Primary Fixation of Open Fractures of Tibia - A Comparison Between Intramedullary Interlocking Nail and Uniplaner AO External Fixator as Definitive Fixation
DOI:
https://doi.org/10.21649/akemu.v31i1.5755Keywords:
Open tibial fractures, External fixator, Intramedullary Interlocking nailAbstract
Background: Because of its subcutaneous course, open tibial shaft fractures are challenging to treat and there are more chances of post operative complications like infection and non union. It is a matter of debate that which implant between external fixator and intramedullary interlocking nail is better to fix these fractures.
Objective: To compare the treatment outcome in open tibial diaphyseal fractures treated with uniplaner AO external fixators versus IMIL Nail.
Methods: This prospective interventional study was conducted at the Department of Orthopaedic Surgery King Edward Medical University / Mayo Hospital Lahore between April 2022 and December 2023. A total of 64 patients (32 in each group) were included in the study. After discharge patients were followed up at 2nd, 6th, 12th, 16th , 24th and 36th weeks post-operatively and evaluated for union and infection both clinically and radiologically.
Results: Out of 64 patients, 32 underwent uniplaner AO EF and 32 received IMIL nailing. At 12 weeks post-surgery, 27 (84.3%) patients in the nail group and 11 (34.3%) in the external fixator group exhibited callus formation, with mean bridging callus time of 12.4 ± 2.2 weeks and 16.3 ± 3.6 weeks, respectively. Infections occurred in 5 (15.6%) patients in the nail group and 15 (46.8%) in the fixator group, with 4 and 7 cases eradicated by antibiotics, respectively. At 36 weeks, union was observed in 31 (96.8%) patients in the nail group and 25 (78.1%) in the EF group, while non-union was found in 1 (3.2%) patient in the nail group and 7 (21.8%) patients in the EF group.
Conclusion: IMIL Nail is a better treatment option in patients with open tibial shaft fractures where skin coverage is possible and patient presented within 6 hours of injury.
References
1. Turley L, Barry I, Sheehan E. Frequency of complications in intramedullary nailing of open tibial shaft fractures: a systematic review. EFORT Open Reviews. 2023;8(2):90-9.
2. Vernekar A. Comparative study of open fractures of tibia (Interlocking v/s External fixator). Indian J Orthop Surg. 2023;9(2):100-9.
3. Iqbal Z, Khan TM, Akhtar M, Shahid MA, Ghani I. Outcome of management of diaphyseal fractures of tibia in elderly population. Pak Postgrad Med J. 2020;31(03):151-4.
4. Schade AT, Hind J, Khatri C, Metcalfe AJ, Harrison WJ. Systematic review of patient reported outcomes from open tibia fractures in low and middle income countries. Injury. 2020;51(2):142-6.
5. Wanjema S, Oluoch R, Ayumba BR, Lelei LK. Tibial Diaphyseal Fractures: Aetiology, morphology and treatment in adult patients at Moi Teaching and Referral Hospital, Eldoret, Kenya. East Afr Orthop J. 2020;14(1):8-13.
6. Khattak KA, Hussain B, Ur Rehman N, Ahmad I, Afridi R. Frequency of tibial diaphyseal fractures among patients presenting with motorcycle accidents. Pak J Surg. 2021;37(1):48-52.
7. Schade AT, Khatri C, Nwankwo H, Carlos W, Harrison WJ, Metcalfe AJ. The economic burden of open tibia fractures: a systematic review. Injury. 2021;52(6):1251-9.
8. Kouassi KJ, Akobé JR, Kouassi AA, Fonkoué L, Detrembleur C, Kodo M, et al. Locally developed external fixators as definitive treatment of open tibia diaphyseal fractures: a clinical prospective study conducted in Ivory Coast. Int orthop. 2022;46(1):79-87.
9. Nicolaides M, Pafitanis G, Vris A. Open tibial fractures: An overview. J Clin Orthop Tr. 2021;20:101483.
10. Canton G, Sborgia A, Maritan G, Fattori R, Roman F, Tomic M, et al. Fibula fractures management. World J Orthop. 2021;12(5):254-9.
