الفهرس 
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Abstract
Our present study was conducted in the department of Orthopedics, Sohag university hospital, SohagUniversityduring the period betweenJanuary 2014 and August 2014.
Thirty patients of open tibial shaft fractures typesI&II managed operatively by internal fixation with Interlocking nail (IMN) and Plates and screws during the course of the study were sorted and each was followed for at least 6-9 months.
Follow up of all patients in both groups were carried out regularly with clinical and radiological assessment till 9 months postoperatively. The data thus collected from patients was analyzed, evaluated, compared with each other and the observations were recorded.
Our aim was to evaluate the results of the use of Internal fixation of open tibial shaft fractures typesI&II with Interlocking nail (IMN) and Plates and screws
All the patients were examined clinically and radiological, including detail history of pre morbid status at the time of admission. Patients fulfilling the inclusion criteria was only included in the study.
Internal fixation for open tibial shaft fractures specialy with intramedullary nailing is considerd a safe and effective method for the treatment of most tibial fractures.
This provides stable fixation with minimal violation of the soft tissue envelope. The introduction of interlocking tibial nails has extended the indications of intramedullary fixation, to include extra-articular fractures of the proximal and distal third tibial fractures.
Patients with these fractures treated with intramedullary nails have a high incidence with angular malalignment. Valgus and apex anterior malalignment and anterior displacement of the proximal fragment are the most common deformities with fractures of proximal third of tibia. Varus and valgus deformities occurs with fractures of the distal third tibial fractures.
To overcome these problems and improve outcome, certain modifications to the standard operative technique have been proposed, such as the use of additional buttress plate different patient positioning, extended parapateller or retropateller approaches and the use of blocking screws.
Blocking screws are effective to help obtain and maintain alignment of fractures of the proximal and distal third of the tibial shaft treated with intramedullary nails. The indications for this technique may be extended to other long bone fractures in which angular deformity can complicate intramedullary nail insertion.
Healing within a reasonable period of time. The complication rate was considered minimal. Only two cases of infection, three cases of residiual malalignment of less than 5°.
Careful follow up of the patients is recommended. This technique confirmed by our results minimizes the complication rate of malalignment and facilitates early return to normal activities of the patient.
Mean age in years for this study is 30 years; There was a male preponderance in our patients. A male to female ratio in all patients was about 2:1.
Most common mode of injury in older patients is the simple fall (domestic fall) whilein young patients, falling from height and road traffic accidentsare most common mode of injury.
Majority of patients in present study series were operated within 5 days following admission in hospital.
In our study Pre-operative morbidity about two patients had Chest infection,
4 patient were diabetic and their blood glucose level was controlled pre and postoperative, 3 patient have Ischemic heart disease, 2 patients had DVT and
7 patients had associated head injury.
The patients with chest infection were known cases of COPD, as they were chronic smoker. One case had pulmonary embolism and died 3 days post revision operation despite he was on a thrombolytic therapy
Four cases died during our study one of them died on the day postoperation due to associated head injury.
Superficial would infection was seen in one case postoperative.
No implant related intra operative complications were noted in our study.
Varusdeformity was noted in one case (5%).
Mobilization: We found the mobilization of patients operated by IMN better than those fixed by plates and screws and almost weight bearing of patients from the plates and screws was earlier.
Average time of fracture union: Average time of union in all our 30 patients was about 13 weeks. (Range: 8 to 16 weeks).
Range of Movement according to Olerud – Molanderankel score of 91 to 100 points was considered excellent; 61-90 points, good; 31-60 points, fair; and less than 31, poor
The range of motion that is flexion, extension, abduction, internal and external rotations were good to excellent in most of the cases operated by both the devices. The poor range of motion was attributed to the poor compliance of the patients for regular physiotherapy and also in some cases due poor reduction achieved at the time of surgery thus not getting the best possible result.
In the present study which was carried out in Sohag university hospitals, faculty of medicine, Sohag university from January 2014 to August 2014.
Thirty patients with open tibial shaft fractures type I&II according to Gustilo-Anderson were included.
In our study we aimed to evaluate whether these theoretical advantages could be proved in practice by evaluation of the results of internal fixation for these types of fractures by IMN (interlocking tibial nail) and\or plates and screws.
The management of open tibial shaft fractures has always been a challenge to the surgeon, especially in comminuted fractures. The traditional surgical techniques aiming at anatomical reduction and rigid internal fixation has raised a lot of complications, probably due to soft tissues status and devitalizationof the fracture fragments that renders healing markedly jeopardized.
The introduction of the concept of internal fixation aims to improve the chances of healing as it utilizes the importance of the soft tissue envelope and preserves the vitality of the involved bony segments.
Out of the 30 fractures managed by this method 24 fractures showed uncomplicated healing within a reasonable period of time. The complication rate was considered minimal. Only one case of non-union, two cases of delayed infection and 4 patients of malunion in valgus or varusmalalignment, however we passed through a learning curve during performing this study, with most of the complications occurring in the early cases.
We recommend that this method could be used in the management of open tibial shaft fractures types I&II.
The procedure however is technically demanding, requiring the availability of appropriate tools and surgical implants,Careful follow up of the patients is recommended. This technique confirmed by our results minimizes the complication rate and facilitates early return to normal activities of the patient. Achieving a good quality reduction at the level of the bone segment should be the objective for anatomical axis restoration.