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UNREAMED INTRAMEDULLARY NAIL OR EXTERNAL FIXATION FOR OPEN TIBIAL FRACTURES? A RANDOMISED PROSPECTIVE STUDY

Postgraduate Institute of Medical Education and Research, Chandigarh.

As management of open tibial fractures remains controversial, we hypothesised that unreamed intramedullary nail offers inherent advantages of a nail as well as external fixation, while limiting the morbidity of external fixation.

We undertook a prospective randomised study to compare management of open tibial fractures with external fixator or intramedullary nail until fracture union or failure. Our study included 30 consecutive open tibial fractures (Gustilo I, II & IIIA) between 4 cm distal to knee and 4 cm proximal to ankle in skeletally mature adults, who presented to a level-1 trauma centre. Alternate patients were treated by external fixation or unreamed nail i.e. 15 in each group. Standard protocol for debridement and fixation was followed. External fixators were removed at 6 weeks. All cases were followed until fracture union, the main outcome measurement.

26 (87%) males and 4 (13%) females; age 20–60 years (Mean 33.8). All fractures in both groups united. Time to union averaged 7.9 months for both groups. Incidence of wound problems, infection, hardware failure and delayed union were comparable. However, there was higher incidence of angular deformities and stiffness of knee and ankle in external fixation group, although not statistically significant.

We found no statistically significant difference between unreamed intramedullary nailing and external fixation for the management of open tibial diaphyseal fractures. Ease of weight bearing as well as absence of angular deformities and joint stiffness were distinct advantages in the nailing group. Therefore we recommend unreamed nail for Gustilo I, II & IIIA open tibial fractures.

Correspondence should be addressed to Mr Bimal Singh, c/o BOSA at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE