Comparative study of the efficacy of gentamicin-coated intramedullary interlocking nail versus regular intramedullary interlocking nail in Gustilo type I and II open tibia fractures

Purpose:Open tibia fracture is prone to infection,consequently causing significant morbidity and increasing the hospital stay,occupational loss and onset of chronic osteomyelitis.Intramedullary nailing is one choice for treating tibia shaft fractures.To improve the delivery of antibiotics at the tissue-implant interface,many methods have been proposed as a part of prophylaxis against infection.This study was conducted to study the role of gentamicin-impregnated intramedullary interlocking(IMIL)nail in the prevention of infection in Gustilo typeⅠandⅡopen tibia fractures and to compare the results with regular intramedullary nail.Methods:The study included 28 patients with open tibia fractures(Gustilo type 1 or type 2);of them 14 underwent regular IMIL nailing and the other 14 were treated with gentamicin-coated nailing.Randomization was done by alternate allocation of the patients.Follow-up was done postoperatively(day 1),1 week,6 weeks,and 6 months for bone union,erythrocyte sedimentation rate(ESR),hemoglobin and C?reactive protein(CRP).Statistical significance was tested using unpaired t-test.A p value less than 0.05 was considered significant.Results:There were 4 cases of infection in controls(regular IMIL nail)and no infection among patients treated with gentamicin-coated nail during the follow up(Х^2=4.66,p=0.031).At 6 months postoperatively,CRP(p=0.031),ESR(p=0.046)and hemoglobin level(p=0.016)showed significant difference between two groups.The bone healing rate was better with gentamicin-coated nail in comparison to regular IMIL nail at 6 months follow-up(p=0.016).Conclusion:Gentamicin-coated IMIL nail has a positive role in preventing infection in Gustilo typeⅠandⅡopen tibia fractures.

Correlation between tibial nail length and olecrenon to 5th metacarpal head measurement: An anthropometric study

Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecranon to 5th metacarpal head"(O-MH)measurement can be used to reliably predict the tibial nail length.Methods:This was a cross sectional study involving 100 volunteers.Measurements were done and recorded by two observers on two separate occasions.Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus(TT-MM).O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched.Statistical analysis was done to find out correlation between two measurements and influence of age,gender and body mass index on them.Results:Paired t-test showed no systematic error between the readings.Intraclass correlation coefficient showed strong agreement in inter and intra observer settings.Strong correlation was found between the TT-MM&O-MH measurements using Pearson's correlation coefficient test(r=0.966).Hierarchical regression analysis showed age,gender and BMI have no statistically significant bearings on these measurements and their correlations.Conclusion:O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.