Abstract
Open fractures occur as a result of great violence. Hence they are associated with considerable damage to the soft tissue envelope due to dissipation of the energy, displacement and comminution of long fragments. Secondary to this, there is local disruption of blood supply which results in more necrotic tissues. This impedes new angiogenesis as well as decreases the viability of the mesenchyme cells. Because of the severe violence, this fracture may be of compound nature. This deals to even more necrosis and by predisposing to infection, it further increase the risk of non-union. These high velocity injuries majority were associated with bone loss. These fractures requires staged reconstruction, it further increase the risk of nonunion. Some surgeons use external fixation as a primary treatment until the soft tissues have healed and then employ another technique to secure union. Theoretically, the biomechanical and biological advantages of reamed intramedullary nailing would be expected to give good results, but the method has hazards, in particular infection. We therefore performed a prospective study to analyse the outcome of conversion to internal fixators in open fractures of lower limbs.
Highlights
Open Injuries are usually high energy injuries and are frequently associated with life threatening polytrauma .Due to complexity of these injuries and their management, they have received significant attention; with most of this attention been directed at definitive treatment after arrival to an emergency department 1
Devitalized soft tissues are an ideal medium for the proliferation of bacteria and the risk of infection is very high unless early treatment is implemented, including debridement, treatment with antibiotics and fixation
The duration of external fixation averaged twenty eight days.there was 29 fractures in which pin tracts got infected. they were treated with antibiotics based on culture and sensitivity obtained from the pin tract discharge
Summary
Tscherne has grouped the developments into four eras of life preservation, limb preservation, infection prevention and functional restoration 2.The problem of contamination was recognized even in the 16th century by Ambroise Pare who emphasized the need of cleaning the wounds of all foreign matter and necrotic tissue and leaving the wound open 3. The annual incidence of open fractures of long bones has been estimated to be 11.5 per 100 0006.persons with 40% occurring in the lower limb, commonly at the tibial diaphysis. The lack of muscular protection along the anteromedial aspect of the tibia and poor blood supply predispose open tibial fractures to certain complications.
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