Unreamed Intramedullary Nail versus External Fixation in Grade III Open Tibial Fractures

Purpose. To compare immediate interlocking nailing with external fixation followed by delayed interlocking nailing, for Gustilo type IIIB open tibial fractures. Methods. 23 patients with Gustilo IIIB open tibial fractures were treated with either immediate unreamed interlocking nailing (n=9) or external fixation followed by delayed unreamed interlocking nailing (n=14). Patient age, sex ratio, fracture site, fracture type, and severity were similar in both groups. The time to union, deep infection rate, and nonunion rate in the 2 groups were compared. Results. In the immediate and delayed nailing groups, respective mean times to union were 21 (standard deviation [SD], 14) months and 14 (SD, 8) months; nonunion rates were 44% (4/9) and 36% (5/14), and deep infection rates were 22% (2/9) and 7% (1/14). All corresponding differences were not statistically significant. Conclusion. Prospective, randomised, multicentre studies are needed to assess whether there are significant differences between the 2 treatment methods.

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Staged Reconstruction of Complex Open Tibial Fractures Using Hoffmann External Fixation

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-198309000-00017 ◽

1983 ◽

Vol &NA; (178) ◽

pp. 130???161 ◽

Cited By ~ 2

Author(s):

CHARLES C. EDWARDS

Keyword(s):

External Fixation ◽

Tibial Fractures ◽

Open Tibial Fractures ◽

Staged Reconstruction

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Operative Choice for Open Tibial Shaft Fracture in Children: A Comparative Study of External Fixator Vs. Elastic Stable Intramedullary Nail

10.21203/rs.3.rs-628593/v1 ◽

2021 ◽

Author(s):

Pan Hong ◽

Saroj Rai ◽

Xin Tang ◽

Ruikang Liu ◽

Jin Li

Keyword(s):

Clinical Outcomes ◽

External Fixator ◽

Intramedullary Nail ◽

Shaft Fracture ◽

Tibial Fractures ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Elastic Stable Intramedullary Nail ◽

Open Tibial Fractures ◽

Significant Difference

Abstract IntroductionExternal fixator (EF) is a preferred choice for open tibial fractures, but pin tract infection (PTI) and refracture are common complications. Elastic stable intramedullary nail (ESIN) has been reported in the treatment for open tibial fractures. This study aims to compare the clinical outcomes of EF vs. ESIN in the treatment for open tibial shaft fracture in children retrospectively.Material and methodsPatients aged 5-11 years old with Gustilo-Anderson II and IIIA tibial shaft fracture treated at our institute from January 2008 to January 2018 were reviewed retrospectively and categorized into EF (n = 55) and ESIN (n = 37) group. Patients with pathological fracture, neuromuscular disorder, metabolic disease, previous tibial fracture or instrumentation, and polytrauma were excluded. Patients with follow up less than 24 months or incomplete medical records were also excluded. ResultsIn all, fifty-five patients (33 males, 22 females) were included in the EF group, whereas 37 patients (21 males, 16 females) were included in the ESIN group. There was no significant difference between the two groups concerning sex, age, body weight, duration from injury to surgery, Gustilo-Anderson (GA) classification, and concomitant injuries. There was no patient of nonunion and malunion in either group. The incidence of implant prominence was higher in the ESIN group (16%) than those in the EF group (0), P < 0.001. The angulation was higher in the EF group than ESIN group in coronal and sagittal plane, P < 0.001. The radiological union was faster in the ESIN group (7.0 ± 0.9, weeks) than those in the EF group (9.0 ± 2.2), P < 0.001. Limb length discrepancy (LLD) was significantly longer in the EF group (12.1 ± 4.4, mm) than those in the ESIN group (7.3 ± 4.3, mm), P < 0.001. ConclusionESIN is a viable option in selected patients of GA grade II and IIIA open tibial fractures with comparable clinical outcomes as external fixator, but with less complications including superficial infection, residual angulation and refracture after hardware removal.

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