A prospective study of functional outcome of primary intra-medullary nailing in type 3A and 3B open tibial diaphyseal fractures

Abstract

Objectives: In a developing country such as ours, patients with Type III open Tibial fractures often reach the hospital late (after initial 6 hours) of sustaining high-velocity trauma. Primary internal fixation becomes a formidable challenge in such patients. Due to the paucity of articles exclusively dealing with this topic, we did a study to determine the functional outcome of primary intramedullary nailing in these patients. Materials and Methods: A prospective study was conducted with patients above 18yrs of age with Type 3A and 3B open Tibial Diaphyseal fractures presenting late after injury, initially treated with thorough wound debridement and lavage, followed by internal fixation with intra-medullary nailing. Patients were followed up at fixed intervals for a period of 1year. Results: 25 patients were enrolled in the study, 23 males and 2 females, time elapsed from injury to surgery ranged from 7hrs to as long as 5 days, average -2.66 days. 23 patients had a RUST score of 12 at 1yr follow-up. Functional outcome with Ketenjian and Shelton Criteria was excellent- good in 21 patients. 2 cases (8%) developed non-union, 3 cases (12%) developed post-op infection (Osteomyelitis). Conclusion: Thorough wound debridement and lavage, followed by primary intra-medullary nailing of Type 3A & 3B open Tibial diaphyseal fractures, have shown good results despite delay in presentation and surgery, in comparison to external fixation and secondary nailing.