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. 2019 Sep-Oct;10(5):941-948.
doi: 10.1016/j.jcot.2018.10.016. Epub 2018 Nov 24.

Unreamed Intra-Medullary Nail Versus Half Pin External Fixator in Grade III [A & B] Open tibia fractures

Sandeep Garg  1 , Vikram Khanna  2 , M P Goyal  1 , Narendra Joshi  1
Affiliations

Unreamed Intra-Medullary Nail Versus Half Pin External Fixator in Grade III [A & B] Open tibia fractures

Sandeep Garg et al. J Clin Orthop Trauma. 2019 Sep-Oct.

Erratum in

Abstract

Background: Tibia fracture is the most common long bone fracture. The fractures of tibia are commonly open fractures due to subcutaneous position of the tibia. The choice of technique for stabilization of open tibia fractures includes - External fixation, unreamed intra-medullary nails [URTN], Reamed intra-medullary nails, ORIF with Plating.

Objectives: To evaluate & compare the results of Unreamed Intra-Medullary Nail Versus Half Pin External Fixator in Grade III [A & B] Open tibia fractures.

Methods: This prospective clinical study [Randomized chit box] was done on 50 patients presenting to our institute within 24 h of injury. Only those who were skeletally mature with open tibia fracture Grade IIIA & IIIB [Gustilo-Anderson] were included in this study. After initial management, radiological assessment was done. Following this adequate wound debridement, skeletal stabilization with either primary URTN or external fixator was done. Inspection and debridement were repeated at 48-h intervals until the wound was considered clean.

Results: 50 cases [25 each group] were compared in terms of - Final Alignment of the Fracture, Presence of Infection/Non-union/Mal-union, Hardware failure, Time to Bone Union, Number of Operative Procedures after index admission. Mean time to full weight bearing was 20.96 weeks in URTN group versus 24.8 weeks in Ex-fix group. 5 in URTN group required further surgery for non-union versus 11 patients in Ex-fix group. There were 6 significant pin track infection. Removal of nail was required in 1 case of deep infection.

Conclusion: This study supports the use of the URTN over External fixator in the treatment of severe open tibia fractures.

Keywords: External fixator; Intra-Medullary Nail; Soft tissue management; Tibia fractures; Unreamed.

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Figures

Fig. 1
Fig. 1
Intraop and immediate postop clinical picture of patient of the URTN group.
Fig. 2
Fig. 2
Immediate postop Xray of the URTN group.
Fig. 3
Fig. 3
Immediate postop clinical picture of patient of the ExFix group.
Fig. 4
Fig. 4
Immediate postop Xray of the ExFix group.
Fig. 5
Fig. 5
Change of the ExFix to Patellar tendon bearing cast.
Fig. 6
Fig. 6
2 cases showing the soft tissue coverage with the help of flap and with the help of skin grafting.
See this image and copyright information in PMC

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