Open fracture of the tibial shaft, results of management with external fixator followed by casting or nailing

ABSTRACT

To compare the results of management by secondary intramedullary nailing and POP casting in stable open tibial fractures of Gustilo-IIIA of winquist type-I and II and to assess which is the better mode of treatment after removal of fixator, whether POP casting or intramedullary nailing in our hospital our setup and resources in terms of union and likelihood of complications like malunion, non-union and infection. This randomized cohort study was conducted in the Department of Orthopaedic, Nishtar Hospital, Multan during the period from April 2005 to December 2006. A total of 50 patients were included in the study. The age range was 20-40 years. The patients included were who had fracture of Gustilo type-IIIA open fractures of winquist criteria-I and II. Out of 50 patients, 37 [74%] were injured as road traffic accident, 3 [6%] patients sustained fire arm injury, 2 [4%] patients injured on domestic accident with fall of wall on their body. Out of 50 patients, 12 [24%] had age from 11-20 years, 14 [28%] from 21-30 years, 18 [36%] from 31-40 years and 6 [12%] patients had 41-48 years. While considering the major complications in present study, it was found that these are less marked in secondary nail group as compared to secondary casting group. Wound infection developed in 9 [36%] cases and non-union occurred in 1 [4%] cases of secondary nailing. While in secondary casting group wound infection developed in 8 [32%] cases and non-union occurred in 2 [5%] cases. It is concluded that both methods can be used for the treatment of open type-IIIA tibial diaphyseal fractures