Open Tibial Shaft Fractures Research Articles

OPEN TIBIAL SHAFT FRACTURES

Objective: The purpose of the study was to evaluate the clinical results afteroperative treatment of open tibia fractures (grade IIIA/B) with external fixator. Material andmethods: 25 patients with open fractures of the tibial diaphysis, classified as type III A and B,according to the Gustilo classification, were operatively treated in Agency Headquarter HospitalLandikotal. All the patients were treated with an external fixator. The time of the union of thefracture, problems with the union (malunion and nonunion), infection were examined astreatment outcome. Late complications and their treatment was not the object of the study. Thefollow-up period was at least 8 months. Result: The end results of the external fixation of 25 tibialshaft fractures, 18 (72%) men and 7 (28%) women, average age 37.7 (16-65). The union rate was83%. Nonunion rate was 12%. And malunion rate was 5% (fig-I). Fifteen patients had Gustilo typeIIIA injury while 10 patients had type IIIB injury (fig-II). Pins tract infection rate was 10%. Theaverage time of fractures healing was 28.5 weeks (15-22). There were 3 cases with woundinfection and no sequestrum formation. Conclusions: External fixation is a simple and effectivemeans of treating all types of open tibial shaft fractures

Intercalary allograft reconstruction in a patient with large tibial defect: Case report

A fit 26 year-old-man presented to our Department with an open fracture of the left tibial shaft (AO 42-C3). The fracture was initially treated with an External Fixator, which was replaced by an intramedullary Grosse Kempf nail after 4 months. In the following year he developed an atrophic non-union and we witnessed the increasing bone resorption at the fracture site which led to the nail breakage. An accurate CT pre-operative planning was made and a revision surgery was successfully performed: the broken nail was removed and intercalary allograft reconstruction was made, using a compressible intramedullary nail. Whereas in literature it is well described how intercalary allografts can be used to fill the massive diaphyseal defects after tumor resections, we assumed it could also be an adequate technique to treat a large bone defect at a non-union site.

External fixation of segmental tibial shaft fractures.

Tibial shaft fractures are the most common type of large long-bone fractures. Segmental tibial shaft fractures are severe injuries and its treatment can be followed by a high incidence of complications, nonunion, delayed union, malunion, infection or compartment syndrome. The most common treatment strategy is intramedullary fixation. Results of the unilateral external fixation treatment for segmental tibial shaft injuries are presented in this paper. Patients with segmental tibial shaft fractures, AO/OTA 42-C2 were treated as urgent cases by unilateral external fixation. Mitkovic-type external fixator was used in all of these fractures. There were 32 patients with segmental tibial shaft fractures (AO/OTA 42-C2), 20 males and 12 females, average age of 43.5years. Average time of union was 5.9 (4.1-7.4) months for closed and 6.2 (5.1-7.9) months for open fractures. Average follow-up was 18 (26-60) months. Nine patients (28.12%) had open segmental tibial shaft fracture (2 Grade I, 2 Grade II, 1 Grade IIIA, 4 Grade IIIB). Union rate was 81.25% (26 cases). Nonunion rate was 18.75% (6 cases) and malunion 3.12% (1 case). Nonunion was higher in patients with open fractures (4). Compartment syndrome had been diagnosed in 6 cases (18.75%) with closed fracture and fasciotomy was performed when external fixator was applied. There were no deep infections. Pin tract infection was present in 7 cases (21.85%). Treatment of segmented tibial shaft fractures can be followed by a number of complications. Unilateral external fixation with convergent orientation of pins provides three-dimensional stability of the fracture and good biomechanical conditions for fracture healing, with lower complications rate.

PRIMARY UNREAMED NAILING IN GRADE I, II AND IIIA OPEN FRACTURES OF THE TIBIA SHAFT: A PROSPECTIVE STUDY OF THE OUTCOMES IN 80 PATIENTS

Introduction. To evaluate the incidences of union, nonunion and infection in the treatment of open tibial shaft fractures of Gustilo–Anderson types I, and IIIA treated with primary unreamed solid intramedullary locked nail (UTN). Materials and Methods. It is a prospective study of 80 open tibial shaft fractures. According to the AO classification, 36 patients (44%) were of type A, 29 (36%) were of type B and 15 (18%) were of type C. According to the Gustilo–Anderson classification, 31 patients (38.7%) were of grade I, 24 (30%) were of grade II and 25 (31%) were of grade IIIA. For the definitive stabilization of the fracture was used a UTN. Results. Bone healing was achieved in 98.4% of the cases, with a mean time of 24.2 weeks, ranging from 14 weeks to 110 weeks. Union without infection was seen in 70 patients (87%) and nonunion was seen in five patients (6%). Deep infection was seen in three patients (3.7%) and malunion was seen in two patients (2.5%). Conclusion. The treatment of open tibial shaft fractures with unreamed solid intramedullary locked nail allows high rates of bone healing and low rates of nonunion and deep infection, and if the presence of infection is excluded, then the results of unreamed nailing and reamed nailing are the same.

