title: Internal fixation in compound type III fractures presenting after golden period.
abstract: OBJECTIVE
  Patients often reach the hospital late after passage of golden hours (initial 6 hours) after sustaining high-velocity injuries. The decision of internal fixation in Gustilo's Type IIIA and IIIB fractures becomes a formidable challenge in patients reaching late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients.
  
  
  METHODS
  Sixty-three patients, having 70 compound fractures (46 Type IIIA and 24 IIIB), which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged from 18 to 48 months with mean of 28 months.
  
  
  RESULTS
  Overall infection rate noted was (n = 11) 15.71% (8.7% in IIIA, and 29.16% in IIIB). The difference in deep infection rate between Type IIIA and Type IIIB was found to be statistically significant (P value < 0.01). Nonunion was seen in five fractures. Functional evaluation using Katenjian's criteria, showed 62.85% (44 fractures of 70) good to excellent results.
  
  
  CONCLUSIONS
  Satisfactory results may be obtained in Gustilo's Type IIIA and IIIB fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged.
authors.affiliation: Department of Orthopedic Surgery, J.N Medical College, Aligarh Muslim University, Aligarh - 202 002, Uttar Pardesh, India.
authors.forename: Quamar
authors.initials: Q
authors.lastname: Azam
authors.forename: Mka
authors.initials: M
authors.lastname: Sherwani
authors.forename: Mazhar
authors.initials: M
authors.lastname: Abbas
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.forename: Naiyer
authors.initials: N
authors.lastname: Asif
authors.forename: Ab
authors.initials: A
authors.lastname: Sabir