Unreamed intramedullary nail versus external fixation in grade III open tibial fractures.
BACKGROUND
The optimum method for skeletal stabilization of severe open fractures of the tibial shaft remains controversial.


METHODS
We compared the results of the AO unreamed tibial nail (URTN) with external fixation (Ex-Fix) in the treatment of patients with a grade III injury of the tibial diaphysis. Thirty patients were retrospectively reviewed, with a mean follow-up of 25 months (range, 12-56 months). Seventeen patients were treated with external fixation (grade IIIA, 12 patients; grade IIIB, 4 patients; and grade IIIC, 1 patient) and 13 with a URTN (grade IIIA, 6 patients; grade IIIB, 6 patients; and grade IIIC, 1 patient). Both groups were comparable with respect to age, gender, fracture severity, and Injury Severity Score.


RESULTS
Mean time to full weight bearing was 37.4 weeks in the Ex-Fix group versus 22.2 weeks in the URTN group (p = 0.0069, t test). Seven patients in the Ex-Fix group required further surgery for nonunion versus two in the URTN group. There were four significant pin track infections. Removal of URTN was required in one case of deep infection.


CONCLUSIONS
This study supports the use of the URTN over external fixation in the treatment of severe open tibial fractures.
Shannon
Fintan J
FJ
Department of Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland. fjshannon@eircom.net
Mullett
Hannan
H
O'Rourke
Kieran
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D016267:External Fixators; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D015599:Trauma Severity Indices