Staged conversion from temporary external fixation to internal fixation for open fractures of tibial shaft

Objective To evaluate the clinical efficacy and safety of planed conversion from temporary external fixation to internal fixation for open fractures of tibial shaft. Methods We retrospectively reviewed 31 patients with high-energy open fracture of tibial shaft who had been treated from October 2008 to October 2016 at Department of Orthopaedics, in our hospital. They were 20 males and 11 females, with an average age of 38.7 years (from 15 to 79 years). By the Gustilo classification, 2 cases were type I, 9 type II, 17 type ⅢA and 3 type ⅢB; by the AO/OTA classification, 3 cases were type 42A, 10 type 42B, and 18 type 42C. External fixation was temporally applied for the fracture ends after thorough debridement to recover the tibial length and alignment. The wounds were closed directly in 23 cases and covered with vacuum sealing drainage in 8. The external fixators were removed after their systemic condition and/or local condition of soft tissue recovered. After plaster casts were maintained for 4 to 7 days to allow for healing of the pin tracts, conversion into secondary definite internal fixation started. Plating was applied in 24 patients and intramedullary nailing in 7 patients. Results The 31 patients gained fellow-up from 13 to 61 months (mean, 22.3 months). All fractures gained bony union after an average of 18.7 weeks (from 14 to 31 weeks). No wound complication or infection was observed. According to the Johner-Wruh’s criteria, 24 cases were rated as excellent, 4 as good and 3 as fair, giving an excellent to good rate of 90.3%. Conclusion The staged conversion from temporary external fixation to internal fixation is effective and safe for open fractures of tibial shaft, leading to limited complications of soft-tissue and a high rate of fracture union. Key words: Tibial fractures; External fixator; Fracture fixation, internal; Fractures, open; Damage control

抗生剤含有セメントネイル, Masquelet法, Ilizarov法で治療した脛骨骨幹部開放骨折に対する髄内釘後の化膿性骨髄炎

抗生剤含有セメントネイル, Masquelet法, Ilizarov法で治療した脛骨骨幹部開放骨折に対する髄内釘後の化膿性骨髄炎

PMD104 - Real-World Infection and Non-Union Rates Associated With Closed or Open Fractures of the Tibial Shaft Requiring Open Reduction and Internal Fixation

Potential complications of tibial shaft fractures treated with open reduction and internal fixation (ORIF) include infection and non-union. This study evaluated the 30, 60, 90, 180 and 365 days and 18 and 24 months infection and non-union rates following open and closed fractures of the tibial shaft requiring ORIF. This retrospective observational cohort study included data from Truven Commercial Claims and Encounters, Medicare Supplemental, and Medicaid databases. Patients aged ≥18 years with open or closed fractures of the tibial shaft requiring ORIF during an out- or an inpatient admission occurring between January 1, 2007 through June 30, 2017 were included in the study. Outcomes of interest were Infection), non-union and a composite endpoint of infection or nonunion. A total of 19,383 patients from commercial, 2,654 from the Medicare and 2,299 from the Medicaid populations with tibial shaft fracture (~8% open and ~ 92% closed) requiring an ORIF were identified. The rates for infection ranged from 1.82% -7.44% for commercial, 2.94%-12.32% for the Medicare, and 2.70%- 11.28% for the Medicaid populations between 30-day and 24-month follow-up period. The rates for non-union ranged from 0.48% -8.75% for commercial, 0.38%-5.97% for the Medicare and 0.26%- 7.98% for the Medicaid populations between 30-day and 24-month follow-up period. The rates for the composite end point (infection or non-union) ranged from 2.25% to 14.59% for commercial, 3.32% to 16.56% for the Medicare, and 2.91% to 16.87% for the Medicaid populations between the 30-day and 24-month follow-up period. Around 8% patients had open tibial shaft fractures whereas around 92% had closed tibial shaft fractures. During the 24 months follow-up, the rates of infection and non-union ranged from 7.44%- 12.32% and 5.97%- 8.75% respectively over the commercial, Medicare and Medicaid populations.

