The tibia is exposed to frequent injury; it is the most commonly fractured long bone. Because one third of the tibial surface is subcutaneous throughout most of its length, open fractures are more common in the tibia than in any other major long bone. We evaluated and compared the outcome of the unreamed intramedullary nailing and limb reconstruction system (LRS, Orthofix) in the treatment of type IIIA Gustilo-Anderson open fractures of tibial diaphysis.
Materials and methods: This study involved prospective evaluation of 160 patients of type IIIA open fracture of tibia treated at our institute between August 2008 to December 2015. 80 cases were treated with orthofix were labelled as group A and 80 cases treated with unreamed intramedullary nailing were labelled as group B.
Result: Average time of union in group A was an average 35 weeks (30-40 weeks) in 64 cases (80%) with 16 cases (20%) of non-union which were subsequently treated with bone grafting and showed union at an average 40 weeks (38-44 weeks). Group B showed average time of union at an average 29 weeks (24-38 weeks) in 66 cases (82.5%) with 10 cases(12.5 %) of infective non-union at which subsequently treated with external fixator and showed union at average 36 weeks (34-38 weeks). 4 cases which showed delayed union were dynamised and bone grafted and showed union at an average 32 weeks.
Conclusion: Intramedullary nailing can be used in the management of type IIIA fractures as it allows early union and primary closure with the avoidance of secondary procedures with the risk of higher rate of deep infection. Orthofix gives lower rate of infection with slightly delayed union compared to nailing with the need for secondary procedures.