Outcomes of intramedullary nailing for open fractures of the tibial shaft

Abstract

Aim: To establish superficial and deep infection rates and time to union of open tibial shaft fractures treated with primary debridement and locked intramedullary nails.
Materials and methods: The clinical records and radiographs were retrospectively reviewed of 74 Gustilo-Anderson grades 1 to 3A open tibial shaft fractures that were treated by initial debridement and intramedullary nail fixation over a two-year period. Sixty-three men and nine women with a mean age of 33 years (range 16–67) were followed up for a mean period of 18 months (range 7–32).
Results: Sixteen patients (22%) sustained grade 1 injuries, 38 (51%) grade 2, and 20 (27%) had grade 3A injuries. Thirteen patients (18.1%) were HIV positive. The mean time to surgery was 28 hours (range 8–112). The overall infection rate was 17.6%. Superficial infection developed in 10.8% and deep infection occurred in 6.8%. There was no association between time to surgery and infection rate (p=0.878). There was no association between HIV status and infection (p=0.471). There was no association between type of closure and sepsis (p=0.410). The mean time to union was 17 weeks (range 12–50). Five patients (6.9%) had delayed union and one patient failed to unite without undergoing secondary procedures.
Conclusion: The management of Gustilo-Anderson grade 1 to 3A open tibial shaft fractures with primary debridement and
locked intramedullary nailing shows good short-term results with low infection and non-union rates despite delay in surgical
management or HIV infection.
Level of evidence: Level 4