OUTCOME OF MANAGEMENT OF DIAPHYSEAL FRACTURES OF TIBIA IN ELDERLY POPULATION

Abstract

Background: Diaphyseal fractures of the tibia currently account for approximately 2% of all fractures presenting to orthopedic surgeons. Epidemiology has changed markedly during the last two decades with overcrowding and related to improved road safety. In comparison to young population majority of these fracture occur predominantly in females as compared to males in old population.

Objectives: To determine the outcome of diaphysis fractures of tibia in elderly patients

Methods: This study was carried out in department of orthopaedic Jinnah hospital Lahore from 2014-2017. One hundred and twenty patients both males and females in the age range of 65 to 80years, having diaphyseal fractures of tibia were included in the study. The patients with poly-trauma and with peri-prosthetic fractures were excluded from the study. After detailed medical history, clinical examination, the x-rays of tibia fibula AP and Lateral views including joint above and below were done to determine the configuration of the fracture. Each patient was followed at 1^st, 2nd and at 6^th week and then at 3rd month, 4th month, 6th month and later at 1 year. Data was entered and analyzed in SPSS ver: 21.0 and was presented and frequency and percentages. Cross tabulation was done for open and closed fracture for outcome and Chi Square test was used to assess statistical significance with p value of ≤0.05.

Results: 62.5% were females and 37.5% were males with mean age of 72 + 5.45 years. The mode of injury in most of the patients was slip and fall 85% and 70 % of patients had closed fractures. Reamed intra medullary nailing was done in 80 patients and 25 patients with open fracture were treated with external fixator. In the remaining 5 patients we applied the POP cast. Nonunion was labeled at 9 months and was seen in 10.0% of patients while the delayed union was seen in 33.0% (40) of the patients. Among the patients who had nonunion 5 patients were treated with intramedullary nailing and 7 patients were treated with external fixator. Infection was seen in 10.0% (12) of patients and this happened in the patient with open fracture. No patient was lost in follow-up during the study. Overall mortality rate was 30% in the 1^st year.