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Category: Volume 07 Issue 11 November 2019
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Title: External Fixation versus Unreamed Interlocking Intramedullary Nailing for Open Tibia Fracture

Authors: Mabrouk S. Bohalfaya, Ali B. Hamad

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.169

Abstract

Open fractures of tibia are more common in active adults due to direct trauma, and they pose a major therapeutic challenge due to high incidence of postoperative complications. Although locked unreamed intramedullary nail (IMN) and external fixator (EF) are the most common treatment modalities, the superior mode of management remains controversial. The purpose of this study was to compare the outcome of open tibial shaft fractures in adults treated with locked undreamed conducted in orthopaedic department at Almarj Teaching Hospital for a period of twenty four months from June 2014 to June 2016.In this study, fifty-six open tibia shaft fractures in fifty-four patients were divided into two groups, twenty five fractures were treated by unreamed locked IMN, and thirty one fractures were treated by EF. Thirty six fractures were due to gunshot wound and explosive injury, ten were due to RTA, and ten were due to indirect trauma. According to Anderson Gustilo classification eleven fractures were type I, sixteen were type II, and twenty nine were type III. All cases were prospectively followed for twenty four months. The rate of union, soft tissues healing, and any complication were recorded. To analyze the results a chi square test and an SPSS software were used to study the significant relation and association between multiple variables of these two groups. Nineteen fractures healed uneventfully seven of EF group and twelve of IMN group, ten fractures had superficial infection seven of EF group and three of IMN group, four fractures developed deep infection all were EF group, four fractures had malunion two of EF group and two of IMN, six fractures had delayed union two of EF group and four of IMN group, five fractures had nonunion threeof EF group and two of IMN group, three fractures ended with amputation all were EF group, two fractures had broken distal locking screws, and three fractures were exchanged from  EF into IMN.

Locked unreamed intramedullary nail (IMN) appears to be a better option for the treatment of Gustilo type I, II, and IIIA open tibial shaft fractures compared to external fixator as it shows less complication rate.

Keywords: Tibia fractures, Intramedullary nails, External fixator.

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Corresponding Author

Dr Mabrouk S. Bohalfaya

M.D. Arab Board, M.D. Libyan Board Orthopedics, Assistant Professor Faculty of Medicine Benghazi University -  Benghazi, Hawari General Hospital, Orthopedic Department