Abstract
Aim: To establish superficial and deep infection rates and time to union of open tibial shaft fractures treated with primary debridement and locked intramedullary nails.Materials and methods: The clinical records and radiographs were retrospectively reviewed of 74 Gustilo-Anderson grades 1 to 3A open tibial shaft fractures that were treated by initial debridement and intramedullary nail fixation over a two-year period. Sixty-three men and nine women with a mean age of 33 years (range 16–67) were followed up for a mean period of 18 months (range 7–32).Results: Sixteen patients (22%) sustained grade 1 injuries, 38 (51%) grade 2, and 20 (27%) had grade 3A injuries. Thirteen patients (18.1%) were HIV positive. The mean time to surgery was 28 hours (range 8–112). The overall infection rate was 17.6%. Superficial infection developed in 10.8% and deep infection occurred in 6.8%. There was no association between time to surgery and infection rate (p=0.878). There was no association between HIV status and infection (p=0.471). There was no association between type of closure and sepsis (p=0.410). The mean time to union was 17 weeks (range 12–50). Five patients (6.9%) had delayed union and one patient failed to unite without undergoing secondary procedures.Conclusion: The management of Gustilo-Anderson grade 1 to 3A open tibial shaft fractures with primary debridement andlocked intramedullary nailing shows good short-term results with low infection and non-union rates despite delay in surgicalmanagement or HIV infection.Level of evidence: Level 4
Highlights
The treatment of open tibial fractures is difficult and often controversial with no general consensus on their management.[1]
The recent increase in the use of circular external fixators for open tibial fractures is encouraging especially in high energy injuries but this method has to be individualised on a patient-to-patient basis.[15,16]
This study aims to establish superficial and deep infection rates and time to union of open tibial shaft fractures treated with primary debridement and locked intramedullary nails in our local environment
Summary
The treatment of open tibial fractures is difficult and often controversial with no general consensus on their management.[1]. The recent increase in the use of circular external fixators for open tibial fractures is encouraging especially in high energy injuries but this method has to be individualised on a patient-to-patient basis.[15,16]
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