Abstract
We treated 36 open tibial fractures (32 patients) by primary intramedullary nailing and debridement and treatment of open wounds. There were 13 grade I, 14 grade II and 9 grade III according to Gustilo-Anderson classification. After a minimum follow-up of 8 months, there were two cases of superficial infection and one of deep infection. Thirty-one fractures united within 6 months with a mean period to union of 22 weeks. There were four delayed unions and one non-union. There was a longer union time and a higher rate of delayed or non-union in the complex and/or comminuted grade IIIB fractures. Intramedullary nailing, with appropriate soft-tissue treatment, gives good results in the treatment of open tibial fractures.
Résumé
Nous avons traité 36 fractures ouvertes du tibia (32 malades) par enclouage centromédullaire et débridement des plaies. Il y avait 13 grades I, 14 grades II et 9 grades III selon la classification de Gustilo-Anderson. Après un minimum de suivi de 8 mois il y avait deux cas d’infection superficielle et un d’infection profonde. 31 fractures ont consolidé en moins de 6 mois avec un délai moyen de 22 semaines. Il y avait quatre retards de consolidation et une non—consolidation. Il y avait un délai de consolidation plus long et un taux plus élevé de consolidation retardé ou de non consolidation dans les fractures complexes et/ou comminutives de grade IIIB. L’enclouage centromédullaire avec traitement approprié des lésions des parties molles, donne de bons résultats dans le traitement des fractures tibiales ouvertes.
Full Text
The Full Text of this article is available as a PDF (107.4 KB).
Acknowledgement
SIGN (Surgical Implant Generation Network), founded by Dr. Lewis G. Zirkle, was created in 1999 as a humanitarian, non-profit corporation in Washington, USA with a goal to provide improved health care and proper orthopaedic treatment of fracture at little or no cost to people in need throughout the world. All implants and instruments were provided free of cost by SIGN, USA to our institution in Nepal.
Footnotes
Statement on conflict of interest: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
References
- 1.Alberts Injury. 1999;30:519. doi: 10.1016/s0020-1383(99)00143-6. [DOI] [PubMed] [Google Scholar]
- 2.BachClin Orthop 1989241892924483 [Google Scholar]
- 3.Bhandari M, Guyatt GH, Swiontkowski MF, Schemitscch EH (2001) Treatment of open fracture shaft of tibia: a systematic overview and metaanalysis. J Bone Joint Surg [Br] 83:62–68 [DOI] [PubMed]
- 4.Bonatus Clin Orthop. 1997;339:58. doi: 10.1097/00003086-199706000-00008. [DOI] [PubMed] [Google Scholar]
- 5.Court-Brown CM, McQueen MM, Quaba AA, Christie J (1991) Locked intramedullary nailing of open tibial fractures. J Bone Joint Surg [Br] 73:959–964 [DOI] [PubMed]
- 6.Goldhahn S, Moser R, Bigler R, Matter P (2000) Treatment methods and outcomes of tibial shaft fractures in Switzerland. A prospective multicenter study of the Swiss AO.[Article in German], Swiss Surg 6:315–322 [DOI] [PubMed]
- 7.Greitbauer Clin Orthop. 1998;350:105. doi: 10.1097/00003086-199805000-00015. [DOI] [PubMed] [Google Scholar]
- 8.Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg [Am] 58:453–458 [PubMed]
- 9.Hasenhuttl K (1981) The treatment of unstable fractures of the tibia and fibula with flexible medullary wires. A review of two hundred and thirty-five fractures. J Bone Joint Surg [Am] 63:921–931 [PubMed]
- 10.Henley J Orthop Trauma. 1998;12:1. doi: 10.1097/00005131-199801000-00001. [DOI] [PubMed] [Google Scholar]
- 11.Holbrook JL, Swiontkowski MF, Sanders R (1989) Treatment of open fractures of the tibial shaft: ender nailing versus external fixation. A randomized prospective comparison. J Bone Joint Surg [Am] 71:1231–1238 [PubMed]
- 12.Ikem Int Orthop. 2001;25:386. doi: 10.1007/s002640100277. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Klein Arch Orthop Trauma Surg. 1989;109:314. doi: 10.1007/BF00636168. [DOI] [PubMed] [Google Scholar]
- 14.KlemmClin Orthop 1986212893769301 [Google Scholar]
- 15.Littenberg, B; Weinstein, L P et al (1998) Closed fractures of the tibial shaft, a meta-analysis of three methods of treatment, J Bone Joint Surg [Am] 80:174–183 [DOI] [PubMed]
- 16.Lottes Clin Orthop. 1974;105:53. [PubMed] [Google Scholar]
- 17.Melcher J Trauma. 1995;39:1123. doi: 10.1097/00005373-199512000-00020. [DOI] [PubMed] [Google Scholar]
- 18.Melcher GA, Claudi B, Schlegel U, Perren SM, Printzen G, Munzinger J (1994) Influence of type of medullary nail on the development of local infection. An experimental study of solid and slotted nails in rabbits. J Bone Joint Surg [Br] 76:955–959 [PubMed]
- 19.Melcher Injury. 1993;24:407. doi: 10.1016/0020-1383(93)90107-h. [DOI] [PubMed] [Google Scholar]
- 20.Schandelmaier Clin Orthop. 1997;342:164. [PubMed] [Google Scholar]
- 21.Stegemann J Orthop Trauma. 1995;9:117. doi: 10.1097/00005131-199504000-00005. [DOI] [PubMed] [Google Scholar]
- 22.Toivanen Int Orthop. 2001;25:110. doi: 10.1007/s002640000083. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Tornetta P 3rd, Bergman M, Watnik N, Berlowitz G, Steuer J (1994) Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and nonreamed locked nailing. J Bone Joint Surg [Br] 76:13–19 [PubMed]
- 24.Whittle AP, Russel TA, Taylor JC, Lavelle DG (1992). Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg [Am] 74:1162–1171 [PubMed]