PMD106 - Complications, Health Care Resource Utilization and Costs Associated with Type III Open Fractures of the Tibial Shaft Requiring Open Reduction and Internal Fixation

Potential complications of tibial shaft fractures treated with open reduction and internal fixation (ORIF) include infection, and non-union. Type III open fractures are the result of high energy trauma which typically result in bone loss and lacerations. This study evaluated 1-year rates of infection and non-union along with health care resource utilization and costs in patients with type III open fractures of the tibial shaft requiring ORIF in the United States (US). This retrospective observational cohort study included data from Truven Commercial Claims and Encounters database. Patients aged ≥18 years with Gustilo type III open fractures of the tibia requiring ORIF during an out- or an inpatient admission occurring between January 1, 2007 through June 30, 2017 were included in the study. Outcomes of interest were Infection, non-union , health care resource utilization in terms of readmissions and emergency room visits and all-cause costs during 1-year follow-up period after ORIF. A total of 580 patients with open tibial type III fractures that underwent ORIF were identified. Most of the patients were male (78.97%) with a mean(SD) age of 38.79(13.98) years and the mean(SD) Charlson co-morbidity index of 0.25(0.74). The rates of infection and non-union during the 1-year follow-up period were 35.99%. and 36.94% respectively. The rates of readmission and emergency room visits during the follow-up were 48.41% and 34.08% respectively. The mean(SD) total healthcare cost during the 1-year follow-up was $62,060 ($78,802) which was mostly due to medical costs ($ 59,502) and to a lesser extent, prescription ($2,558) costs. Patients receiving ORIF for type III open tibial shaft fractures have high complication rates and increased health care resource utilization and costs in the US. Better cost efficient medical techniques are required to successfully treat patients and address the current economic burden.

Minimally invasive plate osteosynthesis has equal safety to reamed intramedullary nails in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures

ObjectivesThe best fixation method for open tibial fractures has long been a matter of debate, many studies have recommended the use of intramedullary nails over external fixation for treating such fractures, recent studies also showed favorable results for the use of plates in managing open tibial fractures. However, there are very few (if any) reports in the literature comparing the use of minimally invasive plate osteosynthesis to reamed intramedullary nails in the fixation of open tibial fractures.The aim of this study was to compare the safety & efficiency of minimally invasive plate osteosynthesis to reamed intramedullary nails in treating open tibial shaft fractures. DesignA single-center, parallel group, prospective, randomized study. SettingAcademic Level 1 Trauma Center, during the period from October 2014 to December 2016. PatientsA total of 60 patients with open tibial fractures were randomized to reamed intra-medullary nails (R-IMN) (group A) or minimally invasive plate osteosynthesis (MIPO) (group B). Outcome measurementPatients were assessed for union (clinical & radiographic) & complications (e.g.; non–union, infection). ResultsNo statistically significant differences were found between the 2 methods in term of the incidence of infection or non-union. Time to full union was shorter for the R-IMN group when compared to that of the MIPO group & that was found to be statistically significant. ConclusionMIPO technique has equal safety to R-IMN technique in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures, as both techniques have similar rate of infection & non-union. These findings suggest that the MIPO technique can be considered a valid treatment alternative for such fractures. Level of evidenceLevel II, Therapeutic study.

Early Outcome of Treatment of Open Tibial Shaft Fractures Using External Fixators in Resource-Poor Setting

To document the outcome of treatment in the first six months for open tibial shaft fractures managed with external fixators in resource-poor economy and the pattern of presentation of open tibial shaft fractures, a 12-month prospective observational study was conducted from January 2010 to December 2010. All the patients were recruited from the accident and emergency department of the University of Calabar Teaching Hospital. The demographic data of each patient, the type of injury, the mechanism of injury, and the outcomes were assessed. Moreover, 42 patients with open tibial shaft fracture were recruited for this study with forty (95.2%) patients successfully followed up for six months while two patients (4.8%) were lost to follow-up. Their ages ranged from 18 to 65 years with a mean age ± standard deviation of 33.5 ± 12.8 years. Majority of the patients (77.5%) were aged 20-50 years. There was a male to female ratio of 3:1. A total of 7 (17.5%) fractures healed after 20 weeks, Type IIIB fractures were 3 (7.5%), Type IIIA fractures were 4 (10%), but all Type II fractures had united between 12 and 15 weeks. The middle third fractures 9 (22.5%) had the highest number of fracture union within 16-20 weeks. The major cause of the injuries was from motorcycle accidents, which were 30 (75%), and others were from cars 7 (17.5%) and buses 3 (7.5%). This was largely due to the utilization of motorcycles as the major means of commercial transportation in the city until it was banned recently. However, they are still in use in the suburbs. The higher the Gustillo and Anderson grading of the open fracture of tibia, the more severe the wound and bone infection that occurred, and a significant interval between the injury time, wound debridement, and the time the external fixator was applied showed poor outcome for those who presented late (after two weeks of injury).

