating
• Plate is a load bearing implant
• Haematoma is removed
• No wt bearing= no compression
• High infection

22. •Load sharing implant
• Stress shielding is less.
• Peri implant fractures are less.
• Loading can be done early in IM nail,
• IM nail can be done without opening the
fracture site,
•The union rate is high, because the fracture
hematoma is preserved and the cambium layer
of periosteum which is needed for bony
healing is preserved.
Advantages with IM Nail

23. Conclusion
• Plating ×××
• IM nail
• Reamed or unreamed : results

25. Open and closed tibial fractures - Reamed
versus unreamed nailing
Orthop. trauma dir. 2009; 04; 15-24
Summary
Evidence from one large and three smaller
randomized controlled trials suggests that time
to union may be faster and the proportion of
patients with nonunion lower with the use of
reamed compared with unreamed nails. The
rate of complications appears to be similar
between groups. Rates of reoperation were
not statistically different between groups.
Additional studies that measure patient
function and quality of life could help
substantiate these findings and provide more
definitive evidence regarding advantages of
reamed versus unreamed nailing of tibial
fractures.