TIBIAL SHAFT FRACTURES ARE MOST COMMON AMONGST FRACTURES OF LONG BONES.TIBIA IS VERY SUPERFICIAL BONE AND SUSCEPTIBLE TO INJURY AND CAN RESULT IN EITHER SIMPLE OR COMPOUND FRACTURES OF TIBIA. AS SUCH TIBIA IS WEIGHT BEARING  BONE AND IF NOT TREATED PROPERLY AND NOT REHABILITATED EARLY THEN MAY END UP TO SEVERE  DEFORMITY,LEADING TO DISABILITY IF INFECTED SEVERELY MAY END UP TO BELOW KNEE AMPUTATION .SO TIBIA NEEDS CAREFUL ATTENTION  AND METHOD BY WHICH PERSON CAN BE REHABILITATED EARLIEST AND GO BACK TO HIS/HER WORK.THERE ARE AS MANY AS 5 MILLIONS FRACTURE OF TIBIA ALL OVER THE WORLD AND THERE ARE AS MANY AS 2MILLIONS FRACTURE OF TIBIA IN INDIA.SO IF THE PATIENTS CAN NOT GO BACK TO THEIR WORK WITHIN STIPULATED TIME SAY 3-4 WEEKS THEN IS GREAT LOSS OF EARNING OF THE SAID PATIENT AND THUS LEADING TO NATIONAL LOSS  AND THUS LEADING TO NATIONAL ECONOMICAL LOSS.THERE IS LOSS OF WORKING HOURS AND THUS LEADING TO LABUR LOSS AND IN TURN TO LOSS OF NATION.

THERE ARE SIMPLE  AS WELL AS COMPUND FRACTURES OF TIBIA.THIS MAY OCCUR IN TRAFFIC ROAD ACCIDENTS OREMERGENCIES LOKE EARTH QUAKE OR AFFECTION BY STORM OR BY MAJOR ACCIDENTS.

SO IT IS PRIMA FACIE DUTY TO UPLIFT MORAL OF PATIENT AND GIVE HIM MORAL BOOST FOR REHABILITATION AND CONFIDENCE.iF HEAD OF FAMILY IS DOWN WITH THIS FRACTURE THEN THINKING THAT HIS 4-6 MONHS ARE LOST WHEN TREATED BY ROUTICE PLASTER TREAMENT AND THEN 2-3 MONTHS ARE LOST IN ADDITION FOR PHYSIOTHERAPY AND THEN AND THEN ONLY HE RESUMES  HIS/HER WORK.

SO IT IS VERY IMPORTANT TO HVE SUCH METHOD BY WHICH THE PATIENTS ARE MADE TO BEAR WEIGHT EARLIEST AND RESUMES THEIR WORK AS EARLY AS POSSIBLE SAY WITHIN 4-6 WEEKS THEN  AT LEAST 202  WORKING HOURS ARE BEING SAVED AND HE STARTS HI WORKING WITHIN 4-6 WEEKS.a SMILE OF SATISFACTION IS THERE ON HIS FACE  AT THE END.

MATERIALS & METHOD-

900 cases of fracture of tibia  of different varieties have been treated in last 9-10 years & followed for years & till union & removal of this new nail Few cases were not available for follow up.The cases have been treated at Medical college Hospital , N.M.Wadia Charitable hospital & Daga orthopaedic hospital  Solapur, KBN Hospital Gulburga and cases operated at different centres where workshops have been taken into account .The method, behaviour,,complications, effect of immediate weight bearing , implant failure such as pathological bending and breaking etc have been studied in details & inferences have been drawn.The different D  nails have been used were of differnt diameters such as 8mm,9 mm and 10mm.

900 cases have been treated by this method till date.and apprx. more than 20000 cases have treated all over India at different centres of Indiaand abroad such as Pakistan, Bangla Desh, Thailand and Ukraine 

The union has occurred in 98% of cases of tibial fractures of different types such as simple, segmental, comminuted, Compound Gr.I,II,III ,etc.The ages were from 11 years to 90 years. There were least complications in these cases compared to similar other methods.

the configuration of  nail is clover leaf in cross section & it tries to prevent the rotation by itself. D shaped platform  at upper end which acts like beam over two walls of nail & takes all  impact of hammer during entry of nail in the cavity & during weight bearing. that is why  there is less percentage of pathological bending & breaking of D nail  inspite of immediate  weight bearing after operation .The operative step of osteal flap helps in building bony hood which tries to prevent proximal  migration of nail into knee joint during weight bearing also.There is compressibility of this nail in transeverse axis and thus lower tapering distal end negotiates the distal fragment very well without splintering it which is feature of other interlocking nails .so now-a-days others have started designing  lower tapering end  but without posterior slit which is advantageous of D nail.

Now there is provision of hole for passing guide wire  at D shaped platform  for thosewho want to use guide wire and get difficulty in redution by sqeezing method.But the guide has to be passed thru; D nail only  when it raches to the distal end of proximal  fragment of fracture ,as there is posterior  slit  and if passed over guide wire the nail may be moved away . 

The bending force is 52Kg per Sq. cm as against 42 KG per sq. Cm in other similar interlocking nails.So this nail is optimum strong & resilient and that is why there is physiological bend during  progress of nail in the medullary cavity of given tibia.And thus the incidence of bending [pathological] & breaking of nail is only 2% as against 6% of other similar nails.

The Cortices of tibiae of Indian patients are not as thick as of western people.So 9mm diameter Daga nail is averagely just sufficient,But 8mm diameters are commonly required for young female patients and 9mm and 10 mm D nails are being used for males

The design of daga nail is totally different from all other interlocking nail & the technique is just very simple,easy , minimum traumatizing and the system is very cost effective and is affordable by common man.

This is only totally Indian designed interlocking nail and completely Indigenous.

Since day one Daga nailing is dynamic as usually it is locked  in small distal fragment & the weight is borne on the day of surgery . The head which is fit snugly in the entry window helps in preventing the rotation of remaining fragment working like stating  screw but not exactly like that without disadvantages of nstatic interlocking syatem .This is shown at each operation where with flexion & extension the head of nail does not come out at all

There are only two holes for accommodation  of  interlocking screws one at upper end and another at lower part.If there is severe communition then one can interlock proximally also other wise there is no need of interlocking at both places as static interlocking causes  delayed or nonunion and unless and until one screw is removed the union never occurs.

Early weight bearing causes axial compression at fracture site and leads to neo-osteogenesis which in turn leads to early union.So many patients have started driving motor bikes  on 10th post operative day abd cars on 17th post operative day.The pain at fracture site disappears very fast and the patients start wlaking within 8-10 days after operation.

There is no external plaster of any kind after operation.

900 cases of fracture of tibia have been treated with this method with 98% rate of union ,0% rate of breaking of interlocking screws inspite of immediate weight bearing as against  universal rate of 6% inspite of late weight bearingsuch as after 3 weeks, 2% rate of bending or breaking of nail inspite of immediate weight bearing as against 6% universal  rate of other interlocking nails where the weight

 is differed till 3-4 weeks.

Almost 20000 operations have been done till date by apprx 200 orthopaedic surgeons all over India.

This original work has been presented at State, Interstate, National and International level.

Nearly 70-75 workshops have been arranged successfully at different centres of India and abrod such as Pakistan, Bangala Desh, Thailand with operative demonstartion.