Outcomes of intramedullary nailing for open fractures of the tibial shaft

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

Functional outcome and complications in closed and grade I open tibia shaft fracture operated with intramedullary interlocking nail

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Treatment of open tibia fracture is controversial. Complications such as infection, re-operation, non-union and poor consolidation are also relatively common after these fractures. While grade II and III fractures are mostly treated with detriment and external fixator, grade I fractures are a matter of controversy. The purpose of this study is to evaluate factors affecting deep infections and fracture healing of closed and grade I open fracture of the tibial shaft treated with immediate or delayed interlocking IMN, and to study the functional outcome of the same</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">60 Patients admitted to our institute with diagnosis of closed or grade 1 open tibia shaft fracture aged more than 18 years old between May 2016 to December 2016 were included. After initial evaluation and investigation, they were posted for surgery. Closed reduction and fixation with intramedullary nailing were done under spinal anesthesia. After discharge patients were followed up at an interval of 3 weeks, 3 months and 6 months and were evaluated using Johner and Wruhs criteria</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">In our study, 91.67% patients have got excellent, 3.33% good and 1.67% poor results according to Johner and Wruhs criteria</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">Closed and grade one open fractures of the tibia shaft, managed with interlocking intramedullary nailing involves minimal surgical trauma and negligible blood loss while provides the advantages of early ambulation, lower rate of infection, delayed union, non-union and mal-union</span><span lang="EN-IN">.</span></p><p class="abstract"> </p>

Analysis of primary interlocking nailing for open fractures of tibial shaft

Background: The results of closed intramedullary nailing technique are excellent for treating fractures of the tibial shaft. Court Brown reported that the time to union and infection rates were similar when open tibial fractures were treated by reamed locked intramedullary nail or an external fixator. But references regarding the results, incidence of infection, nonunion related to the specific type of open injuryare limited. Hence we decided to analyse primary interlocking nailing for open tibial fractures. Materials & Methods: All patients with open tibial fractures treated with primary interlocking nail were evaluated. Wound debridement and nailing were performed with image intensifier guidance. Static or dynamic locking was done depending upon the fracture stability. Results: 44 patients with 44 fractures were included in the study. 15 (34%) type I, 19 (43%) type II, 9 (20%) type IIIA, 1 type IIIB open fractures were treated. Reaming was done in 41 (93%) patients. Nine (20%) of the nails were dynamically locked. 95% united uneventfully except two (5%). The average time to union was 26 weeks for type I fractures, 29 weeks for type II, 34 weeks for type IIIA, 38 weeks for the type IIIB. There were three deep infections (7%). Conclusions: Primary Interlocking nailing for tibial open fractures is an excellent mode of therapy. Interlocking nailing reduces the incidence of complications like infection (7%), nonunion (5%). It is more acceptable to patients than external fixators.

A true silent compartment syndrome in a competent sensate patient: Case report

A true silent compartment syndrome in a competent sensate patient: Case report

Medial Malleolus Fracture Fixation in the Setting of Concomitant Tibial Shaft Fractures

