Management of Diaphyseal Tibia Fractures with Interlocking Sign Nail after Open Reduction without Using Image Intensifier

Objective: To evaluate clinical and radiological outcome of closed diaphyseal fracture of tibia by doing open reduction and fixation by inter-locking intramedullary (SIGN) nail without using image intensifier Patients and Methods: A total number of 30 patients with isolated closed diaphyseal fracture were included in this study. Instead of using standard tibial interlocking nail system which requires image intensifier (fluoroscope) to fix the fracture without opening it, we used SIGN (Surgical Implant Generation Network) system to fix. SIGN nail surgeries including proximal and distal locking were done without using image intensifier, but the fracture was opened to reduce and fix it. Johner and Wruh’s Criteria with modification was used to measure final outcome. Results: Out of 30 tibia fractures, male to female ratio was 4:1. Average study period was 1.3±0.25 years. Mean age of the study population was 35.75±13.16 years. Fracture pattern observed was transverse (n=12; 40%), oblique (n=05; 16.6%) and spiral (n=13; 43.3%). Five (16.6%) patients had delayed union. Three of these were also infected. All the five cases were dynamized and infected cases underwent repeated debridements to gain union. Only one patient went into infected non-union. Excellent, good, fair and poor results were achieved in 43.3%, 33.3%, 16.6% and 6.6% patients, respectively. Conclusion: SIGN method of nailing for closed tibial diaphyseal fractures is an excellent option despite open reduction. As this surgery can be performed without the use of image intensifier, it reduces radiation hazards and requirement of costly equipment in countries like ours. Also, it is ideal in disaster situation.