title: Outcome of application of primary versus secondary Illizarov's fixator in open tibial shaft fractures.
abstract: BACKGROUND
  The present study aimed to compare outcome of primary and secondary Illizarov's fixator application as a treatment method for type III open tibial fractures in terms of non-union and wound infection.
  
  
  METHODS
  This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov's apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov's application, primary (n=28) and secondary (n=20).
  
  
  RESULTS
  In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were significantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group.
  
  
  CONCLUSIONS
  Primary wound closure and Illizarov's fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov's fixation, mostly due to a significantly less number of patients with a bone defect in the primary group.
authors.affiliation: Medical College, V.C.S.G. Government Medical Sciences and Research Institute, Srinagar, Pauri Garhwal, India; H.N.B. Base & Teaching Hospital, P.O.-Srikot, Srinagar, Srinagar Garhwal, Uttarakhand 246174, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Department of Orthopaedics, IMS BHU, Varanasi, India, Varanasi, Uttar Pradesh 221005, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singh
authors.affiliation: Fortis Flt Lt Rajan Dhall Hospital, Ringgold Standard Institution, Safdarjung Enclave, New Delhi, Delhi 110070, India.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Jain
authors.affiliation: Fortis Hospital, Shalimar Bagh Ringgold Standard Institution, Safdarjung Enclave, New Delhi, Delhi 110033, India.
authors.forename: Narender
authors.initials: N
authors.lastname: Rohilla
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences Ringgold Standard Institution, New Delhi, Delhi 110029, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Trikha
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences Ringgold Standard Institution, New Delhi, Delhi 110029, India.
authors.forename: Chandra
authors.initials: C
authors.lastname: Yadav
keywords: Debridement; Illizarov’s fixator; Limb salvage; Open fractures; Tibial fractures