Category: Ankle, Trauma Introduction/Purpose: The association between tibial shaft fractures and concomitant posterior malleolus fractures has been well-studied; however less is known about tibial shaft fractures and concomitant medial malleolus fractures. Treatment of tibial shaft fractures with a plate or intramedullary nail in the setting of concomitant medial malleolus fracture may pose obstacles to standard medial malleolus fractures fixation due to hardware that impedes optimal screw placement. The purpose of this study is to report the presentation and management strategies used to treat medial malleolus fractures in the setting of concomitant tibial shaft fractures. Methods: From 2011 to 2015, seven (1.4%) patients were identified with concomitant tibial shaft fractures and isolated medial malleolus fractures. Data was collected through review of patient charts, radiographs, and operative reports including the following variables: demographics, injury patterns, fixation techniques, and outcomes. Five male patients and two female patients with a mean age of 39.1 years (range, 13.9-67.9 years) were included. Three patients reported tobacco use. Mechanisms of injury included motor vehicle accident (n=4), fall from standing (n=2), and pedestrian versus vehicle (n=1). Average medial malleolus fracture fragment length was 19.1 mm (range, 14.3-29.4 mm). Tibial shaft fractures were open in four cases, and included five transverse patterns, one spiral pattern, and one segmental fracture. All patients were treated surgically for tibial shaft and medial malleolus fractures simultaneously. All medial malleolus reductions were anatomic. The average time to union for medial malleolus fractures was 3.12 months (range 1.53 to 5.93 months). Results: Fixation techniques included screw (n=5) or buttress plate (n=2) fixation for the medial malleolus, and intramedullary nailing (6) or blade plate fixation (n=1, prior TKA) for the tibial shaft. Of the five medial malleolus fractures treated with screw fixation, screws were positioned anteriorly (n=2) or medially (n=2) to tibial shaft fixation implant in four cases; in one case the distal extent of the tibial nail was proximal to the medial malleolar screws. One buttress plate was placed with screws distal to the tibial nail, another was placed angling one proximal screw anterior and one posterior to the tibial nail. Two patients reported complications following surgery: one with chronic pain and one with wound dehiscence and delayed union at the open tibial shaft fracture site. Conclusion: Seven patients were treated operatively for concomitant tibial shaft and medial malleolus fractures, requiring careful attention to placement of medial malleolar screws or buttress plate due to the presence of implant used to treat the tibial shaft fracture. Medial malleolar screws can safely be redirected anteriorly or medially to accommodate the tibial shaft fracture implant, with acceptable fracture union outcomes in this small case series. Further biomechanical and long-term data may help to validate these adjustments to standard techniques.

Treatment of open fracture of shaft of tibia-fibula Gustilo type III-B by SIGN interlocking nail and wound coverage by muscle flap within 72 hours of injury

<p class="abstract"><strong>Background:</strong> The open fracture of tibia-fibula Gustilo type III-B may threaten the survival of the injured leg. The objective of<strong> </strong>the study purpose was to see the effect of early coverage following fixation of open tibial shaft fracture<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> This clinical trial was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka from July 2004 to June 2006 for a period of two (2) years. Patients at age group of 18 years or above with both sexes presented with open fracture shaft of tibia-fibula Gustilo type III-B were selected as study population. The patients were surgically managed by SIGN Interlocking nail and wound coverage by muscle flap within 72 hours of injury. Bacteriological study of the wound was done in all cases.<strong> </strong>All fixation and coverage were performed within 72 hours of injury. Patients grading improved on subsequent follow up. Evaluation of results was done at every post-operative follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total number of<strong> </strong>12 young patients with open fracture tibia-fibula Gustilo III-B were recruited for this study. Their age varies from 18 years to 48 years. A total number of 83.33% cases wound debridement was done within 12 hours of injury. Most of the soft tissue healed (91.67%) within 0 to 20 days. There were no cases developed limb length discrepancy angulations or rotation. Superficial infections were occurred in 1(8.33%) case but no evidence of deep infection. In this study excellent result were obtained from 9 cases (75%), good results were found in 2 cases (16.67%), fair results from 1 case (8.33%)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> In conclusion early intramedullary fixation and exposed bone coverage by muscle flap is very important for prevention of infection, minimizing bone death simultaneously enhances bone healing<span lang="EN-IN">.</span></p>

Open tibial shaft fracture treatment with plating within 6 hours and between 6-24 Hours after Injury

Open tibial shaft fracture treatment with plating within 6 hours and between 6-24 Hours after Injury

Open Tibia Shaft Fractures and Soft-Tissue Coverage: The Effects of Management by an Orthopaedic Microsurgical Team.

