Open tibia fracture, due to high energy or low enegy trauma classified according to Gustilo-Anderson classification system. The mode of fixation, been a subject of controvercy and some authors have proposed a need to address the issue of breach of soft tissue in these injuries.
Methods: The study included a total 50 patients of open tibia fractures managed in AHRC from june 2010 to june 2015.There was 10 patients of type II, 4 patients of type IIIA and 36 patients of type IIIB according to Gustilo-Anderson classification.29 patients were admitted to ORTHO A unit managed with enders nail where 21 patients admitted to ORTHO B unit managed with external fixator. The outcome was assessed by duration of fracture union, number of surgeries required, incidence of infection and malalignment.
Results: Open tibia fractures were mostly in males (90%) where 70% were young patients with a mean age of 36.2.Among these patients 80% sustained high velocity injury. Mean period of fracture union in enders group were 25+-7 weeks while in external fixator group was 39.4+-14 weeks. Our study also reveals fractures associated with head injury united earlier.24 out of 29 cases managed by enders nail required <3 surgeries while 15/ 21 cases managed by external fixator required >4 furthur surgeries. Among these 50 cases infection detected in 12 cases (all were treated by external fixator; 11 cases belong to Gustilo-Anderson IIIB group). 35% malalignment in external fixator group in comparison to 4% in patients treated with enders nail.
Conclusion: Open tibia fracture treated with ender nail united earlier than external fixator and total number of surgeries to achieve union in ender nail was significantly lesser than external fixator group. Infection and malalignment rate was also high in external fixation cases.