11. Makaram NS, Leow JM, Clement ND, Oliver WM, Ng ZH, Simpson Cet al. Risk factors associated with delayed and aseptic nonunion following tibial diaphyseal fractures managed with intramedullary nailing. Bone & Joint Open. 2021;2(4):227-35.
12. Soni JK, Kulkarni S, Khodnapur G, Bagewadi R, Nandi SS. Management of Open Tibial Diaphyseal Fractures by Limb Reconstruction System As Primary and Definitive Treatment: A Prospective Cohort Study. Cureus. 2023;15(5):2-8.
13. Hao ZC, Xia Y, Xia DM, Zhang YT, Xu SG. Treatment of open tibial diaphyseal fractures by external fixation combined with limited internal fixation versus simple external fixation: a retrospective cohort study. BMC musculoskelet disord. 2019;20(1):311-20.
14. Jain S, Patel P, Gupta S. External fixator as a definitive treatment for tibial diaphyseal fractures. Ortho J MPC. 2020;26(1):34-9.
15. Umrani KB, Tunio ZH, Mengal MA, Qureshi AH, Ahmed P, Kalhoro N. Comparative study on intramedullary nailing versus AO external fixation in the management of gustilo type II, IIIA, and IIIB tibial shaft fractures. Professional Med J 2020;27(6):1199-205.
16. Greco T, Cianni L, Polichetti C, Inverso M, Maccauro G, Perisano C. Uncoated vs. Antibiotic‐Coated Tibia Nail in Open Diaphyseal Tibial Fracture (42 according to AO Classification): A Single Center Experience. BioMed Res Int. 2021;2021(1):7421582.
17. Albushtra A, Mohsen AH, Alnozaili KA, Ahmed F, Aljobahi YM, Mohammed F, et al. External Fixation as a Primary and Definitive Treatment for Complex Tibial Diaphyseal Fractures: An Underutilized and Efficacious Approach. Orthop Res Rev. 2024;16(1):75-84.
18. Rupp M, Popp D, Alt V. Prevention of infection in open fractures: where are the pendulums now?. Injury. 2020;51(1):57-63.
19. Albright PD, MacKechnie MC, Roberts HJ, Shearer DW, Rojas LG, Segovia J, Quintero JE, et al. Open tibial shaft fractures: treatment patterns in Latin America. J Bone Joint Surg. 2020;102(22):126.
20. Plumarom Y, Wilkinson BG, Willey MC, An Q, Marsh L, Karam MD. Sensitivity and specificity of modified RUST score using clinical and radiographic findings as a gold standard. Bone Jt Open. 2021;2(10):796-805.
21. Gorad K, Rahate V, Shinde G, Taralekar G, Prabhu V, Singh L. Use of Southampton Scoring for Wound Healing in Post-surgical Patients: Our Experience in Semi-urban Setup. Arch Clin Biomed Res. 2021;5(1):36-41.
22. Haonga BT, Liu M, Albright P, Challa ST, Ali SH, Lazar AA, et al. Intramedullary nailing versus external fixation in the treatment of open tibial fractures in Tanzania: results of a randomized clinical trial. J Bone Joint Surg. 2020;102(10):896-905.
23. Ayoub I, Malik AT, Singh T, Basit A, Arfee S. Short term outcome of Gustilo Anderson open type 3A mid shaft tibia fractures using intramedullary interlocking nail and external fixator: A prospective Cohort study. Int J Health Sci, 2022;6(4), 8280–6.
24. Cortez A, Urva M, Haonga B, Donnelley CA, von Kaeppler EP, Roberts HJ, et al. Outcomes of intramedullary nailing and external fixation of open tibial fractures: three to five-year follow-up of a randomized clinical trial. J Bone Joint Surg. 2022;104(21):1877-85.
25. Kisitu DK, O'Hara NN, Slobogean GP, Howe AL, Blachut PA, O'Brien PJ, et al. Unreamed intramedullary nailing versus external fixation for the treatment of open tibial shaft fractures in Uganda: a randomized clinical trial. J Orthop Trauma. 2022;36(9):349-57.
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