Study of functional outcome of management by external fixation followed by definitive internal fixation in compound tibial fractures

Abstract

Aim: To study the functional outcome of compound tibial fractures managed by external fixation followed by definitive internal fixation. Methodology: This prospective study was done from November 2016 to November 2018, for a period of 24 months, in Department of Orthopaedics & Traumatology, Osmania General Hospital, Hyderabad. Patient with compound tibial fractures meeting all the inclusion criteria were treated by external fixation followed by definitive internal fixation, later followed up regularly to check for functional outcome of the fracture in terms of fracture union both clinically and radiologically, improvement in leg motion, ability to walk. Results: In our series, Male predominated with the ratio of 9:1. In our series, RTA was the predominant cause of injury. In RTA, 2-wheeler Vs. 4- wheeler was the most common (10 cases). In our series, 23% of the patients had Associated Injuries. Most of the fractures were in middle half of the tibia. average time to admission after injury was 9 hours (Minimum of 1½ hours to 45 hours). In cases referred from outside Hyderabad average time to admission after injury was 15½ hours. In our series, average time from admission to surgery (External fixation) was 6½ hours (minimum of 1 hour to 14 hours). Union was observed in 11 of the 13 patients. The mean time to union was 27 weeks (range 20 weeks to 40 weeks). The timing of secondary intramedullary nailing in our study shows that Grade II open fractures were undergone nailing with average of 11.8 days with the range of 6 -20 days. Grade III A fractures have undergone nailing with average of 30 days with the range of 14 – 48 days. For grade III B fractures nailing was done with the average of 32.5 days ranging from 28– 45 days. The final outcome mainly depends on the age of the patient, time of admission since injury, type of injury. Good result is favoured by the debridement technique, appropriate selection of timing for external fixation and intramedullary nailing. Conclusion: Early intervention and aggressive soft tissue management in open tibial fractures result in decreased number of procedures, minimal hospital stay and early return to their daily routine.