Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing.
BACKGROUND
The aim of this study was to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of type IIIA open fractures of the tibia.


METHODS
Sixty-one patients with open type IIIA tibial shaft fractures were treated with an IEF (n = 32) or UTN (n = 29). Both groups were compared for union time, secondary outcomes of nonunion, infections, mechanical failure of the implant, and malunion.


RESULTS
The average time-to-bone healing was 19 weeks (range 14-23 weeks) for IEF and 21 weeks (range 16-36 weeks) for UTN; it was significantly shorter in the IEF group (P = 0.039). One patient had refracture in the IEF group. Malunion occurred in four patients for each group. Posttraumatic osteomyelitis occurred in two patients in the IEF group and in three patients in the UTN group. In the IEF group, additional surgical procedures were indicated in three cases including sequestrectomy (n = 1), and pin replacement (n = 2). In the UTN group, seven patients needed additional surgery including bone grafting (n = 3), nail exchanged (n = 1), and posttraumatic osteomyelitis (n = 3).


CONCLUSIONS
The results of the current study showed that IEF technique had a notable incidence of pin-tract infection, joint contracture, and shorthening related to treatment of the delayed union. The UTN technique had the disadvantage of a posttraumatic osteomyelitis and delayed union requiring additional surgery. We believe that the decision to use IEF or UTN should be made on a case-by-case basis.
Inan
Muharrem
M
Orthopedic Department, Medical Faculty, Yeditepe University, Istanbul, Turkey. minan@yeditepe.edu.tr
Halici
Mehmet
M
Ayan
Irfan
I
Tuncel
Mehmet
M
Karaoglu
Sinan
S
D000293:Adolescent; D000328:Adult; D003286:Contracture / Q000209:etiology; D005260:Female; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000209:etiology; D005597:Fractures, Open / Q000145:classification / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology; D010543:Peroneal Nerve / Q000293:injuries; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D013978:Tibial Fractures / Q000145:classification / Q000601:surgery*; D013997:Time Factors