| Objective:To design an adjustable weight-bearing brace for patients with AO type B closed tibial shaft fractures managed by interlocking intramedullary nail and investigate its clinical results.Methods:A total of 68 consecutivet patients with AO type B closed tibial shaft fractures managed by interlocking intramedullary nail were recruited in to our study from September 2014 to August 2015. All patients was randomly divided into two groups, with 34 patients in group A and 34 in group B. The control group (A group) was treated by conventional therapy after operation. While B group were received the adjustable weight-bearing brace 1-week postoperation. All cases were evaluated for clinical, radiological and functional outcomes. The visual analogue scale (VAS) scores, weight-bearing status and Johner-Wruhs scale were used for clinical and functional outcomes. While the RUST (Radiographic Union Score for Tibial Fractures) system and bony fusion was used for radiological outcomes.Results:All the patients except 6 case were followed up 7 to 15 months, average 11.2 months. Mean VAS scores was 2.52 ± 0.80 and 0.87 ± 0.62 respectively in group A at 3-months and 6-months follow-up. While the mean VAS scores was 2.97 ± 0.85 and 1.42 ± 0.83 in group B. There is a statistical differences of VAS scores between two groups at 3-months and 6-months follow-up (P< 0.05). The mean of weight-bearing status increased from (44.12 ± 17.47)% at 1-months follow-up to (71.97± 17.41)% at 1-months follow-up and (86.36± 12.45)% at 6-months follow-up in group A. While the mean weight-bearing status was (53.79± 11.04)%, (84.09 ± 12.21)% and (94.35 ± 10.63)% in group B. Significant differences of weight-bearing status was found between two groups (all P<0.05). The mean blood loss volume during surgery was 79.6 ± 27.8 ml in A group and 508.2 ± 125.6 ml in B group. Significant improvement of VAS scores at post operation compared with pre-operatively was observed in the two groups. Patients had successful bony fusion at a mean of 3.91 ± 1.01 and 3.32 ± 0.70 months at their follow-up in A and B group respectively (P<0.01). The mean of RUST score increased from 5.35± 1.37 at 1-months follow-up to 8.67 ±1.14 at 1-months follow-up and 10.33± 1.08 at 6-months follow-up in group A. While the mean RUST score was 6.45± 0.75,9.94± 0.86 and 11.29± 0.86 in group B. Statistical analysis revealed that there was significant difference in RUST score between A and B group at their follow-up (P<0.01). The functional outcome was assessed using Johner-Wruhs scale and the functions of the 19 cases and 27 cases were classified as excellent while the other 12 cases and 4 cases were marked as good in A and B group respectively (P<0.05).Conclusion:Early application of the adjustable weight-bearing brace for patients with AO type B closed tibial shaft fractures managed by interlocking intramedullary nail can reduce postoperative pain, accelerate the growth of callus shorten the bony healing time and receive a satisfied functional recovery. Patients can be assisted with the brace for early weight-bearing. Moreover, the brace can be used as a routine postoperative adjuvant therapy tool for AO type closed B tibial shaft fractures managed by interlocking intramedullary nail. |
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