To compare the timing of soft-tissue (flap) coverage and occurrence of complications before and after the establishment of an integrated orthopaedic trauma/microsurgical team. Retrospective cohort study. A single level 1 trauma center. Twenty-eight subjects (13 pre- and 15 post-integration) with open tibia shaft fractures (OTA/AO 42A, 42B, and 42C) treated with flap coverage between January 2009 and March 2015. Flap coverage for open tibia shaft fractures treated before ("preintegration") and after ("postintegration") implementation of an integrated orthopaedic trauma/microsurgical team. Time from index injury to flap coverage. The unadjusted median time to coverage was 7 days (95% confidence interval, 5.9-8.1) preintegration, and 6 days (95% confidence interval, 4.6-7.4) postintegration (P = 0.48). For preintegration, 9 (69%) of the patients experienced complications, compared with 7 (47%) postintegration (P = 0.23). After formation of an integrated orthopaedic trauma/microsurgery team, we observed a 1-day decrease in median days to coverage from index injury. Complications overall were lowered in the postintegration group, although statistically insignificant. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Management of Open Tibial Shaft Fractures: Does the Timing of Surgery Affect Outcomes?

Open tibial shaft fractures require emergent care. Treatment with intravenous antibiotics and fracture débridement within 6 to 24 hours is recommended. Few studies have examined outcomes when surgical treatment is performed >24 hours after occurrence of the fracture. This retrospective study included 227 patients aged ≥18 years with isolated open tibial shaft fractures in whom the time to initial débridement was >24 hours. The statistical analysis was based on time from injury to surgical débridement, Gustilo-Anderson classification, method of fixation, union status, and infection status. Fractures débrided within 24 to 48 hours and 48 to 96 hours after injury did not show a statistically significant difference in terms of infection rates (P = 0.984). External fixation showed significantly greater infection rates (P = 0.044) and nonunion rates (P = 0.001) compared with intramedullary nailing. Open tibial shaft fractures should be débrided within 24 hours after injury. Our data indicate that after the 24-hour period and up to 4 days, the risk of infection remains relatively constant independent of the time to débridement. Patients treated with external fixation had more complications than did patients treated with other methods of fixation. Primary reamed intramedullary nailing appears to be a reasonable option for the management of Gustilo-Anderson types 1 and 2 open tibial shaft fractures. Level III retrospective study.

Surgical management of open tibial shaft fractures in adults by reamed versus unreamed intramedullary interlocking nailing: A comparative study

Back ground and objectives: Tibial diaphyseal fractures are one of the commonest long bone fractures encountered by most of the orthopaedic surgeons. Because most of the length of tibia is subcutaneous throughout, open fractures are more common in tibia than in any other major long bone. Because of high prevalence of complications associated with these fractures, management is often is difficult and the optimum method of treatment remains a subject of controversy. This prospective study was conducted at the department of orthopaedics, KIMS Hubli to evaluate and compare the results of closed interlocking intramedullary nailing with and without reaming in the treatment of the open fractures of mid shaft tibia in adults. It was done to compare the efficiency of interlocking intramedullary nailing with and without reaming in treatment of open fractures of mid shaft tibia with other studies in terms of time required for union, rate of malunion and malrotation, rate of infection and range of motion of ankle and knee joint.Materials and methods: This study was done on 50 patients between the age group of 25-40yrs admitted under Department of Orthopaedics of Karnataka Institute of Medical Sciences Hospital, Hubli with open fractures mid shaft of tibia selected based on inclusion & exclusion criteria during the period from 1/08/2013 to 31/07/2015 treated surgically using reamed/unreamed intramedullary interlocking nailing. Of the 50 patients 25 were treated by reamed and 25 by unreamed intramedullary interlocking nailing. All the cases were fresh fractures and traumatic in nature. They were done with the procedure as early as possible and the secondary procedures were done when needed. The cases were followed up for an average period of 6-9 months. None of the cases were lost to follow up. Results: Open fractures of the tibial shaft managed with or without reamed interlocked intramedullary nailing gave good functional results and patient satisfaction It involves minimal surgical trauma and less blood loss. It provides the advantages of early ambulation, lower rates of infection, delayed union, non union and malunion compared to other treatment modalities. It provides with early weight bearing and earlier returns to work. In our series, the overall functional outcome according to Johner and Wruhs’ criteria is equal and there is no significant difference in both reamed and unreamed nailing in open tibial shaft fractures in adults. Interpretation and conclusions: Intramedullary nailing is one of the methods of treatment for open tibial shaft fractures in adults, despite the fact that controversy exists regarding the choice of reamed or unreamed intramedullary nailing. There are no clear indications or contraindications for choosing either option. Clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft. The over-all functional outcome according to the Johner and Wruhs’ criteria was similar between the two groups, with no evidence that reaming delays the process of union. Considering the ease of performing the technique and the decreased operative time, unreamed interlocking nailing may have an edge over reamed interlocking nailing.